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International Journal of Mental Health
ISSN: 0020-7411 (Print) 1557-9328 (Online) Journal homepage: http://www.tandfonline.com/loi/mimh20
Determinants of self-reported mental health and
utilization of mental health services in Canada
Bruce McDonald, Madhura Kulkarni, Mustafa Andkhoie, Jeffrey Kendall,
Spencer Gall, Shankar Chelladurai, Mohsen Yaghoubi, Stephanie McClean,
Michael Szafron & Marwa Farag
To cite this article: Bruce McDonald, Madhura Kulkarni, Mustafa Andkhoie, Jeffrey Kendall,
Spencer Gall, Shankar Chelladurai, Mohsen Yaghoubi, Stephanie McClean, Michael Szafron &
Marwa Farag (2017): Determinants of self-reported mental health and utilization of mental health
services in Canada, International Journal of Mental Health, DOI: 10.1080/00207411.2017.1345045
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INTERNATIONAL JOURNAL OF MENTAL HEALTH
https://doi.org/10.1080/00207411.2017.1345045
Determinants of self-reported mental health and
utilization of mental health services in Canada
Bruce McDonald, Madhura Kulkarni, Mustafa Andkhoie, Jeffrey Kendall,
Spencer Gall, Shankar Chelladurai, Mohsen Yaghoubi, Stephanie McClean,
Michael Szafron, and Marwa Farag
School of Public Health, University of Saskatchewan, Saskatoon, Canada
ABSTRACT
Research evidence suggests that the prevalence of mental
health conditions in Canada has increased while a considerable
percentage of people with a mental health issue do not
seek professional mental health services. Weighted logistic
regression models were used to determine whether age, sex,
income, and education predict the self-reported mental health
status of Canadians and their odds of utilizing mental health
services. This study found clear disparities in reporting mental
health and utilization of mental health services. Young adults
(aged 25 to 44) have 1.4 times (95% CI: 1.3 to 1.6 times) higher
odds of reporting poorer mental health status than seniors
(aged 65 or older). Females are 2.7 times (95% CI: 2.3 to 3.1
times) more likely to utilize mental services than males. The
lowest income group (<$15,000) has 2.2 times (95% CI: 1.9 to 2.4
times) higher odds of rating poorer mental health status than
the highest income group (>$80,000). The least educated group
(<high school education) has 1.5 times (95% CI: 1.3 to 1.6 times)
higher odds of reporting poorer mental health status than the
highest educated group (post-secondary education). However,
the highest educated group is 1.6 times (95% CI: 1.3 to 2.0
times) more likely to utilize mental health services than the
least educated group. Even in a country that has a universal
health insurance system such as Canada, disparities and
inequities associated with mental health burden and health
care utilization persist, specifically among groups with lower
education, lower income, and males.
KEYWORDS
Health disparities; mental
health; self-reported; service
utilization; social
determinants of health
Introduction
Mental health is a concern for many Canadians, with estimates that 1 in 5
Canadians will suffer some form of mental health issue in their lifetime
(Lesage et al., 2006). In addition, reports predict that the number of
people living with mental illness will increase by 31% over the next 30 years
(Smetanin et al., 2011). In terms of economic burden, evidence suggests that
mental illness is among the costliest conditions in Canada (Smetanin et al.,
2011). In 2007–2008, $14.3 billion in public expenditures was estimated to
none defined
CONTACT Marwa Farag marwa.farag@usask.ca School of Public Health, University of Saskatchewan,
104 Clinic Place, Room 3334, Saskatoon, SK S7N 5E3, Canada.
© 2017 Taylor & Francis
have been spent on mental health services and supports in Canada, which
represents 7.2% of total government health expenditures (Jacobs et al., 2010).
In Canada, there are persistent gaps between the number of people who are
affected by a mental health condition and those who actually seek help, with
studies showing only around 40–60% of people with a mental health problem
seeking professional assistance (Lesage et al., 2006; Andrews & Carter, 2002).
