Polysubstance Use and Mental Health Among Immigrants in Canada during the Pandemic

Background: Polysubstance use (PSU) refers to the use of multiple addictive substances simultaneously or in a specified period (Connor et al., 2014). Individuals with mental health issues are more likely to alleviate symptoms such as depression, anxiety, or trauma with substances. Conversely, substance use can exacerbate existing mental health conditions or trigger new issues. Although the comorbidities between substance use and mental health issues have been well established, studies of the bidirectional relationship between PSU and mental health remain limited, particularly among immigrants, who often experience social isolation, settlement stresses, and have the least access to health resources (Aragona et al., 2020). Notably, COVID worsened the existing health and financial plights experienced by immigrants (Đoàn et al., 2021). Given this backdrop, this study aims to (1) explore PSU patterns among immigrants in Canada during the pandemic; (2) examine the association between PSU and mental health problems among immigrants in Canada; and (3) understand how PSU among immigrants impacts their needs to seek related help.

Methods: The study used the sixth wave of the Canadian Perspectives Survey Series (CPSS). Conducted by Statistics Canada in 2021, this wave focused on the use of alcohol, cannabis, opioids, and non-prescription substances during the pandemic. The study sample consisted of those who self-identified as immigrants (N=680). PSU was measured by the multi-use of at least two substances in the last 30 days. Mental health was measured by self-reported mental health and the change since COVID-19. Seeking related help was measured by self-reported answers for help sought for any substance use issue question. Multiple logistic regression analysis estimates the association between PSU and mental health variables, adjusted for age, gender, education, marital status, and employment status.

Results: The majority of study participants are female (51.5%). Most participants fell within the 35 to 44 years age group (20.5%) and have a university degree (57.3.%). Nearly 47% of immigrant participants (n=316) reported using one substance, and 16.9 % of immigrants (n=115) reported PSU, with nearly 98% reporting using alcohol. A bidirectional relationship between PSU and mental health problems was found. With their mental health condition getting worse, immigrants were more likely to have PSU (AOR=1.30; 95% CI =[1.07,1.57], p<0.01) and those who had PSU in the last 30 days were at high risk of having mental health problems compared to before the COVID-19 pandemic (AOR=1.74; 95% CI =[1.16, 2.74], p < 0.01). Immigrants who had PSU were also 6 times more likely to seek help for substance use issues relative to non-PSU users (AOR=6.97; 95% CI =[3.13, 15.82], p <0.001).

Conclusion and Implications: This study indicated that immigrants in Canada were susceptible to using at least one substance during the pandemic and alcohol was the most popular substance used with other substances. PSU and mental health problems can be mutually reinforcing risk factors among immigrants, which calls for public health responses. There is a pressing need for further research to explore the underlying mechanisms driving PSU and mental health disparities among immigrants.