Mental health service use by Chinese immigrants with severe and persistent mental illness.

OBJECTIVE: To investigate whether recent Chinese immigrants in British Columbia diagnosed with severe and persistent mental illness used mental health services at a lower rate than a similar group of nonimmigrants and longer-term immigrants. METHOD: Subjects were selected from linked immigration and health administrative databases. Their health service use records for the years 1992 to 2001 were extracted. Rates and rate ratios of use for severe psychiatric disorders for Chinese immigrants and the comparison group were calculated for 4 types of health services: mental health visits to general practitioners (GPs), visits to psychiatrists, psychiatric hospitalizations, and use of psychiatric medications. Rates and rate ratios of use for any mental health condition were calculated for the above 4 types of services, plus community mental health service and nonmental health visits to GPs. RESULTS: The Chinese immigrants (n = 786) and comparison subjects (n = 3962) having severe and persistent mental illness were identified. For serious mental disorders, Chinese immigrants were more likely to visit psychiatrists (RR = 1.36) but less likely to use the other types of services, with rate ratios ranging from 0.51 to 0.81. Including all mental health conditions, Chinese immigrants were less likely to use all 6 types of services, with rate ratios ranging from 0.41 to 0.90. CONCLUSIONS: Except for psychiatric visits for serious disorders, recent Chinese immigrants diagnosed with severe and persistent mental illness used fewer mental health services than subjects from the comparison group. Seriously ill Chinese immigrants may experience problems with access to mental health services.

Rate of mental health service utilization by Chinese immigrants in British Columbia.

OBJECTIVE: Reports suggest that immigrants are under-served by the mental health service system. The aim of this study is to examine the rates of mental health visits and hospitalization of Chinese immigrants in British Columbia using historic administrative databases. METHOD: A total of more than 150,000 Chinese immigrants who landed in BC between 1985 and 2000 were identified from an immigration database which was linked to the province's administrative health records, as part of a national study on immigrant health. Controls were individually matched to immigrants by sex, age and region and randomly selected from the general BC population. RESULTS: Preliminary results confirm that, while Chinese immigrants use less overall health care than controls, the difference in utilization rates is particularly pronounced with regard to mental health problems, especially for visits to psychiatrists and psychiatric hospitalization. DISCUSSION: The under-utilization of mental health services may reflect better health status, ongoing barriers to access, or other factors. There are different implications for health policy-makers. Further research is necessary to determine the reasons for the low rates of utilization.

Why do Chinese Canadians not consult mental health services: health status, language or culture?

Data from the Canadian Community Health Survey Cycle 1.1 showed that Chinese immigrants to Canada and Chinese individuals born in Canada were less likely than other Canadians to have contacted a health professional for mental health reasons in the previous year in the province of British Columbia. The difference persisted among individuals at moderate to high risk for depressive episode. Both immigrant and Canadian-born Chinese showed similar characteristics of mental health service use. The demographic and health factors that significantly affected their likelihood to consult mental health services included Chinese language ability, restriction in daily activities, frequency of medical consultations, and depression score. Notwithstanding lower levels of mental illness in ethnic Chinese communities, culture emerged as a major factor explaining differences in mental health consultation between Chinese and non-Chinese Canadians.

Differences in Mental Health Diagnoses between Recent Chinese Immigrants and a Comparison Population in British Columbia.

Linked administrative data indicate that the distributions of mental health diagnoses are different for recent Chinese immigrants in British Columbia compared to a matched group reflecting the general population, as recorded in payments to general practitioners and psychiatrists between 1992 and 2001. Chinese immigrants were much less likely to have consultations for the mental disorders that were most common in the general population. Among those who saw a psychiatrist, psychotic conditions accounted for a larger proportion of visits for Chinese immigrants than those from the general population. The opposite was true for depressive conditions. The findings illuminate nuances in the disparity in mental health service utilization between Chinese immigrants and the general population.

Determinants of mental health consultations among recent Chinese immigrants in British Columbia, Canada: implications for mental health risk and access to services.

Linked immigration and health administrative databases were analyzed to study the factors associated with the rate of mental health consultations with physicians in 1992-2001 of over 150,000 Chinese immigrants in British Columbia, Canada. Results showed that number of years since landing and rate of non-mental health visits to general practitioners were the most consistent variables associated with mental health consultations to general practitioners and psychiatrists in all sex and age groups. Other variables associated with the rate of consultations were age, place of origin, educational level, marital status and English skill. Supply of physicians was not observed to be associated with mental health consultations. The findings are consistent with Andersen's behavioral model of health care utilization and introduce components specially pertinent to immigrants and mental health service utilization. They also highlight sub-populations among immigrants who may be at risk of experiencing mental health problems or encountering barriers to care.