Abstract
ObjectivePublic and private mental health-funded services differ in terms of accessibility, affordability, and perceived quality, potentially impacting outcomes. Understanding how different mental health service types and sociodemographic factors correlate with depressive symptoms is critical for informing equitable mental health policies and resource allocation. This study investigates the associations between type of mental health service used and depressive symptoms.MethodData from Mental Health Research Canada's National Poll Understanding the Mental Health of Canadians 2022 to 2024 was analyzed. Depressive symptoms were measured using the Patient Health Questionnaire-9 (PHQ-9). Mental health-funded services were classified as public or private. Linear and logistic regressions examined associations with depressive symptom severity (total PHQ-9 scores) and presence of depressive symptoms (PHQ-9 score ≥ 10). Mediation analysis was conducted to explore the mediating effects of household income on the relationship between funded service type and depressive symptoms.ResultsThe study included 2,072 adults, with 1,000 (47.4%) reporting depressive symptoms. Compared to public services, individuals using private services (n = 880, 41.8%) had lower PHQ-9 scores (aCoef: -1.34, 95% CI [-1.97, -0.70]; p < .001) and lower odds of having depressive symptoms (aOR: 0.74, 95% CI [0.60, 0.91]; p = .004). Household income partially mediated the relationship between funded service type and PHQ-9 scores, accounting for 39.5% of the effect (p < .001), and fully mediated the relationship with the presence of depressive symptoms, with a mediation effect of 40.6%. Additionally, individuals who attended services monthly, weekly, or more frequently had higher odds of having depressive symptoms (aOR: 2.86, 95% CI [1.23, 6.68]; p = .015).ConclusionThis study highlights the complex interplay between mental health service types used, sociodemographic factors, and mental health outcomes. These insights underscore the need to address barriers to effective mental health care access and tailor interventions to individuals' socioeconomic and demographic contexts to optimize outcomes.Plain Language Summary TitleHow Public and Private Mental Health Services Relate to Depression in Canada.