Racial and gender disparities in reasons for seeking mental healthcare in Canada

Abstract

Introduction

Although mental health problems are widespread, access to services remains limited. This study aims to examine the reasons for seeking mental healthcare among racially diverse individuals in Canada.

Methods

A cross-sectional survey was conducted among 553 participants (52% women) from diverse racial backgrounds, including Arab (n = 84), Asian (n = 147), Black (n = 89), Indigenous (n = 67), White (n = 104), and mixed racial identity participants (n = 62). Participants completed a sociodemographic form and measures assessing reasons for mental healthcare seeking and major experiences of racial discrimination. Separate logistic regression models for each outcome were performed.

Results

Anxiety (58.8%), depression (50.3%), stress/burnout (41.8%) were the most frequently reported reasons for seeking mental healthcare. Bivariate logistic regression showed significant racial disparities in seeking mental healthcare related to anxiety, with Arab (odds ratio [OR] = 0.33, p < 0.001), Asian (OR = 0.41, p = 0.001), and Black participants (OR = 0.52, p = 0.032) having lower odds of seeking mental healthcare compared with White participants. Indigenous participants had higher odds of seeking mental healthcare for post-traumatic stress disorder (PTSD)-related concerns (OR = 3.21, p = 0.001), whereas Asian participants had lower odds of seeking mental healthcare for PTSD-related concerns (OR = 0.42, p = 0.022). Gender differences were also observed across several seeking mental health care reasons.

Conclusions

These findings indicate that mental health service utilization is linked to both racial and gender factors, highlighting the need for targeted strategies to improve equitable access to mental healthcare across diverse populations.

Introduction

Over 5 million Canadians aged 15 years and older (18.3% of the general population) met the criteria for at least one mental health disorder in 2022, including mood disorders, anxiety-related problems, and substance use disorders [1, 2]. While mental disorders vary in their presentation, they occur across all demographic and socioeconomic groups [3]. In Canada specifically, these conditions affect every segment of society, transcending individual demographic and economic differences [4]. This issue is present across all racial groups, affecting both racialized and non-racialized communities, though it is unequally distributed among them [5]. However, racialized communities often experience social and structural conditions, including social exclusion, interpersonal, institutional, and systemic racial discrimination, economic marginalization, and limited access to culturally appropriate services, that increase both the risk of developing mental health disorders and their persistence over time [6, 7].

Despite this widespread prevalence among the general Canadian population, access to mental health services remains highly limited [8]. In fact, among individuals with a mood, anxiety, or substance use disorder, only 48.8% had spoken with any type of health professional, with 12.7% consulting a psychiatrist and 11.4% consulting a psychologist [2]. Moreover, as documented by a national survey among Canadians aged 12 and older with perceived mental healthcare needs, Canadians often feel lost when trying to navigate mental health and addictions care. Common barriers include long wait times, shortages of mental healthcare providers, cultural and language barriers, concerns about stigma, and the high cost of services not covered by private insurance plans [9, 10].

These barriers highlight the challenges Canadians face in accessing mental healthcare [11]. As a result, many individuals live with untreated mental disorders, which are well known to significantly affect their lives, lead to multidimensional problems, and create economics burdens [12]. The consequences include decreased quality of social interactions, suicidal thoughts, financial difficulties, reduced academic performance, and unemployment [13, 14]. Among individuals diagnosed with a mental disorder, approximately 58.8% report needing care, yet only 43.8% have received psychotherapy or counselling services, representing a gap between need and access [2]. Furthermore, a study found that depression and anxiety were associated with financial instability and unemployment [15].

Research has shown that access barriers are particularly pronounced among racialized and immigrant populations, intensifying existing challenges [16]. Studies have also indicated that immigrants and racialized individuals report greater unmet mental healthcare needs than other populations [16, 17]. Furthermore, mental health inequalities are sustained by multiple social determinants. Key factors include socioeconomic conditions, discrimination (including racism, xenophobia, and homophobia), socio-cultural connection and community belonging, and healthcare access and quality [18].

These disparities persist across the lifespan, as mental health inequalities affect individuals from childhood through older adulthood. Research demonstrates that children from immigrant, refugee, and racialized and ethnic minority backgrounds have significantly lower rates of mental health service utilization. For instance, in Ontario, children from these demographic groups are 20% to 45% less likely to access mental health services compared to their counterparts [19]. Similar disparities are observed among racialized immigrant older adults who, compared to White Canadians, demonstrate significantly higher odds of reporting poor or fair mental health (OR = 2.23), perceiving life as stressful (OR = 1.49), having psychiatric comorbidities (OR = 1.42), and experiencing unmet mental healthcare needs (OR = 2.02) [20].

Despite extensive research on barriers and challenges to accessing mental health resources, to our knowledge, no Canadian study has specifically examined the reasons and motivations for seeking mental healthcare. Among the minority of individuals who are able to consult a mental health professional, their reasons for seeking mental healthcare remain unclear. This presents an important research gap, as mental healthcare encompasses a wide range of specializations, each offering distinct expertise and services. That is, the reasons why individuals seek care and the professionals they consult may vary considerably across populations, particularly when considering cultural and racial backgrounds and gender. Understanding these dynamics is essential to inform interventions and adapt services for all racial groups. This can highlight the specific needs, challenges, and disparities faced by different racial groups. This approach is particularly important for communities historically affected by systemic inequities and underrepresentation in research.

The current study is guided by minority stress theory to understand disparities in reasons for seeking mental healthcare across racial groups in Canada. Minority stress theory suggests that individuals from marginalized groups are disproportionately exposed to social stressors, including discrimination, which may be linked to mental health experiences [21]. There may be differences in seeking mental healthcare between racialized and non-racialized individuals, which may be linked to cultural values, stigma, mistrust and other social and institutional factors [22]. Consistent with this framework, the present study examined race, gender, and experiences of racial discrimination as key factors that may contribute to disparities in reasons for seeking mental healthcare.

In response to this gap in the literature, the present paper aims to: (1) explore and compare the reasons that lead different racial groups, including Arab, Asian, Black, White, and Mixed-race individuals to seek mental health services in Canada; and (2) identify shared and distinct motivations across different racial groups. The ultimate objective of this study is to provide evidence to improve the equity, inclusiveness, and cultural relevance of mental health services in Canada.

Methods

Design and data collection

Data for this study were collected through a survey of individuals from different ethnic communities in Canada who had received mental healthcare within the past five years. The survey was conducted over a two-week period in September 2024 using Computer-Assisted Web Interviewing (CAWI), administered and facilitated by Léger (LÉO), Canada’s largest research firm. Eligible participants were: (1) lived in Canada; (2) were aged 16 years old and older; (3) could understand English or French; (4) had received mental healthcare in the last five years. This sample reflects the experiences and reasons for seeking mental healthcare among individuals who accessed services and does not represent mental health needs, unmet needs, or help-seeking behaviours in the general Canadian population. To enhance racial and ethnic representation, we oversampled Arab, Asian, Indigenous, and Black participants using ethnic profiling data from the LÉO panel [23, 24]. This intentional oversampling aimed to include groups that are often overlooked or aggregated under the broad “visible minority” category, enabling more precise and disaggregated analysis. Based on this oversampling approach, a random sample of 38,456 Léger panel members was contacted via e-mail, each receiving a unique, single-use link to access the survey. Of those, 3,077 clicked on the link. Following a screening questionnaire, 2,476 were deemed ineligible based on inclusion criteria. Of the 601 who were eligible, 48 refused to participate, resulted in a response rate of 92.01%. A total of 553 participants completed the survey.

The study was approved by the University of Ottawa’s Research Ethics Board (#H-11-22-8694) and Montfort Hospital (#22-23-09-029), with electronic informed consent obtained from all participants. Participants aged 16–17 years were permitted to provide their own informed consent, in accordance with Canadian research ethics guidelines and Research Ethics Board approvals, which did not require parental consent for adolescents deemed capable of understanding the nature and implications of research participation [25]. Survey participation was voluntary, responses were collected anonymously, and stored on secure institutional servers, and participants could withdraw from the survey at any time before submission. Information about mental health support resources was made available to participants at the end of the survey.

Measures

Sociodemographic measures. Participants were asked to report sociodemographic characteristics, which included gender, sexual orientation, age, education, religion, province, race/ethnicity, language, employment status, household income, and marital status.

Reasons for seeking mental healthcare. Participants were asked about the reasons that led them to seek mental health services and care, using the following question: “What type of mental health problem did you consult for?”. They could select among 15 reasons: anxiety/excessive worry (generalized, social, health-related), depression/mood problems, stress/burnout, difficulty managing emotions (e.g., anger, frustration), relationship or family problems, sleep problems/insomnia, grief/loss, trauma-related symptoms/posttraumatic stress disorder (PTSD)/complex trauma, obsessive–compulsive disorder (OCD)/intrusive thoughts/compulsions/rituals, alcohol or substance use/addiction, attention difficulties/attention-deficit/hyperactivity disorder (ADHD) or related symptoms, food- or weight-related concerns/eating disorders (e.g., anorexia nervosa, bulimia), low self-esteem/self-confidence, personality disorders or personality traits (including borderline personality disorder), and psychosis or symptoms of psychotic disorders (e.g., hallucinations, delusions). Participants could also select “Other” and provide a specification. Multiple reasons for seeking mental healthcare could be endorsed. These categories were intended to capture participants’ self-reported reasons for seeking mental healthcare and should not be interpreted as formal clinical diagnoses.

Major experiences of racial discrimination. The Major Experiences of Discrimination Scale (MEDS) is designed to assess major experiences of discrimination like being treated unfairly by the police or facing discrimination in school or housing [26]. It contains 7 items with a two-point scale (Yes, No). If yes, then it also assesses how recent the incident was. A higher summary score indicates a higher frequency of perceived discrimination. The scale has been widely used in research involving racially diverse individuals in Canada and has demonstrated good internal consistency [27].

Statistical analysis

We used descriptive statistics to summarize the sociodemographic characteristics of participants, presenting categorical variables as frequencies and percentages. The prevalence of seeking mental healthcare outcomes was described using proportions along with 95% confidence intervals, calculated for each racial group. Differences in the prevalence of each mental health outcome across racial categories were assessed using chi-square (χ²) tests of association.

