Do primary care providers who speak Chinese improve access to mental health care of Chinese immigrants?

BACKGROUND: The utilization of health care providers who share the language and culture of their patients has been advocated as a strategy to improve access to the mental health care of immigrants. This study examines the relationship between patients receiving primary care from health care providers who speak Chinese and the rate of mental health diagnosis and consultation among Chinese immigrants in British Columbia (BC), Canada. METHODS: The study analyzed 3 linked administrative databases: an immigration database, BC’s health databases and BC’s physician register. The study population consisted of more than 270 000 recent Chinese immigrants to BC, with sex and age-matched comparison subjects. We calculated the odds ratios (ORs) of being diagnosed with common mental health conditions and the rate ratios (RRs) of mental health visits per year of health plan registration, by proportion of general care received from Chinese-speaking physicians; this was done using logistic regression and generalized linear models, adjusting for sex, age and time registered in the health plan. RESULTS: Among Chinese immigrants, a higher proportion of care received from Chinese-speaking general practitioners (GPs) was associated with a lower probability of being diagnosed with neurotic disorders (OR = 0.87; 95% confidence interval [CI] 0.80–0.95), drug dependence (OR = 0.22; 95% CI 0.14–0.35), adjustment reaction (OR = 0.39; 95% CI 0.33–0.46) and depressive disorder not elsewhere classified (OR = 0.47; 95% CI 0.42–0.52), as well as a lower rate of mental health service utilization (RR = 0.65%; 95% CI 0.61–0.69). Among the comparison group, a higher proportion of primary care received from Chinese-speaking GPs was associated with a lower probability of being diagnosed with affective psychoses (OR = 0.53; 95% CI 0.47–0.59), neurotic disorders (OR = 0.49; 95% CI 0.47–0.51), drug dependence (OR = 0.28; 95% CI 0.24–0.32), acute reaction to stress (OR = 0.54; 95% CI 0.51–0.57), adjustment reaction (OR = 0.36; 95% CI 0.33– 0.39), depressive disorder not elsewhere classified (OR = 0.30; 95% CI 0.29–0.32) and anxiety/depression (OR = 0.83; 95% CI 0.80–0.86), and with lower rates of mental health service utilization (RR = 0.32; 95% CI 0.30–0.33). CONCLUSIONS: Although Chinese-speaking primary care physicians may facilitate Chinese immigrants’ access to medical care, these physicians may not optimize diagnosis and treatment of mental health problems. Our findings have implications for access to mental health care by minority populations in metropolitan centres in Canada and North America, where immigrants rely heavily on health care practitioners who speak their native language for their primary care.

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