title: Use of mental health care for nonpsychotic conditions by immigrants in different admission classes and by refugees in Ontario, Canada.
abstract: BACKGROUND
  Most Canadian newcomers are admitted in the economic, family, or refugee class, each of which has its own selection criteria and experiences. Evidence has shown various risks for mental health disorders across admission classes, but the respective service-use patterns for people in these classes are unknown. In this study, we compared service use for nonpsychotic mental health disorders by newcomers in various admission classes with that of long-term residents (i.e., Canadian-born persons or immigrants before 1985) in urban Ontario.
  
  
  METHODS
  In this population-based matched cross-sectional study, we linked health service databases to the Ontario portion of the Citizenship and Immigration Canada database. Outcomes were mental health visits to primary care physicians, mental health visits to psychiatrists, and emergency department visits or hospital admissions. We measured service use for recent immigrants (those who arrived in Ontario between 2002 and 2007; n = 359 673). We compared service use by immigrants in each admission class during the first 5 years in Canada with use by age- and sex-matched long-term residents. We measured likelihood of access to each service and intensity of use of each service using conditional logistic regression and negative binomial models.
  
  
  RESULTS
  Economic and family class newcomers were less likely than long-term residents to use primary mental health care. The use of primary mental health care by female refugees did not differ from that of matched long-term residents, but use of such care by male refugees was higher (odds ratio 1.14, 95% confidence interval 1.09-1.19). Immigrants in all admission classes were less likely to use psychiatric services and hospital services for mental health care. Exceptions were men in the economic and family classes, whose intensity of hospital visits was similar to that of matched long-term residents.
  
  
  CONCLUSIONS
  Immigrants in all admission classes generally used less care for nonpsychotic disorders than longterm residents, although male refugees used more primary care. Future research should examine how mental health needs align with service use, particularly for more vulnerable groups such as refugees.
authors.affiliation: Anna Durbin, MPH, is a PhD candidate in the Institute of Health Policy, Management and Evaluation at the University of Toronto, Toronto, Ontario.
authors.forename: Anna
authors.initials: A
authors.lastname: Durbin
authors.affiliation: Elizabeth Lin, PhD, is an Associate Professor in the Department of Psychiatry, University of Toronto, and a Scientist in the Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Ontario.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lin
authors.affiliation: Rahim Moineddin, PhD, is an Associate Professor in the Department of Family and Community Medicine, University of Toronto, and a Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Leah S. Steele, BA, MD, PhD, CCFP, is an Assistant Professor in the Department of Family and Community Medicine, University of Toronto; a Scientist in the Department of Family and Community Medicine and the Keenan Research Institute of the Li Ka Shing Knowledge Institute, St. Michael's Hospital; and an Adjunct Scientist with the Institute for Clinical Evaluative Sciences, Toronto, Ontario.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Steele
authors.affiliation: Richard H. Glazier, MD, MPH, is a Senior Scientist with the Institute for Clinical Evaluative Sciences; a Professor in the Department of Family and Community Medicine at the University of Toronto and St. Michael's Hospital; and a Scientist with the Centre for Research on Inner City Health in the Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, Ontario.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007802:Language; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012036:Refugees / Q000706:statistics & numerical data; D012737:Sex Factors; D012959:Socioeconomic Factors; D013997:Time Factors; D055815:Young Adult