To examine factors associated with self-reported reasons for seeking mental healthcare, we conducted separate logistic regression models for each outcome to allow identification of distinct correlates across different reasons for seeking mental healthcare. For each model, both crude (unadjusted) and multivariable (adjusted) analyses were performed. Racial identity was the primary predictor of interest, with White participants serving as the reference group. Experience of major racial discrimination was included as a key independent variable across all models. Adjusted models controlled for relevant sociodemographic covariates, including gender identity, province of residence, primary spoken language, religion, education level, and household income. Covariates and predictors were selected a priori based on the study’s theoretical framework and existing literature. As the analysis was exploratory and not designed to test specific hypotheses, covariate inclusion was guided by conceptual relevance rather than a hypothesis-driven variable selection procedure. For outcomes with fewer than 50 observed events, Firth penalized logistic regression was used to reduce small-sample bias and address potential issues related to sparse data or separation. To ensure stable estimates, analyses involving categorical comparisons were restricted to categories with sufficient observations. Odds ratios (ORs), 95% confidence intervals (CIs), and p-values were reported for all predictors. Regarding model diagnostics, multicollinearity among predictors was assessed using variance inflation factors (VIFs). No evidence of problematic multicollinearity was observed.

To visualize how often different mental health problems were reported together by the same individuals, we constructed a co-occurrence matrix based on binary indicators for 16 outcomes. A heatmap was then generated to display the frequency with which each pair of outcomes co-occurred. The matrix was symmetrically calculated using matrix multiplication and included both the diagonal values (showing the total number of respondents endorsing each individual outcome) and the off-diagonal values (representing the number of respondents endorsing both outcomes). The outcomes were labeled using short, intuitive names (e.g., PTSD, OCD, ADHD) to enhance interpretability. Rows and columns were hierarchically clustered to group outcomes with similar co-reporting patterns. Counts were overlaid on the heatmap cells, and the plot was generated using the “pheatmap” package in R.

A two-sided significance level of 0.05 was used for all statistical analyses. Missing data were minimal across study variables; therefore, no imputation procedures were performed, and analyses were conducted using complete-case data. Sociodemographic tabulations were performed in SPSS Statistics version 29.0, while prevalence estimation, chi-square tests, logistic regression models, and co-occurrence visualizations were conducted in R version 4.3.0.

Results

Of 553 participants, 52% were women, 44% were men, and 4.3% had non-binary gender identity. The largest racial groups were Asian (27%), White (19%), and Black (16%) participants. The majority of participants were heterosexual (85%) and English-speaking (73%). Participants were mainly from Ontario (40%), the Prairies and British Columbia (31%), and Quebec (25%). Over half (52%) had a university degree, and 62% were employed. Sample characteristics are presented in Table 1.

Table 1.

Sociodemographic Characteristics of Participants, Presented as Frequency and Percentage (N = 553)

Total	Totala	Arab	Asian	Black	Indigenous	Mixed	White
	553 (100)	84 (15)	147 (27)	89 (16)	67 (12)	62 (11)	104 (19)
Gender identity
Man	227 (44)	27 (36)	74 (54)	37 (46)	26 (41)	18 (30)	45 (46)
Woman	268 (52)	46 (61)	56 (41)	44 (54)	34 (53)	38 (62)	50 (51)
Non-binary/Other	22 (4.3)	2 (2.7)	8 (5.8)	0(0)	4 (6.3)	5 (8.2)	3 (3.1)
Missing	36 (6.5)	9 (10.7)	9 (6.1)	8 (9.5)	3 (4.5)	1 (1.6)	6 (5.8)
Sexual orientation
Heterosexual/Straight	452 (85)	71 (92)	121 (85)	80 (92)	51 (80)	44 (77)	85 (84)
Gay	19 (3.6)	3 (3.9)	7 (4.9)	2 (2.3)	2 (3.1)	1 (1.8)	4 (4.0)
Lesbian	8 (1.5)	2 (2.6)	2 (1.4)	0 (0)	1 (1.6)	3 (5.3)	0 (0)
Bisexual	39 (7.4)	1 (1.3)	11 (7.7)	3 (3.4)	7 (11)	8 (14)	9 (8.9)
Questioning	11 (2.1)	0 (0)	2 (1.4)	2 (2.3)	3 (4.7)	1 (1.8)	3 (3.0)
Missing	24 (4.3)	7 (0.01)	4 (2.7)	2(2.2)	3(4.5)	5(8.1)	3 (2.9)
Language
English	402 (73)	40 (48)	130 (88)	60 (67)	48 (72)	44 (71)	80 (77)
French	105 (19)	33 (39)	11 (7.5)	19 (21)	16 (24)	10 (16)	16 (15)
Bilingual	41 (7.4)	9 (11)	3 (2.0)	10 (11)	3 (4.5)	8 (13)	8 (7.7)
Other	5 (0.9)	2 (2.4)	3 (2.0)	0 (0)	0 (0)	0 (0)	0 (0)
Religion
Hinduism	23 (4.2)	0 (0)	19 (13)	1 (1.1)	1 (1.5)	1 (1.6)	1 (1.0)
Judaism	6 (1.1)	1 (1.2)	1 (0.7)	0 (0)	1 (1.5)	1 (1.6)	2 (1.9)
Islam	82 (15)	46 (55)	20 (14)	8 (9.0)	2 (3.0)	6 (9.7)	0 (0)
Christian	226 (41)	24 (29)	45 (31)	65 (73)	23 (34)	24 (39)	45 (43)
Buddhism	12 (2.2)	0 (0)	9 (6.1)	1 (1.1)	0 (0)	1 (1.6)	1 (1.0)
Other	17 (3.1)	2 (2.4)	7 (4.8)	1 (1.1)	6 (9.0)	1 (1.6)	0 (0)
Non-religion	187 (34)	11 (13)	46 (31)	13 (15)	34 (51)	28 (45)	55 (53)
Marital status
Single	234 (42)	31 (37)	54 (37)	43 (48)	27 (40)	25 (40)	54 (52)
Married	231 (42)	39 (46)	81 (55)	34 (38)	17 (25)	23 (37)	37 (36)
Divorced	34 (6.1)	5 (6.0)	9 (6.1)	5 (5.6)	6 (9.0)	5 (8.1)	4 (3.8)
Widowed	8 (1.4)	1 (1.2)	1 (0.7)	1 (1.1)	4 (6.0)	1 (1.6)	0 (0)
Separated	24 (4.3)	3 (3.6)	2 (1.4)	4 (4.5)	7 (10)	3 (4.8)	5 (4.8)
Other*	22 (4.0)		5 (6.0)	0 (0)	2 (2.2)	6 (9.0)	4 (3.8)
Province
Ontario	221 (40)	28 (33)	77 (52)	40 (45)	12 (18)	20 (32)	44 (42)
Quebec	138 (25)	48 (57)	13 (8.8)	29 (33)	16 (24)	16 (26)	16 (15)
Prairies & British Colombia	169 (31)	6 (7.1)	52 (35)	18 (20)	37 (55)	20 (32)	36 (35)
Atlantic	25 (4.5)	2 (2.4)	5 (3.4)	2 (2.2)	2 (3.0)	6 (9.7)	8 (7.7)
Education
No diploma	18 (3.3)	0 (0)	1 (0.7)	2 (2.2)	5 (7.5)	2 (3.2)	8 (7.7)
Diploma or high school equivalent diploma	67 (12)	11 (13)	11 (7.5)	15 (17)	11 (16)	9 (15)	10 (9.6)
No post-secondary certificate or diploma, but attended a post-secondary institution	40 (7.2)	4 (4.8)	7 (4.8)	4 (4.5)	8 (12)	9 (15)	8 (7.7)
Post-secondary certificate or diploma below a bachelor’s degree	142 (26)	13 (15)	36 (24)	15 (17)	26 (39)	15 (24)	37 (36)
University degree	286 (52)	56 (67)	92 (63)	53 (60)	17 (25)	27 (44)	41 (39)
Employment
No	210 (38)	21 (25)	38 (25.9)	27 (30.3)	39 (58.2)	34 (54.8)	51 (49)
Yes	343 (62)	63 (75)	109 (74.1)	62 (69.7)	28 (41.8)	28 (45.2)	53 (51)
Annual household income
Less than $10,000	16 (3.0)	4 (5.2)	0 (0)	2 (2.3)	4 (6.1)	3 (5.2)	3 (3.2)
$10,000-$19,999	27 (5.1)	3 (3.9)	8 (5.6)	2 (2.3)	7 (11)	2 (3.4)	5 (5.3)
$20,000-$29,999	34 (6.5)	6 (7.8)	5 (3.5)	6 (6.8)	6 (9.1)	6 (10)	5 (5.3)
$30,000-$39,999	41 (7.8)	6 (7.8)	6 (4.2)	6 (6.8)	8 (12)	5 (8.6)	10 (11)
$40,000-$49,999	39 (7.4)	7 (9.1)	11 (7.7)	7 (8.0)	2 (3.0)	2 (3.4)	10 (11)
$50,000-$74,999	77 (15)	10 (13)	22 (15)	16 (18)	12 (18)	7 (12)	10 (11)
$75,000-$99,999	109 (21)	18 (23)	32 (23)	23 (26)	8 (12)	9 (16)	19 (20)
$100,000 or more	183 (35)	23 (30)	58 (41)	26 (30)	19 (29)	24 (41)	33 (35)
Missing	27 (4.9)	7 (8.3)	5 (3.4)	1 (1.1)	1 (1.5)	4 (6.6)	9 (8.7)

^aFrequency (%)

*Those in common-law or dating relationships

Results showed that seeking mental healthcare related to anxiety (58.8%) and depression (50.3%) were the most common problems, followed by stress/burnout (41.8%) and relationship problems (34.2%). The least common reasons for seeking mental healthcare included psychosis /symptoms of psychotic disorders (4%) and personality problems (4%). A statistically significant association was found between seek care for anxiety and race, χ² (5) = 18.5, p = 0.002, where 72.1% of White, 67.7% of participants with mixed racial identity, 62.7% of Indigenous, 57.3% of Black, 51.7% of Asian, and 46.4% of Arab participants seek care for anxiety problems. A significant association was found for seeking mental healthcare related to relationship/family problems, χ² (5) = 11.8, p = 0.038, with the highest rate among participants with mixed racial identity (51.6%) and lowest among Arab participants (28.6%; Table 2). Results also showed a significant association between seeking mental healthcare for PTSD and race, χ² (5) = 45.7, p < 0.001, where the highest rate was found among Indigenous participants (43.3%) followed by participants with mixed racial identity (33.9%), White (19.2%), Black (14.6%), Arab (14.3%), and Asian (8.8%) participants. Likewise, significant differences for seeking care for mental health related to alcohol/substance use problems were found between races, χ² (5) = 17.3, p = 0.004, with the highest rate among Indigenous participants (16.4%) and the lowest among Arab participants (2.4%; Table 2). Race differences were also observed for seeking care for mental health related to grief/loss, feelings of low self-esteem, OCD, and ADHD (Table 2).

