Trends and socioeconomic inequalities in acute mental health service use in Canada, 2004–2019: a nationally representative retrospective cohort study

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BACKGROUND: Acute mental health service use (AMHSU), that is, hospitalisations and emergency department (ED) visits for mental health, have been rising in the Canadian province of Ontario and globally; however, national-level estimates are not available. We examine trends and socioeconomic inequalities in AMHSU in the Canadian adult population between 2004 and 2019. METHODS: Using the Canadian Community Health Survey linked to tax and health administrative datasets, we reported prevalence rates of AMHSU using negative binomial regression models. Income-based absolute inequalities in AMHSU were reported using the Slope Index of Inequality. RESULTS: Over the study period, hospitalisations for mood disorders decreased from 144.8 (95% CI: 116.0-173.7) to 67.5 (95% CI: 54.5-80.4) per 100 000, while those for substance-related disorders (SRD) increased. Rates of ED visits increased for all conditions, with the largest increase for anxiety disorders, from 252.3 (95% CI: 210.9-293.6) to 434.1 (95% CI: 382.2-486.1) per 100 000. Females had higher rates of hospitalisations and ED visits for all conditions except SRD. We found pronounced income-based inequalities in both hospitalisations and ED visits for mental health, comparing those at the top versus bottom of the income distribution. Absolute inequalities for hospitalisations widened for SRD, from -93.6 (95% CI: -131.1 to -56.1) to -135.2 (95% CI: -203.4 to -67.1) per 100 000, and decreased for mood disorders, from -309.5 (95% CI: -443.8 to -175.3) to -126.0 (95% CI: -182.0 to -69.9) per 100 000. Additionally, absolute inequalities increased for ED visits across all mental health conditions. CONCLUSION: Interventions aimed at improving access to preventive services could mitigate observed inequalities in AMHSU.

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