Dataset Information

Trends in mental health service utilisation in immigrant youth in Ontario, Canada, 1996-2012: a population-based longitudinal cohort study.

ABSTRACT:

Objective

To describe trends in mental health service use of youth by immigration status and characteristics.

Design

Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets.

Setting

Ontario, Canada.

Participants

Youth 10-24 years, living in Ontario, Canada.

Exposure

The main exposure was immigration status (recent immigrants vs long-term residents). Secondary exposures were region of origin and refugee status.

Main outcome measure

Mental health hospitalisations, emergency department (ED) visits and outpatient visits within consecutive 3-year time periods. Poisson regression models estimated rate ratios (RR).

Results

Over 2.5 million person years per period were included. Rates of recent immigrant mental health service utilisation were at least 40% lower than long-term residents (p<0.0001).Mental health hospitalisation and ED visit rates increased in long-term residents (hospitalisations, RR 1.09 (95% CI 1.08 to 1.09); ED visits, RR 1.15 (1.14 to 1.15)) and recent immigrants (hospitalisations RR 1.05 (1.03 to 1.07); ED visits, RR 1.08 (1.05 to 1.11)). Mental health outpatient visit rates increased in long-term residents (RR 1.03 (1.03 to 1.03)) but declined in recent immigrant (RR 0.94 (0.93 to 0.95)). Comparable divergent trends in acute care and outpatient service use were observed among refugees and across most regions of origin. Recent immigrant acute care use was driven by longer-term refugees (hospitalisations RR 1.12 (1.03 to 1.21); ED visits RR 1.11 (1.02 to 1.20)).

Conclusions

Mental health service utilisation was lower among recent immigrants than long-term residents. While acute care use is increasing at a faster rate among long-term residents than recent immigrants, the decrease in outpatient mental health visits in immigrants highlights a potential emerging disparity in access to preventative care.

SUBMITTER: Saunders NR

PROVIDER: S-EPMC6144399 | biostudies-literature | 2018 Sep

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Trends in mental health service utilisation in immigrant youth in Ontario, Canada, 1996-2012: a population-based longitudinal cohort study.

Saunders Natasha Ruth NR Lebenbaum Michael M Lu Hong H Stukel Therese A TA Urquia Marcelo Luis ML Guttmann Astrid A

BMJ open 20180917 9

<h4>Objective</h4>To describe trends in mental health service use of youth by immigration status and characteristics.<h4>Design</h4>Population-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets.<h4>Setting</h4>Ontario, Canada.<h4>Participants</h4>Youth 10-24 years, living in Ontario, Canada.<h4>Exposure</h4>The main exposure was immigration status (recent immigrants vs long-term residents). Secondary exposures were region of origin and refugee statu ...[more]

PMID: 30224392

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Project description:ObjectiveTo describe the trends in suicide and emergency department (ED) visits for self-harm in youth by immigration status and immigrant characteristics.DesignPopulation-based longitudinal cohort study from 1996 to 2012 using linked health and administrative datasets.SettingOntario, Canada.ParticipantsYouth 10 to 24 years, living in Ontario, Canada.ExposureThe main exposure was immigrant status (recent immigrant (RI) versus long-term residents (LTR)). Secondary exposures included region of birth, duration or residence, and refugee status.Main outcome measureTrends over time in suicide and ED self-harm were modelled within consecutive 3-year time periods. Rate ratios were estimated using Poisson regression models.Results2.5 to 2.9 million individuals were included per cohort period. LTR suicide rates ranged from 7.4 to 9.4/100 000 male person-years versus 2.2-3.4/100 000 females. RI's suicide rates were 2.7-7.2/100,000 male versus 1.9-2.7/100 000 female person-years. Suicide rates were lower among RI compared with LTR (adjusted relative rate (aRR)=0.70, 95% CI=0.57 to 0.85) with different mechanisms of suicide. No significant time trend in suicide rates was observed (p=0.40). ED self-harm rates for LTR and RI were highest in females (2.6-3.4/1000 LTR females versus 1.1-1.5/1000 males, 1.2-1.8/1000 RI females versus 0.4-0.6/1000 males). RI had lower rates of self-harm compared with LTR (aRR=0.60, 95% CI=0.56 to 0.65). Stratum-specific rates showed a steeper decline per period in RI compared with LTR (RI: aRR=0.85, 95% CI=0.81 to 0.89; LTR: aRR=0.91, 95% CI=0.90 to 0.93). Observed trends were not universal across region of origin and by refugee status.InterpretationSuicide rates have been stable and ED self-harm rates are declining over time among RI youth. These trends by important subgroups should continue to be monitored to allow for early identification of subpopulations of immigrant youth in need of targeted and culturally appropriate public health interventions.

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Dataset Information

Trends in mental health service utilisation in immigrant youth in Ontario, Canada, 1996-2012: a population-based longitudinal cohort study.

Objective

Design

Setting

Participants

Exposure

Main outcome measure

Results

Conclusions

Publications

Trends in mental health service utilisation in immigrant youth in Ontario, Canada, 1996-2012: a population-based longitudinal cohort study.

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