1 Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada. helen-maria.vasiliadis@usherbrooke.ca.
2 Centre de recherche Charles-Le Moyne, 150, place Charles-Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada. helen-maria.vasiliadis@usherbrooke.ca.
3 Département des sciences de la santé communautaire, Université de Sherbrooke, 2500, boul. de l'Université, J1K 2R1, Sherbrooke (Québec), Canada.
4 Centre de recherche Charles-Le Moyne, 150, place Charles-Le Moyne, C. P. 200, J4K 0A8, Longueuil (Québec), Canada.
5 Douglas Mental Health University Institute, 6875 boul., H4H 1R3, LaSalleVerdun (Québec), Canada.
6 McGill University, 845 Sherbrooke St W, H3A 0G4, Montreal (Québec), Canada.
7 Department of Psychology, Concordia University, 7141 Sherbrooke West, H4B 1R6, Montreal (Québec),

Objectives: Using Andersen's model of health care seeking behavior, we examined the predisposing, enabling, and need factors associated with mental health service use (MHSU) during the first wave of the COVID-19 pandemic across Canada.

Methods: The sample included n = 45,542 participants in the 5 established regional cohorts of the Canadian Partnership for Tomorrow's Health (CanPath) and who responded to the CanPath COVID-19 health survey (May-December 2020), with complete data on MHSU. Multivariable logistic regression analyses were carried out to study MHSU as a function of predisposing, enabling, and need factors. Analyses were stratified by regional cohort.

Results: Among the need factors, individuals reporting moderate/severe symptoms of depression and anxiety and poorer self-rated mental health were more likely to report MHSU. Among the enabling factors, receipt of informational/financial/practical support was associated with increased MHSU. While income was not consistently associated with MHSU, reported decrease in income was marginally associated with reduced MHSU. Among the predisposing factors, identifying as female or other gender minority was associated with increased MHSU, as was the presence of past-year cannabis use. In contrast, older age and alcohol consumption were associated with reduced MHSU.

Conclusion: Need factors were consistently associated with MHSU. Although income inequities in MHSU were not observed, changes such as reduced income during the pandemic may lead to barriers in accessing mental health services. Future research should focus on better identifying contextual enabling factors and policies that overcome financial barriers to MHSU.