The most widely consulted health professionals are general practitioners (GP),
social workers/counsellors/psychotherapists, psychiatrists, psychologists, and
self-help groups (Lesage et al., 2006). In 2012, the Mental Health Commission
of Canada released the first national strategy for mental health (Mental Health
Commission of Canada, 2012).
Self-rated mental health is considered to be a secondary indicator of overall
mental health according to the Canadian Index of Wellbeing and, as such, can
serve as part of a measure of overall population health (Labonte et al., 2010).
According to Mawani & Gilmour (2010), self-reported mental health is a mea-
sure that captures issues such as psychological distress, depressive symptoms,
and emotional functioning. In the same study, the authors noted that only a
small percentage of respondents self-rated their mental health as fair/poor
(compared to good, very good, and excellent) leading the authors to believe that
people tend to report higher self-reported mental health than their true status.
Therefore, there is a concern that social desirability bias affects this measure.
In addition to self-reported mental health, measures such as life
satisfaction/enjoyment have been used in other studies to capture mental
status. Previous studies have shown that having a higher household income
is associated with better life enjoyment (Blanchflower & Oswald, 2004).
Another study by Helliwell shows that life satisfaction is linked to being
employed and being satisfied at work (Helliwell, 2003).
In terms of utilization of mental health services, evidence suggests that a
number of factors associated with mental health can serve as important predic-
tors for utilization of mental health services; these include high levels of
perceived stress, self-perceived poor general health, depression, and negative life
events such as divorce (Sareen et al., 2005). According to Steele, Dewa, Lin, & Lee
(2007), education level was positively associated with mental health utilization.
In a study by Patten & Beck (Patten & Beck, 2004), women over the age of 44 and
those with one or more chronic conditions had higher odds of utilization of
mental health care, as measured by anti-depressant medication use. The purpose
of this study is to examine the determinants of both self-reported mental health
and utilization of mental health services in Canada.
Methods
The dataset used in this analysis is the Canadian Community Health Survey
(CCHS), 2005 which collects information related to mental health status,
2 B. MCDONALD ET AL.
health care utilization, and health determinants in the Canadian population.
This national cross-sectional survey was a stratified random sample, which
covered 98% of the population aged 12 years and above. Aboriginal people
on reserves, institutional residents, full-time members of the Canadian Forces,
and residents of certain remote regions were excluded from the survey
(Statistics Canada, 2005). The sample size of this survey is 132,221. We used
the 2005 CCHS dataset because it contained a mental health component.
Models
In this study, we used three logistic regression models, as follows: (1) the first
model investigates the predictors of lower self-reported mental health status
as compared to higher self-reported mental health in the Canadian
population; (2) the second model examines the predictors of mental health
professional consultation in the Canadian population (in three out of the
ten provinces); and (3) the third model examines the determinants of mental
health professional consultation only for the subset of the sample which
reported “fair” or “poor” mental health status.
In our first model, the sample size was 129,840 participants out of the
132,221 participants (98.2% response rate) who responded to the question
on self-reported mental health status. In our second model, data from a spe-
cial topics mental health service survey question, which was only administered
in three Canadian provinces (New Brunswick, Ontario, and Alberta), was
used. The sample size of the three provinces was 58,786, out of which
56,568 participants (96.2% response) answered the special topics mental
health service question. The same subset of the three provinces was then used
to examine the third research question concerning the likelihood of utilizing
mental health care services. Since the third model uses an even smaller subset
of the data, the sample size of the three provinces self-rating “fair” or “poor”
mental health status is 6,835, out of which 3,191 (46.7% response) answered
the special topics mental health service question.
Outcome variables
In the first model where we predict the odds of lower self-reported mental
health status as compared to the higher self-reported mental health, the
outcome variable “self-reported mental health status” was collapsed from five
categories to the following two categories: (1) higher reported mental
health status and (2) lower reported mental health status. The higher reported
mental health status is the combination of participants that identify
their mental health statuses as “excellent” or “very good.” The lower reported
mental health status is the combination of participants that identify their
mental health statuses as “good,” “fair,” or “poor.” The justification for
INTERNATIONAL JOURNAL OF MENTAL HEALTH 3
collapsing good, fair, or poor mental health into one category was based on
the assumption that those who self-identify as having the highest need for
mental health services tend to report self-reported mental health as good, fair,
or poor vs. very good or excellent. This assumption is supported by Labonte
et al. (2010), where the distinction between good, fair, or poor as one group,
and excellent and very good as another, was based on the findings that the
probability of reporting depression increases as the likelihood of reporting
very good or excellent decreases.
