Survey on Living with Chronic Diseases in Canada - 2014

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Table of Contents

Introduction (XINT)

Introduction (XINT) - Question identifier:XINT_R01

This survey is conducted under the Statistics Act, and your answers will be kept strictly confidential. Although your participation in this survey is voluntary, your cooperation is important so that the information collected will be as accurate and complete as possible.

This survey is conducted in collaboration with the Public Health Agency of Canada with the purpose of collecting information on Canadians with chronic health conditions.

Introduction (XINT) - Question identifier:XINT_R02

You may remember recently completing the Canadian Community Health Survey. This is a follow-up to that survey.

The data will be used by health professionals and public health programs with the aim of improving health outcomes for Canadians with chronic conditions. The information may also be used by Statistics Canada for other statistical and research purposes.

General Health (XGEN)

General Health (XGEN) - Question identifier:XGEN_R01

I would like to start with some general background questions.

General Health (XGEN) - Question identifier:XGEN_Q01

In general, would you say your health is...?

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor
  • 8: RF
  • 9: DK

General Health (XGEN) - Question identifier:XGEN_Q02

Using a scale of 0 to 10, where 0 means "Very dissatisfied" and 10 means "Very satisfied", how do you feel about your life as a whole right now?

  • 00: Very dissatisfied
  • 01: |
  • 02: |
  • 03: |
  • 04: |
  • 05: |
  • 06: |
  • 07: |
  • 08: |
  • 09: |
  • 10: Very satisfied
  • 98: RF
  • 99: DK

General Health (XGEN) - Question identifier:XGEN_Q03

In general, would you say your mental health is...?

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor
  • 8: RF
  • 9: DK

General Health (XGEN) - Question identifier:XGEN_Q04

Thinking about the amount of stress in your life, would you say that most days are...?

  • 1: Not at all stressful
  • 2: Not very stressful
  • 3: A bit stressful
  • 4: Quite a bit stressful
  • 5: Extremely stressful
  • 8: RF
  • 9: DK

Confirmation of Diagnosis (XCNM)

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_R01

Now I would like to ask some questions about mood and anxiety disorders.

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q01A

To begin, do you have a mood disorder such as depression, bipolar disorder, mania or dysthymia that has been diagnosed by a health professional?

  • 1: Yes
  • 2: No

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q01B

Have you ever been diagnosed with a mood disorder (such as depression, bipolar disorder, mania or dysthymia)?

  • 1: Yes
  • 2: No

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q01C

What kind of mood disorder [do/did] you have?

  • 1: Depression
  • 2: Seasonal affective disorder ((SAD) or seasonal depression)
  • 3: Dysthymia
  • 4: Bipolar disorder (manic depression)
  • 5: Mania
  • 6: Other
  • 8: RF
  • 9: DK

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q02

How old were you when you were first diagnosed with a mood disorder?

Min = 0; Max = 130

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q03

How old were you when you first started experiencing symptoms related to your mood disorder?

Min = 0; Max = 130

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q04A

Do you have an anxiety disorder such as a phobia, obsessive-compulsive disorder or panic disorder that has been diagnosed by a health professional?

  • 1: Yes
  • 2: No

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q04B

Have you ever been diagnosed with an anxiety disorder (such as a phobia, obsessive-compulsive disorder or panic disorder)?

  • 1: Yes
  • 2: No

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q04C

What kind of anxiety disorder [do/did] you have?

  • 01: Phobia (excluding social phobia and agoraphobia)
  • 02: Social phobia
  • 03: Agoraphobia
  • 04: Obsessive-compulsive disorder (OCD)
  • 05: Generalized anxiety disorder
  • 06: Panic disorder
  • 07: Post traumatic stress disorder
  • 08: Other
  • 98: RF
  • 99: DK

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q05

How old were you when you were first diagnosed with an anxiety disorder?

Min = 0; Max = 130

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q06

How old were you when you first started experiencing symptoms related to your anxiety disorder?

Min = 0; Max = 130

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_Q07

During the Canadian Community Health Survey, it was reported that you had [a mood disorder/an anxiety disorder/a mood disorder and an anxiety disorder] that had been diagnosed by a health professional, but this time it was reported that you do not. What is the reason for this change?

