Mental Health Service Use Patterns for Immigrant Groups in Ontario: Population Based Studies

Background: Immigrants have diverse pre-immigration, peri-immigration, and post-immigration experiences. Despite being exposed to distinct mental health stressors, little is known about immigrant groups' service use for non-psychotic mental health disorders in the host country.Objective: Three studies assessed mental health service use by recent newcomers who settled in Ontario, Canada compared to use by age-and-sex matched long term residents (Canadian-born individuals or pre-1985 immigrants). Each study focused on one factor associated with one of the three stages of immigration: pre-immigration (region of origin), peri-immigration (admission class), and post-immigration (area material deprivation).Methods: Population-based administrative data sources were linked to measure primary care visits, psychiatrist visits, and hospital use (i.e., emergency department visits or hospital admissions) for non-psychotic disorders by recent immigrants (i.e., within five years of arrival)in Ontario during 1993-2012. Results: Immigrants' service use patterns for non-psychotic mental health disorders differed from long term residents, with immigrants generally using less mental health care. In the pre-immigration study on world region of origin, immigrants from all regions used less psychiatry and hospital services than long term residents, while immigrants' use of primary care relative to long term residents varied by region of origin.In the peri-immigration study on admission class, male refugees were more likely to use primary care than long term residents. No admission class of immigrants had greater use of psychiatry or hospital care than comparators. In the post-immigration study on material deprivation, immigrants were over-represented in deprived areas. While residence in more deprived areas was associated with greater use of primary and hospital mental health care, immigrants exhibited smaller increases in use than long term residents.Discussion: Given rising immigration levels globally and Ontario, reviews of existing practices and policies are necessary to better understand immigrants' lower use of mental health service use and different patterns of use than long term residents.Ph.D