Mental Health Status, Health Care Utilisation, and Service Satisfaction among Immigrants in Montreal: An Epidemiological Comparison

Examining recovery and mental health service satisfaction among young immigrant Muslim women with mental distress in Quebec

OBJECTIVE

The overall aim of this study was to understand the experiences and perspectives of immigrant Muslim women in Quebec living with mental illness, who have recently used formal mental health services such as an accredited therapist, psychologist, or clinician. Specific objectives included (i) eliciting and examining their self-identified barriers and facilitators to recovery; (ii) exploring links between religion and mental health; and (iii) self-reported satisfaction with mental health services received.

METHODS

We adopted a qualitative approach, facilitating the prioritization of participant perspectives. This involved semi-structured interviews with 20 women who (i) identified as Muslim; (ii) had used mental health services in the last three years; and (iii) were 18 + years of age. Interviews were transcribed and analyzed using thematic analysis techniques.

RESULTS

Three prominent themes emerged from the analysis. These themes were (i) stigma and misunderstandings in families (especially parents) and sometimes in the ethno-religious community, both acting as barriers to health service utilization and recovery; (ii) frustrating clinical experiences within formal mental health care settings, in particular a perceived lack of cultural and religious competence, which negatively affected service utilization and the development of a therapeutic alliance; and (iii) deeply-held religious beliefs, practices and trust in God imparting a rhythm, purpose and meaning, which were strong facilitators to recovery.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

These findings suggest that recovery from mental illness can be advanced by a three-pronged approach in this population. First, anti-stigma mental health literacy interventions could be held in collaboration with Muslim community groups. Second, there is a need for further religious and cultural competence interventions, resources and trainings for mental health professionals working with Muslims. Third, self-care resources should be developed that harness aspects of religious practices that can give structure, meaning, purpose and hope. All this could ultimately foster recovery in this population.

Using a health equity lens to measure patient experiences of care in diverse health care settings

People who are structurally disadvantaged and marginalized often report poor health care experiences, such as inequitable treatment, due to intersecting forms of stigma and discrimination. There are many measures of patient experiences of care, however, few are designed to measure equity-oriented health care. In alignment with ongoing calls to integrate actions in support of health equity, we report on the development and testing of patient-reported experience measures that explicitly use a health equity and intersectional lens. Our analysis focuses on two different scales: the Equity-Oriented Health Care Scale-Ongoing, which was evaluated in primary health care settings where patients have an ongoing relationship with providers over time, and the Equity-Oriented Health Care Scale-Episodic, which was tested in an emergency department where care is provided on an episodic basis. Item Response Theory was used to develop and refine the scales. The psychometric properties of each scale were also evaluated. The Equity-Oriented Health Care Scale-Ongoing was first tested with a cohort of 567 patients. The Equity-Oriented Health Care Scale-Episodic was subsequently tested in an emergency department setting with 284 patients. Results of the Item Response Theory analysis for each scale yielded a brief index that captured the level of equity-oriented care when care is ongoing (12 items) or episodic (9 items). Both scales showed evidence of internal consistency and concurrent validity, based on a high correlation with quality of care. They are brief, easy-to-administer patient-reported experience measures that can support organizations to monitor quality of care. Their availability enhances the possibility of measuring equity-oriented health care in diverse contexts and can provide nuanced understandings of quality of care through an intersectional and equity lens.

Food Related Challenges and Mental Health Among U.S. African Migrants: A Narrative Review

The United States' (US) African immigrant (AI) population is growing, yet they are underrepresented in health and nutrition research. This population experiences difficulties finding culturally appropriate foods and navigating the US food environment (FE), is highly food insecure (FI), and vulnerable to mental disorders. This review examined the current evidence for AIs' food and mental health outcomes and connections; and identified gaps in the literature and future research opportunities. A literature search was conducted using Google Scholar, PubMed, CINAHL, MEDLINE, and SCOPUS. Twenty-one studies were identified, reporting high (37-85%) FI rates, poor diet quality, and increased risk of mental disorders among participants. Challenges in the FE, lack of transportation, limited access to ethnic foods, low SES, and language barriers were associated with FI and poor diet quality. Similarly, discrimination, substance use, and immigration status were associated with depression and anxiety. However, studies examining the connection between AI's food experience and mental health are lacking. AIs are at a higher risk for FI, poor diet quality, and mental disorders. Ethnic-specific research to understand the connection between their food and mental health is needed to reduce nutrition and mental health disparities.