Table 2.

Proportion (%) and 95% confidence intervals of mental health problems by racial identity, with chi-square tests of association

Outcome	Total % (95% CI)	Arab % (95% CI)	Asian % (95% CI)	Black % (95% CI)	Indigenous % (95% CI)	Mixed % (95% CI)	White% (95% CI)	Chi-square test
Total	553	84	147	89	67	62	104
Anxiety/excessive worry	58.8 (54.7, 62.9)	46.4 (35.8, 57.1)	51.7 (43.6, 59.8)	57.3 (47, 67.6)	62.7 (51.1, 74.3)	67.7 (56.1, 79.4)	72.1 (63.5, 80.7)	χ²(5) = 18.5, p = 0.002
Depression/low mood	50.3 (46.1, 54.4)	45.2 (34.6, 55.9)	44.9 (36.9, 52.9)	46.1 (35.7, 56.4)	58.2 (46.4, 70)	62.9 (50.9, 74.9)	52.9 (43.3, 62.5)	χ²(5) = 9.1, p = 0.105
Stress/burnout	41.8 (37.7, 45.9)	36.9 (26.6, 47.2)	44.9 (36.9, 52.9)	46.1 (35.7, 56.4)	35.8 (24.3, 47.3)	51.6 (39.2, 64.1)	35.6 (26.4, 44.8)	χ²(5) = 7.2, p = 0.208
Difficulty in managing emotions	26.2 (22.6, 29.9)	16.7 (8.7, 24.6)	23.8 (16.9, 30.7)	30.3 (20.8, 39.9)	31.3 (20.2, 42.5)	35.5 (23.6, 47.4)	25 (16.7, 33.3)	χ²(5) = 8.9, p = 0.112
Relationship/family problems	34.2 (30.2, 38.1)	28.6 (18.9, 38.2)	29.3 (21.9, 36.6)	31.5 (21.8, 41.1)	35.8 (24.3, 47.3)	51.6 (39.2, 64.1)	36.5 (27.3, 45.8)	χ²(5) = 11.8, p = 0.038
Sleep problems/insomnia	17.4 (14.2, 20.5)	10.7 (4.1, 17.3)	13.6 (8.1, 19.1)	22.5 (13.8, 31.1)	26.9 (16.3, 37.5)	17.7 (8.2, 27.3)	17.3 (10, 24.6)	χ²(5) = 9.9, p = 0.079
Grief/loss	11.4 (8.7, 14)	4.8 (0.2, 9.3)	5.4 (1.8, 9.1)	10.1 (3.8, 16.4)	13.4 (5.3, 21.6)	24.2 (13.5, 34.9)	17.3 (10, 24.6)	χ²(5) = 22.9, p < 0.001
Trauma related symptoms/post-traumatic stress disorder	19.5 (16.2, 22.8)	14.3 (6.8, 21.8)	8.8 (4.3, 13.4)	14.6 (7.3, 21.9)	43.3 (31.4, 55.1)	33.9 (22.1, 45.7)	19.2 (11.7, 26.8)	χ²(5) = 45.7, p < 0.001
Obsessive/compulsive disorder	6 (4, 7.9)	1.2 (0, 3.5)	4.1 (0.9, 7.3)	4.5 (0.2, 8.8)	4.5 (0, 9.4)	16.1 (7, 25.3)	8.7 (3.3, 14.1)	χ²(5) = 17.7, p = 0.003
Alcohol/substance use	6.3 (4.3, 8.4)	2.4 (0, 5.6)	2.7 (0.1, 5.4)	7.9 (2.3, 13.5)	16.4 (7.5, 25.3)	6.5 (0.3, 12.6)	6.7 (1.9, 11.5)	χ²(5) = 17.3, p = 0.004
Attention-deficit/hyperactivity disorder	7.2 (5.1, 9.4)	1.2 (0, 3.5)	4.8 (1.3, 8.2)	3.4 (0, 7.1)	13.4 (5.3, 21.6)	17.7 (8.2, 27.3)	8.7 (3.3, 14.1)	χ²(5) = 22.2, p=0.001
Food or weight related problems/eating disorders	6.3 (4.3, 8.4)	7.1 (1.6, 12.7)	4.1 (0.9, 7.3)	4.5 (0.2, 8.8)	6 (0.3, 11.6)	11.3 (3.4, 19.2)	7.7 (2.6, 12.8)	χ²(5) = 4.8, p = 0.445
Feelings of low self-esteem	17.7 (14.5, 20.9)	8.3 (2.4, 14.2)	15 (9.2, 20.7)	11.2 (4.7, 17.8)	20.9 (11.2, 30.6)	29 (17.7, 40.3)	26 (17.5, 34.4)	χ²(5) = 19.2, p = 0.002
Personality disorders/traits	4 (2.3, 5.6)	2.4 (0, 5.6)	2 (0, 4.3)	3.4 (0, 7.1)	1.5 (0, 4.4)	6.5 (0.3, 12.6)	8.7 (3.3, 14.1)	χ²(5) = 10.1, p = 0.072
Psychosis/symptoms of psychotic disorders	4 (2.3, 5.6)	7.1 (1.6, 12.7)	1.4 (0, 3.2)	2.2 (0, 5.3)	7.5 (1.2, 13.8)	6.5 (0.3, 12.6)	2.9 (0, 6.1)	χ²(5) = 9, p = 0.11
Other	3.3 (1.8, 4.7)	4.8 (0.2, 9.3)	4.8 (1.3, 8.2)	1.1 (0, 3.3)	3 (0, 7.1)	3.2 (0, 7.6)	1.9 (0, 4.6)	χ²(5) = 3.6, p = 0.616

Total sample size for each racial group is presented; however, the denominators used to calculate proportions and confidence intervals vary across mental health outcomes and are based on non-missing responses for each outcome.

Co-occurrence analysis (Fig. 1) showed anxiety as the most central issue, frequently paired with depression (n = 201), stress (153), and low self-esteem (80). Depression also co-occurred with stress (144) and low self-esteem (79). Difficulty managing emotions often overlapped with anxiety (113), depression (105), and low self-esteem (56). PTSD commonly co-occurred with anxiety (76), depression (66), and relationship problems (58). Though less prevalent, ADHD, OCD, and substance use showed meaningful links with anxiety, depression, and PTSD. Eating-related problems often co-occurred with low self-esteem (20) and anxiety (26). Emotional and behavioral problems frequently co-occurred in presenting problems.

Fig. 1.

Co-occurrence of mental health problems. This heatmap displays the frequency of co-occurring reasons for seeking mental healthcare across participants. Each cell represents the number of individuals reporting both corresponding problems. Darker colors indicate higher frequencies of co-occurrence. The values shown in each cell represent raw counts. Hierarchical clustering (dendrograms) is used to group outcomes with similar co-occurrence patterns, based on similarity in seeking care profiles

Table 3 presents findings from both crude and adjusted logistic regression models assessing associations between sociodemographic variables, including race and experiences of major racial discrimination, and specific reasons for seeking mental healthcare. Regarding seeking care for ADHD, Arab participants were 81% less likely to seek care compared to White participants (OR = 0.19, p = 0.025). However, a non-significant association was found after adjusting for sociodemographic and other factors (AOR = 0.23, p = 0.126). Results showed participants identifying as non-binary gender identity had significantly higher odds of seeking care related to ADHD compared to men (OR = 7.92; p < 0.001; AOR = 6.95, p = 0.002).

Table 3.

Odds Ratios (ORs) and 95% Confidence Intervals (CIs) (crude and adjusted), for the Association Between Race, Racial Discrimination, and Reasons for Seeking Mental Healthcare

Outcome	Variable	Category	COR (95% CI)	p value	AOR (95% CI)*	p value
Attention-deficit/ hyperactivity disorder (ADHD)	Gender	Men (Reference)
		Women	0.66 (0.3–1.43)	0.294	0.52 (0.22–1.2)	0.127
		Other	7.92 (2.87–21.3)	< 0.001	6.95 (2.06–23.93)	0.002
	Province	Ontario (Reference)
		Quebec	1.24 (0.5–2.95)	0.634	2.98 (0.6–13.07)	0.174
		Prairies & British Colombia	1.8 (0.84–3.93)	0.131	1.01 (0.4–2.54)	0.984
		Atlantic	2.58 (0.63–8.41)	0.172	1.42 (0.29–5.45)	0.634
	Language	English (Reference)
		French	0.6 (0.21–1.42)	0.262	0.23 (0.04–1.3)	0.097
		Bilingual	0.7 (0.14–2.21)	0.578	0.48(0.07–2.27)	0.375
	Religion	Christian (Reference)
		Muslim	0.49 (0.1–1.67)	0.278	1.13 (0.18–4.91)	0.884
		Other	1.02 (0.26–3.14)	0.968	0.46 (0.06–2.14)	0.344
		Non-religion	2.13 (1.07–4.41)	0.032	1.51 (0.65–3.65)	0.343
	Race	White (Reference)
		Arab	0.19 (0.02–0.83)	0.025	0.23 (0.02–1.46)	0.126
		Asian	0.55 (0.2–1.48)	0.233	0.38 (0.1–1.25)	0.111
		Black	0.41 (0.1–1.33)	0.141	0.43 (0.07–1.84)	0.264
		Indigenous	1.63 (0.62–4.3)	0.317	1.22 (0.4–3.63)	0.717
		Mixed	2.24 (0.89–5.78)	0.086	1.56 (0.51–4.67)	0.428
	Education	High school or less (Reference)
		Some post-secondary	0.54 (0.25–1.22)	0.137	0.35 (0.13–0.92)	0.034
		University degree	0.29 (0.13–0.66)	0.003	0.35 (0.12–0.96)	0.042
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.27 (0.1–0.65)	0.003	0.47 (0.16–1.26)	0.134
		High: $100,000+	0.65 (0.31–1.33)	0.238	1.05 (0.42–2.67)	0.914
	Major racial discrimination		1.01 (0.83–1.21)	0.904	0.9 (0.67–1.16)	0.425
Alcohol/substance use	Gender	Men (Reference)
		Women	0.5 (0.23–1.06)	0.071	0.43 (0.17–0.99)	0.048
		Other	1.36 (0.26–4.75)	0.675	0.82 (0.12–3.86)	0.811
	Province	Ontario (Reference)
		Quebec	0.23 (0.05–0.75)	0.012	0.82 (0.12–3.82)	0.814
		Prairies & British Colombia	1.25 (0.6–2.58)	0.553	0.54 (0.19–1.38)	0.201
		Atlantic	1.31 (0.25–4.58)	0.711	0.94 (0.14–4.05)	0.937
	Language	English (Reference)
		French	0.05 (0–0.39)	0.001	0.05 (0–0.6)	0.014
		Bilingual	1.04 (0.27–2.91)	0.952	0.97 (0.2–3.74)	0.970
	Religion	Christian (Reference)
		Muslim	0.11 (0–0.89)	0.035	0.14 (0–1.32)	0.096
		Other	3.25 (1.23–8.29)	0.018	3 (0.87–10.23)	0.082
		Non-religion	1.79 (0.83–3.99)	0.141	1.99 (0.79–5.26)	0.145
	Race	White (Reference)
		Arab	0.4 (0.07–1.56)	0.197	1.71 (0.25–9.03)	0.551
		Asian	0.42 (0.12–1.35)	0.143	0.24 (0.05–1)	0.050
		Black	1.18 (0.4–3.46)	0.756	1.11 (0.27–4.43)	0.877
		Indigenous	2.65 (1.01–7.32)	0.048	2.54 (0.81–8.43)	0.111
		Mixed	1 (0.27–3.28)	1.000	1.07 (0.26–4.04)	0.926
	Education	High school or less (Reference)
		Some post-secondary	0.62 (0.27–1.47)	0.268	0.57 (0.2–1.63)	0.284
		University degree	0.3 (0.12–0.73)	0.008	0.6 (0.2–1.92)	0.384
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.56 (0.25–1.23)	0.150	0.74 (0.28–1.94)	0.545
		High: $100,000+	0.37 (0.14–0.86)	0.021	0.5 (0.16–1.43)	0.199
	Major racial discrimination		1.25 (1.05–1.48)	0.014	1.25 (1–1.55)	0.049
Anxiety	Gender	Men (Reference)
		Women	2.02 (1.41–2.92)	< 0.001	1.9 (1.26–2.87)	0.002
	Province	Ontario (Reference)	1.02 (0.42–2.47)	0.968	0.85 (0.32–2.27)	0.747
		Quebec	0.81 (0.53–1.25)	0.352
		Prairies & British Colombia	1.34 (0.89–2.03)	0.169	0.88 (0.43–1.78)	0.713
		Atlantic	0.92 (0.4–2.17)	0.849	1.26 (0.78–2.05)	0.347
	Language	English (Reference)			0.81 (0.32–2.09)	0.651
		French	0.75 (0.49–1.16)	0.199
		Bilingual	0.55 (0.28–1.04)	0.068
	Religion	Christian (Reference)
		Muslim	0.88 (0.53–1.47)	0.624	2.42 (1.26–4.78)	0.009
		Other	1.04 (0.58–1.89)	0.904	1.63 (0.81–3.33)	0.172
		Non-religion	1.43 (0.96–2.13)	0.082	1.67 (1.04–2.69)	0.034
	Race	White (Reference)
		Arab	0.33 (0.18–0.61)	< 0.001	0.2 (0.09–0.46)	< 0.001
		Asian	0.41 (0.24–0.7)	0.001	0.36 (0.19–0.68)	0.002
		Black	0.52 (0.28–0.94)	0.032	0.62 (0.3–1.26)	0.186
		Indigenous	0.65 (0.34–1.25)	0.197	0.5 (0.24–1.05)	0.067
		Mixed	0.81 (0.41–1.62)	0.550	0.77 (0.36–1.69)	0.515
	Education	High school or less (Reference)
		Some post-secondary	0.66 (0.38–1.14)	0.140	0.62 (0.32–1.17)	0.148
		University degree	0.61 (0.36–1.01)	0.061	0.72 (0.38–1.35)	0.309
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.6 (0.39–0.93)	0.023	0.69 (0.42–1.12)	0.137
		High: $100,000+	0.98 (0.63–1.53)	0.941	1.22 (0.72–2.07)	0.456
	Major racial discrimination		0.88 (0.79–0.97)	0.012	0.94 (0.83–1.07)	0.344
Depression	Gender	Men (Reference)
		Women	1.39 (0.97–1.99)	0.070	1.38 (0.93–2.04)	0.107
		Other	1.73 (0.72–4.34)	0.228	1.14 (0.44–3.06)	0.789
	Province	Ontario (Reference)
		Quebec	1.17 (0.76–1.8)	0.466	1.51 (0.76–3.03)	0.238
		Prairies & British Colombia	1.25 (0.83–1.87)	0.285	1.2 (0.76–1.9)	0.432
		Atlantic	1.02 (0.44–2.35)	0.961	1 (0.41–2.44)	0.997
	Language	English (Reference)
		French	1.04 (0.68–1.6)	0.865	0.81 (0.39–1.63)	0.551
		Bilingual	0.77 (0.4–1.46)	0.422	0.78 (0.35–1.72)	0.532
	Religion	Christian (Reference)
		Muslim	0.99 (0.6–1.65)	0.979	1.08 (0.57–2.06)	0.808
		Other	1.09 (0.61–1.97)	0.765	0.96 (0.48–1.93)	0.919
		Non-religion	1.05 (0.71–1.55)	0.801	0.91 (0.58–1.43)	0.686
	Race	White (Reference)
		Arab	0.73 (0.41–1.31)	0.294	0.51 (0.23–1.12)	0.097
		Asian	0.71 (0.43–1.18)	0.190	0.71 (0.39–1.28)	0.252
		Black	0.76 (0.43–1.34)	0.345	0.64 (0.33–1.24)	0.189
		Indigenous	1.24 (0.67–2.32)	0.495	0.83 (0.42–1.64)	0.582
		Mixed	1.51 (0.8–2.9)	0.209	1.29 (0.64–2.64)	0.478
	Education	High school or less (Reference)
		Some post-secondary	0.89 (0.53–1.5)	0.672	0.84 (0.46–1.53)	0.575
		University degree	0.57 (0.35–0.93)	0.025	0.64 (0.35–1.15)	0.136
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.61 (0.4–0.94)	0.025	0.77 (0.48–1.24)	0.283
		High: $100,000+	0.55 (0.36–0.85)	0.007	0.75 (0.45–1.23)	0.249
	Major racial discrimination		1.14 (1.03–1.27)	0.011	1.17 (1.04–1.33)	0.012
Difficulty with emotional management	Gender	Men (Reference)
		Women	1.38 (0.92–2.09)	0.122	1.29 (0.82–2.03)	0.271
		Other	1 (0.32–2.66)	0.997	0.73 (0.22–2.09)	0.573
	Province	Ontario (Reference)
		Quebec	1.72 (1.05–2.81)	0.032	1.73 (0.78–3.81)	0.175
		Prairies & British Colombia	1.83 (1.15–2.92)	0.010	1.91 (1.13–3.23)	0.016
		Atlantic	1.26 (0.44–3.17)	0.647	1.43 (0.48–3.79)	0.488
	Language	English (Reference)
		French	1.18 (0.72–1.89)	0.506	1.06 (0.47–2.38)	0.881
		Bilingual	1.22 (0.58–2.42)	0.587	0.89 (0.34–2.15)	0.800
	Religion	Christian (Reference)
		Muslim	0.64 (0.32–1.2)	0.182	0.86 (0.38–1.84)	0.697
		Other	1.23 (0.63–2.33)	0.537	1.4 (0.63–3.04)	0.399
		Non-religion	1.42 (0.92–2.19)	0.115	1.53 (0.92–2.55)	0.101
	Race	White (Reference)
		Arab	0.62 (0.29–1.26)	0.194	0.85 (0.33–2.14)	0.740
		Asian	0.93 (0.52–1.68)	0.801	0.91 (0.45–1.84)	0.786
		Black	1.31 (0.69–2.47)	0.408	1.64 (0.77–3.52)	0.198
		Indigenous	1.37 (0.69–2.71)	0.365	0.97 (0.45–2.08)	0.931
		Mixed	1.65 (0.83–3.28)	0.151	1.49 (0.69–3.22)	0.307
	Education	High school or less (Reference)
		Some post-secondary	1.01 (0.58–1.8)	0.969	0.86 (0.45–1.65)	0.644
		University degree	0.7 (0.41–1.22)	0.199	0.66 (0.35–1.28)	0.216
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.73 (0.45–1.18)	0.198	0.98 (0.57–1.68)	0.937
		High: $100,000+	0.72 (0.44–1.17)	0.188	1.02 (0.58–1.81)	0.933
	Major racial discrimination		1.11 (0.99–1.24)	0.067	1.91 (1.13–3.23)	0.016
Food/weight-related disorders	Gender	Men (Reference)
		Women	4.08 (1.57–13.15)	0.003	4.01 (1.5–13.22)	0.004
		Other	19.3 (5.33–76.38)	< 0.001	13.42 (3.36–58.08)	< 0.001
	Province	Ontario (Reference)
		Quebec	3.1 (1.26–8.18)	0.013	3.15 (0.8–12.49)	0.100
		Prairies & British Colombia	2.07 (0.82–5.55)	0.125	1.69 (0.59–5.08)	0.330
		Atlantic	5.93 (1.57–20.3)	0.011	3.47 (0.76–14.19)	0.103
	Language	English (Reference)
		French	1.29 (0.54–2.79)	0.543	0.93 (0.25–3.55)	0.919
		Bilingual	0.94 (0.19–3.02)	0.924	1.29 (0.22–5.38)	0.751
	Religion	Christian (Reference)
		Muslim	1.04 (0.35–2.74)	0.934	1.02 (0.24–3.84)	0.980
		Other	0.95 (0.24–2.87)	0.933	0.66 (0.1–2.99)	0.609
		Non-religion	1.12 (0.52–2.43)	0.767	1 (0.4–2.48)	0.999
	Race	White (Reference)
		Arab	0.96 (0.32–2.79)	0.947	0.47 (0.1–1.95)	0.305
		Asian	0.53 (0.18–1.53)	0.239	0.41 (0.09–1.51)	0.182
		Black	0.6 (0.17–1.88)	0.383	0.5 (0.12–1.86)	0.302
		Indigenous	0.8 (0.22–2.54)	0.717	0.31 (0.06–1.23)	0.098
		Mixed	1.53 (0.53–4.36)	0.421	0.72 (0.21–2.29)	0.582
	Education	High school or less (Reference)
		Some post-secondary	0.83 (0.33–2.22)	0.703	0.8 (0.28–2.42)	0.678
		University degree	0.59 (0.25–1.56)	0.275	0.71 (0.25–2.19)	0.533
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.46 (0.19–1.04)	0.061	0.58 (0.22–1.4)	0.225
		High: $100,000+	0.47 (0.2–1.06)	0.068	0.61 (0.22–1.63)	0.328
	Major racial discrimination		1.2 (0.99–1.42)	0.058	1.24 (0.96–1.57)	0.095
Grief/loss	Gender	Men (Reference)
		Women	1.55 (0.87–2.81)	0.142	1.74 (0.89–3.51)	0.109
		Other	1.02 (0.16–3.86)	0.980	1 (0.14–4.52)	0.998
	Province	Ontario (Reference)
		Quebec	0.79 (0.37–1.6)	0.518	0.86 (0.24–2.84)	0.804
		Prairies & British Colombia	1.35 (0.74–2.49)	0.326	1.15 (0.56–2.36)	0.698
		Atlantic	1.11 (0.25–3.51)	0.875	0.82 (0.17–2.95)	0.784
	Language	English (Reference)
		French	0.5 (0.2–1.08)	0.101	0.59 (0.14–2.3)	0.465
		Bilingual	1.21 (0.44–2.83)	0.687	2.02 (0.58–6.28)	0.240
	Religion	Christian (Reference)
		Muslim	0.4 (0.11–1.06)	0.094	0.42 (0.09–1.44)	0.205
		Other	0.43 (0.1–1.29)	0.181	0.31 (0.05–1.28)	0.155
		Non-religion	1.46 (0.83–2.58)	0.193	1.05 (0.53–2.07)	0.878
	Race	White (Reference)
		Arab	0.25 (0.07–0.69)	0.014	0.33 (0.06–1.27)	0.134
		Asian	0.28 (0.11–0.65)	0.004	0.33 (0.11–0.94)	0.046
		Black	0.54 (0.22–1.24)	0.155	0.54 (0.19–1.49)	0.240
		Indigenous	0.74 (0.3–1.73)	0.499	0.59 (0.19–1.63)	0.321
		Mixed	1.52 (0.7–3.3)	0.284	1.64 (0.67–4.02)	0.274
	Education	High school or less (Reference)
		Some post-secondary	1.02 (0.48–2.27)	0.958	0.8 (0.33–2.05)	0.634
		University degree	0.73 (0.35–1.59)	0.399	0.93 (0.38–2.44)	0.882
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.83 (0.44–1.56)	0.557	1.03 (0.49–2.15)	0.946
		High: $100,000+	0.47 (0.22–0.96)	0.041	0.51 (0.21–1.2)	0.127
	Major racial discrimination		1.13 (0.98–1.31)	0.088	1.17 (0.96–1.42)	0.101
Low self-esteem	Gender	Men (Reference)
		Women	1.26 (0.78–2.05)	0.341	1.21 (0.7–2.09)	0.494
		Other	1.24 (0.34–3.58)	0.710	0.84 (0.21–2.69)	0.781
	Province	Ontario (Reference)
		Quebec	0.87 (0.48–1.54)	0.638	0.71 (0.25–1.95)	0.511
		Prairies & British Colombia	1.16 (0.69–1.95)	0.564	0.75 (0.39–1.39)	0.364
		Atlantic	1.5 (0.52–3.83)	0.415	1.24 (0.39–3.47)	0.695
	Language	English (Reference)
		French	0.9 (0.5–1.56)	0.721	1.29 (0.44–3.65)	0.637
		Bilingual	0.61 (0.2–1.47)	0.310	0.99 (0.29–2.89)	0.983
	Religion	Christian (Reference)
		Muslim	0.79 (0.37–1.6)	0.534	1.31 (0.5–3.21)	0.570
		Other	1.24 (0.56–2.54)	0.579	0.77 (0.28–1.94)	0.589
		Non-religion	1.33 (0.81–2.2)	0.260	1.2 (0.66–2.2)	0.553
	Race	White (Reference)
		Arab	0.27 (0.1–0.62)	0.004	0.2 (0.06–0.62)	0.008
		Asian	0.51 (0.27–0.96)	0.039	0.43 (0.19–0.95)	0.039
		Black	0.36 (0.16–0.77)	0.012	0.31 (0.12–0.77)	0.014
		Indigenous	0.75 (0.35–1.55)	0.450	0.49 (0.2–1.16)	0.111
		Mixed	1.17 (0.57–2.35)	0.667	1.02 (0.45–2.26)	0.967
	Education	High school or less (Reference)
		Some post-secondary	0.95 (0.51–1.79)	0.862	0.73 (0.35–1.55)	0.402
		University degree	0.56 (0.31–1.05)	0.063	0.69 (0.33–1.5)	0.338
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.43 (0.25–0.74)	0.003	0.52 (0.28–0.95)	0.036
		High: $100,000+	0.36 (0.2–0.64)	< 0.001	0.41 (0.21–0.8)	0.010
	Major racial discrimination		1.14 (1–1.28)	0.042	1.22 (1.04–1.42)	0.013
Obsessive-compulsive disorder (OCD)	Gender	Men (Reference)
		Women	2.23 (1.02–5.32)	0.044	3.19 (1.31–8.75)	0.010
		Other	6.2 (1.65–20.77)	0.009	3.88 (0.8–16.62)	0.089
	Province	Ontario (Reference)
		Quebec	1.64 (0.57–4.72)	0.351	5.78 (1.36–23.6)	0.019
		Prairies & British Colombia	3.27 (1.4–8.38)	0.006	2.85 (1.14–7.69)	0.025
		Atlantic	3.01 (0.54–12.13)	0.185	1.61 (0.26–7.23)	0.571
	Language	English (Reference)
		French	0.34 (0.07–1.07)	0.067	0.18 (0.03–0.96)	0.045
		Bilingual	2.14 (0.73–5.35)	0.154	1.63 (0.41–5.95)	0.477
	Religion	Christian (Reference)
		Muslim	0.97 (0.32–2.53)	0.955	2.19 (0.6–7.4)	0.227
		Other	0.88 (0.22–2.65)	0.839	1.01 (0.22–3.81)	0.984
		Non-religion	0.8 (0.35–1.78)	0.586	0.55 (0.21–1.36)	0.194
	Race	White (Reference)
		Arab	0.19 (0.02–0.83)	0.025	0.06 (0–0.42)	0.004
		Asian	0.47 (0.16–1.31)	0.149	0.39 (0.11–1.33)	0.133
		Black	0.53 (0.15–1.61)	0.269	0.29 (0.07–1.09)	0.066
		Indigenous	0.55 (0.13–1.8)	0.331	0.26 (0.05–1.07)	0.063
		Mixed	2.01 (0.78–5.24)	0.146
	Education	High school or less (Reference)
		Some post-secondary	0.44 (0.18–1.08)	0.074	0.35 (0.13–0.97)	0.044
		University degree	0.35 (0.15–0.84)	0.020	0.5 (0.19–1.38)	0.175
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.41 (0.17–0.94)	0.036	0.42 (0.16–1.04)	0.062
		High: $100,000+	0.42 (0.17–0.96)	0.040	0.45 (0.16–1.16)	0.097
	Major racial discrimination		1.07 (0.86–1.29)	0.527	1.15 (0.9–1.45)	0.262
Personality disorders	Gender	Men (Reference)
		Women	3.9 (1.34–15.1)	0.011	2.5 (0.79–10.06)	0.124
		Other	7.72 (1.23–42.1)	0.032	5.93 (0.79–38.52)	0.079
	Province	Ontario (Reference)
		Quebec	1.04 (0.33–3.06)	0.943	3.5 (0.57–19.55)	0.169
		Prairies & British Colombia	1.16 (0.41–3.18)	0.778	0.79 (0.2–2.87)	0.717
		Atlantic	2.65 (0.48–10.33)	0.232	2.11 (0.33–10.19)	0.397
	Language	English (Reference)
		French	0.98 (0.3–2.6)	0.965	0.39 (0.05–2.66)	0.335
		Bilingual	0.82 (0.09–3.37)	0.809	0.94 (0.09–4.97)	0.944
	Religion	Christian (Reference)
		Muslim	1.06 (0.19–4.23)	0.942	1.73 (0.13–13.45)	0.638
		Other	1.54 (0.28–6.23)	0.581	1.88 (0.16–12.83)	0.564
		Non-religion	2.39 (0.94–6.72)	0.069	2.08 (0.68–7.01)	0.204
	Race	White (Reference)
		Arab	0.31 (0.06–1.14)	0.081	0.16 (0.01–1.3)	0.091
		Asian	0.25 (0.06–0.81)	0.020	0.16 (0.02–0.86)	0.031
		Black	0.41 (0.1–1.33)	0.141	0.42 (0.06–2.04)	0.295
		Indigenous	0.23 (0.02–1.02)	0.053	0.26 (0.03–1.31)	0.108
		Mixed	0.77 (0.22–2.38)	0.662	0.69 (0.17–2.45)	0.576
	Education	High school or less (Reference)
		Some post-secondary	0.71 (0.24–2.29)	0.552	0.44 (0.12–1.63)	0.212
		University degree	0.5 (0.17–1.57)	0.222	0.66 (0.19–2.4)	0.514
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.46 (0.16–1.21)	0.115	0.55 (0.17–1.63)	0.280
		High: $100,000+	0.18 (0.03–0.61)	0.005	0.18 (0.03–0.7)	0.012
	Major racial discrimination		0.7 (0.45–0.98)	0.033	0.67 (0.38–1.03)	0.072
Post-traumatic stress disorder (PTSD)	Gender	Men (Reference)
		Women	3.37 (2.06–5.7)	< 0.001	4.85 (2.64–9.35)	< 0.001
		Other	2.57 (0.79–7.22)	0.089	1.45 (0.35–5.01)	0.576
	Province	Ontario (Reference)
		Quebec	0.67 (0.37–1.16)	0.163	0.62 (0.22–1.66)	0.349
		Prairies & British Colombia	0.96 (0.59–1.57)	0.881	0.42 (0.21–0.8)	0.010
		Atlantic	0.91 (0.29–2.4)	0.866	0.55 (0.15–1.68)	0.317
	Language	English (Reference)
		French	0.69 (0.37–1.21)	0.215	0.7 (0.24–2.01)	0.513
		Bilingual	1.08 (0.47–2.27)	0.845	1.41 (0.45–3.96)	0.534
	Religion	Christian (Reference)
		Muslim	0.68 (0.32–1.36)	0.295	0.78 (0.29–1.98)	0.611
		Other	1.44 (0.71–2.84)	0.297	1.43 (0.54–3.66)	0.458
		Non-religion	1.22 (0.75–1.97)	0.425	0.79 (0.42–1.47)	0.453
	Race	White (Reference)
		Arab	0.72 (0.32–1.56)	0.411	0.52 (0.17–1.54)	0.249
		Asian	0.42 (0.19–0.87)	0.022	0.37 (0.14–0.94)	0.038
		Black	0.72 (0.33–1.53)	0.396	0.4 (0.15–1.05)	0.066
		Indigenous	3.21 (1.63–6.45)	0.001	3.15 (1.36–7.49)	0.008
		Mixed	2.15 (1.05–4.44)	0.036	1.83 (0.78–4.34)	0.162
	Education	High school or less (Reference)
		Some post-secondary	0.96 (0.54–1.75)	0.903	0.95 (0.45–2.05)	0.896
		University degree	0.4 (0.22–0.72)	0.002	0.76 (0.35–1.67)	0.481
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.32 (0.19–0.55)	< 0.001	0.39 (0.21–0.73)	0.004
		High: $100,000+	0.33 (0.19–0.56)	< 0.001	0.41 (0.21–0.8)	0.010
	Major racial discrimination		1.26 (1.12–1.42)	< 0.001	1.35 (1.15–1.59)	< 0.001
Psychosis	Gender	Men (Reference)
		Women	0.39 (0.14–0.98)	0.045	0.25 (0.07–0.72)	0.010
		Other	1.09 (0.12–4.84)	0.921	0.37 (0.03–2.3)	0.315
	Province	Ontario (Reference)
		Quebec	0.58 (0.14–1.87)	0.376	1.17 (0.18–6.16)	0.858
		Prairies & British Colombia	1.32 (0.52–3.37)	0.556	0.69 (0.19–2.36)	0.561
		Atlantic	1.36 (0.14–6.29)	0.744	0.92 (0.07–5.79)	0.941
	Language	English (Reference)
		French	0.28 (0.03–1.13)	0.078	0.14 (0.01–1.14)	0.066
		Bilingual	1.24 (0.24–4.11)	0.758	0.75 (0.11–3.71)	0.745
	Religion	Christian (Reference)
		Muslim	2.42 (0.72–7.84)	0.147	1.35 (0.27–6.37)	0.706
		Other	2.88 (0.77–9.87)	0.109	1.86 (0.4–8.25)	0.421
		Non-religion	1.4 (0.47–4.22)	0.539	1.43 (0.4–5.38)	0.579
	Race	White (Reference)
		Arab	2.46 (0.68–10.63)	0.173	4.37 (0.64–34.57)	0.132
		Asian	0.51 (0.08–2.66)	0.416	0.5 (0.07–3.7)	0.481
		Black	0.83 (0.14–4.36)	0.822	0.63 (0.05–5.79)	0.683
		Indigenous	2.55 (0.66–11.34)	0.175	2.53 (0.48–16.29)	0.272
		Mixed	2.23 (0.53–10.28)	0.271	3.08 (0.57–20.47)	0.190
	Education	High school or less (Reference)
		Some post-secondary	0.52 (0.17–1.6)	0.246	0.33 (0.09–1.17)	0.086
		University degree	0.42 (0.15–1.22)	0.107	0.44 (0.11–1.76)	0.237
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.2 (0.05–0.61)	0.004	0.34 (0.08–1.12)	0.078
		High: $100,000+	0.33 (0.11–0.87)	0.025	0.49 (0.12–1.69)	0.262
	Major racial discrimination		1.28 (1.03–1.56)	0.028	1.24 (0.95–1.6)	0.118
Relationships problems	Gender	Men (Reference)
		Women	1.51 (1.03–2.21)	0.035	1.59 (1.04–2.43)	0.032
		Other	1.43 (0.55–3.5)	0.445	1.2 (0.41–3.3)	0.724
	Province	Ontario (Reference)
		Quebec	1.32 (0.84–2.07)	0.230	1.21 (0.59–2.51)	0.600
		Prairies & British Colombia	1.26 (0.82–1.93)	0.288	0.99 (0.61–1.61)	0.976
		Atlantic	1.51 (0.63–3.51)	0.340	1.14 (0.43–2.88)	0.791
	Language	English (Reference)
		French	1.02 (0.64–1.6)	0.923	0.97 (0.45–2.07)	0.932
		Bilingual	1.95 (1.01–3.73)	0.043	2.19 (0.97–4.99)	0.059
	Religion	Christian (Reference)
		Muslim	0.55 (0.3–0.97)	0.045	0.58 (0.28–1.18)	0.139
		Other	0.6 (0.3–1.14)	0.131	0.58 (0.25–1.24)	0.172
		Non-religion	1.18 (0.79–1.76)	0.421	1.21 (0.76–1.92)	0.419
	Race	White (Reference)
		Arab	0.72 (0.38–1.33)	0.297	0.85 (0.37–1.94)	0.708
		Asian	0.69 (0.4–1.19)	0.179	0.83 (0.44–1.56)	0.560
		Black	0.8 (0.44–1.45)	0.459	0.69 (0.33–1.41)	0.311
		Indigenous	0.97 (0.51–1.83)	0.924	0.78 (0.38–1.6)	0.504
		Mixed	1.85 (0.98–3.53)	0.058	1.31 (0.64–2.67)	0.455
	Education	High school or less (Reference)
		Some post-secondary	1.81 (1.04–3.23)	0.039	2.12 (1.11–4.22)	0.027
		University degree	1.25 (0.74–2.18)	0.418	1.47 (0.77–2.93)	0.258
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.98 (0.62–1.55)	0.917	1.08 (0.64–1.8)	0.780
		High: $100,000+	1.31 (0.83–2.06)	0.245	1.35 (0.79–2.31)	0.273
	Major racial discrimination		1.05 (0.94–1.17)	0.367	1.13 (0.99–1.29)	0.060
Sleep problems	Gender	Men (Reference)
		Women	1.44 (0.89–2.37)	0.142	1.5 (0.89–2.56)	0.133
		Other	0.98 (0.22–3.1)	0.979	1.07 (0.23–3.65)	0.922
	Province	Ontario (Reference)
		Quebec	1.27 (0.71–2.24)	0.412	1.9 (0.74–4.82)	0.179
		Prairies & British Colombia	1.43 (0.84–2.43)	0.184	1.16 (0.63–2.14)	0.628
		Atlantic	0.77 (0.18–2.38)	0.683	0.75 (0.16–2.49)	0.673
	Language	English (Reference)
		French	0.95 (0.52–1.64)	0.855	0.73 (0.27–1.9)	0.523
		Bilingual	0.64 (0.21–1.54)	0.361	0.6 (0.17–1.74)	0.377
	Religion	Christian (Reference)
		Muslim	0.52 (0.24–1.04)	0.078	0.85 (0.33–2.02)	0.720
		Other	0.8 (0.36–1.64)	0.556	0.81 (0.3–1.96)	0.651
		Non-religion	0.62 (0.36–1.03)	0.069	0.62 (0.34–1.13)	0.124
	Race	White (Reference)
		Arab	0.59 (0.24–1.36)	0.227	0.36 (0.11–1.1)	0.082
		Asian	0.73 (0.36–1.47)	0.371	0.61 (0.27–1.4)	0.246
		Black	1.38 (0.68–2.84)	0.370	0.95 (0.41–2.2)	0.897
		Indigenous	1.76 (0.83–3.7)	0.137	1.21 (0.51–2.81)	0.663
		Mixed	1.03 (0.44–2.33)	0.943	0.86 (0.34–2.11)	0.744
	Education	High school or less (Reference)
		Some post-secondary	0.76 (0.4–1.48)	0.414	0.66 (0.32–1.39)	0.264
		University degree	0.71 (0.39–1.33)	0.268	0.71 (0.35–1.51)	0.365
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.67 (0.39–1.16)	0.155	0.92 (0.49–1.71)	0.785
		High: $100,000+	0.66 (0.38–1.14)	0.137	0.94 (0.49–1.82)	0.861
	Major racial discrimination		1.12 (0.99–1.27)	0.071	1.11 (0.94–1.29)	0.212
Stress	Gender	Men (Reference)
		Women	1.17 (0.82–1.68)	0.386	1.34 (0.9–1.99)	0.148
		Other	0.87 (0.33–2.11)	0.758	0.58 (0.2–1.55)	0.293
	Province	Ontario (Reference)
		Quebec	0.93 (0.6–1.44)	0.739	0.88 (0.44–1.77)	0.727
		Prairies & British Colombia	1.34 (0.89–2.02)	0.158	1.45 (0.91–2.29)	0.116
		Atlantic	1.43 (0.61–3.29)	0.401	1.6 (0.66–3.93)	0.296
	Language	English (Reference)
		French	0.81 (0.52–1.26)	0.364	1.19 (0.58–2.47)	0.629
		Bilingual	1.19 (0.62–2.27)	0.596	1.39 (0.62–3.08)	0.422
	Religion	Christian (Reference)
		Muslim	1.09 (0.65–1.81)	0.751	1.32 (0.7–2.51)	0.399
		Other	1.36 (0.75–2.45)	0.307	1.3 (0.66–2.59)	0.449
		Non-religion	0.78 (0.52–1.15)	0.212	0.85 (0.54–1.33)	0.472
	Race	White (Reference)
		Arab	0.99 (0.54–1.81)	0.976	0.71 (0.32–1.56)	0.396
		Asian	1.45 (0.86–2.45)	0.161	1.23 (0.68–2.25)	0.498
		Black	1.55 (0.87–2.77)	0.140	1.26 (0.64–2.46)	0.507
		Indigenous	1.01 (0.53–1.91)	0.974	0.66 (0.32–1.35)	0.263
		Mixed	1.93 (1.02–3.68)	0.044	1.73 (0.86–3.52)	0.125
	Education	High school or less (Reference)
		Some post-secondary	0.87 (0.51–1.47)	0.592	0.72 (0.4–1.32)	0.291
		University degree	0.89 (0.55–1.46)	0.642	0.78 (0.43–1.41)	0.401
	Income	Low: < $49,999 (Reference)
		Middle: $50,000–$99,000	0.96 (0.62–1.48)	0.852	1.02 (0.63–1.65)	0.924
		High: $100,000+	1.01 (0.65–1.56)	0.965	1.05 (0.63–1.73)	0.857
	Major racial discrimination		1.15 (1.03–1.27)	0.01	1.13 (1–1.28)	0.045

*Results from separate logistic regression models for each mental health concern (e.g., anxiety, depression, ADHD), adjusted for sociodemographic variables. Each outcome was modeled independently to assess the impact of race and major racial discrimination. COR, Crude odds ratio; AOR, Adjusted odds ratio

Regarding seeking mental healthcare for alcohol or substance use, Indigenous participants were 2.65 times more likely to seek care compared to White participants (OR = 2.65, p = 0.048); however, this likelihood became non-significant after controlling for other variables (AOR = 2.54, p = 0.111). In the adjusted model, women were less likely to seek care for alcohol or substance use compared to men (AOR = 0.43, p = 0.048). Concerning seeking mental healthcare for anxiety, results showed Arab participants were 67%, Asian participants 59%, and Black participants 48% less likely to seek care compared to White participants (OR = 0.33, p < 0.001; OR = 0.41, p = 0.001; OR = 0.52, p = 0.032, respectively). After adjusting for other variables, significant differences were only found for Arab and Asian participants (AOR = 0.20, p < 0.001; AOR = 0.36, p = 0.002, respectively). Women were more likely to seek care for anxiety compared to men (AOR = 1.9, p = 0.002). Regarding seeking mental healthcare for PTSD, Indigenous participants were 3.21 times more likely to seek care compared to White participants (OR = 3.21, p = 0.001). This finding was significant after controlling for other variables (AOR = 3.15, p = 0.008). Likewise, participants with mixed racial identity were 2.15 times more likely to seek care for PTSD compared to White participants (OR = 2.15, p = 0.036); however, no significant differences were found after adjusting for other variables. Asian participants were 58% less likely to seek care for PTSD compared to White participants (OR = 0.42, p = 0.022; AOR = 0.37, p = 0.038). Women were likely to seek care for PTSD compared to men (OR = 3.37, p < 0.001; AOR = 4.85, p < 0.001).

Moreover, results showed that Arab and Asian participants were less likely to seek care for grief/loss compared to White participants (OR = 0.25, p = 0.014; OR = 0.28, p = 0.004, respectively). After adjusting for other variables, this likelihood was only significant among Asian participants (AOR = 0.33, p = 0.046). No gender differences were found for seeking mental healthcare for grief/loss (Table 3). Arab, Asian, and Black participants were less likely to seek care for low self-esteem compared to White participants (Table 3). No gender differences were found for seeking mental healthcare for low self-esteem (Table 3). Arab participants were less likely to seek care for OCD compared to White participants (OR = 0.19, p = 0.025; AOR = 0.06, p = 0.004). Women were more likely to seek care for OCD in both unadjusted (OR = 2.23, p = 0.044) and adjusted model (AOR = 3.19, p = 0.010). Participants with non-binary gender identity were more likely to seek care for OCD (OR = 6.2, p = 0.009); this finding was not significant in adjusted model. Asian participants were less likely to seek care for personality problems compared to White participants (OR = 0.25, p = 0.020; AOR = 0.16, p = 0.031). Women and participants with non-binary gender identity were likely to seek care for personality problems. This finding was only significant in the unadjusted model (Table 3). For seeking mental healthcare related to stress, participants with mixed racial identity were 1.93 times more likely to seek care (OR = 1.93, p = 0.044). No significant result was found in the adjusted model (Table 3). Also, no gender differences were observed regarding seeking mental healthcare for stress. While no significant race difference was found for seeking mental healthcare for food/weight-related disorders, results showed women and participants with non-binary gender identity were more likely to seek care compared to men (Table 3). No race differences were observed for seeking mental healthcare related psychosis, relationship problems, and sleep problems (Table 3).

The relationship between major racial discrimination and seeking mental healthcare was tested. Unadjusted regression models showed participants with higher levels of major racial discrimination were more likely to seek care for alcohol (OR = 1.25, p = 0.014), depression (OR = 1.14, p = 0.011), low self-esteem (OR = 1.14, p = 0.042), PTSD (OR = 1.26, p < 0.001), psychosis (OR = 1.28, p = 0.028), and stress (OR = 1.5, p = 0.01). Participants with higher levels of major racial discrimination were less likely to seek care for anxiety (OR = 0.88, p = 0.012) and personality problems (OR = 0.7, p = 0.033). Adjusted regression models showed that participants with higher levels of major racial discrimination were more likely to seek care for alcohol (AOR = 1.25, p = 0.049), depression (AOR = 1.17, p = 0.012), difficulty with emotional management (AOR = 1.91, p = 0.016), low self-esteem (AOR = 1.22, p = 0.013), PTSD (AOR = 1.35, p < 0.001), and stress (AOR = 1.13 p = 0.045).

Discussion

The purpose of the current study was to explore the reasons for seeking mental healthcare among Arab, Asian, Black, Indigenous, and White individuals in Canada. Results showed that the most common reasons for seeking mental healthcare include anxiety, depression, stress/burnout, and relationship problems, whereas the least common reasons were personality problems and psychosis. According to data from the World Health Organization (WHO), anxiety and depression problems rank among the most prevalent mental health problems globally [28]. Moreover, based on the WHO data, approximately 15% of adults of working age were affected by a mental disorder due to discrimination, excessive workloads, job security and other reasons [29]. These statistics may highlight not only the scale of the problem but also how work environments, with their structural pressures, can decrease psychological well-being in Canada and elsewhere, which may increase the likelihood that affected individuals will seek mental healthcare.

This connection between the prevalence of mental health problems and seeking mental healthcare is also evident in Canada. Indeed, recent studies conducted in Canada have shown that anxiety, depression, and stress-related problems are highly prevalent in the general population [23, 24, 30], meaning individuals may be more likely to experience these symptoms and seek help. Likewise, according to reports from Statistics Canada, people with a mood, anxiety, or substance use disorder are more likely to seek mental healthcare (e.g., talking to a psychiatrist, psychologist, social worker) compared to those without a mood, anxiety, or substance use disorder [2].

The low rates of seeking mental healthcare specifically for psychosis observed in the present study can be interpreted in light of the disorder’s lower prevalence compared to more common problems like anxiety, depression, and stress-related problems. With far fewer individuals affected by psychotic disorders in the general population [31, 32], it is unsurprising that absolute numbers of people seeking mental healthcare for psychosis are correspondingly lower. According to the WHO, most people with schizophrenia worldwide do not receive appropriate mental healthcare, and only a minority of individuals with psychosis access specialist services [33]. Studies have shown that barriers to access appear to be the primary obstacle to mental health treatment engagement for individuals with psychotic disorders [34]. Thus, while psychosis affects fewer people overall, those affected face disproportionately severe challenges in obtaining timely and appropriate support.

Consistent with previous studies, the current findings indicate racial disparities in seeking mental healthcare [35–37]. Arab individuals were less likely to seek care for anxiety, grief/loss, OCD, low self-esteem, and ADHD-related problems compared to White individuals. Black individuals were less likely to seek care for anxiety and low self-esteem problems compared to White individuals. Asian individuals were less likely to seek care for anxiety, grief/loss, PTSD, personality, and low self-esteem problems compared to White individuals.

While previous studies have documented a higher prevalence of mental health problems among racialized individuals [20, 23, 24], it remains critical to examine why their mental health needs may persist or manifest differently, even when care is received. Evidence from Canada suggests that these disparities are partly rooted in inequities in access to care: Black individuals experiencing elevated psychological distress were found to have lower access to mental health services compared with their White counterparts [37]. Several interrelated factors may help explain these patterns. First, experiences of racial discrimination play a central role in shaping mental health disparities. Racialized individuals are frequently exposed to racism within the healthcare system, which fosters mistrust toward providers and institutions [38, 39]. This mistrust, in turn, can undermine both engagement with services and continuity of care. Second, structural and interpersonal factors, such as provider bias, limited cultural competence and humility, and systemic racism may lead to the misinterpretation of mental health symptoms and needs. These dynamics increase the risk of inappropriate or suboptimal interventions [37, 40–42]. Moreover, repeated discriminatory experiences further exacerbate mistrust and may discourage racialized individuals from seeking or continuing mental healthcare [43]. Consequently, even when racialized individuals do access mental health services, systemic racism and entrenched biases within healthcare systems may be associated with disparities in the quality and effectiveness of care received [16]. Another potential factor can be stigma [44]. Racialized individuals may fear being labeled by the mental healthcare system [20, 45], which could increase the risk of marginalization and discourage them from seeking help.

Additionally, systemic inequities such as socioeconomic challenges may be associated with disparities in mental healthcare [46]. Moreover, barriers to primary care and longer wait times further constrain timely access to mental healthcare [47]. Another potential factor is the shortage of mental healthcare professionals, particularly the lack of racially and culturally representative providers serving racialized communities [16, 37]. In this regard, a Canadian survey conducted in 2018 among 328 Black individuals found that 60% reported greater willingness to use mental health services if the provider were Black [47]. Therefore, structural and systemic discrimination, socioeconomic inequities, and a shortage of mental healthcare providers may contribute to mental healthcare disparities.

Indigenous individuals were 3.21 times more likely than White individuals to seek care for post-traumatic stress disorder (PTSD), an association that remained significant in the adjusted model. While they were also 2.65 times more likely to seek mental healthcare for alcohol-related problems in the unadjusted analysis, this association was no longer statistically significant after adjusting for confounding factors. These elevated rates of seeking mental healthcare related to PTSD should be interpreted cautiously and within the broader context of trauma exposure and systemic inequities rather than as reflecting Indigenous identity itself. Notably, this pattern emerges despite well-documented mistrust of healthcare systems among Indigenous peoples, rooted in historical and ongoing discrimination that has consistently been shown to deter mental health service use [48–50]. The willingness to seek care under such conditions may indicate the severity and persistence of trauma-related distress. This observation is consistent with a growing body of evidence showing that racial discrimination and chronic exposure to microaggressions intensify PTSD symptoms among Indigenous and other racialized populations in Canada [49, 51, 52]. Discriminatory experiences not only exacerbate trauma responses but also shape patterns of service use, contributing to persistent disparities in PTSD-related care [53–55].

The elevated likelihood of seeking mental healthcare for alcohol-related problems must be interpreted within this broader context of trauma exposure. PTSD among Indigenous individuals frequently co-occurs with substance use disorders, which remain among the most prevalent mental health challenges in this population [56]. The elevated likelihood of seeking mental healthcare for substance-related problems may also be associated with maladaptive coping in response to intergenerational trauma and persistent structural stressors [49]. However, substance use among Indigenous patients is often interpreted through a lens of stigma within health-care settings. Pervasive stereotypes frequently lead to the assumption that Indigenous patients are intoxicated or that substance use is the primary explanation for their symptoms. The death of Joyce Echaquan, following the reported dismissal of her symptoms based on assumptions related to substance use, has become an important example in discussions of systemic racism in Canadian healthcare [57]. This case is not an isolated event but rather emblematic of the enduring systemic racism faced by Indigenous peoples within the Canadian health-care system [58].

Moreover, the current findings indicated gender differences in seeking mental healthcare, with women presenting higher rates of anxiety, food/weight-related disorders, OCD, PTSD, and relationship problems, but lower rates of alcohol and psychosis. These findings are consistent with literature that identifies gender as a determinant of mental health service utilization [16, 59]. These patterns are consistent with the internalized-externalized disorders framework, which suggests that women are more likely to experience and seek care for internalized disorders (e.g., anxiety, PTSD), whereas men are more likely to present with externalized disorders, such as substance-related problems and psychosis [60]. Likewise, individuals with other gender identity were more likely to seek mental healthcare related to ADHD and food/weight-related disorders. This higher rate among individuals with other gender identity might be explained by a high prevalence of mental health problems among individuals with other gender identity reported in Canada [23, 24] Minority-stress theory indicates gender-diverse individuals often experience chronic stress and discrimination [21], resulting in the development of mental health problems, especially eating disorders [61].

Implications

The findings from this study have significant implications for the understanding and management of mental health services across diverse populations. First, as a high-income country with a publicly funded healthcare system, Canada has substantial resources to support population mental health; however, depression, anxiety, and stress remain common problems in all racial groups and particularly among racialized and Indigenous populations [23, 24, 62]. The findings highlight continued demand for mental health services and suggest the importance of examining structural, social, and access-related factors that may be linked to psychological well-being and patterns of seeking mental healthcare across populations. These results underscore the need for ongoing efforts to improve access to equitable and responsive mental health services. The immediate priorities should include launching national mental health initiatives (e.g., employer-funded counselling), expanding preventive programs in schools, communities, and primary care to build resilience against anxiety, depression, stress/burnout, and other mental health problems, while considering the racial disparities observed. It is also important to conduct targeted research to explore the socioeconomic, cultural, and structural determinants of these disorders. Second, equally important is tackling the disparities faced by Indigenous communities in Canada, where higher rates of PTSD and substance use disorders may be directly related to the ongoing effects of colonialism, intergenerational and complex racial trauma, and persistent discrimination. These historical and systemic factors not only increase vulnerability but also deeply damage trust in the healthcare system. To make real progress, policies should prioritize Indigenous-led initiatives, which focus on culturally safe care, mandatory anti-racism training for health providers, and community-driven programs that directly confront intergenerational trauma. Investing in these approaches would help decrease these gaps.

Third, the observed racial disparities in seeking mental healthcare may highlight the potential importance of targeted training for mental healthcare providers. Such training should explicitly address how systemic racism is associated with trust and seeking mental healthcare. Moreover, it should equip providers with practical strategies to recognize and counteract cultural stereotypes and stigmas that distort clinical assessments, misguide diagnoses, and alienate patients from diverse backgrounds, particularly Indigenous individuals. In the V-TRaC lab, an anti-racist program was developed for all mental health professionals, which has shown promising results in enhancing cultural competence and humility among providers in school settings [63]. This program may be further adapted and evaluated in broader contexts through the addition of practice-based components and dedicated modules addressing Indigenous-specific biases. This approach would allow for faster, lower-cost implementation than developing new programs, while supporting timely, evidence-based progress toward equity in access to care.

Fourth, there is a need to ensure that healthcare providers are knowledgeable about the experiences of gender-diverse individuals in order to effectively respond to the mental health challenges faced by non-binary individuals. Future training efforts may consider implementing educational programs that raise awareness of intersectionality, especially between mental health and gender, to create a more inclusive healthcare environment and to improve outcomes for marginalized populations. Fifth, beyond training graduate students and current mental healthcare providers, the mental health system in Canada may benefit from addressing persistent structural barriers to service access, including language, geographic location, and socioeconomic constraints [16]. For instance, regions with substantial linguistic diversity require targeted recruitment strategies that prioritize multilingual providers. Moreover, disparities in service availability across communities indicate the need for mechanisms that ensure more equitable access [16]. In areas where in-person services remain limited, the development and deployment of responsible artificial intelligence (AI)-supported counselling tools may represent a potential approach to reducing gaps in care [64]; however, their implementation should be guided by empirical evidence and ongoing research evaluating their effectiveness, equity, and safety [65, 66]. Finally, it is important to develop national and local awareness programs about mental health problems and their symptoms to increase mental health literacy, which may be helpful to identify mental health problems at an early stage and to promote formal help-seeking behaviours [67].

Limitations

Despite its importance, the present study has several limitations that should be acknowledged. First, a central limitation of this study is our reliance on self-reported reasons for seeking mental healthcare rather than clinician-documented information from client files. Ideally, clinical records would provide more precise and detailed data on presenting problems, diagnoses, and the clinical motivations for seeking care. However, in Canada, healthcare administrative and clinical records generally do not include information about patients’ race or ethnicity, and there is no standardized collection of these data across provinces and care settings [68]. As a result, it is currently not possible to link clinician-recorded reasons for seeking care with patients’ racial or ethnic identities using existing health record systems, which constrained our ability to examine race-based differences using clinical file data. Second, although we examined reasons for seeking mental healthcare, future studies should investigate structural or interpersonal barriers that may prevent individuals from seeking mental healthcare in the first place. This gap is especially consequential for racialized and Indigenous populations, for whom seeking care decisions may be shaped by systemic racism, mistrust of the healthcare system, cultural misalignment of services, and prior experiences of racial discrimination in healthcare systems. These factors should also be taken into account when interpreting the findings. Third, the cross-sectional design limits interpretation of the findings. Because data were collected at one time point, the results reflect associations rather than causal relationships. Longitudinal studies are needed to examine these patterns over time. Fourth, the number of participants identifying as sexual minorities was insufficient for inclusion of sexual orientation in the main analyses, which prevented an intersectional analysis. Fifth, the dataset lacked representation from several provinces, including Nova Scotia, New Brunswick, and other provinces, which limits the generalizability of the findings to the national population. Sixth, several potentially important confounding factors were not assessed, such as urban versus rural residence, variability in internet access, and other contextual conditions that may influence both access to care and reported reasons for seeking care. Future research should integrate these variables to provide a more comprehensive understanding of inequities in mental health service utilization across diverse communities. Finally, as multiple regression models were conducted across several outcomes, the possibility of Type I errors should be considered when interpreting the findings. Given the exploratory nature of this study, formal false discovery rate correction was not applied to avoid the likelihood of missing potentially important associations; therefore, statistically significant findings should be interpreted cautiously. Several estimates had wide confidence intervals, particularly for less frequent outcomes and smaller racial subgroups. In addition, the analyses were based on an unweighted oversampled panel, which may limit the generalizability of the findings. Accordingly, these findings should be considered preliminary, and replication in independent, population-based samples is needed to confirm them.

Conclusions

In conclusion, this study highlights persistent and patterned disparities in reasons for seeking mental healthcare across racial and gender groups in Canada. Consistent with minority stress theory, the findings suggest that experiences of racial discrimination and broader social contexts may be linked to differences in reasons for seeking mental healthcare among diverse populations. These results underscore the importance of an intersectional lens that considers the interconnected roles of race, gender, and social stressors in shaping mental health experiences and reasons for seeking mental healthcare. Addressing these disparities requires a comprehensive approach to mental healthcare that prioritizes equity, cultural competence, cultural humility, cultural safety, and structural responsiveness to ensure that mental healthcare is accessible, appropriate, and effective for populations that have been historically marginalized within healthcare systems.

Author contributions

J.M.C., S.M.M.M.F.: study design. T.K.: data analysis and results. S.M.M.M.F., J.M.C.: interpretation of the results. S.M.M.M.F., M.M.O., T.K., J.M.C.: drafting the manuscript. S.M.M.M.F., J.M.C.: critical revision. J.M.C: supervision. All authors read and approved the final version of the manuscript.

Funding

This article was supported by the grant #469050 from the Social Sciences and Humanities Research Council (SSHRC) and Canadian Institutes of Health Research (CIHR).

Data availability

The data are not publicly available due to privacy and ethical restrictions. They are available on request from the corresponding author.

Declarations

Ethics approval and consent to participate

The study was approved by the University of Ottawa’s Research Ethics Board (#H-11-22-8694) and Montfort Hospital (#22-23-09-029), with electronic informed consent obtained from all participants. All human-related procedures were performed in accordance with the ethical guidelines and regulations of the University of Ottawa and Montfort Hospital.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.