Language ability and virtual mental healthcare utilisation among immigrant and refugee youth: a population-based cohort study

• Published in: Archives of disease in childhood p. archdischild-2023-326507
• Main Authors: Mohamud, Hodan, Toulany, Alene, Grandi, Sonia M, Altaf, Azmina, Fu, Longdi, Strauss, Rachel, Saunders, Natasha Ruth
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health 19-09-2024; BMJ Publishing Group LTD
• Subjects: Caregivers; Children & youth; Cohort analysis; Country of birth; COVID-19; Economics; Health care; Health insurance; Health literacy; Health services utilization; healthcare disparities; Immigrants; Immigration; Language; Language Acquisition; Language proficiency; Language Skills; Language Tests; mental health; Mental health care; Original research; paediatrics; Pandemics; Pediatrics; Personal health; Population studies; Refugees; Self report; Canada; Ontario Canada; paediatrics; mental health; healthcare disparities
• ISSN: 0003-9888; 1468-2044; 1468-2044
• DOI: 10.1136/archdischild-2023-326507

Background and objectivesThe widespread adoption of virtual care during the pandemic may not have been uniform across populations, including among paediatric immigrants and refugees. We sought to examine the association between virtual mental healthcare utilisation and immigration factors.MethodsThis population-based cohort study of immigrants and refugees (3–17 years) used linked health administrative databases in Ontario, Canada (March 2020 to December 2021). Exposures included self-reported Canadian language ability (CLA) at arrival and immigration category (economic class, family class and refugee). The primary outcome was the visit modality (inperson/virtual) measured as a rate of physician-based mental healthcare visits. Modified Poisson regression model estimated adjusted rate ratios (aRRs) with 95% CIs.ResultsAmong 22 420 immigrants, 12 135 (54%) did not have CLA (economic class: 6310, family class: 2207, refugees: 3618) and 10 285 did (economic class; 6293, family class: 1469, refugees: 2529). The cohort’s mean age (SD) was 12.0 (4.0) years and half (50.3%) were female. Of 71 375 mental health visits, 47 989 (67.2%) were delivered virtually. Compared with economic class immigrants with CLA (referent), refugees with and without CLA had a lower risk of virtual care utilisation (CLA: aRR 0.89, 95% CI 0.86 to 0.93; non-CLA: aRR 0.80, 95% CI 0.77 to 0.83), as did family class immigrants with CLA (aRR 0.96, 95% CI 0.92 to 0.99). No differences in virtual care utilisation were observed among economic class immigrants with CLA and other immigrant groups.ConclusionsLanguage ability at arrival and immigration category are associated with virtual mental healthcare utilisation. Whether findings reflect user preference or inequities in accessibility, particularly for refugees and those without CLA at arrival, warrants further study.