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Mental health services underutilized by those with depression in Ontario

Despite the incidence of major depression in Ontario, Canada, more than half of patients said they did not utilize physician-based mental health services. Researchers found, however, that women used services about 10% more than men.

"It's concerning to us that many Ontarians with mental health needs are not accessing clinician-based care," study researcher Katherine L. W. Smith, MHSc, an epidemiologist at the Centre for Research on Inner City Health of St. Michael's Hospital, said in a press release. "Some people may seek nonmedical types of support or care, such as clergy, alternative medicine, psychologists or social workers. But we don't know for sure, so the gap remains of concern."

Smith and colleagues, including Flora Matheson, PhD, medical sociologist at St. Michael's, linked data from the Canadian Community Health Survey (2000-2001) to medical records in Ontario (n=24,677). Major depression was reported in 7.8% of the sample population. Of those, 55.3% did not see a physician for mental health in the following year, although researchers are unsure why.

Flora Matheson

They hypothesize that ethnic groups may be uncomfortable utilizing physician-based mental health care or might prefer to use nonmedical services. Additionally, some people may be deterred because of stigma.

Although women were more likely to seek care than men, researchers reported that men sought help once a mental health problem reached a certain threshold, according to the press release. Among those with depression, there was a 5% gap in which sex sought care for mental illness — slightly more women than men saw a primary care physician for depression (30.4% vs. 24.6%). There was a smaller difference in which sex saw a specialty physician, such as a psychiatrist.

Researchers reported a significant difference by sex among those without major depression — 21% of women used mental health services vs. 13% of men.

"Physicians may be partly responsible for some of the observed differences in mental health system contact," the researchers wrote. "Evidence suggests that doctors are more likely to ask questions about feelings and emotions of their female patients, which could explain some of the higher mental health service use in the primary care sector among women. Future research should focus on gender differences in mental health specialty referral patterns and whether severity of illness influences the level of care received by men and women (eg, primary care or specialist)."

Disclosure: The researchers report no relevant financial disclosures.