Immigrants’ Use of Online Mental Health Services during the COVID-19 Pandemic

Abstract

Purpose: Canadian immigrants tend to have poorer mental health than Canadians and lower access to mental health resources. Online mental health services (OMHS) offer promise in improving access to mental health care and has not been well-researched for Canadian immigrants. Thus, this study characterized Canadian immigrants’ OMHS use during the COVID-19 pandemic considering confounders (i.e., age and previous OMHS use) and effect modifiers (i.e., gender and income). Methods: Data collected by Mental Health Research Canada were used to evaluate the prevalence of OMHS use and immigrants’ access to OMHS. Immigrant groups were defined by generation status and newcomer status, examined with separate models. First generation immigrants were defined by being born abroad, second generation by being born in Canada with at least one parent born abroad, and third generation by being born in Canada with both parents. Multiple logistic regressions accounted for confounders and effect modifiers. Pandemic phase was explored as a hierarchical variable, but included as a covariate instead due to insufficient evidence suggesting clustering. Results: From February 2021 to July 2022, self-reported OMHS use was 11.5%, nearly double the pre-pandemic prevalence of 6.5%. First generation immigrants had significantly lower odds of OMHS use (OR=0.558, 95% CI: 0.409-0.761) compared to third generation Canadians, while second generation Canadians had similar odds (OR=0.987, 95% CI: 0.726-1.342), controlling for covariates. Younger age, self-identifying as female, low income, previous OMHS use, and later pandemic phase increased the odds of OMHS use compared to older age, being male, medium or high income, no previous OMHS use, and earlier pandemic phase. Interactions between immigrant status with income and gender were significant only for first generation immigrants. The second model indicated similar odds of OMHS use for immigrants who lived in Canada for less than five years and those who lived in Canada for more than five years when controlling for age and previous OMHS use (OR= 0.961, 95% CI: 0.722-1.279). Conclusion: This study provided an understanding of immigrants’ OMHS access in Canada and factors influencing OMHS use. It highlighted the need for strategies to increase access for first generation immigrants to ensure equitable OMHS access.