The relationship between neighbourhood income and youth mental health service use differs by immigration: Analysis of population-based data in British Columbia, Canada

Abstract

Abstract Purpose We investigated the relationship between neighbourhood income quintile and mental health service use by immigration among youth and explored changes during the COVID-19 pandemic. Method We used administrative data to examine mental health service use in British Columbia, Canada, among youth aged 10 to 24 between April 1, 2019, and March 31, 2022. We compared rates of community-based service use, emergency department visits, and hospitalizations and the proportion of involuntary admissions by neighbourhood income quintile and immigration. We used models stratified by immigration to estimate the relationship with income. Results Non-immigrant youth used substantially more services than immigrant youth. Service use increased following the pandemic's start and peaked between January and March 2021. We observed a clear income gradient for community-based service use among both immigrant and non-immigrant youth, but the direction of the gradient was reversed. Service use was highest among non-immigrant youth in lower-income neighbourhoods and lowest for immigrant youth in lower-income neighbourhoods. We observed similar patterns of income gradient for non-immigrant youth for emergency department visits and hospitalization. The proportion of involuntary admissions was higher for immigrant youth. Conclusions Mental health service use was substantially lower among immigrant youth than non-immigrant youth, but higher proportions of immigrant youth were hospitalized involuntarily. The reverse income gradient patterns observed for community-mental health service use are noteworthy and suggest significant barriers to accessing preventable care among immigrant youth, particularly those living in lower-income neighbourhoods.