Electronic Thesis and Dissertation Repository

Thesis Format

Monograph

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Wilk, Piotr

Abstract

The dual continua model of mental health posits that mental illness and mental well-being exist on distinct but related dimensions, offering a holistic framework for understanding one’s mental health. This study examined the relationship between mental health status, defined by the dual continua model, and odds of mental health-related emergency department (ED) visits over three years among adolescents and emerging adults in Ontario and Alberta. Furthermore, the moderating role of unmet mental health care needs was explored. Linked survey and administrative data were used to implement a longitudinal cohort study design. Results suggest mental health status was associated with ED visits, but not once covariates were accounted for. There was no evidence for moderation by unmet mental health care needs. Prior mental health ED visits and residing in Ontario were significantly associated with ED visits. Further research is recommended to investigate the nature of this relationship.

Summary for Lay Audience

Mental health is a complex concept involving both presence of mental illnesses and level of positive mental health, such as feelings of happiness and life satisfaction. The dual continua model of mental health helps us understand this complexity by showing that mental illness and positive mental health are separate but related aspects of our overall mental health. For example, a person can experience mental illness or symptoms of a mental illness while still having high levels of life satisfaction, or they may have no mental illnesses but still feel unhappy.

This study explored whether mental health status, as described by the dual continua model, could predict the odds of using emergency departments (EDs) for mental health-related reasons over a three-year period. This study also looked at whether difficulties accessing mental health care, known as unmet mental health care needs, might influence this relationship. To investigate these research questions, we used survey data from people in Ontario and Alberta, combined with administrative health care data from EDs in these two provinces. Our approach involved following a group of individuals over time to track patterns in mental health care use.

Our findings showed that a person’s mental health status based on the dual continua model was linked to how often they visited EDs for mental health concerns, however, this relationship was better explained by other factors. We also found no evidence that unmet mental health care needs played a role in this relationship. However, factors like having a past mental health-related ED visit and living in Ontario were linked to higher chances of using the ED for mental health reasons.

These results suggest that other factors beyond mental health status might drive ED use, such as the availability and accessibility of regular mental health care services. The study highlights the importance of providing ongoing support for people who repeatedly use EDs for mental health concerns, ensuring they can access care when and where they need it. This research helps policymakers and health care providers better understand how to support vulnerable individuals and reduce reliance on EDs for mental health care.

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