title: Is the statistical association between sex and the use of services for mental health reasons confounded or modified by social anchorage?
abstract: OBJECTIVE
  Confounding and interaction have differing implications for the interpretation of findings and the design of research, mental health services, and policy. This study aimed to verify whether the association between sex and the use of services for mental health reasons is confounded or modified by social anchorage.
  
  
  METHODS
  We undertook a case-control study nested in Cycle 1.2 of the Canadian Community Health Survey. Cases were defined as users of general medical services for mental health reasons in the previous 12 months, and control subjects were defined as never-users of any services for mental health reasons. The pattern of social anchorage was described by the roles of parent, spouse, worker, and their combination.
  
  
  RESULTS
  Overall, women are 2.9 times more likely than men to use general services for mental health reasons. However, this inequality between women and men decreases substantially or subsides in individuals who are less anchored to Canadian society. For instance, in single parents and in unemployed parents, the odds of using general services for mental health reasons are similar in women and in men. The pattern of social anchorage tends to modify, but not to confound, the association between sex and the use of services.
  
  
  CONCLUSIONS
  Ignoring the interaction between sex and the pattern of social anchorage distorts the interpretation of the inequality between women and men in the use of general medical services for mental health reasons and may affect the design of comprehensive mental health services and policy.
authors.affiliation: Unité de psychiatrie sociale, Centre de recherche Fernand-Seguin, Montreal, Quebec. adrapeau.hlhl@ssss.gouv.qc.ca
authors.forename: Aline
authors.initials: A
authors.lastname: Drapeau
authors.forename: Alain
authors.initials: A
authors.lastname: Lesage
authors.forename: Richard
authors.initials: R
authors.lastname: Boyer
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D016022:Case-Control Studies; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008875:Middle Aged; D015995:Prevalence; D011584:Psychology; D017678:Sex Distribution; D015406:Single Parent / Q000706:statistics & numerical data; D012944:Social Support