Mental distress and healthcare utilisation among sami and non-sami adults: a prospective registry-linked cohort study utilising data from the SAMINOR 2 questionnaire survey and the Norwegian control and payment of health reimbursements database (2012–2022)

Mental distress is associated increased healthcare utilisation, but little is known about whether the relationship between mental distress and use of health care services differs between Sami and non-Sami populations in Norway. The aim of this study was to investigate whether level of mental distress was associated with a different pattern of use of primary and specialised healthcare services among Sami and non-Sami populations. Data from the SAMINOR 2 Questionnaire Survey were linked to data from the Norwegian Control and Payout of Health Refunds Database and Statistics Norway. Level of mental distress based on the 10 items Hopkins Symptom Checklist was the primary exposure variable. Participants were categorised as Sami or non-Sami and stratified by sex. Primary and specialist healthcare utilisation, and the interaction between mental distress and ethnicity, were assessed by estimating incidence rates and incidence rate ratios from Negative binomial generalised linear models with a log link. The primary model was adjusted for age, years of education, and chronic conditions. Mental distress was associated with increased utilisation of both primary and specialist healthcare services across all ethnic and sex groups. Only minor differences in use of health care were observed between the two ethnic groups. Ethnicity did not significantly modify the associations between mental distress and use of health care. The association between mental distress and healthcare use was largely similar across ethnic groups after adjustment for covariates. Comparable utilisation rates should not be interpreted as evidence of identical healthcare-seeking processes, as cultural, contextual, and structural factors may influence how individuals engage with healthcare services. Further research should explore pathways to healthcare among Sami and non-Sami populations.