  • 1: Error in CCHS - Never had a mood or anxiety disorder
  • 2: Never diagnosed by a health professional
  • 3: Does not want to complete this survey
  • 4: Does not remember completing the CCHS
  • 5: Other
  • 8: RF
  • 9: DK

Confirmation of Diagnosis (XCNM) - Question identifier:XCNM_R08

You have said that you have never been diagnosed with a mood or anxiety disorder. Since this survey applies only to people with mood or anxiety disorder, you are not eligible to participate in today's survey. Thank you for your time.

Medication Use (XMEM)

Medication Use (XMEM) - Question identifier:XMEM_R01

The next few questions are about medications that have been prescribed by a doctor or other health professional.

Medication Use (XMEM) - Question identifier:XMEM_Q01

Currently, are you taking any prescription medications for your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_Q02

Have you ever taken any prescription medications for your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_Q03

What are the reasons that you [are no longer taking/have never taken] any prescription medications for your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 01: No medication prescribed
  • 02: Side-effects
  • 03: Too costly / no insurance
  • 04: Controlled without medication
  • 05: Embarrassed / uncomfortable / concerned what others would think
  • 06: Do not want to become dependent
  • 07: Other
  • 08: No reason
  • 98: RF
  • 99: DK

Medication Use (XMEM) - Question identifier:XMEM_Q04

Thinking back to when you were first diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], how long was it before you were started on prescription medication?

  • 1: Less than 1 month
  • 2: 1 month to less than 6 months
  • 3: 6 months to less than 1 year
  • 4: 1 year to less than 2 years
  • 5: 2 years to less than 5 years
  • 6: 5 years or more
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_R05

The next few questions are about the type of medications that may have been prescribed for your [mood disorder/anxiety disorder/mood or anxiety disorder]. Some prescription medications may be taken on a regular basis and others may be taken as needed.

Medication Use (XMEM) - Question identifier:XMEM_Q05

Currently, how many different types of prescription medications do you take on a regular basis for your [mood disorder/anxiety disorder/mood disorder and anxiety disorder]?

  • 1: One
  • 2: Two
  • 3: Three
  • 4: Four or more
  • 5: None
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_Q06

Excluding medications taken on a regular basis, currently, how many different types of prescription medications do you take as needed for your [mood disorder/anxiety disorder/mood disorder and anxiety disorder]?

  • 1: One
  • 2: Two
  • 3: Three
  • 4: Four or more
  • 5: None
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_R07

Now think about only those medications taken on a regular basis for your [mood disorder/anxiety disorder/mood or anxiety disorder].

Medication Use (XMEM) - Question identifier:XMEM_Q07

In the past month, were there any days when you took less medication than you were recommended to (in terms of frequency or dosage)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_Q08

How often did you take less medication than you were recommended to (in the past month)?

  • 1: Once or twice
  • 2: A few times
  • 3: Half the time
  • 4: Most of the time
  • 5: All of the time
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_Q09

In the past month, were there any days when you took more medication than you were recommended to (in terms of frequency or dosage)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_Q10

How often did you take more medication than you were recommended to (in the past month)?

  • 1: Once or twice
  • 2: A few times
  • 3: Half the time
  • 4: Most of the time
  • 5: All of the time
  • 8: RF
  • 9: DK

Medication Use (XMEM) - Question identifier:XMEM_Q11

Currently, are you taking any natural health products (such as a vitamin, mineral or herbal supplement) for your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM)

Self-management (XSMM) - Question identifier:XSMM_R01

The next questions are about things that people might do as a result of being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder].

You may feel that some of these questions do not apply to you, but it is important that we ask the same questions of everyone.

Self-management (XSMM) - Question identifier:XSMM_Q01A

As a result of being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], did you ever exercise or participate in physical activities to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q01B

Are you still doing this?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q01C

How often do you do this?

  • 1: Every day
  • 2: 4 to 6 times per week
  • 3: 2 to 3 times per week
  • 4: Once a week
  • 5: Less than once a week
  • 6: Less than once a month
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q01D

What are the reasons why [you do not/you no longer/you do not frequently] exercise or participate in physical activity (to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder])?

