Use of mental health services by children and youth in Ontario military families compared with the general population: a retrospective cohort study

Alyson L. Mahar; Heidi Cramm; Lixia Zhang; Alice B. Aiken; Simon Chen; Ben Ouellette; Lynda Manser; Paul Kurdyak

doi:10.9778/cmajo.20200312

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Table 1:

Baseline characteristics of children and youth in Canadian Armed Forces families and children and youth in the general population, matched by age, sex and geography

Characteristic	No. (%) in CAF n = 5478	No. (%) in general population n = 21 912	p value
Age category, yr^*			–
0–6	2673 (48.8)	10 692 (48.8)
7–9	867 (15.8)	3468 (15.8)
10–14	1249 (22.8)	4996 (22.8)
15–19	689 (12.6)	2756 (12.6)
Sex, female^*	2665 (48.6)	10 660 (48.6)	–
Geography^*			–
South East	1379 (25.2)	5516 (25.2)	–
Champlain	2527 (46.1)	10 108 (46.1)
North Simcoe Muskoka	1096 (20.0)	4384 (20.0)
North East	177 (3.2)	708 (3.2)
Other	299 (5.5)	1196 (5.5)
Median community income quintile			< 0.001
Lowest	457 (8.3)	4031 (18.4)
2	878 (16.0)	3904 (17.8)
3	1277 (23.3)	4363 (19.9)
4	1513 (27.6)	4873 (22.2)
Highest	1341 (24.5)	4577 (20.9)
Missing	12 (0.2)	164 (0.7)
Rural residence	1147 (20.9)	5574 (25.4)	< 0.001

Note: CAF = Canadian Armed Forces, other = all other regions of Ontario.
↵* A matching variable, therefore not compared statistically.

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Table 2:

Likelihood of use of mental health services in children and youth in Canadian Armed Forces families (n = 5478) compared with general population group (n = 21 912), matched by age, sex and geography

Type of mental health service	No. (%) of events	RR^* (95% CI)	RR^† (95% CI)
Family physician visit^‡
CAF	935 (17.1)	1.25 (1.17 to 1.33)	1.25 (1.17 to 1.34)
General population	2993 (13.7)	Ref.	Ref.
Pediatrician visit^‡
CAF	426 (7.8)	0.85 (0.77 to 0.94)	0.87 (0.79 to 0.96)
General population	1993 (9.1)	Ref.	Ref.
Psychiatrist visit^§
CAF	137 (2.5)	0.92 (0.77 to 1.10)	0.95 (0.79 to 1.14)
General population	594 (2.7)	Ref.	Ref.
ED visit^§
CAF	116 (2.1)	1.13 (0.93 to 1.37)	1.19 (0.97 to 1.45)
General population	411 (1.9)	Ref.	Ref.
Hospital admission^§
CAF	32 (0.6)	0.96 (0.65 to 1.39)	0.99 (0.67 to 1.46)
General population	134 (0.6)	Ref.	Ref.

Note: CAF = Canadian Armed Forces, CI = confidence interval, ED = emergency department, RR = relative risk, ref. = reference category.
↵* Adjusted for age (continuous), sex and region.
↵† Adjusted for age (continuous), sex, region, median community income and rurality.
↵‡ Derived from modified Poisson regression with robust error variance.
↵§ Derived from logistic regression and interpreted according to the rare outcome theory equating odds ratios with relative risks.

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Table 3:

Frequency of use of outpatient mental health services between children and youth in Canadian Armed Forces families compared with general population group, matched by age, sex and geography^*

Type of mental health visit	Mean no. of visits ± SD	RR^†^‡ (95% CI)	RR^‡^§ (95% CI)
Family physician
CAF	2.51 ± 2.82	1.04 (0.95 to 1.14)	1.06 (0.96 to 1.17)
General population	2.51 ± 4.79	Ref.	Ref.
Pediatrician
CAF	3.73 ± 3.57	1.09 (0.98 to 1.20)	1.11 (1.00 to 1.23)
General population	3.44 ± 3.77	Ref.	Ref.
Psychiatrist
CAF	5.46 ± 13.50	0.98 (0.64 to 1.51)	0.99 (0.65 to 1.52)
General population	5.67 ± 9.66	Ref.	Ref.
Emergency department
CAF	1.55 ± 1.71	1.00 (0.80 to 1.25)	1.01 (0.80 to 1.26)
General population	1.59 ± 1.66	Ref.	Ref.

Note: CAF = Canadian Armed Forces, ref. = reference, RR = relative risk, SD = standard deviation.
↵* Among those who had at least 1 visit.
↵† Adjusted for age (continuous), sex and region.
↵‡ Derived from Poisson regression with an offset of follow-up time.
↵§ Adjusted for age (continuous), sex, region, median community income and rurality.

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Table 4:

Comparison of mean time to first mental health–related visit between children and youth in Canadian Armed Forces families and a general population comparator group, matched by age, sex and geography^*

Type of mental health visit	Mean no. of days ± SD	Adjusted DD^†^‡ (95% CI)	Adjusted DD^‡^§ (95% CI)
Family physician
CAF	450 ± 321	−55 (−79 to −32)	−57 (−80 to −33)
General population	505 ± 323	Ref.	Ref.
Pediatrician
CAF	449 ± 297	33 (2 to 64)	30 (−1 to 62)
General population	420 ± 329	Ref.	Ref.
Psychiatrist
CAF	580 ± 309	108 (49 to 167)	103 (43 to 163)
General population	479 ± 340	Ref.	Ref.

Note: CAF = Canadian Armed Forces, DD = days difference, ref. = reference, SD = standard deviation.
↵* Among those who had at least 1 visit.
↵† Adjusted for age (continuous), sex and region.
↵‡ Derived from linear regression.
↵§ Adjusted for age (continuous), sex, region, median community income and rurality.