Atlantic Voice: World renowned health survey, right under our noses
One of the most highly respected health studies in the world has been going on in Nova Scotia for more than 60 years.
But few people here have ever heard of it.
That's because the people behind the research have never published the name of the county where they started their interviews back in 1952.
"If you're asking people to talk to you about their health and life experiences" says Dr. Jane Murphy of the Harvard Medical School.
"You feel the need to protect them. And we have. We have never never used the name of a person."
The researchers also thought the whole community should be anonymous. So they chose "Stirling County."
"There is a Stirling county in Scotland so it seemed appropriate for New Scotland as well."
Ground-breaking questions
Murphy started out a researcher with the project and then went on to marry the man behind the work, the late Dr. Alexander Leighton. At that time he was a professor of psychiatry at Cornell University in New York.
He wanted to do a broad survey to find out how many people living in any given community were suffering from some degree of mental illness. He also wanted to know what affect those illnesses had on individuals and on the community as a whole.
Back in the late 40's those were ground-breaking questions. Until then, psychiatry was almost exclusively focused on people in mental institutions.
The two World Wars changed all that.
"(In the United States) we had a draft during the Second World War and every potential inductee was interviewed faced to face by a psychiatrists and many more were rejected because of psychiatric problems than anyone thought would be true .... But at least that effort drew attention to the fact that we really didn't know about the distribution of these kinds of problems."
After the wars, the occurrence of shell shock, or combat stress, also signalled a need to study individuals in the community; for the first time, psychiatrists were starting to wonder whether a person's environment could have a direct impact on their mental health.
This was the first time that psychiatrists thought to look at race, education, family structure and income to see whether those factors might affect a person's mental health.
It was the very beginning of a field of study known as psychiatric epidemiology. It involves looking at the health issues in a particular population over a period time, what contributes to those illnesses, and what happens to the people who get sick.
Dr. John Cairney is a professor at McMaster University in Hamilton and president of the Canadian Academy of Psychiatric Epidemiology, which Alexander Leighton founded in the 1980's.
"If we understand that so few people, very few people relatively speaking with a mental health problem end up immediately receiving care then the the only way you can answer that question is go directly into a community, knock on doors if you will and interview individuals... and try to ascertain if they have a mental health and addiction related problem. It's as simple as that. You have to go to where people live and work and play.... Alex really understood that at a very very early point in the development of psychiatric epidemiology."
In the Stirling County study, gathering the facts and figures has been a long and painstaking process. The first interviews were in 1952; researchers spoke with 1000 adults.
In 1970, they followed up with that first group and interviewed 1200 more. In 1992, they tracked those still living from the first 2 groups, and interviewed 1400 more people. Thousands and thousands of hours of interviews — all done face to face.
Helping communities heal themselves
Epidemiology is not about gathering data for data's sake; it's about finding out how to help people. When research shows who's at risk of developing mental illness, clinicians and governments can step in with programs to help.
It's about communities healing themselves.
The Stirling County study has inspired community based wellness programs in Canada and in parts of the United States.
But here in Nova Scotia, where the research was done, some say, we've ignored the results.
Kristy is a family therapist in Stirling County (we are not using her last name to protect the anonymity of the community.) She says, community based wellness programs thrived for awhile in this province, but then the focus shifted.
"I think that what's happened is that in the context of the whole wellness service,physical as well as mental health, we are little Dutch boys with our fingers in the dykes. We're not really looking at fixing the whole dam ...Healthcare is a phenomenal cost, don't get me wrong; but there are ways of delivering healthcare that are far more economical and far more constructive If you get something when it's a small cut, you can put a band-aid on it, you can fix it and it will heal. But if it becomes a gaping bedsore, you're in trouble.
And what we seem to do is, we've loaded our healthcare on the acute end, rather that looking at the constructive, preventative, wellness enhancement injury prevention, health promotion kinds of things.
Some residents not happy about the research
The Stirling County study is famous internationally not only because of the results but because of the methods and questions the researchers used.
Even psychiatrists at the time were only just starting to catalogue symptoms of mental illness and searching for words to describe them.
These days, people would know what you meant if you asked if they were depressed or anxious. Back then, they had to find words that were accurate, but still would be commonly understood; words like "feeling low" or 'hopeless' or 'in poor spirits"
Not every one was delighted by the research. Arnold took part in the first survey but stopped after one or two interviews.
They were prying into private affairs," he says. "They were trying to find out who was crazy and who was sane."
"I forbid them to survey my wife because the questions upset her. They were asking along of personal questions and she didn't think the questions they were asking her were any of their business.
"The ones I remember were really private questions such as How often did you make love ... that's one of the things that upset my wife so much."
Even today, people in Sterling county are reluctant to talk about mental health. Most people in the community don't know about the study because of the pseudonym. But even those who do prefer to stay quiet. They think their connection to a mental health survey casts them in a dubious light.
"If Alexander Leighton had done a study on cardiovascular health .... nobody'd have a problem. Everyone would be front and centre; yeah that was us! But where it's mental illness, mental health? No. And that's in 2015! " says Kristy.
She thinks it's a shame.
"If you look at it from what this has given mental health research, what it has taught us about longitudinal research, what it has taught us about qualitative and quantitative research, within the context of the mental health field, when you look at the what the people of Stirling County have given the academic community, have given the world, have given clinicians, this should be a source of pride. But instead it's a source of 'oh my goodness, we can't talk about that ..."
Stirling County Study Continues
Almost 65 years after the project was born, the Stirling County study continues to prompt discussion, and lead to more exploration. Jane Murphy is 85-years-old but she's still trying to process the data.
For instance, even though the overall numbers for depression haven't changed (about 20 per cent) the demographic has — it used to be older men and women who suffered from depression, now its younger women. Jane would love to find out why.
And now with funding that a Canadian colleague helped her to get, she hopes to go back and track down those people who took part in the 1992 survey.
Listen to Atlantic Voice for Eileen McInnis' documentary.