Healthy Immigrant Effect or Under-Detection? Examining Undiagnosed and Unrecognized Late-Life Depression for Racialized Immigrants and Nonimmigrants in Canada

OBJECTIVES

Immigrants to Canada tend to have a lower incidence of diagnosed depression than nonimmigrants. One theory suggests that this "healthy immigrant effect (HIE)" is due to positive selection. Another school of thought argues that the medical underuse of immigrants may be the underlying reason. This unclear "immigrant paradox" is further confounded by the intersecting race-migration nexus.

METHODS

This population-based study analyzed data of participants (n = 28,951, age ≥45) from the Canadian Community Health Survey (2015-2018). Multivariable logistic regression was employed to examine associations between race-migration nexus and mental health outcomes, including depressive symptoms (Patient Health Questionnaire [PHQ-9] score ≥10).

RESULTS

Compared to Canadian-born (CB) Whites, immigrants, regardless of race, were less likely to receive a mood/anxiety disorder diagnosis (M/A-Dx) by health providers in their lifetime. Racialized immigrants were mentally disadvantaged with increased odds of undiagnosed depression (Adjusted odds ratio [AOR] = 1.76, 99% Confidence interval [CI]:1.30-2.37), whereas White immigrants were mentally healthier with decreased odds of PHQ depression (AOR=0.75, 99%CI: 0.58, 0.96) and poor self-rated mental health (AOR=0.56, 99% CI=0.33, 0.95). Among the subpopulation without a previous M/A-Dx (N = 25,203), racialized immigrants had increased odds of PHQ depression (AOR = 1.45, 99% CI: 1.15-1.82) and unrecognized depression (AOR = 1.47, 99% CI: 1.08-2.00) than CB Whites. Other risk factors for undiagnosed depression include the lack of regular care providers, emergency room as the usual source of care, and being home renters.

DISCUSSION

Despite Canadian universal health coverage, the burden of undiagnosed depression disproportionately affects racialized (but not White) immigrants in mid to late life. Contingent on race-migration nexus, the HIE in mental health may be mainly driven by the healthier profile of White immigrants and partly attributable to the under-detection (by health professionals) and under-recognition of mental health conditions among racialized immigrants. A paradigm shift is needed to estimate late-life depression for medically underserved populations.

Determinants of life satisfaction among migrants in South Africa: an analysis of the GCRO's quality of life survey (2009-2021)

BACKGROUND

Migrant populations in any country are a vulnerable group, and psycho-demographic research measuring life satisfaction has been used to assess migrants' well-being in developed and developing countries. However, South Africa, with its high influx of migrant populations, has investigated these topical concerns from the perspective of xenophobia, with mixed findings. However, no, or very few studies have examined life satisfaction among migrants in South Africa. This study, therefore, extends previous literature by examining the determinants of life satisfaction among South Africa's internal and international migrant populations.

METHODS

We conducted a cross-sectional study from the 2009 to 2021 Gauteng City-Region Observatory (GCRO) Quality of Life (QoL) surveys among migrant populations in two ways: a full sample and a gender-stratified sample. A sample of male and female migrants ranging from 15 to 49 years of age were recruited into this study. Cantril's Self-Anchoring Ladder Life Satisfaction scale captured their life satisfaction alongside relevant social demographic factors. Descriptive statistics were applied for the data analysis of the demographic factors. Bivariate and multivariate logistics regression analyses were conducted to assess the associations and the predictive factors of life satisfaction among migrants, both internal and international.

RESULTS

The key findings were the gender distribution of life satisfaction, showing that more international (male - 66.0% and female - 67.1%) migrants reported having a thriving life satisfaction than internal migrants (male - 61.7% and female - 61.5%). Findings from the Pearson correlation coefficient revealed a significant association between the individual, household, and community factors by migrant status (ρ < 0.05). However, the probit coefficients revealed that individual factors (age 48+: AOR = 2.18, 95% CI: 1.13, 3.23, and secondary/higher education: AOR = 1.1., 95% CI: 0.01, 1.19) and household factors (two persons living in households (H/H): AOR = 1.05, 95% CI: 0.50, 1.10), and community factors (international migrant status: AOR = 2.12, 95% CI: 0.08, 2.16) significantly increase the prediction of higher odds of life satisfaction by gender among migrants. The ordered logit coefficients also showed that individual factors (middle and high income and having health insurance) and household factors (receiving SASSA social grant) predicted the highest life satisfaction among migrants (internal and international).

