Impact of the COVID-19 pandemic on mental health and addictions-related visits among citizens of the Métis Nation of Ontario: a repeated cross-sectional study

The COVID-19 pandemic led to unprecedented levels of poor mental health, yet Métis-specific experiences remain underreported, despite the Métis being one of the three constitutionally recognized Indigenous Peoples in Canada. This study examined changes in mental health and addictions (MHA)-related outpatient health service utilization among Métis Nation of Ontario (MNO) citizens before and during the COVID-19 pandemic. This was a population-based repeated cross-sectional study. Administrative health data in Ontario, Canada (2017–2022) was linked with the MNO Citizenship Registry (2022). Monthly MHA-related outpatient visit rates were compared between pre-COVID-19 (March 2017-February 2020) and post-COVID-19 (March 2020-December 2022), and rate ratios comparing observed and expected rates were derived using Poisson generalized estimating equations adjusted for age and sex. Stratifications by age and sex were also examined. Among 28,400 MNO citizens, the monthly MHA-related outpatient visit rate was 47.8 per 1000 population pre-COVID-19. During the pandemic, the observed MHA-related outpatient visit rates were 13% higher than expected (95% CI:1.02-1.26). MHA-related outpatient visits post-COVID were higher in females compared to males and MNO citizens aged 65 and older compared to younger citizens. Female MNO citizens aged 65 years and older had the greatest increases in monthly visit rates for mood and anxiety disorders (aRR = 1.45, 95% CI: 1.27-1.65), substance use disorders (aRR = 3.74, 95% CI: 2.03-4.63), and schizophrenia spectrum and other psychotic disorders (aRR = 3.14, 95% CI: 2.00-4.94). In contrast, male MNO citizens aged 65 years and older had the greatest increase in monthly visit rate for other diagnoses (aRR = 1.87, 95% CI: 1.65-2.12). This underscores the importance of high-quality, contemporary data on the mental health outcomes of Métis people to inform the allocation of scarce mental health resources. The findings emphasize the need for targeted mental health interventions, ongoing monitoring, and culturally tailored support to address the mental health needs of the Métis community.