School Climate and Mental Health Service Use Among Sexual Minority Adolescents: Adolescent Stress Experience over Time Study (ASETS)

Background and Purpose. Sexual minority adolescents (SMA) experience disproportionate rates of mental health concerns, including higher rates of generalized anxiety. When compared to heterosexual adolescents, SMA are more likely to seek mental health services to address these concerns. There is abundant evidence indicating that less affirming and supportive school climates constitute a severe form of stress for SMA. These findings are in line with Minority Stress Theory, which posits less supportive climates may influence the development of adverse mental health symptoms. Yet, it is unknown whether homonegative school climates are associated with SMA seeking mental health services, or whether this association, if present, is related to greater experiences of anxiety symptoms. Thus, the goal of the current study was to examine associations among homonegative school climate, anxiety symptoms, and having a mental health provider, while controlling for sociodemographic characteristics. It was hypothesized that homonegative school climate would be positively associated with 1) having a mental health provider and 2) anxiety symptoms. In turn, anxiety symptoms were expected to be positively associated with having a mental health provider. The link between homonegative school climate and having a mental health provider was expected to be mediated by anxiety symptoms.

Methods. The sample was obtained from SMA (N=1,076) who are part of an ongoing longitudinal study. We relied on those with complete data at 12 month and answered questions on health provider access (n=835). Ages ranged from 14-17 (M=15.86 years, SD = 0.98). Participants completed questionnaires assessing homonegative school climate and anxiety symptoms at Time 1 and having a mental health provider (Yes/No) at Time 3. Statistical mediation was tested using probit link functions to account for the binary outcome variable.

Results. Results indicated that the total effect (c path) of homonegative school climate on having a mental health provider was positive and significant (probit b=0.01, CI=0.001, 0.020). The effect of homonegative school climate on anxiety symptoms (a1) was significant (b=0.38, CI=0.28, 0.49); and the association between anxiety symptoms and having a mental health provider (b1) was also positive and significant (probit b=0.04, CI=0.020, 0.053). The indirect effect (a1*b1) of homonegative school climate on having a mental health provider through anxiety symptoms was significant (b=0.01, CI=0.003, 0.010). The direct effect (c’) of homonegative school climate on having a mental health provider was non-significant after anxiety was introduced into the model (probit b=0.01, CI=-0.003, 0.010).

Conclusions and Implications. Results indicated that homonegative school climates were associated with SMA having a mental health provider linked through heightened anxiety symptoms. This finding may suggest homonegative school climates exacerbate symptoms of anxiety, thereby generating a greater need for mental health service use. School-based policies aimed at addressing homonegative climates may be one way to reduce experiences of stress thereby reducing the need for mental health service use. Additionally, a better understanding of the role minority-specific stressors have on both mental health and service use may increase mental health providers’ awareness of the needs and concerns of sexual minority adolescents when seeking care.