The second and the third models are where we identify the predictors of
mental health professional consultation in the Canadian population; the
outcome variable is a dichotomous “yes/no” variable asking the participants:
“in the past 12 months, have you seen, or talked on the telephone, to a health
professional about your emotional or mental health?”
Predictor variables
In all three models, the following predictor variables were selected for
model testing: province of residence of respondent, sex, age (12 to 24, 25 to
44, 45 to 64, 65 to 80 or more), marital status (married, common-law,
widow/separated/divorced, single/never married), working status in the last
week (at work, absent, no job, unable/permanent), highest level education
obtained (<than secondary, secondary grad., other post-secondary,
post-secondary grad.), has at least one chronic condition (responded to yes
to one the chronic conditions listed in the CCHS survey, excluding anxiety
or mood disorder), total household income (less than $15,000,
“$15,000–$29,999,” “$30,000–$49,999,” “$50,000–$79,999,” and $80,000 or
more), and ever consumes 5 or more drinks at one time.
Age was collapsed from sixteen to four categories in order to increase the
power to detect significant difference between broader categories. The
variable asking if respondents ever consumed 5 or more drinks at one time
was collapsed from six categories into a binary variable that reflected whether
an individual engaged in risky drinking at any frequency or never engaged in
any risky drinking. Risky drinking is defined as more than three drinks for
women and more than four drinks for men during one single occasion at least
once a month or more (Butt et al., 2011).
Data analytic procedures
A binary logistic regression was used for the three models using the analytical
software Stata version 12.1. Backwards model building method was used for
all three logistic models. The significance level of the model was chosen to
be 5%. Sample weights provided by Statistics Canada survey was used in
the analysis. All linearity and absence of multicolinearity assumptions held
4 B. MCDONALD ET AL.
true for the variables used in the final models. The goodness-of-fit test and
predictive ability of the finals models were checked.
Results
According to the survey, 38.7%, 37.9%, 18.8%, 3.8%, and 0.82% of the
Canadian population in Canada self-rate their mental health to be “excellent,”
“very good,” “good,” “fair,” and “poor,” respectively. Consequently,
we observe that 76.6% of Canadians self-rate their mental health status as
“excellent” or “very good,” whereas 23.4% of the population self-rates their
mental health status as “good,” “fair,” or “poor.”
The use of mental health care services was examined in three provinces:
Alberta, Ontario, and New Brunswick. The survey indicated that 8.5% of
individuals in the aforementioned three provinces utilized mental health
services. In addition, the survey shows that individuals that self-rate their
mental health as “excellent,” “very good,” “good,” “fair,” and “poor” have
mental health service utilization rates of 2.8%, 7.2%, 14.9%, 38.1%, and
57.2%, respectively (see Table 1). Thus clearly indicating increasing use of
mental health services as self-reported mental health descends from favorable
“excellent” status to unfavorable “poor” mental health status.
Factors influencing self-rated mental health in Canada
Model 1 presented in Table 2 was used to examine the likelihood of reporting
poorer mental health in Canada. The model shows that individuals aged 12 to
24 years, 25 to 44 years, and 45 to 64 years have 1.20 times, 1.41 times, and
1.38 times, respectively, higher odds of rating their mental health status as
“poor/fair/good” (versus “excellent/very good” mental health status) than
seniors. Therefore, among all the age groups, seniors have the highest odds
of rating their mental health status as excellent or very good whereas adults
aged 25 to 44 years are most likely to report poorer mental health status.
