Changes in mental health and substance use associated with the COVID-19 pandemic

1. Changes in mental health and
substance use behaviours associated
with the COVID-19 pandemic in
New Brunswick
Dr. Chris Folkins, PhD, BScPhm
Feb 22, 2023

2. Acknowledgements
3
This work was supported by funds to the Canadian Research Data Centre Network (CRDCN) from
the Social Sciences and Humanities Research Council (SSHRC), the Canadian Institute for Health
Research (CIHR), the Canadian Foundation for Innovation (CFI), and Statistics Canada. Although
the research and analysis are based on data from Statistics Canada, the opinions expressed do not
represent the views of Statistics Canada.

3. 4
Research Team – NB-IRDT Pathways to Professions
Clark Brewster
Emily Thomson
Rebecca Foster
Kelsi Evans
● Bachelor of Science (Bio-Psych)
● Graduation Year: 2023
● Bachelor of Science
(Biochemistry)
● Graduation Year: 2023
● Bachelor of Arts (Bio-Psych)
● Graduation Year: 2022
● Bachelor of Science (Chemistry)
● Graduation Year: 2022 Chandy Somayaji
Senior Data Analyst, NB-IRDT
Data analysis lead:

4. 5
Background:
- Many studies have found evidence of negative mental health outcomes and increased
substance use associated with the COVID-19 pandemic, in Canada and internationally
- Limited research focused on NB

5. 6
Magalhaes, S., Gorman-Asal, M. & Somayaji, C. (2021). Survey Results on Mental Health Impacts of
COVID-19 in New Brunswick. Fredericton, NB: New Brunswick Institute for Research, Data and Training.
https://www.unb.ca/nbirdt/research/publications/survey-results-on-mental-health-impacts-of-covid19-in-new-
brunswick.html
Mental health impacts of COVID-19 pandemic in New Brunswick
- NB-IRDT analysis of surveys conducted by Mental Health Research Canada
during the pandemic
• Asked respondents to rate how selected social factors, economic factors, and recreational activities
positively or negatively affected their mental health during pandemic
• Asked respondents about changes in substance use and household conflict during pandemic
• Results broken down by population subgroups
• Provides understanding of factors having greatest impact on self-perceived mental health; evidence of
increased alcohol and cannabis use and increased household conflict

6. 7
Why are these studies important?
- Understand the toll of the pandemic on mental health and substance use
• What are the consequences?
• Who (where) is most impacted?
- Provide NB-specific data – understand how challenges/needs may differ here vs. elsewhere
- Inform public health policy and effective use of resources
e.g. development of targeted interventions and support
- Results relevant for: • Pandemic recovery
• Preparedness for future challenges
• Better understanding of areas of vulnerability in our population

7. 8
Our study - Research Objectives
1. Examine changes in mental health and substance use behaviours associated
with the COVID-19 pandemic in New Brunswick by comparing survey data
from before vs. during the pandemic
2. Identify personal characteristics associated with adverse mental health
outcomes and increased substance use during the pandemic
3. Identify pandemic–related experiences associated with adverse mental
health outcomes and increased substance use during the pandemic

8. 9
What is different about our work?
- Different surveys used – expanded variety of research questions
- Different method used: 2-timepoint approach

9. 10
StatCan Surveys
1. Pre-pandemic timepoint
2. Pandemic timepoint
Canadian Community Health Survey (CCHS) – results from 2016 and 2019
Annual cross-sectional survey that collects information related to health status, health care utilization and health
Determinants for the Canadian population
Survey on COVID-19 and Mental Health (SCMH) – results from 2020 and 2021
Limited cross-sectional survey (2 cycles) that collects data to assess the impacts of COVID-19 on the mental health
and well-being of Canadians

10. 11
Advantage of 2-timepoint approach
- Direct measure (eg. survey-based screening tool for depression) can be made before
and during pandemic, and results compared to characterize change
- 1-timepoint approach must rely on recall and self-reflection to characterize change
eg. Do you feel worse now compared to before the pandemic?
*Risk of bias*

11. 12
Previous research using 2-timepoint survey approach
Capaldi C, Liu L, Dopko RL. Positive mental health and perceived change in mental health among adults in Canada
during the second wave of the COVID-19 pandemic. Health Promot Chronic Dis Prev Can. 2021; 41(11): 359-77
Liu L, Capaldi C, Dopko RL. Suicide ideation in Canada during the COVID-19 pandemic.
Health Promot Chronic Dis Prev Can. 2021; 41(11): 378-91

