Despite growing evidence that anxiety can be a significant problem in late-life, information regarding the use of mental health services by older adults for anxiety is lacking. The current research project consists of three studies focusing on this issue. The first study examines the rates of mental health service use among older adults with anxiety disorders and high levels of anxiety symptoms, as well as individual characteristics associated with this use. The second study examines various aspects of social support as correlates of anxiety disorders in older adults, and the role of social support as an enabling resource for mental health service use. Finally, the third study examines three important outcomes of service use among older adults: treatment satisfaction, perceived treatment effectiveness, and dropout. The data for these studies came from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), a national population-based survey that includes 12,792 respondents aged 55+ years. This research found that older adults with significant anxiety were less likely to use services than those with mood disorders, and that indicators of need for services were the strongest predictors of use. Lower levels of functional social support were related to the presence of anxiety disorders among older adults, and lower levels of perceived emotional/informational support and positive social interactions predicted greater use of services for adults throughout the lifespan. Finally, older adults were generally satisfied with services, perceived them as helpful, and were likely to remain in treatment. Analyses indicated that individual characteristics likely play only a small role in these outcomes. In general, this project provides new and important information that can inform policy, clinical work, and future research regarding late-life anxiety.

Despite growing evidence that anxiety can be a significant problem in late-life, information regarding the use of mental health services by older adults for anxiety is lacking. The current research project consists of three studies focusing on this issue. The first study examines the rates of mental health service use among older adults with anxiety disorders and high levels of anxiety symptoms, as well as individual characteristics associated with this use. The second study examines various aspects of social support as correlates of anxiety disorders in older adults, and the role of social support as an enabling resource for mental health service use. Finally, the third study examines three important outcomes of service use among older adults: treatment satisfaction, perceived treatment effectiveness, and dropout. The data for these studies came from the Canadian Community Health Survey: Mental Health and Well-Being (CCHS 1.2), a national population-based survey that includes 12,792 respondents aged 55+ years. This research found that older adults with significant anxiety were less likely to use services than those with mood disorders, and that indicators of need for services were the strongest predictors of use. Lower levels of functional social support were related to the presence of anxiety disorders among older adults, and lower levels of perceived emotional/informational support and positive social interactions predicted greater use of services for adults throughout the lifespan. Finally, older adults were generally satisfied with services, perceived them as helpful, and were likely to remain in treatment. Analyses indicated that individual characteristics likely play only a small role in these outcomes. In general, this project provides new and important information that can inform policy, clinical work, and future research regarding late-life anxiety.

Purpose: The first objectives of the current study was to determine whether disparities exist in mental health and mental health service use between minority and majority Canadian Francophone and Anglophone communities both within and outside of Quebec. The second objectives was to examine if official language minority-majority status was associated with the presence of common mental health problems and mental health service utilization.<p> Methodology: The current study used data from the Canadian Community Health Survey: Mental Health and Well-being, Cycle 1.2.7 Two main comparisons were made: Quebec Francophones to Quebec Anglophones, and outside Quebec Francophones to outside Quebec Anglophones. Twelve-month and lifetime prevalences of mental disorders and mental health service use were examined through bivariate analyses. Logistic regression analyses determined whether official language minority-majority status significantly predicts mental health problems and mental health service use using the Determinants of Health Model8-10 and Andersens behavioural model.11-13<p> Results: Very few significant differences were found between official language groups both outside and within Quebec, though some notable differences were found between Quebec and outside Quebec: Anglophones and Francophones outside Quebec had a higher prevalence of poor mental health and low life satisfaction compared their respective language counterparts in Quebec. Respondents from outside Quebec had a higher prevalence of consulting with a psychiatrist than respondents from Quebec. There was no significant association between membership in an Official Language Minority Community and mental health problems, and mental health service use. Implications: Although our results indicate that very few differences exist between official language minority and majority groups, these findings remain important and can help aid key stakeholders redirect resources and develop policies and programs towards areas and geographic locations wherein health disparities exist.

Purpose: The first objectives of the current study was to determine whether disparities exist in mental health and mental health service use between minority and majority Canadian Francophone and Anglophone communities both within and outside of Quebec. The second objectives was to examine if official language minority-majority status was associated with the presence of common mental health problems and mental health service utilization.<p> Methodology: The current study used data from the Canadian Community Health Survey: Mental Health and Well-being, Cycle 1.2.7 Two main comparisons were made: Quebec Francophones to Quebec Anglophones, and outside Quebec Francophones to outside Quebec Anglophones. Twelve-month and lifetime prevalences of mental disorders and mental health service use were examined through bivariate analyses. Logistic regression analyses determined whether official language minority-majority status significantly predicts mental health problems and mental health service use using the Determinants of Health Model8-10 and Andersens behavioural model.11-13<p> Results: Very few significant differences were found between official language groups both outside and within Quebec, though some notable differences were found between Quebec and outside Quebec: Anglophones and Francophones outside Quebec had a higher prevalence of poor mental health and low life satisfaction compared their respective language counterparts in Quebec. Respondents from outside Quebec had a higher prevalence of consulting with a psychiatrist than respondents from Quebec. There was no significant association between membership in an Official Language Minority Community and mental health problems, and mental health service use. Implications: Although our results indicate that very few differences exist between official language minority and majority groups, these findings remain important and can help aid key stakeholders redirect resources and develop policies and programs towards areas and geographic locations wherein health disparities exist.

