Negotiating Intersecting Identities in Mental Health Service Use: Experiences of Black and Hispanic LGBTQ Young Adults

Background: Young adulthood presents particular challenges for racial, ethnic, sexual, and gender minority individuals in need of mental health treatment. Evidence suggests African-American and Hispanic young adults (aged 18-25) with mental health problems are less likely to obtain professional care. In addition, LGBT individuals are vulnerable to discrimination and negative experiences when contacting service providers. The developmental stage of emerging adulthoodcan be a pivotal period for navigating treatment options, when individuals are forming their values, attitudes, and adult selves.Young adulthood is especially critical to examine as young people in this stage are in the midst of identity formation, developing a sense of self in relation to social identity groups.Given the risk for mental health disparities among several identity characteristics, the intersection of multiple identities requires special consideration.

Methods: To better understand how they navigated intersecting identities in the context of using mental health services, 31 Black (58%) and Hispanic (42%), LGBTQ (39% transgender, 32% bisexual, 19% gay, 10% lesbian)young adults (mean age = 22.16) were interviewed in-depth about their experiences.All had received past professional mental health treatment, most for mood disorders (84%). Purposeful sampling was used to include young adults endorsing symptoms of mood or anxiety disorder within the past 2 years and exclude those that had only used services for neurodevelopmental disorders. Participants were recruited from the New York City area in 2016-2017. A constructivist grounded theory approach was used to focus on processes (i.e., thoughts, feelings, and actions) involving intersecting marginalized identities within the context of decisions about using mental health services. Analytic coding yielded a final list of categories and sub-categories. Actions and processes through which one or more categories affected another led to creating a preliminary theoretical framework. Triangulation of sources of data and multiple analysts,expert checking, and numerous peer-reviews strengthened the rigor of the analysis.

Results: Analyses revealed that young adults negotiated multiple marginalized identities through identity content shifting: separating from unhelpful social norms, managing stigmatized aspects of identity, and integrating helpful identity alternatives. The negotiation processes described by participants paralleled the tasks of identity development in that the possibilities for addressing mental health problems available through their multiple identities were explored and personal attitudes and behaviors about mental health help-seeking were constructed.Concealing mental health or LGBTQ statuses was adaptive to get mental health needs met and avoid rejection and discrimination. Participants’ experiences showed that there were strengths afforded by intersecting identities. They expressed how “being different” led to greater introspection, self-acceptance, and autonomy that allowed them to “think outside the box” and challenge social norms that discouraged help-seeking.

Conclusions: Both researchers and clinicians should increase focus on processes of resilience among young sexual and gender minorities, particularly those of color. Young LGBTQ people of color might need support in negotiating the complex relationship with marginalized identities.Research is needed on assessments andinterventions that consider identity formation and that can affect the decision-making process and levels of treatment engagement among racial-ethnic minority young adults who are LGBTQ.