Our analysis shows that marital status has a significant effect on self-rated
mental health. “Common law,” “widow/separated/divorced,” and “single/never
married” have 13%, 24%, and 24%, respectively, higher odds of rating their
Table 1. Self-rated mental health and health professional consultation (Canadian Population
Health Initiative, 2009).
Self-rated mental health
Consulted mental health professional
YES NO
Excellent 2.8% 97.2%
Very Good 7.2% 92.8%
Good 14.9% 85.1%
Fair 38.1% 61.9%
Poor 57.2% 42.8%
Total 8.5% 91.5%
INTERNATIONAL JOURNAL OF MENTAL HEALTH 5
mental health status poorer compared to “married” individuals.
Married individuals are most likely to self-rate their mental health status to
be excellent or very good.
In terms of total income, households with “<$15,000,” “$15,000–$29,999,”
“$30,000–$49,999,” and “$50,000–$79,999” incomes have 2.2 times, 2.0 times,
1.6 times, and 1.3 times, respectively, higher odds of reporting poorer
mental health status compared to households with “$80,000 or more” income.
Therefore, having a higher income is significantly associated with reporting
better mental health.
Individuals with “less than secondary school” and “secondary graduate” as
highest level of education have 48% and 10%, respectively, higher odds of
Table 2. Likelihood of reporting “poor/fair/good” versus “excellent/very good” mental health in
Canada, 2005. (Model 1; Canadian Population Health Initiative, 2009).
Odds Ratio 95% CI
Lower Upper
Age (Ref: 65 years or more)
12 to 24 years 1.200* 1.059 1.361
25 to 44 years 1.407* 1.268 1.561
45 to 64 years 1.376* 1.252 1.513
Sex (Ref: Female)
Male 1.040 0.984 1.100
Marital Status (Ref: Married)
Common law 1.129* 1.034 1.233
Widow/separated/divorced 1.240* 1.138 1.352
Single/never married 1.242* 1.153 1.338
Total household income (Ref: $80,000 or more)
No to <$15,000 2.164* 1.929 2.429
$15,000–$29,999 1.973* 1.794 2.170
$30,000–$49,999 1.611* 1.487 1.746
$50,000–$79,999 1.284* 1.193 1.382
Highest Education (Ref: Post-secondary)
<than secondary 1.482* 1.347 1.631
Secondary graduate 1.098* 1.009 1.194
Other post-secondary 1.103 0.988 1.231
Working status last week (Ref: Present last week)
Absent last week 1.111 0.985 1.253
No job last week 1.197* 1.118 1.281
Unable/permanent 2.889* 2.384 3.501
Chronic condition 1.742* 1.632 1.858
Ever had 5 or more drinks 1.110* 1.047 1.176
Province (Ref: Yukon/NWT/Nunavut)
NFLD & LAB. 0.748* 0.603 0.927
PEI 0.708* 0.550 0.911
Nova Scotia 0.979 0.802 1.193
New Brunswick 1.100 0.905 1.338
Quebec 0.802* 0.676 0.951
Ontario 0.998 0.845 1.180
Manitoba 1.028 0.844 1.253
Saskatchewan 0.982 0.811 1.188
Alberta 0.982 0.818 1.178
British Columbia 1.046 0.879 1.246
*Significant at the 0.05 level of significance.
6 B. MCDONALD ET AL.
rating their mental health status poorer compared to individuals with
“post-secondary” education. Therefore, individuals with post secondary
education are most likely to self-rate their mental health status as excellent
or very good.
Model 1 also shows that individuals who are “unable to or permanently
cannot work” have 2.89 times higher odds of reporting poorer mental health
compared to individuals who have a job. In addition, unemployed individuals
have 1.20 times higher odds of reporting poorer self-rated mental health
status compared to individuals with a job. Therefore, employment is strongly
associated with reporting better mental health status.
Individuals with any type of chronic condition (one or more conditions)
have 74% higher odds of reporting poorer mental health compared to
individuals with no chronic condition. In addition, individuals who drink 5
or more drinks at least once a month have 11% higher odds of reporting
poorer mental health status compared to individuals who do not drink.
