title: Examining the relationship between neighbourhood deprivation and mental health service use of immigrants in Ontario, Canada: a cross-sectional study.
abstract: OBJECTIVE
  While newcomers are often disproportionately concentrated in disadvantaged areas, little attention is given to the effects of immigrants' postimmigration context on their mental health and care use. Intersectionality theory suggests that understanding the full impact of disadvantage requires considering the effects of interacting factors. This study assessed the inter-relationship between recent immigration status, living in deprived areas and service use for non-psychotic mental health disorders.
  
  
  METHODS
  Matched population-based cross-sectional study.
  
  
  METHODS
  Ontario, Canada, where healthcare use data for 1999-2012 were linked to immigration data and area-based material deprivation scores.
  
  
  METHODS
  Immigrants in urban Ontario, and their age-matched and sex-matched long-term residents (a group of Canadian-born or long-term immigrants, n=501,417 pairs).
  
  
  METHODS
  For immigrants and matched long-term residents, contact with primary care, psychiatric care and hospital care (emergency department visits or inpatient admissions) for non-psychotic mental health disorders was followed for 5 years and examined using conditional logistic regression models. Intersectionality was investigated by including a material deprivation quintile by immigrant status (immigrant vs long-term resident) interaction.
  
  
  RESULTS
  Recent immigrants in urban Ontario were more likely than long-term residents to live in most deprived quintiles (immigrants--males: 22.8%, females: 22.3%; long-term residents--both sexes: 13.1%, p<0.001). Living in more deprived circumstances was associated with greater use of mental health services, but increases were smaller for immigrants than for long-term residents. Immigrants used less mental health services than long-term residents.
  
  
  CONCLUSIONS
  This study adds to existing research by suggesting that immigrant status and deprivation have a combined effect on recent immigrants' care use for non-psychotic mental health disorders. In settings where immigrants are over-represented in deprived areas, policymakers focused on increasing immigrants' access of mental health services should broadly address the influence of structural and cultural factors beyond the disadvantage.
authors.affiliation: Research Associate at Canadian Mental Health Association (Toronto branch), Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.
authors.forename: Anna
authors.initials: A
authors.lastname: Durbin
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada Institute of Clinical Evaluative Sciences, Toronto, Canada.
authors.forename: Rahim
authors.initials: R
authors.lastname: Moineddin
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Canada Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Canada.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Lin
authors.affiliation: Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada Institute of Clinical Evaluative Sciences, Toronto, Canada Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Ontario, Canada.
authors.forename: Leah S
authors.initials: LS
authors.lastname: Steele
authors.affiliation: Institute of Clinical Evaluative Sciences, Toronto, Canada Keenan Research Centre of the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Ontario, Canada Department of Family and Community Medicine, University of Toronto, Canada.
authors.forename: Richard H
authors.initials: RH
authors.lastname: Glazier
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D054242:Emigrants and Immigrants; D004641:Emigration and Immigration; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D009864:Ontario; D010342:Patient Acceptance of Health Care; D011203:Poverty; D011320:Primary Health Care; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D035862:Vulnerable Populations; D055815:Young Adult
keywords: MENTAL HEALTH; PRIMARY CARE; PSYCHIATRY