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Mental health service utilization by Chinese immigrants and Canadian-born Chinese in British Columbia Chen, Alice W.

Abstract

A population-based research of rates and patterns of mental health service utilization of Chinese in British Columbia was conducted by secondary analyses of three linked administrative data systems and a survey database. The three data systems comprised the federal immigration database, provincial healthcare databases and the provincial physicians register. The linkage resulted in a study population of more than 150,000 Chinese immigrants and each immigrant was matched by sex and age to a comparison subject randomly selected from the province’s health plan registry. The survey database was the Canadian Community Health Survey Cycle 1.1 consisting of 18,000 respondents in British Columbia including 1084 ethnic Chinese. Results from the administrative databases showed that Chinese immigrants had much lower rates of utilization of all types of mental health services. Factors associated with mental health visits to general practitioners and psychiatrists by these Chinese immigrants included years since landing, rate of non-mental health visits, age, place of origin, education, marital status, English language skill and health service delivery area. Among a smaller cohort of 786 Chinese immigrants and 3962 comparison subjects diagnosed with severe and persistent mental illness, Chinese immigrants also had lower rates of utilization of all types of mental health services. The severely ill Chinese immigrants were also less likely than comparison subjects to receive comorbid diagnoses of less serious mental disorders. The majority of the immigrants’ mental health care was provided by Chinese-speaking physicians. As a result of the practice pattern of these physicians, higher proportion of mental health care received from them was associated with lower odds of receiving diagnoses of some disorders. Results from the survey database showed that both immigrant and Canadian-born Chinese were less likely than the non-Chinese to have contacted mental health professionals, even after adjusting for their lower probability of suffering from major depression. This research confirms the disparity in mental health service utilization concerning Chinese in British Columbia and provides evidence that both lower psychiatric morbidity and cultural barriers contribute to this disparity. Findings support Andersen’s behavioural model of health care utilization and highlight the role of physician practice patterns in disparity.

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