  • 01: Already doing this for other reasons
  • 02: Lack of will power / self-discipline
  • 03: Time constraints / too busy
  • 04: Prevented by physical condition
  • 05: Didn't know it is important / recommended
  • 06: Too costly / financial constraints
  • 07: Other
  • 08: No reason
  • 98: RF
  • 99: DK

Self-management (XSMM) - Question identifier:XSMM_Q02A

Since being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], did you ever smoke (cigarettes, cigars or pipes)?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q02B

Did you ever quit smoking to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q02C

Are you still not smoking?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q02D

What are the reasons why you are not trying to quit smoking (to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder])?

  • 1: Already doing this for other reasons
  • 2: Lack of will power / self-discipline
  • 3: Habit / unable to stop
  • 4: Prevented by physical condition
  • 5: Didn't know it is important / recommended
  • 6: Other
  • 7: No reason
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q03A

Since being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], did you ever regularly drink more than [10/15] drinks of alcohol a week?

When we use the word "drink", it means:
- one bottle or can of beer or a glass of draft
- one glass of wine or a wine cooler
- one drink or cocktail with 1 and ¿ ounces of liquor.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q03B

Did you ever limit your alcohol consumption to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q03C

Do you still limit your alcohol consumption (to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder])?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q03D

What are the reasons why you are not trying to limit your alcohol consumption (to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder])?

  • 1: Already doing this for other reasons
  • 2: Lack of will power / self-discipline
  • 3: Habit / unable to stop
  • 4: Prevented by physical condition
  • 5: Didn't know it is important / recommended
  • 6: Other
  • 7: No reason
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q04A

Since being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], did you ever use street drugs?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q04B

Did you ever stop using street drugs to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q04C

Are you still not using street drugs?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q04D

What are the reasons why you are not trying to stop using street drugs (to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder])?

  • 1: Already doing this for other reasons
  • 2: Lack of will power / self-discipline
  • 3: Habit / unable to stop
  • 4: Prevented by physical condition
  • 5: Didn't know it is important / recommended
  • 6: Other
  • 7: No reason
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q05A

As a result of being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], did you ever attempt to adopt good sleep habits to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

Good sleep habits include such things as keeping a regular sleep schedule, blocking out unwanted noise or limiting the amount of light entering your bedroom.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q05B

Are you still doing this?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q06

As a result of being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], did you ever develop a care plan or a crisis plan?

A care plan or a crisis plan is an informal or formal understanding between family members or friends about how to support you when your mental health might be compromised.

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q07

Did you ever use light therapy to help manage your mood disorder?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q08

Did you ever engage in reflective or meditative practices to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Self-management (XSMM) - Question identifier:XSMM_Q09

Did you ever educate yourself about your [mood disorder/anxiety disorder/mood or anxiety disorder] to help manage it?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contact with Health Professionals (XCHM)

Contact with Health Professionals (XCHM) - Question identifier:XCHM_R01

Now I would like to ask you some questions about your contacts with health professionals about your [mood disorder/anxiety disorder/mood or anxiety disorder].

Contact with Health Professionals (XCHM) - Question identifier:XCHM_Q01

During the past 12 months, have you seen, or talked on the telephone to, any of the following people about your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 01: Family doctor or general practitioner
  • 02: Psychiatrist
  • 03: Psychologist
  • 04: Social worker, counsellor, or psychotherapist
  • 05: Nurse or nurse practitioner
  • 06: Other medical doctor or specialist
  • 07: Other health professional (please specify)
  • 08: None
  • 98: RF
  • 99: DK

Contact with Health Professionals (XCHM) - Question identifier:XCHM_Q02

What are the reasons why you have not seen or talked to any health professional about your [mood disorder/anxiety disorder/mood or anxiety disorder] in the past 12 months?