12. 13
Research Objectives 1 and 2 - Methods:
- Analyze results from Statistics Canada surveys, comparing timepoints
before vs. during pandemic
- Study population: NB residents age 19+

13. 14
Outcomes
Prevalence of :
- Depression
- Anxiety
- Low self-rated mental health
- Habitual binge drinking
- Habitual cannabis use

14. 15
- Raw prevalence difference (during vs. before pandemic)
- Multivariate logistic regression modeling likelihood of outcome
during vs before pandemic
Results Output
Regression covariates:
• Age, sex
• Health region of residence; rural vs urban residence
• Household composition (lives alone vs not alone)
• Income quintile
• Education level (less than HS, HS, post-secondary)

15. 16
Depression
- Prevalence based on PHQ-9 validated screening tool
Eg. Over the past 2 weeks, how often have you…
Had little interest or pleasure in doing things?
0: Not at all
1: Several days
2: More than half the days
3: Nearly every day
9 Questions Total
Total score Depression
severity
0-4 None/minimal
5-9 Mild
10-14 Moderate
15-19 Mod-Severe
20-27 Severe
Total score 10+ counted as depression

16. 17
Depression – Raw Prevalence
0
5
10
15
20
25
%
prevalence
(+/-
95%CI)
Pre-pandemic Pandemic
6.3%
20.5%
+14.2 percentage points*
(95% CI: 10.6 – 17.9)
3.25x
Prevalence of Depression

17. 18
Depression – Multivariate Logistic Regression
0 1 2 3 4
Odds Ratio (+/- 95% CI) – Pandemic vs. Pre-Pandemic timepoint
Dependent variable: Prevalence of depression
2.3 Depression
more likely
during pandemic

18. 19
Personal characteristics associated with increased prevalence of
depression during pandemic
1. Compare likelihood of depression between groups of individuals with different characteristic
values at both the pre-pandemic and pandemic timepoints (generate Odds Ratio)
2. Compare magnitude of difference (value of Odds Ratio) at each timepoint
Pre-Pandemic
Likelihood of depression in
YOUNG vs. OLD
Pandemic
Likelihood of depression in
YOUNG vs. OLD
OR1 OR2
vs.

19. 20
Example
Pre-pandemic
Age 19-39
(vs 65+)
Pandemic
3.3x more likely
to be depressed
2.7x more likely
to be depressed
- Relative difference between 19-39 and 65+ decreases during pandemic
- Suggests that likelihood of depression increases more sharply in 65+ group

20. 21
Pre-Pandemic OR Pandemic OR
Age 19-39 (vs. 65+) 3.3 2.7
Low income (vs. high income) 2.7 Not significant
Fredericton (vs. Moncton) Not significant 1.3
Urban (vs. rural) Not significant 1.5
Lives alone (vs. lives with others) Not significant 1.4
Personal characteristics associated with increased prevalence of
depression during pandemic

21. 22
Anxiety
- Prevalence based on GAD-7 validated screening tool
Eg. Over the past 2 weeks, how often have you…
Been unable to stop or control worrying?
0: Not at all
1: Several days
2: More than half the days
3: Nearly every day
7 Questions Total
Total score Anxiety
severity
0-4 Minimal
5-9 Mild
10-14 Moderate
15+ Severe
Total score 10+ counted as anxiety

22. 23
Anxiety – Raw Prevalence
0
5
10
15
20
25
%
prevalence
(+/-
95%CI)
Pre-pandemic Pandemic
14.3%
17.4% +3.1 percentage points
(95% CI: -0.8 – 7.0)
No significant change in
Prevalence of Anxiety

23. 24
Anxiety – Multivariate Logistic Regression
0.6 0.7 0.8 0.9 1 1.1 1.2 1.3 1.4 1.5
Dependent variable: Prevalence of anxiety
1.13
No significant
change in
likelihood of
anxiety during
pandemic
Odds Ratio (+/- 95% CI) – Pandemic vs. Pre-Pandemic timepoint

