Marginalized Identities and Mental Health Service Use Among LGBTQ, Black and Hispanic Young Adults

Background and Purpose: Research on mental health outcomes among racial, ethnic, sexual, and gender minority young people in the U.S. indicates increased risks for treatment disparities when these identity statuses intersect. Behavioral health conditions cause the greatest burden of disability in young adults, yet only an estimated 32% utilize treatment. Identity development is a key developmental task of young adulthood. However, evidence of how having intersecting marginalized identities is related to using mental health services is lacking. More than a demographic classification, identity refers to one’s sense of self in relation to social identity groups. As such this study 1) examined the association of identity and service use and; 2) described the experience and expression of intersecting minority identities in the context of service use.

Methods: A mixed methods, convergent parallel design was used to examine identity salience, patterns of treatment, and cultural experiences of 31 Black and Hispanic, LGBTQ young adults (mean age = 22.16). All had received past professional mental health treatment and 61% were currently experiencing significant clinical symptoms at the time of the study. 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. Based on service use history, participants were categorized as either continuous (n=17) or discontinuous (n=14) service users. Levels of identity salience were measured for family, race/ethnicity, sexual orientation, gender, religious/spirituality, neighborhood/place, generation, class, community belonging, and collective identity as a whole. Bivariate analyses and multivariable logistic regression were used to explore relationships between continuous service use, demographics, and identity salience scores. Thematic analysis was used to analyze in-depth interviews about the convergence of marginalized identities and service use experiences. Data from validated survey measures and in-depth interviews were triangulated to strengthen and add context to findings.

Results:Higher scores on the collective identity scale were associated with continuous service use (β= .166, p<.05). Connectedness to communities (β = .83, p<.05)and LGB identities (β = .62, p<.05) were associated with on-going mental health service use more than any other identity aspect. Participants described personal experiences of marginalized identities as both barriers and facilitators to their involvement in treatment, butperceived their racial-ethnic groups as primarily opposed to formal mental health help-seeking and described more favorable connections between their LGBTQ identities and mental health service use in terms of greater perceived openness to treatment. Influences of family and religious background impacted experiences of stigma related to mental illness and LGBTQ statuses.

Conclusions: Results suggested that participants’ identity strengths around being sexual/gender minorities and community belonging encouraged service use and engagement with treatment. Identity formation in minority young adults happens at a time when they bear greater responsibility for their own treatment. Strategies and interventions to increase treatment utilization should capitalize on this by assessing and reinforcing strengths around positive identity and community belonging.