  • 01: Don't know who to go to
  • 02: Time constraints (too busy, family responsibilities, work schedule)
  • 03: Wait time too long
  • 04: Too costly/not covered by insurance
  • 05: Prefer to manage the condition themselves
  • 06: Too embarrassed/ uncomfortable/ concerned what others would think
  • 07: Other
  • 08: No reason
  • 98: RF
  • 99: DK

Contact with Health Professionals (XCHM) - Question identifier:XCHM_Q03

In the past 12 months, did you receive psychological counselling to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Contact with Health Professionals (XCHM) - Question identifier:XCHM_Q04

What are the reasons why you did not receive psychological counselling to help manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 01: Don't know who to go to
  • 02: Time constraints (too busy, family responsibilities, work schedule)
  • 03: Wait time too long
  • 04: Too costly/not covered by insurance
  • 05: Prefer to manage the condition themselves
  • 06: Taking medication to manage the condition
  • 07: Too embarrassed/ uncomfortable/ concerned what others would think
  • 08: Other
  • 09: No reason
  • 98: RF
  • 99: DK

Contact with Health Professionals (XCHM) - Question identifier:XCHM_Q05

In the past 12 months, how many psychological counselling sessions did you have?

  • 1: 1 or 2
  • 2: 3 to 5
  • 3: 6 to 9
  • 4: 10 or more
  • 8: RF
  • 9: DK

Clinical Recommendations (XCLM)

Clinical Recommendations (XCLM) - Question identifier:XCLM_R01

The next questions are about things that a doctor, therapist, or other health professional may have suggested to help you manage your [mood disorder/anxiety disorder/mood or anxiety disorder].

You may feel that some of these questions do not apply to you, but it is important that we ask the same questions of everyone.

Clinical Recommendations (XCLM) - Question identifier:XCLM_Q01

Has a doctor or other health professional ever:

... suggested taking prescription medication to help you manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Clinical Recommendations (XCLM) - Question identifier:XCLM_Q02

Has a doctor or other health professional ever:

... suggested getting psychological counselling to help you manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Clinical Recommendations (XCLM) - Question identifier:XCLM_Q03

(Has a doctor or other health professional ever: )

... suggested participating in physical activity or exercise to help you manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Clinical Recommendations (XCLM) - Question identifier:XCLM_Q04

(Has a doctor or other health professional ever: )

... suggested quitting smoking to help you manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 3: Not applicable
  • 8: RF
  • 9: DK

Clinical Recommendations (XCLM) - Question identifier:XCLM_Q05

(Has a doctor or other health professional ever: )

... suggested limiting alcohol consumption to help you manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 3: Not applicable
  • 8: RF
  • 9: DK

Clinical Recommendations (XCLM) - Question identifier:XCLM_Q06

(Has a doctor or other health professional ever: )

... suggested stopping street drug use to help you manage your [mood disorder/anxiety disorder/mood or anxiety disorder]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Clinical Recommendations (XCLM) - Question identifier:XCLM_Q07

(Has a doctor or other health professional ever: )

... suggested using light therapy to help you manage your mood disorder?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM)

Restriction of Activities (XRAM) - Question identifier:XRAM_R01

The next few questions deal with any limitations in your usual activities caused by your [mood disorder/anxiety disorder/mood disorder and anxiety disorder].

Restriction of Activities (XRAM) - Question identifier:XRAM_Q01

In the past 12 months, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] limit you:

... in activities such as recreation, leisure or hobbies?

  • 1: A lot
  • 2: A little
  • 3: Not at all
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM) - Question identifier:XRAM_Q02

In the past 12 months, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] limit you:

... in exercising or playing sports?

  • 1: A lot
  • 2: A little
  • 3: Not at all
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM) - Question identifier:XRAM_Q03

(In the past 12 months, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] limit you:)

... in social activities with family or friends?

  • 1: A lot
  • 2: A little
  • 3: Not at all
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM) - Question identifier:XRAM_Q04

(In the past 12 months, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] limit you:)

... in doing household chores?

  • 1: A lot
  • 2: A little
  • 3: Not at all
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM) - Question identifier:XRAM_Q05

In the past 12 months, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] limit you:

... in running errands or shopping?

  • 1: A lot
  • 2: A little
  • 3: Not at all
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM) - Question identifier:XRAM_Q06

(In the past 12 months, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] limit you:)

... in travelling or taking vacations?

  • 1: A lot
  • 2: A little
  • 3: Not at all
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM) - Question identifier:XRAM_Q07

(In the past 12 months, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] limit you:)

... in taking care of yourself (such as dressing, bathing, and maintaining personal hygiene)?

  • 1: A lot
  • 2: A little
  • 3: Not at all
  • 8: RF
  • 9: DK

Restriction of Activities (XRAM) - Question identifier:XRAM_Q08

Overall, how much did your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] affect your life in the past 12 months?

  • 1: Extremely
  • 2: Quite a bit
  • 3: Moderately
  • 4: A little bit
  • 5: Not at all
  • 8: RF
  • 9: DK

Restriction of Work-related Activities (XRWM)

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_R01

The next questions concern your work activities.

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_Q01

Are you currently working for pay at a job or business?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_Q02

At any time since being diagnosed with [a mood disorder/an anxiety disorder/a mood or anxiety disorder], have you worked for pay at a job or business?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_R03

Now some questions about your current and past work environments.

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_Q03

Because of your [mood disorder/anxiety disorder/mood or anxiety disorder], did you ever:

... change the number of hours you [work/worked]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_Q04

Because of your [mood disorder/anxiety disorder/mood or anxiety disorder], did you ever:

... change the type of work you [do/did]?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_Q05

Because of your [mood disorder/anxiety disorder/mood or anxiety disorder], did you ever:

... change the way in which you [carry/carried] out your tasks at work?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_Q06

Because of your [mood disorder/anxiety disorder/mood or anxiety disorder], did you ever:

... stop work altogether?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Restriction of Work-related Activities (XRWM) - Question identifier:XRWM_Q07

Overall, how much [does/does/do/did] your [mood disorder/anxiety disorder/mood disorder and anxiety disorder] affect your ability to work at your job?

  • 1: Extremely
  • 2: Quite a bit
  • 3: Moderately
  • 4: A little bit
  • 5: Not at all
  • 8: RF
  • 9: DK

Sleep (XSLP)

Sleep (XSLP) - Question identifier:XSLP_R01

Now a few questions about sleep.

Sleep (XSLP) - Question identifier:XSLP_Q01

How long do you usually spend sleeping each night?

  • 01: Under 2 hours
  • 02: 2 hours to less than 3 hours
  • 03: 3 hours to less than 4 hours
  • 04: 4 hours to less than 5 hours
  • 05: 5 hours to less than 6 hours
  • 06: 6 hours to less than 7 hours
  • 07: 7 hours to less than 8 hours
  • 08: 8 hours to less than 9 hours
  • 09: 9 hours to less than 10 hours
  • 10: 10 hours to less than 11 hours
  • 11: 11 hours to less than 12 hours
  • 12: 12 hours or more
  • 98: RF
  • 99: DK

Sleep (XSLP) - Question identifier:XSLP_Q02

How often do you have trouble going to sleep or staying asleep?

  • 1: None of the time
  • 2: A little of the time
  • 3: Some of the time
  • 4: Most of the time
  • 5: All of the time
  • 8: RF
  • 9: DK

Sleep (XSLP) - Question identifier:XSLP_Q03

What are the reasons that you have trouble going to sleep or staying asleep?

  • 01: Racing thoughts, worries, anxiety
  • 02: Work schedule / shift work
  • 03: Too much nicotine / alcohol / caffeine (include energy drinks)
  • 04: Disturbed by others (bed partner, children or pets)
  • 05: Physical condition or pain
  • 06: Bad dreams
  • 07: Other
  • 08: No reason
  • 98: RF
  • 99: DK

Stress (XSTS)

Stress (XSTS) - Question identifier:XSTS_R01

Now a few questions about the stress in your life.

Stress (XSTS) - Question identifier:XSTS_Q01

In general, how would you rate your ability to handle unexpected and difficult problems, for example, a family or personal crisis?

Would you say your ability is...?

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor
  • 8: RF
  • 9: DK

Stress (XSTS) - Question identifier:XSTS_Q02

In general, how would you rate your ability to handle the day-to-day demands in your life, for example, handling work, family and volunteer responsibilities?

Would you say your ability is...?

  • 1: Excellent
  • 2: Very good
  • 3: Good
  • 4: Fair
  • 5: Poor
  • 8: RF
  • 9: DK

Stress (XSTS) - Question identifier:XSTS_Q03

Thinking about stress in your day-to-day life, what would you say is your main source of stress?

