Understanding the Effect of Social Support on Access to Mental Health Care Among Adult Canadians: Findings from a Population-Based Study

Background/Purpose: Previous studies have identified factors influencing unmet healthcare needs based on the behavioral model of access to healthcare services developed by (Aday & Andersen, 1974). The model hypothesized that health care service use is influenced by predisposing, enabling, and need factors (Aday & Andersen, 1974). Predisposing factors describe an individual’s tendency to use healthcare service and include demographic factors such as age, gender, and race/ethnicity. Enabling factors refer to the resources (e.g., marital status, income, and level of education) individuals have and can draw on in accessing healthcare services when needed. In the model, need factors encompass the level of illness and individual’s psychosocial level of functioning that affects their healthcare service use (Aday & Andersen, 1974).

Moreover, although there exists considerable social epidemiological evidence linking social support to various positive health outcomes, the contributory role of social support as a social determinant of access to mental health services in Canada has not been adequately examined. Thus, the objective of this paper was to examine the independent effect of social support on unmet mental health needs among adult Canadians after taking into account predisposing, enabling, and need factors.

Methods: This study uses a secondary data from the 2012 Canadian Community Health Survey – Mental Health (CCHS-MH). A sample of 3,857 respondents aged 20 years and older with perceived mental health needs was analyzed using binary logistic regression. The outcome variable examined was unmet mental health needs and the main explanatory variable examined was social support. Social support was measured based on the Social Provision Scale developed by (Cutrona, 1984) and assesses the availability of various forms of social support to an individual based on his/her perception.

Results: The study found that of the 3,857 respondents with some form of perceived mental health needs, close to a third (31.9%) had unmet needs. Results from the binary logistic regression revealed that social support had a significant independent effect on unmet mental health needs. For each additional increase in social support, the odds of a respondent having unmet needs were predicted to decease by a factor of 10% (AOR=0.90, p<.001, 95% CI=0.89-0.92), net the effect of predisposing, enabling, and need factors. Respondents from Quebec, Manitoba, and Alberta were less likely to have unmet needs when compared to respondents from Ontario. Other factors associated with having unmet mental health needs include: younger age, suicidal ideation, having anxiety issues, and adverse childhood experiences.

Conclusions and Implications: In summary, this paper found social support to be the strongest predictor of access to mental health services over and above predisposing, enabling, and need factors. The finding that individuals with low social support are more likely to have unmet mental health needs underscores the need for social workers to explore ways to improve social support systems for individuals with mental health issues. It is also important for policy makers to develop mental health care policies and programs that are appropriate and meets the needs of individuals with mental health-related problems and who are without adequate social support.