Lastly, province of residence variable shows that Newfoundland and
Labrador, Prince Edward Island and Quebec residents have the highest odds
of rating their mental health status as excellent or very good.
Factors influencing the likelihood of consulting a mental
health professional
Model 2 presented in Table 3 examines factors influencing the likelihood of
consulting a mental health professional in 3 provinces in Canada. Model 2
shows that individuals aged 12 to 24 years, 25 to 44 years, and 45 to 64 years
have 2.7 times, 5.2 times, and 3.8 times, respectively, higher odds of consulting
a mental health professional compared to seniors. Therefore, among all the
age groups, adults aged 25 to 44 years are most likely to consult a mental
health professional whereas seniors aged 65 years or above are least likely
to consult a mental health professional. In addition, our analysis shows that
females have 2.7 times higher odds of consulting a mental health professional
than males.
This study shows that marital status has a significant effect on the likeli-
hood to consult a health professional. Individuals who are “common law,”
“widow/separated/divorced,” and “single/never married” have 32%, 106%,
and 61%, respectively, higher odds of consulting a mental health professional
compared to “married” individuals. Therefore, widowed/separated/divorced
individuals are most likely to consult a mental health professional whereas
married individuals are least likely to consult a mental health professional.
In terms of total income, households with income “$30,000–$49,999” are
1.29 times (1/0.775 = 1.29) higher odds of not consulting a mental health
professional compared to households with “$80,000 or more” income. There-
fore, this middle-income group ($30,000 to $49,000) is least likely to consult a
INTERNATIONAL JOURNAL OF MENTAL HEALTH 7
mental health professional. The remaining income groups are no different
than highest earning group when it comes to consulting a mental health
professional.
Individuals with “post-secondary” and “other post-secondary” as their
highest level of education have 62% and 50%, respectively, higher odds of con-
sulting a mental health professional compared to individuals with “secondary”
education. Therefore, individuals with post-secondary education are more
likely to consult a mental health professional than individuals with lower
levels of education.
Our analyses show that individuals who are “unable to or permanently can-
not work” have 84% higher odds of consulting a mental health professional
compared to individuals with a job. In addition, unemployed individuals
have 21% higher odds of consulting a mental health professional compared
to individuals with a job. During the time of the survey, if the individuals were
absent for the past 7 days prior to this survey, such individuals have 60%
Table 3. Likelihood of consulting a mental health professional in New Brunswick, Ontario, and
Alberta, 2005. (Model 2; Canadian Population Health Initiative, 2009).
Odds Ratio 95% CI
Lower Upper
Age (Ref: 65 years or more)
12 to 24 years 2.700* 1.857 3.926
25 to 44 years 5.223* 3.769 7.239
45 to 64 years 3.767* 2.743 5.174
Sex (Ref: Male)
Female 2.665* 2.328 3.050
Marital Status (Ref: Married)
Common law 1.316* 1.073 1.614
Widow/separated/divorced 2.063* 1.672 2.545
Single/never married 1.612* 1.361 1.910
Total household income (Ref: $80,000 or more)
No to <$15,000 1.069 0.823 1.390
$15,000–$29,999 0.942 0.751 1.182
$30,000–$49,999 0.775* 0.651 0.924
$50,000–$79,999 0.948 0.813 1.107
Highest Education (Ref: Secondary graduate)
< than secondary 1.137 0.837 1.545
Other post-secondary 1.498* 1.120 2.003
Post-secondary 1.620* 1.323 1.984
Working status last week (Ref: Present last week)
Absent last week 1.598* 1.276 2.002
No job last week 1.214* 1.043 1.414
Unable/permanent 1.841* 1.336 2.536
Chronic condition 2.817* 2.322 3.416
Ever had 5 or more drinks 1.068 0.940 1.214
Province (Ref: Ontario)
New Brunswick 1.034 0.846 1.263
Alberta 1.212* 1.049 1.400
Self reported mental health (Ref: Excellent/Very Good)
Poor/Fair/Good 4.549* 4.031 5.134
*Significant at the 0.05 level of significance.
