The Hospital for Sick Children, Toronto, Canada.
Department of Pediatrics, University of Toronto, Toronto, Canada.
Can J Psychiatry. 2023 Dec;68(12):904-915. doi: 10.1177/07067437231156254. Epub 2023 Feb 28.
We sought to evaluate the relationship between social determinants of health and physician-based mental healthcare utilization and virtual care use among children and adolescents in Ontario, Canada, during the COVID-19 pandemic.
This population-based repeated cross-sectional study of children and adolescents (3-17 years; = 2.5 million) used linked health and demographic administrative data in Ontario, Canada (2017-2021). Multivariable Poisson regressions with generalized estimating equations compared rates of outpatient physician-based mental healthcare use during the first year of the COVID-19 pandemic with expected rates based on pre-COVID patterns. Analyses were conducted by socioeconomic status (material deprivation quintiles of the Ontario Marginalization index), urban/rural region of residence, and immigration status.
Overall, pediatric physician-based mental healthcare visits were 5% lower than expected (rate ratio [RR] = 0.95, 95% confidence interval [CI], 0.92 to 0.98) among those living in the most deprived areas in the first year of the pandemic, compared with the least deprived with 4% higher than expected rates (RR = 1.04, 95% CI, 1.02 to 1.06). There were no differences in overall observed and expected visit rates by region of residence. Immigrants had 14% to 26% higher visit rates compared with expected from July 2020 to February 2021, whereas refugees had similarly observed and expected rates. Virtual care use was approximately 65% among refugees, compared with 70% for all strata.
During the first year of the pandemic, pediatric physician-based mental healthcare utilization was higher among immigrants and lower than expected among those with lower socioeconomic status. Refugees had the lowest use of virtual care. Further work is needed to understand whether these differences reflect issues in access to care or the need to help inform ongoing pandemic recovery planning.
我们旨在评估在加拿大安大略省 COVID-19 大流行期间，社会决定因素与基于医生的儿童和青少年心理健康保健利用以及虚拟护理利用之间的关系。
本项基于人群的儿童和青少年（3-17 岁；=250 万）的重复横断面研究使用了加拿大安大略省的健康和人口统计行政数据。使用广义估计方程的多变量泊松回归比较了 COVID-19 大流行第一年的门诊医生为基础的心理健康保健利用率与基于 COVID 前模式的预期率。分析按社会经济地位（安大略省边缘化指数的物质剥夺五分位数）、居住的城乡地区和移民身份进行。
总体而言，与最贫困地区的人群相比，在大流行的第一年，生活在最贫困地区的人群的儿科医生为基础的心理健康保健就诊率低 5%（比率比 [RR] = 0.95，95%置信区间 [CI]，0.92 至 0.98），而最贫困地区的就诊率比预期高 4%（RR = 1.04，95%CI，1.02 至 1.06）。按居住地区划分，观察到的就诊率和预期就诊率没有差异。与预期相比，2020 年 7 月至 2021 年 2 月期间，移民的就诊率高 14%至 26%，而难民的观察就诊率和预期就诊率相似。难民使用虚拟护理的比例约为 65%，而所有阶层的比例为 70%。
在大流行的第一年，移民的儿科医生为基础的心理健康保健利用率较高，而社会经济地位较低的人的利用率低于预期。难民使用虚拟护理的比例最低。需要进一步研究以了解这些差异是否反映了获得护理方面的问题，还是需要帮助为正在进行的大流行恢复计划提供信息。