24. 25
Low self-rated mental health
In general, how is your mental health?
a. Excellent
b. Very good
c. Good
d. Fair
e. Poor
Responses of fair or poor counted as low self-rated mental health

25. 26
Low self-rated mental health – Raw Prevalence
0
5
10
15
20
25
%
prevalence
(+/-
95%CI)
Pre-pandemic Pandemic
9.7%
19.0% +9.3 percentage points*
(95% CI: 6.1 – 12.5)
2x
Prevalence of low
self-rated mental health

26. 27
Low self-rated mental health – Multivariate Logistic Regression
0.8 1 1.2 1.4 1.6 1.8 2
Dependent variable: Prevalence of low self-rated mental health
1.45
Odds Ratio (+/- 95% CI) – Pandemic vs. Pre-Pandemic timepoint
Low self-rated
mental health
more likely
during pandemic

27. 28
Pre-Pandemic OR Pandemic OR
Age 19-39 (vs. 65+) Not significant 3.0
Fredericton (vs. Moncton) Not significant 1.4
Urban (vs. rural) Not significant 1.25
Less than high school education
(vs. post-secondary education)
2.5 Not significant
Cannabis use once/week or
more (vs. less than once/week)
2.5 3.1
Personal characteristics associated with increased prevalence of
low self-rated mental health during pandemic

28. 29
Habitual binge drinking
During the past 30 days, how often have you had
4(women)/5(men) or more drinks on one occasion ?
a. Daily or almost daily
b. 2 to 5 times a week
c. Once a week
d. 2 to 3 times in past 30 days
e. Once in past 30 days
f. Not in past 30 days
Once a week or more counted as habitual binge drinking

29. 30
Habitual binge drinking – Raw Prevalence
0
5
10
15
20
%
prevalence
(+/-
95%CI)
Pre-pandemic Pandemic
8.0%
13.3%
+5.3 percentage points*
(95% CI: 2.2 – 8.4)
1.7x
Prevalence of habitual
binge drinking

30. 31
Habitual binge drinking – Multivariate Logistic Regression
0.5 1 1.5 2 2.5 3
Dependent variable: Prevalence of habitual binge drinking
2.06
Odds Ratio (+/- 95% CI) – Pandemic vs. Pre-Pandemic timepoint
Habitual binge
drinking
more likely
during pandemic

31. 32
Pre-Pandemic OR Pandemic OR
Age 19-39 (vs. 65+) Not significant 2.2
Age 40-64 (vs. 65+) 2.8 Not significant
Male (vs. female) 2.5 2
Post-secondary education (vs.
less than high school education)
Not significant 2.5
Personal characteristics associated with increased prevalence of
habitual binge drinking during pandemic

32. 33
Habitual cannabis use
During the past 30 days, how often did you use cannabis?
a. Never used cannabis
b. Used previously but not in past 30 days
c. 1 day in past 30 days
d. 2 to 3 days in past 30 days
e. 1 or 2 days per week
f. 3 or 4 days per week
g. 5 or 6 days per week
h. Daily
Once a week or more counted as habitual cannabis use

33. 34
Habitual cannabis use – Raw Prevalence
0
2
4
6
8
10
12
14
16
%
prevalence
(+/-
95%CI)
Pre-pandemic Pandemic
8.8%
12.0%
+3.2 percentage points*
(95% CI: 0.2 – 6.3)
1.4x
Prevalence of habitual
Cannabis use

34. 35
Habitual cannabis use – Multivariate Logistic Regression
0.5 1 1.5 2 2.5
Dependent variable: Prevalence of habitual cannabis use
1.7
Odds Ratio (+/- 95% CI) – Pandemic vs. Pre-Pandemic timepoint
Habitual
cannabis use
more likely
during pandemic

35. 36
Pre-Pandemic OR Pandemic OR
Age 19-39 (vs. 65+) 9.5 6
Personal characteristics associated with increased prevalence of
habitual cannabis use during pandemic

36. 37
Research Objectives
1. Examine changes in mental health and substance use behaviours associated
with the COVID-19 pandemic in New Brunswick
2. Identify personal characteristics associated with adverse mental health
outcomes and increased substance use during the pandemic
3. Identify pandemic–related experiences associated with adverse mental
health outcomes and increased substance use during the pandemic

