Sexual Minority Status and Mental Health Service Usage in a Group of At-Risk Adolescents

• In Event: 3-038 - Mental Healthcare for Sexual and Gender Minority Adolescents: Access, Utilization, and Effectiveness

Integrative Statement

Following from minority stress theory (Meyer, 2003), existing research suggests that sexual minority youth experience more mental health problems when compared to their heterosexual peers (Institutes of Medicine, 2011). What is less well understood, however, is if these higher levels of mental health problems translate into greater likelihood of using mental health services. While poorer mental health would be anticipated to increase the likelihood of service use, sexual minority youth may have reduced access to mental health services due to structural barriers to service usage (e.g., lower levels of family support, greater discrimination when trying to use services). The goal of the current study was to explore the association between sexual minority status and mental health service usage, and to assess how this association was mediated by the presence of problem behavior.
Participants (n = 664, 46% girls) in an ongoing longitudinal study of children from Quebec, Canada, with and without histories of conduct problems completed assessments of their same-sex attraction, sex of their sexual partners and their sexual identities when they were approximately 15 years old. Their parents completed surveys about their mental health service usage over the past six months, and the adolescent, their parents and their teachers completed assessments of behavior problemsusing the Child’s Behavior Checklist (Achenbach & Rescorla, 2000). Approximately 6% of the participants reported same-sex attraction, 9% reported a sexual minority identity, and 3% reported same-sex sexual behavior. Due to limitations with sample size, a combined variable based on reporting either same-sex attraction, behavior, or identity (10% of the sample) was used in subsequent analyses.
Results: Structural equation models were used to assess direct and indirect associations between sexual minority status and mental health service usage. When direct effects were explored, no significant association was observed between sexual minority status and service usage, controlling for age and gender. When behavior problems were used as mediator, however, two distinct patterns emerged (see Figure 1). First, significant indirect effects, via level of behavior problems were observed, such that sexual minority youth had higher levels of behavior problems, and higher subsequent service usage. A significant negative direct effect, however, was also observed between sexual minority status and health service usage. In other words, when behavior problems were controlled, sexual minority youth were less likely to report mental health service usage than their heterosexual peers.
Discussion: These findings suggest a suppression effect, in that while no difference was initially observable between sexual minority and heterosexual youth with regards to service usage, when examined in the context of behavior problems, sexual minority youth were less likely to report service usage. These findings hint to the need for a better understanding of how sexual minority youth access services and when, and suggest that looking at mean levels of service usage may be deceptive in terms of understanding the service needs among sexual minority youth.

Authors

• Alexa Martin-Storey, Université de Sherbrooke
  Presenting Author

• Michèle Déry, Université de Sherbrooke
  Non-Presenting Author

• Jean-Pascal Lemelin, Université de Sherbrooke
  Non-Presenting Author

• Mélanie Lapalme, Université de Sherbrooke
  Non-Presenting Author

• Caroline Temcheff, McGill University
  Non-Presenting Author