Mental health service use by recent immigrants from different world regions and by non-immigrants in Ontario, Canada: a cross-sectional study.
BACKGROUND
Given that immigration has been linked to a variety of mental health stressors, understanding use of mental health services by immigrant groups is particularly important. However, very little research on immigrants' use of mental health service in the host country considers source country. Newcomers from different source countries may have distinct experiences that influence service need and use after arrival. This population study examined rates of use of primary care and of specialty services for non-psychotic mental health disorders by immigrants to Ontario Canada during their first five years after arrival. Service use by recent immigrants in broad source region groups representing all world regions was compared to use by age-matched Canadian-born or long term immigrants (called long term residents).


METHODS
This matched population-based cross-sectional study assessed likelihood of any use and counts of visits for each of primary care, psychiatric care and hospital care (emergency department visits or inpatient admissions) for non-psychotic mental health disorders from 1993-2012. Adult immigrants living in urban Ontario (n = 912,114) were categorized based on their nine world regions of origin. Sex-stratified conditional logistic regression models and negative binomial models were used to compare service use by immigrant region groups to their age-matched long term residents.


RESULTS
Immigrant were more or less likely to access primary mental health care compared to age-matched long term residents, depending on their world region of origin. Regarding specialty mental health care (psychiatry and hospital care), immigrants from all regions used less than long term residents. Across the three mental health services, estimates of use by immigrant region groups compared to long term residents were among the lowest for newcomers from East Asian and Pacific (range: 0.16-0.82) and among the highest for persons from Middle East and North Africa (range: 0.56-1.23).


CONCLUSIONS
This population-based study showed lower use of mental health services by recent immigrants than long-term immigrants or native born individuals, with variation in immigrants' use linked to world region of origin and type of mental health care. Variation across source region groups underscores the importance of identifying underlying individual characteristics that affect service use to make services more responsive to newcomers.
Canadian Mental Health Association (Toronto branch), Toronto, Canada. anna.durbin@gmail.com.|Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. anna.durbin@gmail.com.
Anna
A
Durbin
Department of Family and Community Medicine, University of Toronto, Toronto, Canada. rahim.moineddin@utoronto.ca.|Institute for Clinical Evaluative Sciences, Toronto, Canada. rahim.moineddin@utoronto.ca.
Rahim
R
Moineddin
Department of Psychiatry, University of Toronto, Toronto, Canada. elizabethbetty.lin@camh.ca.|Provincial System Support Program, Centre for Addiction and Mental Health, Toronto, Canada. elizabethbetty.lin@camh.ca.
Elizabeth
E
Lin
Department of Family and Community Medicine, University of Toronto, Toronto, Canada. lssteele@gmail.com.|Institute for Clinical Evaluative Sciences, Toronto, Canada. lssteele@gmail.com.|Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada. lssteele@gmail.com.
Leah S
LS
Steele
Institute for Clinical Evaluative Sciences, Toronto, Canada. rick.glazier@ices.on.ca.|Keenan Research Centre in the Li Ka Shing Knowledge Institute at St. Michael's Hospital, Toronto, Canada. rick.glazier@ices.on.ca.
Richard H
RH
Glazier
D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital; D054242:Emigrants and Immigrants; D005260:Female; D006301:Health Services Needs and Demand; 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 / Q000453:epidemiology; D011320:Primary Health Care / Q000706:statistics & numerical data; D055815:Young Adult