title: Use of health care services for psychological distress by immigrants in an urban multicultural milieu.
abstract: OBJECTIVE
  Research in the United States tends to attribute low rates of use of mental health services by immigrants to economic barriers. The purpose of our study was to examine this issue in the context of Canada's universal health care system.
  
  
  METHODS
  A survey of the catchment area of a comprehensive clinic in Montreal interviewed random samples of 924 Canadian-born individuals and 776 immigrants born in the Caribbean (n = 264), Vietnam (n = 234), or the Philippines (n = 278) to assess their health care use for somatic symptoms, psychological distress, and recent life events.
  
  
  RESULTS
  Overall rates of use of medical services in the past year were similar in immigrant (78.5%) and nonimmigrant (76.5%) groups. Rates of use of health care services for psychological distress were significantly lower among immigrants (5.5% compared with 14.7%, P < 0.001). This difference was attributable both to a lower rate of use of specialty mental health services by immigrants (2.5% compared with 11.7%, P < 0.001) and to differential use of medical services for psychological distress (3.5% compared with 5.8%, P = 0.02). When level of psychological distress was controlled, Vietnamese and Filipino immigrants were one-third as likely as Canadian-born residents to make use of mental health services. The lower rate of use by immigrants could not be explained by differences in sociodemographics, somatic or psychological symptoms, length of stay in Canada, or use of alternative sources of help.
  
  
  CONCLUSIONS
  Immigrant status is associated with lower rates of use of mental health services, even with universal health insurance. This lower rate of use likely reflects cultural and linguistic barriers to care.
authors.affiliation: Division of Social and Transcultural Psychiatry, McGill University, Montreal, Quebec. laurence.kirmayer@mcgill.ca
authors.forename: Laurence J
authors.initials: LJ
authors.lastname: Kirmayer
authors.forename: Morton
authors.initials: M
authors.lastname: Weinfeld
authors.forename: Giovani
authors.initials: G
authors.lastname: Burgos
authors.forename: Guillaume Galbaud
authors.initials: GG
authors.lastname: du Fort
authors.forename: Jean-Claude
authors.initials: JC
authors.lastname: Lasry
authors.forename: Allan
authors.initials: A
authors.lastname: Young
mesh_terms: D000328:Adult; D000342:Affective Symptoms / Q000453:epidemiology / Q000209:etiology; D000368:Aged; D000529:Complementary Therapies / Q000706:statistics & numerical data; D003466:Cultural Characteristics; D018864:Cultural Diversity; D004641:Emigration and Immigration / Q000706:statistics & numerical data*; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data; D006306:Health Surveys; D006801:Humans; D008016:Life Change Events; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology* / Q000208:ethnology; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D019303:Multilingualism; D010679:Philippines / Q000208:ethnology; D011792:Quebec; D012017:Referral and Consultation / Q000706:statistics & numerical data; D012931:Social Environment; D013001:Somatoform Disorders / Q000453:epidemiology / Q000209:etiology; D019472:Universal Health Insurance; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data; D014744:Vietnam / Q000208:ethnology; D014900:West Indies / Q000208:ethnology