  • 01: Work
  • 02: Financial concerns
  • 03: Family
  • 04: School work
  • 05: Time pressures / not enough time
  • 06: Health
  • 07: Other - Specify
  • 08: None
  • 98: RF
  • 99: DK

Social Provisions Scale (XSPS)

Social Provisions Scale (XSPS) - Question identifier:XSPS_R01

The next questions are about your current relationships with friends, family members, co-workers, community members, and so on. Please indicate to what extent each statement describes your current relationships with other people.

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q01

There are people I can depend on to help me if I really need it.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q02

There are people who enjoy the same social activities I do.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q03

I have close relationships that provide me with a sense of emotional security and well-being.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q04

There is someone I could talk to about important decisions in my life.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q05

I have relationships where my competence and skill are recognized.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q06

There is a trustworthy person I could turn to for advice if I were having problems.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q07

I feel part of a group of people who share my attitudes and beliefs.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q08

I feel a strong emotional bond with at least one other person.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q09

There are people who admire my talents and abilities.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Social Provisions Scale (XSPS) - Question identifier:XSPS_Q10

There are people I can count on in an emergency.

  • 1: Strongly agree
  • 2: Agree
  • 3: Disagree
  • 4: Strongly disagree
  • 8: RF
  • 9: DK

Administration (XADM)

Administration (XADM) - Question identifier:XADM_R01A

In 2013, you responded to the Canadian Community Health Survey. At that time, you gave permission for [Statistics Canada and the "Institut de la Statistique du Québec"/Statistics Canada and your provincial ministry of health] to link information from that survey to your health services information. You also gave us your provincial health number to assist in linking this information.

Administration (XADM) - Question identifier:XADM_R01B

To enhance the data from this survey and to minimize reporting burden for respondents, Statistics Canada will combine your responses from this survey with your information from the 2013 Canadian Community Health Survey. Statistics Canada may also add information from other surveys or administrative data sources. The linked information will be kept strictly confidential and used only for statistical purposes.

Administration (XADM) - Question identifier:XADM_R02

To avoid duplication of surveys, Statistics Canada has signed agreements with the Public Health Agency of Canada, Health Canada[provincial ministries of health and the "Institut de la Statistique du Québec"/and provincial ministries of health] to share the linked survey data. This is your information from today's interview and your information from the Canadian Community Health Survey.

Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses, telephone numbers or health numbers will be provided.

Administration (XADM) - Question identifier:XADM_Q02

The Public Health Agency of Canada, Health Canada [provincial ministries of health and the "Institut de la Statistique du Québec"/and provincial ministries of health] have agreed to keep the information from both surveys confidential and use it only for statistical purposes.

Do you agree to share the linked information?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Administration (XADM) - Question identifier:XADM_R03

To avoid duplication of surveys, Statistics Canada has signed agreements with the Public Health Agency of Canada, Health Canada[provincial ministries of health and the "Institut de la Statistique du Québec"/and provincial ministries of health] to share the information collected in today's interview.

Provincial ministries of health may make this information available to local health authorities, but no identifiable information such as names, addresses, telephone numbers or health numbers will be provided.

Administration (XADM) - Question identifier:XADM_Q03

The Public Health Agency of Canada, Health Canada[provincial ministries of health and the "Institut de la Statistique du Québec"/and provincial ministries of health] have agreed to keep the information confidential and use it only for statistical purposes. Your personal identifiers such as name, address and telephone number will not be shared.

Do you agree to share the information from today's interview?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK

Administration (XADM) - Question identifier:XADM_R04

Although you do not agree to share the linked survey information, we would like your permission to share only the information collected in today's interview with the Public Health Agency of Canada, Health Canada[provincial ministries of health and the "Institut de la Statistique du Québec"/and provincial ministries of health].

Administration (XADM) - Question identifier:XADM_Q04

They have agreed to keep the information confidential and use it only for statistical purposes. Your personal identifiers such as name, address and telephone number will not be shared.

Do you agree to share the information from today's interview?

  • 1: Yes
  • 2: No
  • 8: RF
  • 9: DK
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