Primary Care and Access to Mental Health Consultations among Immigrants and Nonimmigrants with Mood or Anxiety Disorders: Soins de première ligne et accès aux consultations en santé mentale chez les immigrants et les non-immigrants souffrant de troubles de l’humeur ou anxieux

Abstract

Objective: To examine the association between usual place of primary care and mental health consultation among those with self-reported mood or anxiety disorders. We also describe access to mental health services among people who are recent immigrants, longer-term immigrants, and nonimmigrants and determine whether the association with place of primary care differs by immigration group. Methods: We used data from the Canadian Community Health Survey (2015 to 2016) to identify a representative sample of individuals with self-reported mood or anxiety disorders. We used logistic regression, with models stratified by immigration group (recent, longer-term, nonimmigrant), to examine the association between usual place of primary care and receiving a mental health consultation in the previous 12 months. Results: Higher percentages of recent and longer-term immigrants see a doctor in solo practice, and a higher percentage of recent immigrants use walk-in clinics as a usual place of care. Compared with people whose usual place of care was a community health center or interdisciplinary team, adjusted odds of a mental health consultation were significantly lower for people whose usual place of care was a solo practice doctor’s office (AOR = 0.71; 95% CI, 0.62 to 0.82), a walk-in clinic (AOR = 0.75; 95% CI, 0.66 to 0.85), outpatient clinic/other place (AOR = 0.72 95% CI, 0.59 to 0.88), and lowest among people reporting no usual place other than the emergency room (AOR = 0.59; 95% CI, 0.51 to 0.67). Differences in access to mental health consultations by usual place of primary care were greatest among immigrants, especially recent immigrants. Conclusions: People with mood or anxiety disorders who have access to team-based primary care are more likely to report mental health consultations, and this is especially true for immigrants. Expanded access to team-based primary health care may help reduce barriers to mental health services, especially among immigrants.

Inequities in Mental Health Care Facing Racialized Immigrant Older Adults With Mental Disorders Despite Universal Coverage: A Population-Based Study in Canada

“…A detailed explanation of the complete CCHS survey methodology and protocol can be found elsewhere ( Statistics Canada, 2018 ). Consistent with prior research ( Rivera et al, 2021 ), the present study only included respondents who reported having been diagnosed with a mood and/or anxiety disorder ( n = 31,485). Because many racialized immigrants coming from low-income and middle-income countries have diverse ethnocultural perceptions of old age ( Lin, 2021 ), the sample in this analysis was further restricted to participants aged 45 and older ( n = 17,644).…”

“…(e.g., face-to-face or telephone contact).” Previous studies have found that highly distressed individuals may overreport the number of visits compared to administrative records ( Rhodes & Fung, 2004 ). Hence, to lower the risk of recall bias, an aggregated coding (e.g., ever/never) was used for past-year MHC ( Rivera et al, 2021 ). Frequency of visits (mean) was only presented for descriptive purpose.…”

“…Based on the 2016 census, the Philippines, India, China, and Nigeria were top four sources of recent immigrants to Canada, and assuming that such migration trends continue, it is estimated that more than half (57.9%) of all immigrants would be born in Asia by 2036 while a quarter (26.9%) of the total Canadian population (47.7 million) would be immigrants from Asia or Africa in 2041, up from 13.5% in 2016 ( Statistics Canada, 2017 ; 2022 ). Although scientists have been examining the prevalence, disparities, and population patterns of mental health service utilization at the provincial and national levels in Canada ( Chiu et al, 2018 ; Islam et al, 2018 ; Nwoke et al, 2020 ; Rivera et al, 2021 ; Urbanoski et al, 2017 ), contemporary immigration scholarship has typically examined race/ethnicity and migration/nativity status separately and, thus, homogenized distinct experiences of racialized immigrants and White immigrants as a monolithic category to compare with the native-born population in understanding health care inequity.…”

Growing inequities by immigration group among older adults: Population-based analysis of access to primary care and return to in-person visits during the COVID-19 pandemic in British Columbia, Canada

“…We chose to focus on having any visit within the year rather than visit volume as a marker of any contact with primary care. This is particularly important in the context of the pandemic, given the potential for people to have lost contact with healthcare, and who may lack a regular place of care or first point of access (34,35).…”