21: Health care utilization by sexual minority adolescents

Abstract

Purpose: Prior research indicates a strong link between adolescent same-sex sexual orientation (self-identity as gay, lesbian, or bisexual, as well as same-sex attractions or relationships) and compromised mental health, including depression and suicidality. No known research has examined the mental health utilization of this subpopulation of adolescents. Prior work indicates that these youth may be unlikely to disclose their sexual minority status to health care providers; are they less likely to seek mental health care in the first place? Or, because of their elevated levels of compromised mental health, do they utilize mental health care more frequently? Methods: We investigate these questions using data from the National Longitudinal Study of Adolescent Health (Add Health; 19951997). We begin by examining same-sex romantic attractions and relationships (at wave 1) and their associations with mental health services both at waves 1 and 2 (18 months later). All analyses were run separately for males and females because of the strong link between biological sex and mental health services use. All analyses control for the complex sample design of the Add Health study, and for basic demographic characteristics (age, intact family status, parent education, insurance status, ethnicity, and public assistance status). To address our first question (Are sexual minority youth (more or) less likely to seek mental health care?) we examine the link between sexual minority status and mental health care use. To address our second question (Do elevated levels of compromised mental health predict mental health care utilization?) we examine this association accounting for factors correlated with mental health care: victimization experiences, substance use and abuse, and depression (each measured at wave 1). Results: Our results show that sexual minority youth are more likely to report having had mental health counseling compared to heterosexual youth. Notably, same-sex attraction and same-sex relationships (same-sex dating) operate independently: each is associated with increased mental health utilization. Next, results indicate that the findings are robust once controlling for prior victimization, suicidal thoughts, substance abuse, and depression. Specifically, sexual minority status remains a strong predictor of mental health care utilization, independent of these indicators of mental health status. Sexual minority youth were more likely to seek mental health services, even in the absence of symptoms, than their non-same-sex attracted peers. Tests of interactions between sexual minority status and indicators of mental health status will be presented. Conclusions: Possible reasons for increased mental health care utilization of sexual minority youth are discussed, as are implications for targeted health care services provision. Sources of Support: William T. Grant Foundation Scholar Award to the second author.