Thank you very much.
Good morning, honourable members.
My name is Peter Szatmari. I'm a child and youth psychiatrist and director of the Cundill Centre for Child and Youth Depression at the Centre for Addiction and Mental Health.
Thank you so much for the invitation to present to the Standing Committee on the Status of Women. I am very pleased to see that you are addressing an issue that I and many of my colleagues see as a major public health problem in Canada: the mental health of young women aged 12 to 24 years and the widening gender gap in mental health, not only in Canada but also globally.
Sex and gender differences—for simplicity I will refer to gender only—are pervasive in youth mental health. Three disorders—anxiety, self-harm and depression, which very often occur together in a cluster—represent the main causes of adolescent disability worldwide as reported by the World Health Organization. Data in 2014 from Ontario, the only province for which population-based data exist, estimated that up to 20% of adolescents experienced a mental health disorder, again, predominantly anxiety, depression and self-harm.
This triad of conditions shows striking gender differences, each disorder occurring roughly two times more commonly in adolescent females compared to males. Again, data from that 2014 survey show that 10% of adolescent girls report a major depressive disorder, compared to 5% of boys, and 20% of adolescent girls report an anxiety disorder, compared to 10% of boys.
What is even more alarming is that, not only in Ontario but also in most high-income countries globally, rates of these three mental health conditions have increased over time, particularly among girls. The gender gap for this triad of mental health conditions is not only large but becoming greater over time.
The reasons for these gender-based inequities are not clear and are likely to be complex. Some risk factors for anxiety, depression and self-harm are more common in girls, while girls appear to be more vulnerable than boys to the impact of other common risk factors. Female hormonal changes associated with puberty have a profound effect on the developing brain, and early puberty, something that is becoming more common worldwide, is a potent risk factor for depression. Other risk factors for this widening mental health gender gap include the increasing prevalence of sleep disruption among girls and the higher rates of sexual abuse and bullying experienced by adolescent females compared to males.
We know that, during the pandemic, Canadian adolescents reported alarming rates of worsening mental health. Statistics Canada reported that at one point roughly 50% more adolescent girls than boys judged that their mental health was somewhat or much worse compared to prepandemic times.
We are likely to experience even more population-level risk factors in the future, whether that is another pandemic or the challenges associated with the climate crisis. I have only to point to wildfires on the west coast and cyclones in the Atlantic and their impact on the mental health of young people. The mental health of young women in Canada is at heightened risk in the face of these and other similar yet unforeseen disasters.
I have two recommendations that I believe are within the federal mandate for health and that might go some way toward mitigating these challenges.
First, young girls and women throughout Canada should have ready access to consistently high-quality services tailored to their gender, culture and other aspects of identity. The federal government can play a role in encouraging the provinces and territories to come together and support this unified vision, as well as in advocating for a common platform of measurement-based care and outcome monitoring to ensure that gender-based inequities in mental health do not widen further.
Second, Canada is the only G7 country that does not have a population-based survey of the mental health of children and youth that includes repeated measurements over time. As a result, we do not have population-based data on the health, including the mental health, of young people. As a result, we cannot say with confidence that rates of actual disorder or that mental health inequities have truly increased postpandemic, compared to prepandemic. The Canadian health survey on children and youth—