8 B. MCDONALD ET AL.
higher odds of consulting a mental health professional compared to
individuals who were present at work for the past 7 days.
Individuals with any type of chronic condition (one or more conditions)
have 2.8 times higher odds of consulting a mental health professional
compared to individuals with no chronic condition. In addition, individuals
who self-report their mental health status as “poor/fair/good” have 4.5 times
higher odds of consulting a mental health professional compared to
individuals who self-report their mental health status as “excellent/very
good.” Therefore, presence of chronic condition and rating “poor/fair/good”
as mental health status are strong predictors of mental health care services
utilization.
The province variable shows that Alberta residents have 21% higher odds of
consulting a mental health professional compared to Ontario. There is no dif-
ference between Ontario and New Brunswick residence in terms of consulting
a mental health professional.
Factors influencing the likelihood of consulting a mental health
professional among those reporting poorer mental health
Model 3 presented in Table 4 examines factors influencing the likelihood of
consulting a mental health professional among those reporting poor or fair
Table 4. Likelihood of consulting mental health professionals provided they perceive “poor” or
“fair” mental health, 2005. (Model 3; Canadian Population Health Initiative, 2009).
Odds Ratio 95% CI
Lower Upper
Age (Ref: 65 years or more)
12 to 24 years 2.582* 0.959 6.957
25 to 44 years 4.682* 1.959 11.19
45 to 64 years 3.630* 1.558 8.457
Sex (Ref: Male)
Female 2.595* 1.816 3.708
Total household income (Ref: $80,000 or more)
No to <$15,000 2.132* 1.226 3.705
$15,000–$29,999 1.412 0.777 2.567
$30,000–$49,999 1.136 0.677 1.905
$50,000–$79,999 1.198 0.739 1.943
Highest Education (Ref: Secondary graduate)
<than secondary 0.844 0.464 1.537
Other post-secondary 2.104* 1.007 4.339
Post-secondary 2.381* 1.504 3.769
Working status last week (Ref: Present last week)
Absent last week 2.073* 1.126 3.817
No job last week 1.263 0.843 1.894
Unable/permanent 1.843* 1.043 3.226
Chronic condition 5.546* 2.427 12.677
Ever had 5 or more drinks 1.375 0.956 1.978
*Significant at the 0.05 level of significance.
INTERNATIONAL JOURNAL OF MENTAL HEALTH 9
mental health. The model shows that individuals aged 12 to 24 years, 25 to 44
years, and 45 to 64 years have 2.6 times, 4.7 times, and 3.6 times, respectively,
higher odds of consulting a mental health professional compared to seniors.
In addition, females have 2.6 times higher odds of consulting a mental health
professional than males.
In terms of total income, households with less than $15,000 income have 2.1
times higher odds of consulting a mental health professional. The remaining
income groups are no different than highest earning group when it comes to
consulting a mental health professional.
Individuals with “post-secondary” and “some post-secondary” as highest
level of education have 2.4 times and 2.1 times, respectively, higher odds of
consulting a mental health professional compared to individuals with
“secondary” education. Therefore, even with poor or fair mental health status,
individuals with post-secondary education are most likely to consult a mental
health professional.
The results indicate that individuals who are unable to or permanently
cannot work have 1.8 times higher odds of consulting a mental health pro-
fessional compared to individuals with a job (given the individual self-rates
mental health status as “poor” or fair”). During the time of the survey, if
the individuals were absent for the past 7 days prior to this survey, such indi-
viduals have 2.1 times higher odds of consulting a mental health professional
compared to individuals who were present at work for the past 7 days.
Individuals with any type of chronic condition (one or more conditions)
have 5.5 times higher odds of consulting a mental health professional
compared to individuals with no chronic condition.
