Ethnic Differences in Mental Health Status and Service Utilization: A Population-Based Study in Ontario, Canada

Abstract

Background: The purpose of this study was to compare the prevalence of self-reported mental health factors, mental health service use, and unmet needs across the 4 largest ethnic groups in Ontario, Canada: white, South Asian, Chinese, and black groups.

Methods: The study population was derived from the Canadian Community Health Survey, using a cross-sectional sample of 254,951 white, South Asian, Chinese, and black residents living in Ontario, Canada, between 2001 and 2014. Age- and sex-standardized prevalence estimates for mental health factors, mental health service use, and unmet needs were calculated for each of the 4 ethnic groups overall and by sociodemographic characteristics.

Results: We found that self-reported physician-diagnosed mood and anxiety disorders and mental health service use were generally lower among South Asian, Chinese, and black respondents compared to white respondents. Chinese individuals reported the weakest sense of belonging to their local community and the poorest self-rated mental health and were nearly as likely to report suicidal thoughts in the past year as white respondents. Among those self-reporting fair or poor mental health, less than half sought help from a mental health professional, ranging from only 19.8% in the Chinese group to 50.8% in the white group.

Conclusions: The prevalence of mental health factors and mental health service use varied widely across ethnic groups. Efforts are needed to better understand and address cultural and system-level barriers surrounding high unmet needs and to identify ethnically tailored and culturally appropriate clinical supports and practices to ensure equitable and timely mental health care.

Keywords: ethnic groups; mental health; mental health services.

Figure 1.

Forest plot of crude and multivariate-adjusted odds ratios (ORs) of the association between ethnicity and mental health factors and service utilization, Ontario, Canada, 2001 to 2014. Data were derived from the Ontario components of Statistics Canada’s Canadian Community Health Surveys (CCHS). Bootstrap methods were used to derive 95% confidence intervals. Multivariate ORs were adjusted for age, sex, income, education, immigrant status, and CCHS cycle/survey year. Odds ratios (OR) for South Asian, Chinese, and Black individuals are in comparison to a White reference population. ORs were considered to be statistically significant when confidence intervals did not overlap with 1.0.