CONCLUSION

We found substantial evidence that individual-, household-, and community-level factors were associated with life satisfaction among migrants. In particular, the pattern of life satisfaction varied slightly between male and female migrants, as well as with migrant status in South Africa. These findings collectively may provide helpful information for policymakers and practitioners to optimise interventions for migrant populations to improve their life satisfaction. Evidence from this study also calls on the government of South Africa to begin tracking the life satisfaction of its nationals, whether migrants or not.

Why are African immigrants in Montreal reluctant to use mental health services?: a systematic inventory of reasons

PURPOSE

Previous research has shown that non-Caucasian immigrants in Western countries are less likely than native-born people to use mental health services. This study examined the reasons underlying reluctance to use mental health services among African immigrants in Montreal, Canada.

METHODS

The study participants were 280 African immigrants who had experienced symptoms suggesting depression but did not use formal mental health services. They were presented with a questionnaire that contained 65 statements referring to reasons for not using formal mental health services while experiencing those symptoms and were asked to indicate their degree of agreement with each of the statements on a scale of 0-10. Responses were then analyzed using factor analysis.

RESULTS

An eight-factor structure of reasons was found: "Minimizing symptoms and perceived self-efficacy" (61% of the sample), "Relying on spiritual care" (56% of the sample), "Cost and waiting time" (45% of the sample), "Influence of significant others" (34% of the sample), "Lack of cultural competence" (32% of the sample), "Fear of stigmatization" (23% of the sample), "Nature of the consultation" (10% of the sample) and "Social models" (8% of the sample). Scores on these factors were related to participants' demographics.

CONCLUSION

Effectively addressing the underutilization of mental health services among African immigrants requires a multifaceted approach rather than one focused on a single barrier. Our findings suggest critical points that could help develop tailored interventions to address the various barriers to care.

Patient-Oriented Research to Improve Internet-Delivered Cognitive Behavioural Therapy for People of Diverse Ethnocultural Groups in Routine Practice

There has been limited research on improving Internet-delivered Cognitive Behavioural Therapy (ICBT) in routine online therapy clinics that serve people from diverse ethnocultural groups (PDEGs). This article describes a patient-oriented adaptation approach used to address this gap in research. A working group consisting of people with lived experience, community representatives, ICBT clinicians, managers, and researchers was formed. The working group examined archival feedback on ICBT from past patients who self-identified as being from diverse ethnocultural backgrounds (N = 278) and the results of interviews with current patients (N = 16), community representatives (N = 6), and clinicians (N = 3). The archival data and interviews revealed the majority of the patients reported being satisfied with and benefitting from ICBT. Suggestions for improvement were not related to the cognitive-behavioural model and techniques, but rather to making treatment materials more inclusive. Consequently, the ICBT adaptation focused on adding content related to cultural influences on mental health, addressing stigma, diversifying case stories, examples, and imagery, adding audiovisual introductions, and replacing English idioms with more descriptive language. Moreover, further training was offered to clinicians, and efforts were made to improve community outreach. This study demonstrates a process for using patient-oriented research to improve ICBT within routine care serving patients of diverse backgrounds.

Global prevalence of anxiety and PTSD in immigrants: a systematic review and meta-analysis

BACKGROUND

A systematic and meta-analysis of the prevalence of anxiety and posttraumatic stress disorder (PTSD) in immigrants was conducted.

METHODS

Based on the keywords, scientific databases were systematically searched to identify articles. The search included the three databases PubMed, Google Scholar and Research Gate until June 2020. The analysis was performed to assess the prevalence of anxiety and PTSD; subgroups were examined based on anxiety disorders.

RESULTS

The prevalence of agoraphobia, PTSD, generalized anxiety disorder (GAD), panic disorder, obsessive-compulsive disorder (OCD), social phobia and specific phobia were 4, 25, 9, 4, 3, 5 and 8%, respectively.

CONCLUSIONS

Considering the findings of the present study regarding the significant prevalence of anxiety and PTSD in the immigrant population, it is necessary to pay special attention to the mental health of this population.

