title: Changing perceptions of mental health in Canada.
abstract: OBJECTIVE
  Epidemiologic studies typically assess mental health using diagnostic measures or symptom severity measures. However, perceptions are also important. The objective of our study was to evaluate trends in perceived mental health in Canada during the past 20 years using data collected in a series of surveys.
  
  
  METHODS
  Perceived mental health status, the stressfulness of most days, and perceived general health, have been repeatedly measured in national surveys. In our study, the resulting frequencies and 95% confidence intervals were calculated. Distress was also assessed in the same surveys with the Kessler 6 Psychological Distress Scale, and analyzed using mean scores and frequencies based on cut-points. Data synthesis used forest plots. Time trends were assessed using random effects meta-regression models.
  
  
  RESULTS
  No detectable changes in distress were found. Similarly, self-rated general health remained stable. However, over time, Canadians became slightly more likely to report that their mental health was merely fair or poor. Conversely, they have been progressively less likely to perceive that their lives are quite a bit or extremely stressful.
  
  
  CONCLUSIONS
  While these observations are ecological, the 2 trends may be related: distressing emotional experiences may increasingly be interpreted as evidence of a disturbance of mental health rather than a reaction to stressful circumstances. These changing perceptions should not be misinterpreted as an epidemic of poor mental health.
authors.affiliation: Professor, Department of Community Health Sciences, University of Calgary, Calgary, Alberta; Member, Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.
authors.forename: Scott B
authors.initials: SB
authors.lastname: Patten
authors.affiliation: Research Associate, Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
authors.forename: Jeanne V A
authors.initials: JV
authors.lastname: Williams
authors.affiliation: Research Associate, Department of Community Health Sciences, University of Calgary, Calgary, Alberta.
authors.forename: Dina H
authors.initials: DH
authors.lastname: Lavorato
authors.affiliation: Postdoctoral Fellow, Department of Clinical Neurosciences, University of Calgary, Calgary, Alberta.
authors.forename: Kirsten M
authors.initials: KM
authors.lastname: Fiest
authors.affiliation: Professor, Department of Community Health Sciences, University of Calgary, Calgary, Alberta; Interim Director, Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.
authors.forename: Andrew G M
authors.initials: AG
authors.lastname: Bulloch
authors.affiliation: Associate Professor, Department of Psychiatry, University of Calgary, Calgary, Alberta; Member, Mathison Centre for Mental Health Research and Education, Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta.
authors.forename: Jianli
authors.initials: J
authors.lastname: Wang
mesh_terms: D000223:Adaptation, Psychological; D001294:Attitude to Health; D002170:Canada; D059026:Diagnostic Self Evaluation; D006801:Humans; D008016:Life Change Events; D008137:Longitudinal Studies; D001523:Mental Disorders / Q000523:psychology; D008603:Mental Health; D012922:Social Change