Discussion
Based on our analysis, age, marital status, employment status, income, pres-
ence of chronic condition(s), and alcohol consumption were significantly
associated with self-rated mental health. Married individuals, people who have
higher education, and people with higher income were more likely to report
better mental health. People who have chronic condition(s) and those
unemployed, and those who drink 5 or more drinks at least once a month
were more likely to report poorer mental health. Individuals aged 25–44 were
significantly more likely to report worse mental health than all other age
groups. These findings are consistent with the literature; for example, research
in the United Kingdom show improved mental well-being among individuals
with higher wages than those with lower wages (Flint et al., 2014). Also,
research shows that older adults and higher income status have better mental
health status (Meyer et al., 2014). In addition, research shows that people with
lower education and high alcohol consumption are more likely to have lower
mental health status (Kurtze et al., 2013). Also, chronic disease is shown to
10 B. MCDONALD ET AL.
have association with depression (Maideen et al., 2014). Not surprisingly,
marital status is associated with reported mental health as research shows that
degree of loneliness predicts the mental health status (La Grow et al., 2012).
Finally, there was some provincial variation. Newfoundland and Labrador,
Prince Edward Island, and Quebec residents were most likely to self-rate their
mental health status as excellent or very good.
According to Goldsmith & Diette (2012), stressful events, which may be
experienced in higher frequency among those with less education, no employ-
ment, and lower income, have a direct causal effect on an individual’s mental
health, where the stress associated with not being able to make ends meet
leads to depression, helplessness, and poor mental health.
Our results indicate age determines the likelihood of consulting mental
health professionals and also determines the self-assessment of mental health
status. Middle-aged individuals (aged 25 to 44) are most likely to consult
mental health professionals, and they are also most likely to self-rate poorer
mental health. Therefore, our results show that age group that have the high-
est burden of poorer self-reported mental health are also most likely to seek
mental health professionals. This is a positive finding because the groups that
need the support are most likely to seek professional support.
We see that males are less likely to consult mental health professionals.
This finding is consistent with the literature. For example, Berger, Levant,
McMillan, Kelleher, & Sellers (2005) found a close association between
traditional masculinity ideology and negative attitudes toward seeking
psychological help. Our results indicate that targeted strategies towards males
to reduce barriers would be prudent to eliminate gender disparities.
The results indicate that education is an important indicator of poorer
mental health status and, more importantly, the likelihood of seeking
mental health consultation. Higher education reduces the likelihood of poorer
self-reported mental health status and also at the same increases the likelihood
of seeking mental health consultation. Clearly, education is a very important
indicator as it positively affects mental health status in a large population.
Employment status strongly predicts the status of self-reported mental
health, and our results indicate the demand for mental health consultation
is high among not employed individuals. Results regarding income status
indicate that income is a strong indicator of self-reported mental health status.
The interesting finding is that individuals in the lower income categories
are as likely to consult mental health status as the highest income category.
Limitations
There are several limitations of this study. The first and most important is that
data on mental health care services utilization came from only three provinces
in Canada: Alberta, Ontario, and New Brunswick. This reduced the power of
INTERNATIONAL JOURNAL OF MENTAL HEALTH 11
model 2 to detect significant associations, and reduces the ability to generalize
these findings to all of Canada. In addition, responses to the question
pertaining to consultation with specific mental health type (family doctor,
psychiatrist, nurse, psychologist, and social worker) were not mutually
exclusive questions, and therefore, analyses of utilization of services by type
of mental health professional were limited to descriptive analysis, and these
results should be interpreted with caution.
Conclusion
This study indicates that married individuals, people who have higher
education, and people with higher income were more likely to report better
mental health. The evidence generated shows that the age group that
experienced the highest burden (age 25 to 44) of poorer self-reported mental
health was also the most likely to seek mental health professionals. Also,
participants with lower education levels were more likely to report poorer
mental health but also less likely to utilize mental health services. Income
categories were a highly significant predictor, with the lowest income group
most likely to report poorer mental health. However, the results show that
the lower-middle income category is least likely to consult mental health
professionals, which could be an indication of mental health access disparity
in this working poor group.
These findings of this study point to the need for targeted strategies
towards males, people with lower education, seniors, and lower-middle
income level group to reduce barriers to access mental health professionals
in order to eliminate disparities in these groups. Future research should
examine utilization by mental health professional type, especially among
income groups, and predictors of mental health services utilization among
all Canadian provinces and territories.
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