The role of migration in mental healthcare: treatment satisfaction and utilization

Migration rates increase globally and require an adaption of national mental health services to the needs of persons with migration background. Therefore, we aimed to identify differences between persons with and without migratory background regarding (1) treatment satisfaction, (2) needed and received mental healthcare and (3) utilization of mental healthcare.In the context of a cross-sectional multicenter study, inpatients and day hospital patients of psychiatric settings in Southern Germany with severe affective and non-affective psychoses were included. Patients' satisfaction with and their use of mental healthcare services were assessed by VSSS-54 and CSSRI-EU; patients' needs were measured via CAN-EU.In total, 387 participants (migratory background: n = 72; 19%) provided sufficient responses for analyses. Migrant patients were more satisfied with the overall treatment in the past year compared to non-migrant patients. No differences between both groups were identified in met and unmet treatment needs and use of supply services (psychiatric, psychotherapeutic, and psychosocial treatment).Despite a comparable degree of met and unmet treatment needs and mental health service use among migrants and non-migrants, patients with migration background showed higher overall treatment satisfaction compared to non-migrants. The role of sociocultural and migrant-related factors may explain our findings.

Willingness to Use Mental Health Services for Depression Among African Immigrants and White Canadian-Born People in the Province of Quebec, Canada

Studies suggest that non-Caucasian immigrants to Canada are less likely than Canadian-born people to use mental health services. To meet the mental health needs of ethnocultural minorities, insights into their help-seeking attitudes are of great concern. This study examined the willingness of African immigrants and White Canadian-born to seek care for depression from conventional mental health services.  African immigrants (N = 262) and White Canadian-born people (N = 250) living in Montreal, Canada, indicated their willingness to use mental health services under different conditions varying as a function of four factors: the severity of symptoms, the waiting time for first consultation, the type of care offered in the mental health service, and whether informal sources of help were available.  Seven qualitatively different positions were identified: Never Consult (18% of the African immigrants and 1% of the White Canadian-born people); Hesitant (18% of the African immigrants and 7% of the White Canadian-born people); Depends on Waiting Time (16% of the African immigrants); Depends on Waiting Time and Symptoms (22% of the African immigrants); Depends on Symptoms (36% of the White Canadian-born people and 6% of the African immigrants); Willing to consult (33% of the White Canadian-born people and 2% of the African immigrants); Certain to Consult (9% of the White Canadian-born people and 4% of the African immigrants), while 14% of participants in each group did not express any position. African immigrants were more likely to underuse mental health services, compared with White Canadian-born people. The above diversity of positions strongly suggests that the design and implementation of interventions to reduce disparities in African immigrants' use of mental health care must not be "one size fits all" but must be tailored to address these immigrants' differing attitudes and needs.

Unmet Need for Mental Healthcare in a Population Sample in Sweden: A Cross-Sectional Study of Inequalities Based on Gender, Education, and Country of Birth

This cross-sectional study investigated if gender, education, and country of birth were associated with perceived need and unmet need for mental healthcare (i.e., refraining from seeking care, or perceiving care as insufficient when seeking it). Questionnaire and register data from 2008 were collected for 3987 individuals, aged 19-64 years, in a random population-based sample from western Sweden. Descriptive statistics and logistic regression analyses were used. Men were less likely to perceive a need for care than were women, even after adjusting for mental well-being. Men were also less likely to seek care and perceiving care as sufficient. People with secondary education were less likely to seek care than those with university education. There were no statistically significant differences based on country of birth. The observed gender and education-based inequalities increases our understanding of where interventions can be implemented. These inequalities in unmet need for mental healthcare should be targeted by the healthcare system.

[Ethnicity and immigration status: How are they associated with work and depressive symptoms?]

BACKGROUND

The purpose of this research is to determine whether, in the Canadian workforce, cultural identity traits, particularly ethnicity and immigrant status, might modify the association of work with depressive symptoms.

METHOD

Data were derived from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 6477 workers, multilevel regression models were brought into being. Analyses were adjusted for family-related factors, non-work social support, and personal characteristics.

RESULTS

After accounting for potential confounders, ethnicity and work-related factors were distinctly and directly associated with depressive symptoms. Workers belonging to visible minorities had significantly fewer depressive symptoms than their Caucasian counterparts. Unlike Caucasians, they were more often overqualified, less in a position to use their skills, and largely without decision-making authority. On the other hand, all analyses having to do with immigrant status led to inconclusive results.

