title: Comprehensive determinants of health service utilisation for mental health reasons in a Canadian catchment area.
abstract: BACKGROUND
  This study sought to identify factors associated with health service utilisation by individuals with mental disorders in a Canadian catchment area.
  
  
  METHODS
  To be included in the study, participants had to be aged between 15 and 65 and reside in the study location. Data was collected randomly from June to December 2009 by specially trained interviewers. A comprehensive set of variables (including geospatial factors) was studied using the Andersen's behavioural health service model. Univariate, bivariate, and multivariate analyses were carried out.
  
  
  RESULTS
  Among 406 individuals diagnosed with mental disorders, 212 reported using a mental health service at least once in the 12 months preceding the interviews. Emotional problems and a history of violence victimisation were most strongly associated with such utilisation. Participants who were middle-aged or deemed their mental health to be poor were also more likely to seek mental healthcare. Individuals living in neighbourhoods where rental accommodations were the norm used significantly fewer health services than individuals residing in neighbourhoods where homeownership was preponderant; males were also less likely to use services than females.
  
  
  CONCLUSIONS
  Our study broke new ground by uncovering the impact of longstanding violence victimisation, and the proportion of homeownership on mental health service utilisation among this population. It also confirmed the prominence of some variables (gender, age, emotional problems and self-perceived mental health) as key enabling variables of health-seeking. There should be better promotion of strategies designed to change the attitudes of males and youths and to deal with violence victimisation. There is also a need for initiatives that are targeted to neighbourhoods where there is more rental housing.
authors.affiliation: Department of Psychiatry, McGill University, Douglas Hospital Research Centre, Montreal, Quebec H4H 1R3, Canada. flemar@douglas.mcgill.ca
authors.forename: Marie-Josée
authors.initials: MJ
authors.lastname: Fleury
authors.forename: Guy
authors.initials: G
authors.lastname: Grenier
authors.forename: Jean-Marie
authors.initials: JM
authors.lastname: Bamvita
authors.forename: Michel
authors.initials: M
authors.lastname: Perreault
authors.forename: Yan
authors.initials: Y
authors.lastname: Kestens
authors.forename: Jean
authors.initials: J
authors.lastname: Caron
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002170:Canada / Q000453:epidemiology; D002391:Catchment Area, Health / Q000706:statistics & numerical data*; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D019548:Crime Victims / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology; D012044:Regression Analysis; D012111:Residence Characteristics / Q000706:statistics & numerical data*; D017678:Sex Distribution; D012923:Social Class; D014754:Violence / Q000523:psychology / Q000706:statistics & numerical data