Neighbourhood characteristics related to mental health service use among adults with diabetes: a population-based cohort study in New Brunswick, Canada.

OBJECTIVE: It has been postulated that social and economic inequalities may shape the distributions of comorbid diabetes and mental illness. This observational cohort study using linked population-based administrative and geospatial datasets aimed to describe associations between neighbourhood socioenvironments and disorder-specific mental health service use among adults with diabetes in the province of New Brunswick, Canada. RESULTS: A baseline cohort of 66,275 persons aged 19 and over living with diabetes was identified. One-quarter (26.3%) had used healthcare services for mood and anxiety disorders at least once during the six-year follow-up period 2012/2013-2017/2018. Based on Cox proportional hazards models, the risk of mental health service contacts was significantly higher among those residing in the most materially deprived neighbourhoods [HR: 1.07 (95% CI: 1.01-1.14)] compared to those in the least so, and those in areas characterized with the highest residential instability [HR: 1.13 (95% CI: 1.05-1.22)] compared to those in areas with the lowest instability. Among adults with incident diabetes (N = 4410), age and sex but not neighbourhood factors were related to differential help-seeking behaviours for mental health problems. These findings underscored the gap between theoretical postulations and population-based observations in delineating the syndemics of neighbourhood socioenvironments and mental health outcomes in populations with high diabetes prevalence.

Gendering Neighbourhood Marginalization Metrics in Mental Health Services Research: A Cross-Sectional Exploration of a Rural and Small Urban Population.

Background: Little is known about the extent to which socioenvironmental characteristics may influence mental health outcomes in smaller population centres or differently among women and men. This study used a gender-based analysis approach to explore individual- and neighbourhood-level sex differences in mental health service use in a context of uniquely smaller urban and rural settlements. Methods: This cross-sectional analysis leveraged multiple person-based administrative health datasets linked with geospatial datasets among the population aged 1 and over in the province of New Brunswick, Canada. We used multinomial logistic regression to examine associations between neighbourhood characteristics with risk of service contacts for mood and anxiety disorders in 2015/2016, characterizing the areal measures among all residents (gender neutral) and by males and females separately (gender specific), and controlling for age group. Results: Among the province's 707,575 eligible residents, 10.7% (females: 14.0%; males: 7.3%) used mental health services in the year of observation. In models adjusted for gender-neutral neighbourhood characteristics, service contacts were significantly more likely among persons residing in the most materially deprived areas compared with the least (OR = 1.09 [95% CI: 1.05-1.12]); when stratified by individuals' sex, the risk pattern held for females (OR = 1.13 [95% CI: 1.09-1.17]) but not males (OR = 1.00 [95% CI: 0.96-1.05]). Residence in the most female-specific materially deprived neighbourhoods was independently associated with higher risk of mental health service use among individual females (OR = 1.08 [95% CI: 1.02-1.14]) but not among males (OR = 1.02 [95% CI: 0.95-1.10]). Conclusion: These findings emphasize that research needs to better integrate sex and gender in contextual measures aiming to inform community interventions and neighbourhood designs, notably in small urban and rural settings, to reduce socioeconomic inequalities in the burden of mental disorders.

Neighbourhood environments and the risk of hospital admission for cardiometabolic and mental health comorbidities in multiple sclerosis: A population cohort analysis using linked administrative data.

This study exploits administrative data for neuroepidemiological research and examines associations between neighbourhood environments and risk of hospitalization among multiple sclerosis (MS) patients in New Brunswick, Canada. We created a provincial database of MS patients by linking administrative health records with geographic-based characteristics of local communities. Using Cox models, we found the risk of admission for cardiometabolic complications was lower among residents of ethnically homogeneous neighbourhoods (hazards ratio [HR]: 0.75 [95% confidence interval (CI): 0.60-0.95]); that for mental health disorders was higher in socioeconomically deprived (HR: 1.80 [95% CI: 1.06-3.05]) and residentially unstable (HR: 1.61 [95% CI: 1.05-2.46]) neighbourhoods. Results suggest that selected neighbourhood environments may be associated with differential hospital burden among MS patients.

Discrimination in the health care system among higher-weight adults: evidence from a Canadian national cross-sectional survey. / Discrimination dans le système de soins de santé parmi les adultes au poids plus élevé : données issues d'une enquête transversale nationale canadienne.

INTRODUCTION: Weight-related social stigma is associated with adverse health outcomes. Health care systems are not exempt of weight stigma, which includes stereotyping, prejudice and discrimination. The objective of this study was to examine the association between body mass index (BMI) class and experiencing discrimination in health care. METHODS: We used data from the 2013 Canadian Community Health Survey, which included measurements of discrimination never collected previously on a national scale. Logistic regression analysis was used to assess the risk of self-reported discrimination in health care in adults (≥18 years) across weight categories: not obese (BMI < 30 kg/m2), obese class I (BMI = 30-< 35 kg/m2) and obese class II or III (BMI ≥ 35 kg/m2). RESULTS: One in 15 (6.4%; 95% CI: 5.7-7.0%) of the adult population reported discrimination in a health care setting (e.g. physician's office, clinic or hospital). Compared with those in the not obese group, the risk of discrimination in health care was somewhat higher among those in the class I obesity category (odds ratio [OR] = 1.20; 95% CI: 1.00-1.44) and significantly higher among those in class II/III (OR = 1.52; 95% CI: 1.21-1.91), after controlling for sex, age and other socioeconomic characteristics. CONCLUSION: Quantified experiences of weight-related discrimination underscore the need to change practitioner attitudes and practices as well as the policies and procedures of the health care system. More research is needed on the social and economic impacts of weight stigma to inform focused investments for reducing discrimination in the health care system as a microcosm of the society it reflects.

Healthcare Service Use for Mood and Anxiety Disorders Following Acute Myocardial Infarction: A Cohort Study of the Role of Neighbourhood Socioenvironmental Characteristics in a Largely Rural Population.

Depression and other mood and anxiety disorders are recognized as common complications following cardiac events. Some studies report poorer cardiac outcomes among patients in socioeconomically marginalized neighbourhoods. This study aimed to describe associations between socioeconomic and built environment characteristics of neighbourhood environments and mental health service contacts following an acute myocardial infarction (AMI or heart attack) among adults in the province of New Brunswick, Canada. This province is characterized largely by residents in small towns and rural areas. A cohort of all adults aged 45 and over surviving AMI and without a recent record of mental disorders was identified by linking provincial medical-administrative datasets. Residential histories were tracked over time to assign neighbourhood measures of marginalization, local climate zones, and physical activity friendliness (i.e., walkability). Cox models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for the risk of healthcare use for mood and anxiety disorders over the period 2003/04-2015/16 by neighbourhood characteristics. The baseline cohort included 13,330 post-AMI patients, among whom 32.5% were found to have used healthcare services for a diagnosed mood or anxiety disorder at least once during the period of observation. Among men, an increased risk of mental health service use was found among those living in areas characterized by high ethnic concentration (HR: 1.14 (95%CI: 1.03-1.25)). Among women, the risk was significantly higher among those in materially deprived neighbourhoods (HR: 1.16 (95%CI: 1.01-1.33)). We found no convincing evidence of associations between this outcome and the other neighbourhood characteristics considered here. These results suggest that selected features of neighbourhood environments may increase the burden on the healthcare system for mental health comorbidities among adults with cardiovascular disease. Further research is needed to understand the differing needs of socioeconomically marginalized populations to improve mental health outcomes following an acute cardiac event, specifically in the context of smaller and rural communities and of universal healthcare coverage.