CONCLUSION

Ethnicity seems to have some bearing on the association of work with depressive symptoms among members of the Canadian workforce. It might be beneficial to carry out targeted interventions aimed at improving working conditions according to ethnicity and situations involving professional overqualification.

Use of Health Services and Unmet Need among Adults of Russian, Somali, and Kurdish Origin in Finland

Equal access to health care is one of the key policy priorities in many European societies. Previous findings suggest that there may be wide differences in the use of health services between people of migrant origin and the general population. We analyzed cross-sectional data from a random sample of persons of Russian (n = 692), Somali (n = 489), and Kurdish (n = 614) origin and the Health 2011 survey data (n = 1406) representing the general population in Finland. Having at least one outpatient visit to any medical doctor during the previous 12 months was at the same level for groups of Russian and Kurdish origin, but lower for people of Somali origin, compared with the general population. Clear differences were found when examining where health care services were sought: people of migrant origin predominantly visited a doctor at municipal health centers whereas the general population also used private and occupational health care. Self-reported need for doctor's treatment was especially high among Russian women and Kurdish men and women. Compared to the general population, all migrant origin groups reported much higher levels of unmet medical need and were less satisfied with the treatment they had received. Improving basic-level health services would serve besides the population at large, the wellbeing of the population of migrant origin.

Mental disorders among young adults of immigrant background: a nationwide register study in Norway

PURPOSE

Previous research indicates increased risk of various mental disorders in immigrant populations, particularly for schizophrenia and PTSD. However, findings are inconclusive due to variations in contextual factors, characteristics of immigrant groups and study design. Our study aims to investigate prevalence differences of receiving an ICD-10 psychiatric diagnosis between 2008 and 2016 among four first-generation immigrant groups and one second-generation immigrant group compared to ethnic Norwegians.

METHODS

Linked register data from the Norwegian Patient Registry and Statistics Norway were utilised. The sample (age 18-35) comprises 758,774 ethnic Norwegians, 61,124 immigrants originating from Poland, Somalia, Iran and Pakistan and 4630 s-generation Pakistani immigrants. Age- and gender-adjusted binary logistic regression models were applied.

RESULTS

The odds of schizophrenia were significantly elevated for all groups except for Poles. The highest odds were observed for second-generation Pakistani immigrants (adjusted OR 2.72, 95% CI 2.21-3.35). For PTSD, the odds were significantly increased for Somalis (aOR 1.31, 95% CI 1.11-1.54), second-generation Pakistani immigrants (aOR 1.37, 95% CI 1.11-1.70), and in particular for Iranians (aOR 3.99, 95% CI 3.51-4.54). While Iranians showed similar or higher odds of receiving the vast majority of psychiatric diagnoses, the remaining groups showed lower or similar odds compared to ethnic Norwegians.

CONCLUSION

Our findings suggest considerable prevalence differences in receiving a psychiatric diagnosis according to country of origin and generational status compared to ethnic Norwegian controls. The general pattern was lower prevalence of most ICD-10 mental disorders for the majority of immigrant groups compared to ethnic Norwegians, except for schizophrenia and PTSD.

Differences in psychiatric care utilisation among unaccompanied refugee minors, accompanied migrant minors, and Swedish-born minors

PURPOSE

To better understand underutilisation of psychiatric care among migrant children, we compared utilisation of psychiatric care among unaccompanied refugee minors and accompanied migrant minors, with Swedish-born minors.

METHODS

Using a large longitudinal database of linked national registers, we established a retrospective cohort of 1,328,397 people born 1984-1988 comparing minors born in Sweden to 2 Swedish-born parents (95.4%) to minors who had been arriving in Sweden between 2002 and 2011 with a permanent resident permit and were either unaccompanied refugee minors (0.4%), or accompanied migrant minors (4.0%). The outcome measures were different measures of psychiatric care including in- and outpatient care, and prescribed psychotropic medication.

RESULT

Compared with the Swedish-born minors the unaccompanied refugee minors had a higher likelihood of utilisation of all psychiatric care except ADHD medication. However, compared with accompanied migrant minors, the Swedish-born minors had a higher likelihood of having utilised psychiatric care.

