CMAJ
Volume 190, Issue 40, 2018, Pages E1183-E1191

Use of the emergency department as a first point of contact for mental health care by immigrant youth in Canada: A population-based study (Article) (Open Access)

Saunders N.R.* , Gill P.J. , Holder L. , Vigod S. , Kurdyak P. , Gandhi S. , Guttmann A.
  • a Hospital for Sick Children, Canada
  • b Hospital for Sick Children, Canada, Department of Pediatrics, Canada
  • c University of Toronto, ICES, Canada
  • d University of Toronto, ICES, Canada, University of Toronto, Women's College Research Institute, Canada
  • e SickKids Research Institute, Institute of Health Policy, Management and Evaluation, Canada, Women's College Hospital, Centre for Addiction and Mental Health, Canada
  • f Child Health Evaluative Sciences, Canada
  • g University of Toronto, ICES, Canada

Abstract

BACKGROUND: Emergency department visits as a first point of contact for people with mental illness may reflect poor access to timely outpatient mental health care. We sought to determine the extent to which immigrants use the emergency department as an entryway into mental health services. METHODS: We used linked health and demographic administrative data sets to design a population-based cohort study. We included youth (aged 10-24 yr) with an incident mental health emergency department visit from 2010 to 2014 in Ontario, Canada (n = 118 851). The main outcome measure was an emergency department visit for mental health reasons without prior mental health care from a physician on an outpatient basis. The main predictor of interest was immigrant status (refugee, non-refugee immigrant and non-immigrant). Immigrantspecific predictors included time since migration, and region and country of origin. We used Poisson models to estimate adjusted rate ratios (aRRs) and 95% confidence intervals (CIs). RESULTS: The cohort included 2194 (1.8%) refugee, 6680 (5.6%) non-refugee immigrant and 109 977 (92.5%) nonimmigrant youth. Rates of first mental health contact in the emergency department were higher among refugee (61.3%) and non-refugee immigrant youth (57.6%) than non-immigrant youth (51.3%) (refugee aRR 1.17, 95% CI 1.13-1.21; non-refugee immigrant aRR 1.10, 95% CI 1.08-1.13). Compared with non-refugee immigrants, refugees had a higher rate of first mental health contact in the emergency department (aRR 1.06, 95% CI 1.02-1.11). We also observed higher rates among recent versus longer-Term immigrants (aRR 1.10, 95% CI 1.05-1.16) and immigrants from Central America (aRR 1.17, 95% CI 1.08-1.26) and Africa (aRR 1.15, 95% CI 1.06-1.24) versus from North America and Western Europe. © 2018 Joule Inc. or its licensors.

Author Keywords

[No Keywords available]

Index Keywords

immigrant refugee mental health service human Refugees controlled study Western Europe Central America outpatient emergency ward Mental Health Services ethnology mental health care Mental Disorders Cross-Sectional Studies mental disease Young Adult school child migrant cross-sectional study Humans Adolescent male Emigrants and Immigrants female juvenile Africa Article Ontario major clinical study physician patient attitude outcome assessment cohort analysis hospital emergency service Emergency Service, Hospital Patient Acceptance of Health Care Facilities and Services Utilization Child
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85054575955&doi=10.1503%2fcmaj.180277&partnerID=40&md5=cea8f34229943f28a8af848ed7fcafed
DOI: 10.1503/cmaj.180277
ISSN: 08203946
Cited by: 4
Original Language: English