Sobers Mercedes, Smith Peter M, Massaquoi Notisha, Hamilton Hayley A, Gesink Dionne
Dalla Lana School of Public Health (Sobers, Smith, Hamilton, Gesink), University of Toronto; Office of Health Equity, Centre for Addiction and Mental Health (Sobers); Institute for Work & Health (Smith); Department of Health and Society (Massaquoi), University of Toronto [Scarborough]; Institute for Mental Health Policy Research, Centre for Addiction and Mental Health (Hamilton), Toronto, Ont.
CMAJ. 2025 Sep 7;197(29):E901-E914. doi: 10.1503/cmaj.241733.
Race is a social construct reflecting broader systemic forces that can affect health, including mental health. We sought to ascertain whether patterns of mental health care service use are associated with race among adolescents in Ontario.
We conducted a cross-sectional study using data from the 2015-2019 Ontario Student Drug Use and Health Survey. We assessed mental health care access for students in grades 7-12 younger than 20 years based on their responses about their care usage in the past 12 months. We used logistic and Poisson regression models to analyze differences in service utilization, with interaction terms for sex and mental distress (measured using the Kessler Psychological Distress Scale-6 Items).
Black male students with low distress were nearly twice as likely as White males to report initiating care (odds ratio [OR] 1.50, 95% confidence interval [CI] 1.09-2.06). However, when Black males' distress worsened to moderate levels, they became less than half as likely to access care than their White peers (OR 0.41, 95% CI 0.20-0.84). Black females faced disparities at all distress levels, with the gap widening as distress increased (moderate distress OR 0.78, 95% CI 0.46-1.34; serious distress OR 0.60, 95% CI 0.40-0.89). Even after initiating care, Black females mostly had lower odds of access frequency than White females (low distress OR 0.78, 95% CI 0.66-0.92; moderate distress OR 1.00, 95% CI 0.84-1.19; serious distress OR 0.60, 95% CI 0.42-0.85).
Black survey respondents with psychological distress were less likely to report using mental health services than their White peers, with Black female respondents being the least likely to access care. Policy and practice should seek to address systemic racism and a lack of culturally relevant care for Black adolescents with mental distress.
种族是一种社会建构，反映了包括心理健康在内的可能影响健康的更广泛的系统性力量。我们试图确定安大略省青少年心理健康护理服务的使用模式是否与种族有关。
我们使用2015 - 2019年安大略省学生药物使用与健康调查的数据进行了一项横断面研究。我们根据7至12年级、年龄小于20岁的学生对过去12个月护理使用情况的回答，评估他们获得心理健康护理的情况。我们使用逻辑回归和泊松回归模型分析服务利用的差异，并加入性别和心理困扰（使用凯斯勒心理困扰量表 - 6项）的交互项。
低困扰程度的黑人男学生报告开始接受护理的可能性几乎是白人男学生的两倍（优势比[OR] 1.50，95%置信区间[CI] 1.09 - 2.06）。然而，当黑人男学生的困扰程度恶化到中度时，他们获得护理的可能性不到白人同龄人的一半（OR 0.41，95% CI 0.20 - 0.84）。黑人女学生在所有困扰程度下都面临差异，且随着困扰程度增加差距扩大（中度困扰OR 0.78，95% CI 0.46 - 1.34；严重困扰OR 0.60，95% CI 0.40 - 0.89）。即使在开始接受护理后，黑人女学生获得护理频率的几率大多低于白人女学生（低困扰OR 0.78，95% CI 0.66 - 0.92；中度困扰OR 1.00，95% CI 0.84 - 1.19；严重困扰OR 0.60，95% CI 0.42 - 0.85）。
有心理困扰的黑人调查对象报告使用心理健康服务的可能性低于白人同龄人，其中黑人女性调查对象获得护理的可能性最小。政策和实践应致力于解决系统性种族主义问题以及为有心理困扰的黑人青少年提供缺乏文化相关性护理的问题。
