Electronic Thesis and Dissertation Repository

Thesis Format

Integrated Article

Degree

Master of Science

Program

Epidemiology and Biostatistics

Supervisor

Anderson, Kelly K.

Abstract

Ethnicity and socioeconomic status have been implicated as determinants of inpatient mental health service use internationally, but there is little Canadian evidence. This thesis uses data from the 2006 Canadian Census linked to the 2006/07 through 2008/09 Discharge Abstract Database (excluding Ontario and Quebec) to investigate the relative prevalence of psychiatric hospitalization and the relative risk of 30-day readmission following a psychiatric hospitalization for adults (aged 25 to 64) across ethnic groups and socioeconomic status, measured by income, education, and employment. Results suggest that the prevalence of psychiatric hospitalization was lower in ethnic minority groups relative to White Canadians, and for those in higher socioeconomic positions relative to those in lower positions. There were fewer statistically significant differences in the risk of 30-day readmission. Future research should explore these trends with data on mental illness severity or access to other mental health care to improve understanding of reasons for hospitalization.

Summary for Lay Audience

Hospitalization is an indicator of severe mental illness, and can be necessary to manage psychiatric symptoms. Internationally, research has shown that the risk of hospitalization for mental illness is not equal across social groups. Due to the diversity of the Canadian population and differences in access to appropriate health care, it is important to consider ethnicity and socioeconomic status as social determinants of health in research on psychiatric hospitalizations in Canada. Previous international literature suggests that people in ethnic minority groups or lower socioeconomic positions experience more hospitalizations, although few studies control for the effect of other influencing factors. With a high level of correlation between socioeconomic status and ethnicity, it is important to control for the effects of one when studying the other. The ethnic groups included in past literature are often highly aggregated and do not take into account variations within larger ethnic groups (e.g. “Asian”). Furthermore, few studies include multiple dimensions of socioeconomic status. Within Canada there are few studies on social determinants of all hospitalizations for mental illness, although studies have found differences in access to any type of mental health care services across ethnic and socioeconomic groups.

This thesis uses data from administrative hospital discharge records and the 2006 Canadian Census (excluding Ontario and Quebec) to compare the prevalence of hospitalization for mental illness or self-harm and subsequent risk of 30-day readmission across ethnic groups and socioeconomic status. The prevalence of hospitalization was lower in ethnic minority groups and in those in higher socioeconomic positions (measured by education, employment, and income adjusted for family size). There were fewer significant differences in the incidence of 30-day readmission across groups with a few exceptions: West Asian people had higher risk compared to White people, and people who worked 14 to 48 weeks had lower risk of readmission compared to those who worked less than 14 weeks. These associations are likely due to a combination of differing need for and access to mental health services across groups. Future research should include updated data across Canada and should examine the reasons for hospitalization for mental illness across social determinants.

This thesis uses data from administrative hospital discharge records and the 2006 Canadian Census (excluding Ontario and Quebec) to compare the prevalence of hospitalization for mental illness or self-harm and subsequent risk of 30-day readmission across ethnic groups and socioeconomic status. The prevalence of hospitalization was lower in ethnic minority groups and in those in higher socioeconomic positions (measured by education, employment, and income adjusted for family size). There were fewer significant differences in the incidence of 30-day readmission across groups with a few exceptions: West Asian people had higher risk compared to White people, and people who were mostly employed had lower risk of readmission compared to those who were mostly unemployed. These associations are likely due to a combination of differing need for and access to mental health services across groups. Future research should include updated data across Canada and should examine the reasons for hospitalization for mental illness across social determinants.

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