CONCLUSION

Our study shows that during the first years of living in Sweden, there seems to be fewer barriers to psychiatric care for unaccompanied refugee minors compared to the accompanied migrant minors. There are a number of possible reasons for this including stronger ties with the Swedish society.

Gaps in Understanding of the Epidemiology of Mood and Anxiety Disorders among Migrant Groups in Canada: A Systematic Review

OBJECTIVE

Estimates of mood and anxiety disorders are highly variable among migrant groups, as they are influenced by the socio-political context. Our objective was to conduct a systematic review and meta-analysis to synthesize available Canadian evidence on the prevalence and incidence of mood and anxiety disorders among migrant groups.

METHODS

Studies were identified from MEDLINE, EMBASE, and PsycINFO. They were included if they used population-based samples, presented data on the incidence or prevalence of diagnosed or self-reported mood or anxiety disorders for first-generation migrant groups in Canada, and used a Canadian-born or long-term resident reference group.

RESULTS

Nineteen studies met our inclusion criteria. Prevalence ratios ranged from 0.48 to 0.87, and nearly all estimates were obtained from population health surveys. Prevalence estimates among migrant groups were lower than the reference group, with the 90th percentile of estimates ranging from 1.5% to 8.2%. Risk factors for mood and anxiety disorders among migrants included being female, younger, unemployed, having lower income, and living in neighborhoods with a lower proportion of migrants.

CONCLUSIONS

There remain many gaps in our current understanding of mood and anxiety disorders among migrant groups in Canada. Although evidence suggests the prevalence of mood and anxiety disorders are consistently lower among migrant groups, a lack of incidence estimates limits the strength of this conclusion. Future research should focus on comparisons of self-reported and diagnosed estimates, the use of a range of different primary or secondary data sources, and consideration of important risk factors.

PROSPERO CITATION

Jordan Edwards, Malini Hu, Amardeep Thind, Saverio Stranges, Maria Chiu, Kelly Anderson. The burden of mood and anxiety disorders among immigrant and refugee populations in Canada: a systematic review. PROSPERO 2018 CRD42018087869 Available from: http://www.crd.york.ac.uk/PROSPERO/display_record.php?ID=CRD42018087869 .

Predictors of Number of Healthcare Professionals Consulted by Individuals with Mental Disorders or High Psychological Distress

This study assesses the contribution of predisposing, enabling, and needs factors and related variables that predicted the number of healthcare professionals consulted for mental health reasons among 746 individuals with mental disorders and high psychological distress. The data were drawn from the third (T3) and fourth data collection periods (T4) of a longitudinal study conducted in a Quebec/Canada epidemiological catchment area. Hierarchical linear regression was performed on the number of types of healthcare professionals consulted in the 12 months prior to T4. Predictors were identified at T3, classified as predisposing, enabling, and needs factors (i.e., clinical and related variables) according to the Andersen Behavioral Model. Three needs factors were associated with the number of types of healthcare professionals consulted: Post-traumatic stress disorder, stressful events, and marginally suicide ideation. Three enabling factors: Having a family physician, previous use of mental health services, and employment status were also related to the dependent variable. Poor self-perception of mental health status was the only predisposing factor retained. While needs factors were the main predictors of the number of types of healthcare professionals consulted, enabling factors may reduce the influence of needs factors, by the deployment of various strategies that facilitate continuous and appropriate care.

Les traits d'identité culturelle en lien avec le statut d'immigrant et l'ethnicité : quel lien avec les symptômes de détresse psychologique et les symptômes dépressifs dans la main-d'œuvre canadienne? Résultats des neuf cycles de l'ENSP

PURPOSE

This study investigated variations over time of psychological distress and depressive symptoms among working Canadians according to two cultural identity traits: ethnicity and immigration status.

METHOD

Data came from the nine cycles of the National Population Health Survey (NPHS) conducted by Statistics Canada. Based on a sample of 7069 workers, multiple regressions analyses and multilevel regressions models were carried out. Analyses were adjusted for confounders such as age, gender, marital status, household income, social support outside the workplace, level of education, presence of children between 0 and 5 years of age and presence of children from 6 to 11 years of age.

RESULTS

Over time, and after accounting for potential confounders, immigration status is not associated with psychological distress or depressive symptoms. Ethnicity is associated with depressive symptoms, but not with psychological distress symptoms. Visible minorities have less depressive symptoms compared to Caucasians.

