Sociodemographic and mental health predictors of mental health service use across provider types

Abstract

Objective To examine trends in mental health service use across four provider types (family doctors, psychiatrists, psychologists, and social workers) and identify sociodemographic predictors of provider-specific access in Canada. Methods This study analyzes seven cycles (2007–2020) of the Canadian Community Health Survey, a nationally representative cross-sectional survey. Trends over time were examined using weighted proportions and counts of service users. Weighted multivariable logistic regression models were applied to the 2019–2020 cycle to assess associations between sociodemographic factors and provider-specific service use. Results Family doctors were consistently the most accessed providers for mental health concerns, followed by psychologists and social workers, with psychiatrists being least accessed. Psychologist and social worker use increased between 2017 and 2019. In the adjusted regression models (2019–2020), women had higher odds of using family doctors (AOR = 1.21, 95% CI: 1.05–1.39) and social workers (1.19, 1.02–1.40) and lower odds of psychiatrists (AOR = 0.66, 95% CI:0.55–0.79) than men. Adults 65 + had greater odds of family-doctor use (AOR = 4.82, 95% CI: 3.59–6.47) and lower odds of psychologist (AOR = 0.33, 95% CI: 0.24–0.45) and social-worker use (AOR = 0.21, 95% CI:0.16–0.29) than ages 12–17. Post-secondary education (vs less than secondary school) was associated with higher psychologist use (AOR = 1.83, 95% CI 1.12–2.98). Higher income (≥$80,000 vs < $20,000) was associated with lower psychiatrist use (AOR = 0.66, 95% CI 0.50–0.86). Non-Indigenous respondents more often used psychologists (AOR = 1.58, 95% CI: 1.13–2.23), and respondents who are not a visible minority more often used family doctors (AOR = 1.37, 95% CI:1.06–1.77). Conclusion This study reveals a stratified mental health care system in Canada, where sociodemographic factors shape who accesses which providers. While primary care dominates, growth in psychologist and social worker use suggests shifting patterns of engagement. Findings underscore the need for policies that address financial and structural barriers, promote equitable access, and expand coverage for community-based mental health providers.