title: Use of mental health care services by Canadians with co-occurring substance dependence and mental disorders.
abstract: OBJECTIVE
  This study contributes to knowledge of the processes underlying help seeking by those with mental and substance use disorders by examining relationships among need, service use, and satisfaction with mental health care in a population-based sample.
  
  
  METHODS
  Secondary data analyses were performed on responses to the 2002 Canadian Community Health Survey (N=36,984). Diagnostic algorithms classified respondents by past-year diagnostic status, including substance dependence and selected mood and anxiety disorders. Logistic regressions examined associations between diagnostic status and service use, satisfaction, and unmet need for care.
  
  
  RESULTS
  Ten percent of Canadians and 39% of Canadians with a mental disorder or substance dependence sought services in the year preceding data collection. Although those with co-occurring substance dependence and mental disorders reported the poorest mental health and were most likely to seek care, the presence of a mental disorder, regardless of co-occurring substance dependence, contributed primarily to help seeking. Among those who sought services, the use of informal sources of care, including self-help groups, was more common among those with substance dependence. Those with co-occurring disorders reported the lowest satisfaction with care and the greatest prevalence of unmet need.
  
  
  CONCLUSIONS
  The differential use of services, satisfaction, and unmet need across diagnostic status allowed for speculation on differing levels of disability and stigma in the help-seeking process for different types of disorders. The strong association between co-occurring disorders and unmet need for care, including a large proportion of respondents who stated they preferred to self-manage their symptoms, is particularly troubling and deserves future research attention.
authors.affiliation: Health Systems Research and Consulting, Unit T306, Centre for Addiction and Mental Health, 33 Russell St.,Toronto, Ontario, Canada M5S 2S1. karen_urbanoski@camh.net
authors.forename: Karen A
authors.initials: KA
authors.lastname: Urbanoski
authors.forename: Brian R
authors.initials: BR
authors.lastname: Rush
authors.forename: T Cameron
authors.initials: TC
authors.lastname: Wild
authors.forename: Diego G
authors.initials: DG
authors.lastname: Bassani
authors.forename: Saulo
authors.initials: S
authors.lastname: Castel
mesh_terms: D000328:Adult; D002170:Canada; D015897:Comorbidity; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009313:National Health Programs; D019966:Substance-Related Disorders