title: Socioeconomic status and self-reported barriers to mental health service use.
abstract: OBJECTIVE
  Socially disadvantaged individuals are at high risk for having their mental health service needs unmet. We explored the relations among education level, income level, and self-reported barriers to mental health service use for individuals with a mental illness, using data from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2).
  
  
  METHODS
  Our sample group comprised the 8.3% of adult respondents who met the CCHS 1.2 criteria for an anxiety or affective disorder in the past 12 months (n = 3101). We examined the association between education and income levels and self-reported accessibility, availability, or acceptability barriers to mental health care.
  
  
  RESULTS
  Accessibility, availability, and acceptability barriers were reported by 3%, 5%, and 16% of our sample, respectively. Individuals with a high school diploma were less likely than individuals without a high school diploma to report acceptability barriers to care (odds ratio 0.65; 95% confidence interval, 0.45 to 0.93). Higher-income individuals were less likely than lower-income individuals to report acceptability barriers to care (odds ratio 0.69; 95% confidence interval, 0.50 to 0.96). Employment, distress level, age, and family structure were also associated with acceptability barriers.
  
  
  CONCLUSIONS
  Issues related to acceptability explain most of the unmet need for mental health services. Program planners should consider the development of targeted approaches to service delivery and outreach for low-income, working individuals who have not completed high school.
authors.affiliation: Health Systems Research & Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario. leah_steele@camh.net
authors.forename: Leah
authors.initials: L
authors.lastname: Steele
authors.forename: Carolyn
authors.initials: C
authors.lastname: Dewa
authors.forename: Kenneth
authors.initials: K
authors.lastname: Lee
mesh_terms: D000328:Adult; D001008:Anxiety Disorders / Q000453:epidemiology* / Q000628:therapy*; D002170:Canada / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003866:Depressive Disorder / Q000453:epidemiology / Q000523:psychology; D004651:Employment / Q000706:statistics & numerical data; D005190:Family / Q000523:psychology; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data* / Q000600:supply & distribution; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires