{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T14:15:59Z","timestamp":1788099359015,"version":"build-2803163510"},"reference-count":51,"publisher":"SAGE Publications","license":[{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T00:00:00Z","timestamp":1787788800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"DOI":"10.13039\/100011094","name":"Public Health Agency of Canada","doi-asserted-by":"publisher","award":["2425-HQ-000095"],"award-info":[{"award-number":["2425-HQ-000095"]}],"id":[{"id":"10.13039\/100011094","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Can J Psychiatry"],"abstract":"<jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Degree of rurality and neighbourhood deprivation are important factors in understanding variation in mental illness across populations, but epidemiological data on their relevance to mental illness in home care (HC) clients are limited. We estimated the prevalence of several mental illnesses by these characteristics and their interaction effects among HC clients and matched community comparators in Ontario, Canada.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Method<\/jats:title>\n                    <jats:p>We conducted a repeated cross-sectional study using linked health administrative data. HC recipients aged \u226518 years were matched to community comparators on demographics, dementia, and comorbidity. Within each study sample, prevalence estimates were calculated and compared across urban\/rural residence and binary measures of the 4 dimensions of the Canadian Index of Multiple Deprivation (CIMD). Outcomes were derived with validated case definitions for any mental illness, mood\/anxiety disorders, depression and anxiety (with\/without drug claims), schizophrenia, bipolar disorder, and suicide attempt. Prevalence ratios (PRs: 95% CIs) were estimated with modified Poisson regression models adjusted for relevant covariates.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We included 479,064 urban- and 72,862 rural-residing HC clients (mean age 73.2 and 72.4 years, respectively). Mental illnesses were less common in rural than urban clients (e.g., any mental illness 31.3% vs. 39.4%), with adjusted PRs between 0.80 and 0.87. Prevalence estimates were significantly higher among clients in areas more marginalized in residential instability and ethno-cultural composition, with more pronounced adjusted PRs for clients in urban than rural settings (e.g., PR [more vs. less marginalized residential instability] for any mental illness: 1.12 (1.12, 1.13) for urban and 1.07 (1.04, 1.10) for rural clients,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      \u2009&lt;\u20090.001). In matched community comparators, we observed similar patterns by urban\/rural and deprivation measures though mental illness prevalence was significantly lower overall.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Mental illnesses are common among HC clients and vary regionally. Incorporating geographic and socioeconomic indicators into mental health surveillance systems offers insight into mental health disparities that may warrant more targeted interventions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/07067437261468887","type":"journal-article","created":{"date-parts":[[2026,8,27]],"date-time":"2026-08-27T15:08:16Z","timestamp":1787843296000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":0,"title":["Mental Illness Prevalence Among Ontario Home Care Clients: Variation by Urban\/Rural Residence and Deprivation Measures: Pr\u00e9valence de la maladie mentale chez les clients de soins \u00e0 domicile en Ontario : variation selon la r\u00e9sidence urbaine\/rurale et les mesures de d\u00e9favorisation"],"prefix":"10.1177","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-0931-4370","authenticated-orcid":false,"given":"Cindy","family":"Wang","sequence":"first","affiliation":[{"name":"University of Waterloo"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1855-5595","authenticated-orcid":false,"given":"Ruth Ann","family":"Marrie","sequence":"additional","affiliation":[{"name":"Dalhousie University"},{"name":"Department of Medicine, Max Rady College of Medicine, Rady Faculty of Health Sciences, University of Manitoba, Winnipeg, Manitoba, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin","family":"Luo","sequence":"additional","affiliation":[{"name":"ICES, Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6319-5181","authenticated-orcid":false,"given":"James M.","family":"Bolton","sequence":"additional","affiliation":[{"name":"University of Manitoba"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Gruneir","sequence":"additional","affiliation":[{"name":"ICES, Toronto"},{"name":"University of Alberta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erind","family":"Dvorani","sequence":"additional","affiliation":[{"name":"ICES, Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl","family":"Everett","sequence":"additional","affiliation":[{"name":"ICES, Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahra","family":"Goodarzi","sequence":"additional","affiliation":[{"name":"University of Calgary"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ping","family":"Li","sequence":"additional","affiliation":[{"name":"ICES, Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liisa","family":"Jaakkimainen","sequence":"additional","affiliation":[{"name":"ICES, Toronto"},{"name":"University of Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Colleen J.","family":"Maxwell","sequence":"additional","affiliation":[{"name":"University of Waterloo"},{"name":"ICES, Toronto"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"on behalf of the EMHLTH-CC Research Team","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,8,27]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.1016\/S2215-0366(21)00395-3"},{"key":"e_1_3_3_3_2","volume-title":"World mental health report: transforming mental health for all","author":"World Health Organization","year":"2022","unstructured":"World Health Organization. World mental health report: transforming mental health for all. 1st ed. Geneva: World Health Organization; 2022. 1 p."},{"key":"e_1_3_3_4_2","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.36.12.03"},{"issue":"3","key":"e_1_3_3_5_2","first-page":"75","article-title":"Mental health expenditure in Canada","volume":"27","author":"Milliken O","year":"2024","unstructured":"Milliken O, Wang H, Benda MC, Dinh T, Diener A. Mental health expenditure in Canada. J Ment Health Policy Econ. 2024;27(3):75-84.","journal-title":"J Ment Health Policy Econ"},{"key":"e_1_3_3_6_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-024-05311-8"},{"key":"e_1_3_3_7_2","doi-asserted-by":"publisher","DOI":"10.1038\/s41380-023-02138-4"},{"key":"e_1_3_3_8_2","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare12171721"},{"key":"e_1_3_3_9_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2019-029523"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.3389\/fpsyt.2021.712112"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1097\/JGP.0b013e3182331702"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1080\/07317115.2024.2335472"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.1177\/0891988720901790"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jagp.2017.05.021"},{"key":"e_1_3_3_15_2","doi-asserted-by":"publisher","DOI":"10.1002\/gps.4259"},{"key":"e_1_3_3_16_2","doi-asserted-by":"publisher","DOI":"10.1097\/NNR.0000000000000147"},{"key":"e_1_3_3_17_2","doi-asserted-by":"publisher","DOI":"10.1111\/ajag.13396"},{"key":"e_1_3_3_18_2","doi-asserted-by":"publisher","DOI":"10.1177\/0004867419828480"},{"key":"e_1_3_3_19_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.gerinurse.2025.103388"},{"key":"e_1_3_3_20_2","doi-asserted-by":"publisher","DOI":"10.1002\/wps.21160"},{"key":"e_1_3_3_21_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.schres.2020.03.044"},{"key":"e_1_3_3_22_2","doi-asserted-by":"publisher","DOI":"10.1177\/0706743716659246"},{"key":"e_1_3_3_23_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00127-010-0222-2"},{"key":"e_1_3_3_24_2","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.29.3.04"},{"key":"e_1_3_3_25_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jad.2025.119601"},{"key":"e_1_3_3_26_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610223000613"},{"issue":"3","key":"e_1_3_3_27_2","first-page":"433","article-title":"The Canadian Chronic Disease Surveillance System: a model for collaborative surveillance","volume":"3","author":"Lix LM","year":"2018","unstructured":"Lix LM, Ayles J, Bartholomew S, et al. The Canadian Chronic Disease Surveillance System: a model for collaborative surveillance. Int J Popul Data Sci. 2018;3(3):433.","journal-title":"Int J Popul Data Sci"},{"key":"e_1_3_3_28_2","unstructured":"Public Health Agency of Canada. The Canadian Chronic Disease Surveillance System \u2013 an overview [Internet]. 2018 [cited 2025 Dec 3]. https:\/\/www.canada.ca\/en\/public-health\/services\/publications\/canadian-chronic-disease-surveillance-system-factsheet.html."},{"key":"e_1_3_3_29_2","unstructured":"Government of Canada. About Canada\u2019s health care system [Internet]. 2016 [cited 2025 Sept 29]. https:\/\/www.canada.ca\/en\/health-canada\/services\/canada-health-care-system.html."},{"key":"e_1_3_3_30_2","doi-asserted-by":"publisher","DOI":"10.24095\/hpcdp.37.7.02"},{"key":"e_1_3_3_31_2","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2377-13-16"},{"key":"e_1_3_3_32_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpsychores.2016.08.014"},{"key":"e_1_3_3_33_2","doi-asserted-by":"publisher","DOI":"10.1002\/mpr.1559"},{"key":"e_1_3_3_34_2","volume-title":"The Canadian index of multiple deprivation: user guide, 2021","author":"Statistics Canada","year":"2023","unstructured":"Statistics Canada. The Canadian index of multiple deprivation: user guide, 2021. Ottawa, ON: Statistics Canada; 2023. https:\/\/www150.statcan.gc.ca\/n1\/pub\/45-20-0001\/452000012023002-eng.htm."},{"key":"e_1_3_3_35_2","doi-asserted-by":"publisher","DOI":"10.1002\/sim.3697"},{"key":"e_1_3_3_36_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12874-018-0519-5"},{"key":"e_1_3_3_37_2","unstructured":"Stephenson E. Mental disorders and access to mental health care [Internet]. 2023 [cited 2025 Dec 3]. https:\/\/www150.statcan.gc.ca\/n1\/pub\/75-006-x\/2023001\/article\/00011-eng.htm."},{"key":"e_1_3_3_38_2","doi-asserted-by":"publisher","DOI":"10.7870\/cjcmh-2009-0015"},{"key":"e_1_3_3_39_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0276279"},{"key":"e_1_3_3_40_2","doi-asserted-by":"publisher","DOI":"10.1017\/S1041610215000538"},{"key":"e_1_3_3_41_2","doi-asserted-by":"publisher","DOI":"10.1080\/00207411.2023.2218586"},{"key":"e_1_3_3_42_2","doi-asserted-by":"publisher","DOI":"10.1007\/s10903-021-01313-5"},{"key":"e_1_3_3_43_2","volume-title":"Immigration and ethnocultural diversity in Canada: National Household Survey, 2011","author":"Chui T","year":"2013","unstructured":"Chui T. Immigration and ethnocultural diversity in Canada: National Household Survey, 2011. Ottawa, ON: Statistics Canada; 2013."},{"key":"e_1_3_3_44_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmjopen-2014-006690"},{"key":"e_1_3_3_45_2","doi-asserted-by":"publisher","DOI":"10.1017\/S0033291718003227"},{"key":"e_1_3_3_46_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12877-023-04229-x"},{"key":"e_1_3_3_47_2","volume-title":"The state of mental health in Canada 2024: mapping the landscape of mental health, addictions and substance use health","author":"Lowe L","year":"2024","unstructured":"Lowe L, Fearon D, Adenwala A, Harris DW. The state of mental health in Canada 2024: mapping the landscape of mental health, addictions and substance use health. Toronto, ON: Canadian Mental Health Association; 2024."},{"key":"e_1_3_3_48_2","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmen.0000065"},{"key":"e_1_3_3_49_2","unstructured":"Public Health Agency of Canada. Guidance for evaluating the influence of the COVID-19 pandemic on Canadian Chronic Disease Surveillance System measures [Internet]. 2024. https:\/\/health-infobase.canada.ca\/ccdss\/publication\/COVID_Guidance_EN.pdf."},{"key":"e_1_3_3_50_2","doi-asserted-by":"publisher","DOI":"10.1016\/j.drugalcdep.2022.109568"},{"key":"e_1_3_3_51_2","doi-asserted-by":"publisher","DOI":"10.1186\/s12888-019-2369-z"},{"key":"e_1_3_3_52_2","doi-asserted-by":"publisher","DOI":"10.1093\/geronb\/gbab045"}],"container-title":["The Canadian Journal of Psychiatry"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/07067437261468887","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/07067437261468887","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/07067437261468887","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,30]],"date-time":"2026-08-30T13:49:39Z","timestamp":1788097779000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/07067437261468887"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,27]]},"references-count":51,"alternative-id":["10.1177\/07067437261468887"],"URL":"https:\/\/doi.org\/10.1177\/07067437261468887","relation":{},"ISSN":["0706-7437","1497-0015"],"issn-type":[{"value":"0706-7437","type":"print"},{"value":"1497-0015","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,27]]},"article-number":"07067437261468887"}}