This thesis aimed to examine service contact among children and young people with mental health problems, and has three complementary parts. The first is a secondary analysis of data from the British Child and Adolescent Mental Health Survey (BCAMHS) 2004, which explored mental health related service contact in relation to psychopathology over three years. The second and third parts focussed on young people with ADHD in transition from child services, which is a particularly challenging time. This involved a qualitative interview study of young peoples’ experiences, and an analysis of primary care prescribing of ADHD medication over the transition period using a cohort from the Clinical Practice Research Datalink from 2005-2013. Less than a third of children with a psychiatric disorder in BCAMHS reported contact with child mental health services. Instead, teachers were the most frequently used service, with two-thirds reporting mental health related contact. Interviews with young people with ADHD highlighted themes including concerns around medication management post transition and need for information. The prescribing analysis found that the majority of adolescents on ADHD medication at age 16 stopped during the transition period. This continuing disparity between estimates of symptom persistence and medication persistence suggests that many may be stopping medication from which they could still benefit; as various barriers have been identified to ongoing prescribing. In summary, the findings of these three linked studies suggest common themes in terms of unmet needs and gaps between policy and practice in mental health services for children and young people. One of the chief implications is the need for oversight and policy levers to ensure the implementation of best practice, accompanied by complementary efforts to better understand and overcome other barriers to providing optimal care, including research into knowledge and attitudes of different groups and the provision of targeted training.

My dissertation examines the depression prevalence, symptom patterns and dimension, and mental health service use among Chinese Americans. The purpose of this research is to, 1) provide epidemiological data on the prevalence of depression among Chinese Americans, 2) examine sociocultural impacts on the prevalence and specific symptoms patterns of depression, and 3) generate implications for more culturally-sensitive approaches in psychiatric diagnosis and treatment. I use secondary data from the Collaborative Psychiatric Epidemiology Studies (CPES). The CPES consists of three nationally representative surveys conducted between 2001 and 2003. Each of three substantive chapters attempts to a set of issues, and together they contribute to the literature on generational differences in mental health status and help-seeking behaviors among Chinese Americans. The first substantive chapter examines depression prevalence and correlates among different generations of Chinese Americans, using non-Hispanic whites as a comparison group, using weighted multinomial logistic regression. Results of the study indicate that Chinese Americans in general have a lower risk of depression than do non-Hispanic whites. Moreover, the prevalence and correlates of depression do not show a linear trend of difference from first to second to third-or-higher generation Chinese Americans, and then to non-Hispanic whites; rather, the risk of depression and its associated with social relational factors present distinct patterns for first and second generation Chinese Americans, compared to third-or-higher generation Chinese Americans and non-Hispanic whites. Specifically, friend network and extended family network play different roles in their influence on depression risk for different generations of Chinese Americans. In the Chapter Four, I conduct exploratory factor analysis to examine two subgroups of Chinese Americans, the foreign-born and the US-born, and compare them to the non-Hispanic whites. I also conduct weighted binary logistic regression to examine the patterns of depressive symptoms for Chinese Americans (separate by nativity status) and compare the two groups to non-Hispanic whites. I also examine how demographic characteristics and social factors are related to different dimensions of depressive symptoms for each group. I also find very similar factors structures of DSM-IV depressive symptoms among foreign-born Chinese Americans, US-born Chinese Americans, and non-Hispanic whites. For all three groups, suicidal ideation or attempt is a construct that is distinct from the rest of the symptoms items. The three groups have different social correlates, yet there are only minor differences in the social correlates for each one of the four depression dimensions within each group. Chronic physical condition is the most consistently significant predictor, for the negative affect, somatic symptoms, and cognitive symptoms among the two Chinese groups, and for all four dimensions of depression among non-Hispanic whites. Finally, in Chapter Five, I find significant heterogeneity of exclusive complementary and alternative medicine (CAM) use by race/ethnicity and generational status, as well as English proficiency, gender, age, marital status, education, employment status, having insurance, and having any probably psychiatric disorder. Specifically, first generation Chinese immigrants lag behind second, third-or-higher generation Chinese Americans, and non-Hispanic whites in the likelihood of using exclusive CAM services, as well as any services in general. In addition, this chapter finds that exclusive CAM service use was more popular than the use of only conventional Western medicine or a combination of both, among all Chinese Americans except for the second generations. The findings provide a more nuanced understanding of the pattern of mental health service use among Chinese Americans. / Sociology