CONCLUSION

Unlike immigration status, ethnicity seems to explain a portion of mental health inequities among workers. One area to be explored in future researches is whether in the Canadian workforce, work conditions could explain ethnic inequalities in mental health.

What Predicts Stable Mental Health in the 18⁻29 Age Group Compared to Older Age Groups? Results from the Stockholm Public Health Cohort 2002⁻2014

Mental health has decreased in young people since the 1990s, and mental health promotion is an urgent matter. A first step is to identify which social determinants could be of importance for intervention. We used the Stockholm Public Health Cohort, a longitudinal population-based health survey, completed by 31,000 inhabitants in the Stockholm County. We focused on the 18⁻29 age group, n = 3373 (60% females, 40% males) and aimed at assessing which social determinants predict stable mental health, measured as scoring <3 points on the General Health Questionnaire 12 at all time points: 2002, 2007, 2010, and 2014. Forty-six percent of males and 36% of females reported stable mental health. Among the 17 predictors on sociodemographics, socioeconomics, social capital, health behavior, and victimization, six predicted stable mental health in the following order: occupation and especially employment, emotional support, male gender, being born in Sweden, absence of financial strain, and consumption of fruit and berries. In the 30⁻84 age group, 66% males and 55% females reported stable mental health. Nine determinants in the following rank predicted stable mental health: absence of financial strain, occupation and especially being self-employed, emotional support, male gender, physical activity, instrumental support, interpersonal trust, community trust, and absence of hazardous alcohol consumption. Interaction analysis showed significant difference between the younger and older group regarding physical activity and absence of financial strain with importance being higher for the older group. Our findings indicate that the determinants of health differ across the life-course with fewer predictors related to social capital and health behavior in the younger group compared to the older. We conclude that health-promoting interventions should be lifespan-sensitive.

Predictors of mental health service use among individuals with high psychological distress and mental disorders

This study identified predictors of mental health service use over 12 months among 746 individuals with mental disorders and high psychological distress from a catchment area in southwest Montreal, Quebec (Canada). Data collected in 2011 and 2014 were analyzed using Andersen's Behavioral Model of Health Services Use. A hierarchical logistic regression identified predictors of mental health service use. In all, 29% of participants reported using mental health services in the previous 12 months. Three key enabling variables predicted mental health service use: having a family doctor, previous experience with mental health services, and employment. Self-perception of mental health, stressful events, and unmet needs marginally (Needs factors: non-clinical variables) were also associated with the outcome variable. Mental health service utilization depends primarily on organization of the health system, and patient perceptions of its condition (non-clinical needs). Mental health policy should focus on increasing the availability of services and professionals, especially family doctors. Other measures for encouraging service use and overall population wellbeing include raising public awareness around the signs and symptoms of mental illness as a way to promote more rapid response to patient needs, and protecting workplace mental health by reducing stress and stigma toward individuals affected by mental distress.

Patient satisfaction with mental health services based on Andersen's Behavioral Model

OBJECTIVE

The purpose of this article was to assess the satisfaction of adult patients who received mental health services (MHS) in healthcare networks staffed by multidisciplinary professionals and offering a range of MHS, and to identify variables associated with patient satisfaction.

METHODS

This cross-sectional study included 325 patients with mental disorders (MDs) among 4 Quebec health service networks. Data were collected using 9 standardized instruments and participant medical records. A 3-factor conceptual framework (predisposing, enabling, and needs-related factors) based on Andersen's Behavioral Model was used, integrating sociodemographic, clinical, needs-related, service utilization, social support, and quality-of-life (QOL) variables. An adjusted multiple linear regression model was performed.

RESULTS

The global mean score for patient satisfaction was 4.11 (minimum: 2.0; maximum: 5.0). Among the enabling factors, continuity of care, having a case manager, and help received from services were positively associated with patient satisfaction, whereas being hospitalized was negatively associated. Among the needs-related factors, the number of needs was negatively associated with satisfaction.

CONCLUSIONS

Findings demonstrated higher levels of satisfaction among patients who received good continuity of care and well-managed, frequent services in relation to their needs. Dissatisfaction was higher for patients with serious unmet needs or those hospitalized, which underlines the importance of taking these particular variables into account in the interest of improving MHS delivery and patient recovery.