Internet-Based Help-Seeking and Unmet Mental Health Need Among Canadian Youth

Background and Purpose: Canadian youth aged 15 to 24 report the highest rates of unmet mental health need of any age group, with structural barriers including cost, service unavailability, and long wait times identified as key contributors. Internet-based help-seeking has expanded rapidly in this population, yet its relationship to formal mental health service access remains unclear. Two competing models have been proposed: a complementary model in which online engagement facilitates eventual service use, and a substitutive model in which it replaces formal care among those facing access barriers. Using a nationally representative Canadian survey, this study examined whether internet-based help-seeking was associated with unmet need among screener-positive youth and whether specific internet use subtypes were differentially associated with unmet need.

Methods: This cross-sectional study used the 2022 Mental Health and Access to Care Survey. The analytic sample included 1,465 youth (weighted N = 3,199,794) aged 15 to 24 who screened positive for at least one of four conditions: depression, mania, generalized anxiety disorder, or social phobia. The outcome was self-reported unmet mental health need, and the predictor was any internet-based mental health help-seeking in the past 12 months. Survey-weighted logistic regression with 1,000 Fay bootstrap replicate weights estimated the association between internet-based help-seeking and unmet need, adjusting for psychological distress (K6), sex, LGBTQ2+ identity, visible minority status, immigration status, neighbourhood income decile, and rurality. A supplementary analysis examined four internet-based help-seeking subtypes among internet users: symptom information seeking, service navigation, peer support, and online therapy. Two sensitivity analyses addressed potential non-random missingness using scenario-based analysis and multiple imputation.

Results: Among screener-positive youth, 21.4% reported internet-based help-seeking and 15.3% reported unmet mental health need. After covariate adjustment, internet-based help-seeking was associated with more than twice the odds of unmet need (OR 2.49, 95% CI 1.65 to 3.75). Among internet users, peer support seeking was the only subtype independently associated with unmet need (OR 2.29, 95% CI 1.12 to 4.68). Symptom information seeking, service navigation, and online therapy were not associated with unmet need. Among youth with unmet need, the most frequently endorsed barriers were not knowing how to access services (35.9%), cost (30.4%), and service unavailability (26.0%). Sensitivity analyses were directionally consistent with the primary finding, although scenario-based estimates were attenuated (OR range 1.95 to 2.16) and should be interpreted cautiously.

Conclusions and Implications: Among Canadian youth with probable mental health conditions, internet-based help-seeking was associated with persistent unmet mental health need rather than with resolved access to care. Findings are broadly consistent with a substitutive interpretation, suggesting that digital engagement may reflect constrained pathways into formal services. Online peer support seeking may identify a particularly underserved subgroup of youth experiencing sustained gaps in care. These findings underscore the need for policy and practice responses that strengthen navigation from digital help-seeking to formal services and address barriers related to cost, service availability, and knowledge about how to access services.