Dr. Helen-Maria Vasiliadis, Full Professor at the University of Sherbrooke, is at the forefront of new research that sheds light on the factors associated with mental health service use throughout the COVID-19 pandemic. Her recent paper, published in the International Journal of Social Psychiatry, not only unravels the nuances of mental health service use but also advocates for policies to dismantle barriers hindering integrated care.
Addressing gaps in mental health service use research
When researching mental health service use, it is often assessed in a binary way: did you use mental health services or did you not? This approach does not consider those who have sought services but have been unsuccessful in doing so.
Dr. Vasiliadis calls for a more nuanced approach to better understand Canadians’ inequities in mental health care access, especially as changes to health services, like the increased use of telehealth, may carry on beyond the COVID-19 pandemic.
To begin addressing this gap, Dr. Vasiliadis sought out the CanPath health and lifestyle questionnaire administered before the COVID-19 pandemic, as well as two further questionnaires delivered during the first and second waves of the pandemic.
Aims and aspirations of the current study
Using data from CanPath’s COVID-19 health survey (May-December 2020 and January-June 2021), Dr. Vasiliadis and colleagues aimed to assess the predisposing, enabling, and need factors associated with Canadians’ mental health service use until the pandemic’s third wave. According to Andersen’s model of healthcare use (1995):
- Predisposing factors can include demographic factors (e.g., age, sex, race/ethnicity), health behaviours (e.g., smoking, cannabis use, alcohol consumption), social structure, and health beliefs.
- Enabling factors include resources like one’s family and community, their employment status, and their income.
- Need factors refer to one’s perception of their need to use health services, like their perceived health status, their self-rated emotional and mental health, and physical multimorbidity.
By specifically looking into the factors associated with using mental health services and barriers to use, the researchers could unveil subgroups whose mental health care needs are unmet.
Factors affecting mental health service use during the COVID-19 pandemic
So, what were the barriers that Canadians faced to initiating new mental health service use compared to those who had success initiating new services? Dr. Vasiliadis and colleagues unveiled the following findings among individuals with moderate and severe symptoms of depression and anxiety:
The impact of predisposing factors (e.g., age)
Older adults were less likely to start using new mental health services than younger adults throughout the pandemic. But to what extent?
- Older adults were almost four times more likely to report not using mental health services because they weren’t comfortable seeking care.
- They were also more than ten times more likely not to use mental health services because they did not feel the need.
Interestingly, no significant differences were observed based on race or sex.
The impact of behavioural factors (e.g., smoking)
Individuals reporting smoking were close to two times more likely not to use mental health services because they were not comfortable seeking care and because they did not feel the need.
The impact of enabling factors (e.g., income, living alone)
Income and living alone were significant factors affecting mental health service use.
- Those who live alone were more than two times more likely to report not using mental health services because they had difficulty finding an appointment.
- A decrease in one’s income during the pandemic was also related to difficulties in finding appointments.
What understanding barriers to access means for a healthier tomorrow
From the findings above, a deeper understanding of the barriers to mental health service use access is vital to improve service delivery and better prepare for future pandemics.
For older adults, awareness campaigns are needed to emphasize how important it is to seek treatment for their anxiety and depression and explain the process behind available and effective treatments. There is an immense need to increase older adults’ willingness and comfort around initiating new mental health service use when they need it the most.
For those whose income was affected by the pandemic or who live alone, there is a need for policy change, such as removing health system barriers related to availability and accessibility to using mental health services. More focused efforts from health professionals in primary care to identify and follow up with individuals with anxiety and depression who live alone in their area may be needed as they are more at risk of having unmet mental health service needs.
Whether through policy advocacy, community support, or individual awareness, each of us holds a role in shaping a healthier tomorrow. Dr. Vasiliadis and colleagues advocate for public health campaigns that promote healthy behaviours and policies to reduce economic and social barriers to integrated substance use and mental health care.
Vasiliadis, H. M., Spagnolo, J., Fleury, M.J., Gouin, J.P., Roberge, P., Bartram, M., Grenier, S., Shen-Tu, G., Vena, J. E., Wang, J. (2023). Factors associated with mental health service use during the pandemic: Initiation and barriers. International Journal of Social Psychiatry, 207640231194489. Advance online publication. https://doi.org/10.1177/00207640231194489
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