Treatment seeking for depression in Canada and the United States.
OBJECTIVE
Cross-country comparisons of patterns of mental health treatment seeking provide insights into the impact of contextual factors on mental health service use. This study aimed to compare prevalence and predictors of mental health treatment seeking among adults with major depression in Canada and the United States.


METHODS
Data for 751 participants with a probable major depressive episode in the past 12 months were drawn from the 2002-2003 Joint Canada/United States Survey of Health: 304 were from Canada and 447 were from the United States. Probable major depressive episodes were ascertained by the Composite International Diagnostic Interview-Short-Form. Patterns of contacts with mental health and general health providers for mental health reasons were compared.


RESULTS
Prevalence of contacts with any provider for mental health problems was similar among participants with a probable major depressive episode in Canada and the United States (181 Canadians, or 56 percent, compared with 245 Americans, or 52 percent). Canadian participants were more likely than those in the United States to seek treatment for mental health problems from family doctors and general practitioners, and among participants who sought such treatment, Canadians were more likely to also seek treatment from mental health professionals. In both countries, racial or ethnic minorities were less likely than Caucasians to seek treatment. Depression severity was more closely associated with treatment seeking in Canada than in the United States.


CONCLUSIONS
Although studies from the early 1990s showed higher rates of treatment seeking for depression in Canada than in the United States, the more recent data presented here do not show such a gap. However, differences persist in the use of various providers. Compared with the United States, Canada had a closer match between depression severity and treatment, which suggests more efficient allocation of mental health care resources for treatment of depression in Canada.
Mojtabai
Ramin
R
Beth Israel Medical Center, New York, New York 10003, USA. rm322@columbia.edu
Olfson
Mark
M