Adolescent Health and Mental Health Service Use, Settings, and Barriers: Differences by Sexual Minority Status

Background and Purpose: Adolescents have a largely unmet need for health and mental health services and overall do not access services in proportion to their needs (Simpson, Scott, Henderson, & Manderscheid). Very little is known about service use among non-heterosexual (i.e., sexual minority) youth; however, the accumulated research strongly suggests that their need for services is at least equal to the general adolescent population and likely greater due to social factors. Logan and King (2001) suggest that the parent-adolescent relationship plays a key role in whether youth obtain needed services. Sexual minority youth have fewer support resources, such as parental support (Eisenberg & Resnick, 2006), which may contribute both to a need for services as well as greater difficulty accessing services. This paper presents findings from the National Longitudinal Study of Adolescent Health (Add Health), a school-based representative study, and addresses the following research questions: 1) Are the needs for health and mental health services greater for sexual minority youth compared to non-sexual minority youth? 2) Do sexual minority youth access health and mental health services with the same frequency as their peers? 3) Relative to their need, is there an underutilization of services (i.e., unmet need) among sexual minority youth? 4) Do service use settings differ for sexual minority youth? 6) Do sexual minority youth forego needed healthcare services with the same frequency as their peers? 6) Do the barriers to healthcare services reported by sexual minority youth differ from those reported by their peers? 7) Do sexual minority youth report differences in the qualities/closeness of their parent relationships as compared to their peers? Methods: Data is taken from Wave I of Add Health, and consists of a core sample of 18,924 youth in grades 7 – 12 with a subsample of 1,388 sexual minority youth. Add Health uses a complex survey design that stratifies schools by size, type, region, location, and percent white. Youth are selected with unequal probability from 132 schools. Using survey software (Stata 10) and inferential statistics, this study compares group differences on health and mental health need, service use, service use setting, barriers to services, and quality/closeness of parent relationships. Results: Consistent with prior literature, findings demonstrate significantly higher health and mental health need (i.e., sexual health risk, anxiety, depression, suicidality, and history of victimization) among sexual minority youth. Sexual minority youth access mental health services almost two times as frequently as their peers, yet still have greater unmet need. School-based mental health services are accessed significantly less by sexual minority youth. With regard to healthcare, sexual minority youth also have higher unmet health needs and forego needed medical care more frequently, citing barriers related to confidentiality (i.e., not wanting parents to know and fear of what the doctor will say/do). Finally, sexual minority youth report significantly lower levels of closeness to their parents. Conclusions and Implications: These findings highlight the need for tailored interventions aimed at parents, schools, and healthcare providers to promote access to services through understanding and acceptance of sexual minority youth.