Research Snapshot: Ethnic differences in mental health status and service utilization

What you need to know

Approximately 18% to 36% of the population worldwide experiences mental illness. Research from the United States has shown disparities between white individuals and ethnic minority individuals in their access to appropriate mental health and addictions services. Although existing literature has indicated that unmet mental health care needs are an ongoing problem in Ontario, Canada, there remains limited evidence of how unmet care needs vary across ethnic minority groups in the province. In multicultural jurisdictions like Ontario, understanding ethnic differences in mental health status, experiences and service use provides an opportunity to improve mental health services across the province.

What is this research about?

The researchers highlight how mental health status and experiences vary across ethnic groups living in Ontario, Canada. They identified three key components to understanding the relationship between mental health and care needs for ethnic groups. These components were (a) self-reported mental health status, (b) self-reported mental health service use and (c) unmet needs for care (i.e., lack of mental health service encounters among those with mental health care needs).

What did the researchers do?

The researchers used a population-based sample of white, South Asian (i.e., those of Indian, Pakistani, Bangladeshi or Sri Lankan descent), Chinese and Black Canadians aged 12 or older. This study population was taken from a pooled sample of participants of Statistics Canada’s cross-sectional Canadian Community Health Survey (CCHS). The CCHS was translated into over 25 languages and collected self-reported sociodemographic and health-related information.

The mental health related factors included:

What did the researchers find?

The researchers found marked differences across ethnic groups in mental health factors.

Chinese respondents reported the weakest sense of belonging, poorest self-rated mental health and lowest use of mental health services. They also had the highest unmet care needs compared to all ethnic groups, with Chinese adults aged 65 years or older having the highest prevalence of fair or poor self-reported mental health.

Compared to the four ethnic minority groups identified by the researchers, white respondents had a significantly higher lifetime prevalence of suicidal ideation and physician-diagnosed mood or anxiety disorders, as well as past-year mental health service use.

Black respondents and white respondents reported a similar sense of belonging. South Asian respondents reported the strongest sense of belonging across all ethnic groups.

More than half of ethnic minority respondents who reported fair or poor mental health had unmet care needs. White and South Asian respondents were significantly more likely to see their family doctors for mental health needs while Chinese and Black respondents were likely to see their family doctors or an allied health professional.

Whether respondents were Canadian-born or had immigrated to Canada, ethnic minority groups reported lower prevalence of mood or anxiety disorders compared to white respondents. Chinese immigrants reported the highest prevalence of poor self-rated mental health. White and Chinese immigrants reported high rates of a weak sense of belonging compared to Canadian-born respondents.

Through a review of existing literature, the researchers hypothesized that individual factors, such as shame and stigma, as well as system-level factors, such as institutionalized racism or a lack of culturally sensitive mental health services, may explain the reluctance in seeking help for ethnic minority populations.

Limitations of the research

The researchers noted several limitations. Firstly, because this study relied on self-reported data, results may be influenced by cultural differences in reporting or perceptions of mental health. Secondly, the limitations of the CCHS questions made it so that researchers were unable to determine whether the differences observed between ethnic communities in self-reported diagnosed mental health conditions indicated true ethnic differences in mental health burden or were the result of variability in reporting, help-seeking behaviours or access to health services. Thirdly, the researchers utilized data from several waves of the CCHS to obtain a large sample of participants, which may hide temporal trends in mental health status. Lastly, the surveys were limited to Ontario, which may not reflect less racially diverse regions in Canada.

How can you use this research?

The researchers aim to highlight the considerably lower use of mental health services and high unmet care needs of ethnic minority populations. They suggest that further work is needed to understand and address the cultural and systemic barriers ethnic minority populations face. More work is also needed to identify ethnically tailored and culturally appropriate clinical supports and practices to ensure equitable and timely mental health care. The researchers hope that the data collected in their study can be used as a baseline to measure whether future improvements to mental health care outcomes are shared equitably across ethnic groups.

About the researchers

Maria Chiu1,2, Abigail Amartey1, Xuesong Wang1, Paul Kurdyak1,2,3

  1. ICES, Toronto, ON, Canada
  2. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
  3. Health Outcomes and Performance Evaluation (HOPE), CAMH, Toronto, ON, Canada

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