title: Regional and individual influences on use of mental health services in Canada.
abstract: OBJECTIVE
  Knowledge is lacking on the extent to which area-level characteristics contribute to variations observed in the use of mental health services. This study examined the influence of area- and individual-level characteristics on the use of mental health services.
  
  
  METHODS
  Data from a nationally representative, population-based, cross-sectional survey, the Canadian Community Health Survey-Mental Health and Well-Being, consisting of adults aged 15 years or older (n = 36 984), were linked to Canadian 2001 Census profiles according to health region boundaries (n = 97). Multilevel multivariable logistic regression modelling was used to: estimate variation in 12-month self-reported use of health services for mental health reasons between health regions; and, estimate the effects of individual- and area-level need, health resources, and sociodemographic factors on self-reported 12-month use of medical services for mental health reasons.
  
  
  RESULTS
  There was a 2.1% and 3.5% regional variation for general practitioner-family physician (GP-FP) and psychiatric health service use during 12 months, respectively. Most of the regional variation observed was explained by number of physicians per health region and regional and individual need factors. Adults who were middle-aged, had a post-secondary education, low-income, were separated, widowed, or divorced, and Canadian-born were significantly more likely to use GP-FP and psychiatry services for mental health reasons at the individual level, even after adjusting for area- and individual-level need factors.
  
  
  CONCLUSIONS
  Most area-level variation was explained by the availability of health region resources and individual-level need factors. After accounting for need, numerous sociodemographic factors retained their association with use of mental health services. Additional efforts are needed at the area and individual level to reduce inequities through appropriate targeted care.
authors.affiliation: Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario. natalia.diaz.granados@utoronto.ca
authors.forename: Natalia
authors.initials: N
authors.lastname: Diaz-Granados
authors.forename: Katholiki
authors.initials: K
authors.lastname: Georgiades
authors.forename: Michael H
authors.initials: MH
authors.lastname: Boyle
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002170:Canada; D003430:Cross-Sectional Studies; D003625:Data Collection; D003710:Demography; D039721:Diagnostic and Statistical Manual of Mental Disorders; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000523:psychology / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010821:Physicians, Family; D011788:Quality of Life; D012959:Socioeconomic Factors; D055815:Young Adult