Determinants of Service Use among Young Canadians with Mental Disorders

Article excerpt

Objective: To identify the determinants of service use by young Canadians with mental health problems.

Methods: Data were drawn from a recent large Canadian mental health survey. The analyses were conducted on a subsample of 1092 Canadians aged 15 to 24 years and identified as presenting a mood disorder, an anxiety disorder, or a substance-related disorder in the 12 months preceding the survey. We classified variables potentially associated with any type of service use for a mental health problem over a 12-month period according to predisposing, enabling, and need factors. We conducted weighted multivariate logistic regressions to determine the association of each factor with service use.

Results: In the final model, being female and living alone were the predisposing factors associated with service use. None of the enabling factors predicted help seeking. In regard to the perceived need factors, those who had difficulties with social situations were more likely to use services. Having a mood disorder and (or) having a diagnosed chronic illness were the evaluated need factors associated with service use.

Conclusion: Certain groups of young Canadians are less likely to seek help for mental health problems and could be the target of interventions aimed at increasing service use.

(Can J Psychiatry 2005;50:629-636)

Information on funding and support and author affiliations appears at the end of the article.

Clinical Implications

* Only 25% of young Canadians with mental health problems seek help. Therefore, it is essential to initiate interventions that will aim at increasing their use of services.

* Sex, living arrangement, reaction to social situations, diagnosis of mood disorders, and chronic physical disorder influence the likelihood of service use.

* Interventions to encourage service use should be targeted toward people who are less likely to use the services, namely, young men, young people living with their parents or with unrelated others, and people diagnosed with an anxiety or a substance-related disorder.

Limitations

* The survey, which is not specifically designed for young people, does not contain information on familial context.

* The study does not account for the impact of income on service use.

* No distinction is made between types of service, disorder, age, and sex.

Key Words: adolescents, young adults, mental health, mood disorders, anxiety disorders, substance-related disorders, service use, help seeking, Canada

National surveys across developed countries indicate that, when compared with older age groups, people aged 15 to 24 years have the highest rates of mental disorders (1,2). This trend is also observed in the CCHS 1.2 (3), which specifies that 18% of Canadians aged 15 to 24 years meet the criteria for a mood disorder, an anxiety disorder, or a substance-related disorder, compared with almost 12% of those aged 25 to 44 years, 8% of those aged 45 to 64 years, and 3% of those aged 65 years and over. Although young people are particularly at risk for mental disorders, they underuse services for these problems (1,3). Therefore, it is important to investigate factors associated with service use in this particular subgroup.

Prior research has examined potential determinants of help seeking by young people with mental disorders. However, these studies have overlooked some of the factors examined in studies targeting adults in general. For example, factors associated with service use, such as the size of the social network (4) and certain types of living arrangements (5), may also influence young people's help-seeking behaviour. Moreover, few studies based their analyses on an established model of service use. Finally, the only Canadian study that explored the determinants of help seeking by young people with mental disorders only considered a few variables (6). Considering these limitations, this study aims to identify the factors associated with service use for mental health problems by young Canadians. …