Food Insecurity, Perceived Mental Health, and Inequities In Mental Health Service Use Among Canadian Adolescents: A Moderated Mediation Analysis By Visible Minority Status

Background and Purpose: Food insecurity is a structural determinant of adolescent mental health that is unevenly distributed across racialized groups in Canada. Visible minority adolescents experience higher rates of food insecurity alongside lower rates of mental health service use than their non-visible minority peers. Yet it remains unclear whether these disparities reflect differences in perceived mental health, differences in the help seeking pathway, or both. Guided by the help seeking pathways model, this study examined whether the pathway from food insecurity to perceived mental health and service use operates differently for visible minority and non-visible minority adolescents.

Methods: This study used the 2019 to 2020 Canadian Community Health Survey, a nationally representative cross-sectional survey. The analytic sample included 5,144 adolescents aged 12 to 17 years. Food insecurity was measured using the Household Food Security Survey Module and dichotomized as food secure versus any food insecurity. Perceived mental health was assessed using a self-rated item recoded into three ordered categories: poor or fair, good, and very good or excellent. Three past year service outcomes were examined: information services, medication, and counselling. Moderated mediation models were estimated using linear probability models with 1,000 bootstrap replicate weights. Sensitivity analyses using ordered logit and logistic regression were conducted.

Results: Visible minority adolescents had higher rates of food insecurity than non-visible minority adolescents, 23.0% versus 14.5%, and lower rates of mental health service use across the three service outcomes examined. Food insecurity was associated with poorer perceived mental health, and poorer perceived mental health was associated with a higher likelihood of service use across all three outcomes. Significant indirect effects were observed across all outcomes in the full sample, but this pathway operated differently by visible minority status. Indirect effects were significant across all service outcomes among non-visible minority adolescents, but smaller and not statistically significant among visible minority adolescents. Significant moderated mediation was observed for medication and counselling. Path specific analyses showed no significant moderation of the association between food insecurity and perceived mental health, but significant moderation of the association between perceived mental health and medication and counselling use. Sensitivity analyses yielded directionally consistent results.

Conclusions and Implications: For medication and counselling, the attenuated indirect pathway among visible minority adolescents appears to be driven more by differences in the association between perceived mental health and service use rather than by differences in the association between food insecurity and perceived mental health. This pattern is consistent with structural barriers at the point of formal service contact. These findings suggest that lower service use among visible minority youth may reflect a structural access failure rather than a demand side deficit. They also highlight the limits of universal approaches to mental health service delivery and support the need for equity focused responses for food insecure visible minority youth in Canada.