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Introduction The prevalence of mood and anxiety disorders is continuing to increase. Yet, over two thirds of people with mental disorders do not seek treatment. Various changes in the provision of mental health services in Ontario and the population profile makes assessment of the corresponding changes in the pattern and determinants of mental health service utilization timely. Objective To examine and compare, between 1991 and 2002 in Ontario, the rate, patterns, and predictors of health services utilization between individuals with depression, anxiety, or comorbid depression and anxiety disorders. Individuals in these three mutually exclusive groups were examined to determine how the results compare between these three disorder types over an 11 year period. Methods This thesis is based on data from two independent cross-sectional population health surveys: the Mental Health Supplement (1990/91) to the Ontario Health Survey (1990) and the Canadian Community Health Survey, Cycle 1.2 Mental Health and Well-being (2002; Ontario subset). Results The rate of service utilization during the preceding 12 months has increased from 32% in 1991 to 41% in 2002, with a greatest increase seen among individuals with anxiety (17% in 1991 vs. 28% in 2002). Multivariate regression modeling showed changes in the predictors of service utilization between 1991 and 2002. The use of antidepressants and anxiety-reducing medications increased from 2.2% to 7.7%, with the largest increase seen among respondents with anxiety (7% to 25%). The three most commonly sought service providers in both 1991 and 2002 were family physicians, psychiatrists, and social workers: 60%, 26%, and 23%, respectively in 1991 and 73%, 40%, and 30%, respectively in 2002. Nonetheless, 20% of the 1991 respondents and 26% of the 2002 respondents reported unmet needs, with the highest rate seen in the comorbid depression and anxiety group (41% in 1991 and 47% in 2002). Multilevel regression modeling showed that geographic area characteristics were not significant in predicting service utilization. Conclusions These findings suggest that more individuals with depression and/or anxiety are seeking treatment in recent years. However, the persistent high rate of unmet needs suggests that promotion efforts to seeking care and improving access to services is necessary to improve mental health service utilization.