Correlates of Participation in Mental Health Counseling Service Among Midlife and Older Lesbians

Background: Existing literature has established that there is a strong need for mental health (MH) service use among the LGBT population (Filice & Meyer, 2018). A few studies have examined predictors of MH service use among the LGBT population as a whole and some subpopulations such as LGBT youth, and LGBT older adults. However, to our best knowledge, no current study has examined the predictors of MH service use among lesbians above age 50 years old. In a scope review of this line of research, Filice and Meyer (2018) identified the failure of addressing subgroup differences as one of the most salient methodological shortcomings in the literature. The current study examines the correlates of MH service use among midlife and older lesbians. Guided by Andersen's Health Service Use Model as our theoretical framework, we examined three types of correlates of participation in MH treatment, including predisposing factors, enabling factors, and need factors.

Methods: Data was collected utilizing a national online survey of 115 questions (N = 455). The study protocol was approved by the authors institution and gathered descriptive data from U.S. lesbian identified women for a six-month period. We used ordered logistic regression to examine the association between predisposing, enabling, and need factors and frequency of participation in mental health counseling.

Results: We found that for predisposing factors, those who were widowed (OR=4.24, p<.05) and single and not dating (OR=1.83, p<.05) were more likely to participate in MH treatment than those who were partnered. For enabling factors, those who were out to their healthcare providers were more likely to participate in MH treatment than those who were not (OR=3.15, p<.01). For need factors, number of mental health conditions (OR=2.05, p<.001) and being unsatisfied with sex (OR=2.00, p<.01) were positively associated with participation in MH treatment.

Conclusion and Implications: This study reports several important findings that extend the understanding of mental health service use among midlife and older lesbians. The study highlights the need to tailor MH service among lesbians who are socially isolated, particularly widowed and single. Moreover, being out to healthcare provider is an important factor of MH service use, indicating the need of enhancing MH referral and integrating MH service in primary care for midlife and older lesbians. In addition, sexual health should be treated as an integral part of psychological wellbeing in MH treatment. Findings suggest several implications for practice and policies to improve the reach and quality of MH treatment for midlife and older lesbians.