37. 38
Pandemic-related experiences associated with adverse mental health
outcomes and increased substance use during the pandemic
Approach: Multivariate logistic regression based on SCMH results only (pandemic timepoint)
Dependant variables:
- Depression during the pandemic
- Anxiety during the pandemic
- Worse self-rated mental health during (vs before) pandemic
- Increased alcohol consumption during (vs before) pandemic
- Increased cannabis use during (vs before) pandemic

38. 39
Pandemic-related experiences (independent variables)
- Feelings of loneliness or isolation due to pandemic
- Emotional distress due to pandemic
- Challenges in personal relationships with household members due to pandemic
- Physical health problems due to pandemic
- Difficulty meeting financial obligations or essential needs due to pandemic
- Loss of job or income due to pandemic

39. 40
- Increased alcohol use during pandemic
- Increased alcohol use during pandemic due to stress or loneliness
- Increased cannabis use during pandemic
Pandemic-related experiences (independent variables)
Additional independent variables:
• Age, sex, area of residence
• Income quintile, education level
• Household and family composition
• Experience of household violence
• COVID diagnosis history
• Frontline/essential worker status
• Death of friends/family due to COVID
• Frequency and amount of alcohol and cannabis consumption
• Self-care behaviours to support mental/physical health

40. 41
Depression
Likelihood of meeting PHQ-9 depression criteria during pandemic
0 1 2 3 4 5 6 7 8 9 10
Loneliness/isolation
Incr alc – stress/loneliness
Relationship problems
Physical health problems
Diff. meeting needs
Job/income loss
Increased alcohol
Increased cannabis
Emotional distress
2.17
2.82
2.68
2.17
3.64
Odds Ratio (+/- 95% CI)

41. 42
Anxiety
Likelihood of meeting GAD-7 anxiety criteria during pandemic
0 1 2 3 4 5 6 7
Loneliness/isolation
Incr alc – stress/loneliness
Relationship problems
Physical health problems
Diff. meeting needs
Job/income loss
Increased alcohol
Increased cannabis
Emotional distress
1.52
3.04
1.57
2.31
2.58
1.63
Odds Ratio (+/- 95% CI)

42. 43
Worse self-rated mental health
Likelihood of rating mental health as worse during (vs before) pandemic
0 1 2 3 4 5 6 7 8
Loneliness/isolation
Incr alc – stress/loneliness
Relationship problems
Diff. meeting needs
Job/income loss
Increased alcohol
Increased cannabis
Emotional distress
Physical health problems
4.01
3.25
2.34
2.54
3.05
Odds Ratio (+/- 95% CI)

43. 44
Increased alcohol consumption
Likelihood of reporting increased alcohol consumption during (vs before) pandemic
0 0.5 1 1.5 2 2.5 3
Loneliness/isolation
Relationship problems
Diff. meeting needs
Job/income loss
Emotional distress
Physical health problems
1.86
1.75
Odds Ratio (+/- 95% CI)

44. 45
Increased cannabis use
Likelihood of reporting increased cannabis use during (vs before) pandemic
0 1 2 3 4 5 6
Loneliness/isolation
Relationship problems
Diff. meeting needs
Job/income loss
Emotional distress
Physical health problems
Odds Ratio (+/- 95% CI)
2.55
1.93

45. Summary
The COVID-19 pandemic in New Brunswick was associated with increased prevalence of:
Outcome Associated personal characteristics
Depression Age 65+, high income, Fredericton, urban,
living alone
Low self-rated mental health Age 19-39, Fredericton, urban, higher
education, habitual cannabis use
Habitual binge drinking Age 19-39 and age 65+, female, higher
education
Habitual cannabis use Age 65+

46. Pandemic-related experiences associated with adverse mental health outcomes
Factor (due to pandemic) Dep Anx SRMH
Loneliness/isolation
Emotional distress
Relationship problems
Physical health problems
Difficulty meeting essential needs
Job/income loss
Incr. alc. due to stress/loneliness
Increased alcohol
Increased cannabis

47. Pandemic-related experiences associated with increased substance use
Factor (due to pandemic) Alcohol Cannabis
Loneliness/isolation
Emotional distress
Relationship problems
Physical health problems
Difficulty meeting essential needs
Job/income loss

48. Contact
Dr. Chris Folkins
Research Scientist
NB-IRDT
chris.folkins@unb.ca
www.unb.ca/nbirdt