Mental Health Service Use Among Black and Latinx Youth and Emerging Adults Living with HIV: Comparing U.S. and Foreign-Born Youth

Background and Purpose: Minoritized youth and emerging adults (YEA) living with HIV have higher rates of mental health disorders coupled with lower mental health services use compared to their noninfected peers. This paper examines mental health service use among diverse Black and Latinx YEA living with HIV, with a focus on U.S. and foreign-born persons. Foreign-born persons in our study were refugees, asylum-seekers, held temporary protected status, or undocumented status. We used Andersen’s model of healthcare utilization as a framework to examine how predisposing, enabling, and need factors are associated with mental health service use.

Methods: We surveyed 271 Black & Latinx YEA living with HIV in urban areas using a hybrid recruitment strategy (social media, classified ads, public transportation ads, dating apps, and peer-to-peer recruitment). Descriptive statistics were used to examine the frequency of mental health service use, which included any use history of inpatient mental health/residential services, outpatient mental health, and/or mental health medication. We used multivariable logistic regression analyses and hypothesized predisposing factors (foreign-born, older age, Hispanic/Latino, transgender), enabling factors (greater social support), and greater need factors (depression or post-traumatic stress disorder (PTSD) would be associated with more frequent use of varying types of mental health services. When modeling service use, we used two separate indicators of need – depression and PTSD. This allowed us to examine differences in the impact of two different mental health conditions.

Results: Participants’ mean age was 25.2 years (SD=2.4), 95.6% male sex, 58.7% Hispanic/Latino, 49.1% foreign-born, and mean age of first HIV diagnosis 21.3 years (SD=2.9). We found U.S. born participants reported higher rates of depression (20.9%) and PTSD (20.3%) compared to foreign-born participants; depression (13.0%) and PTSD (13.7%). U.S. born participants had higher rates of mental health service use (27.0%) compared to foreign-born participants (9.5%). Multivariable results for the predisposing factors suggest that being foreign born was associated with lower mental health service use in both the PTSD model (aOR:0.18, 95% CI:[0.10,0.39]) and depression model (aOR:0.18, 95% CI:[0.10,0.39]). Other predisposing factors were not significantly different. Related to enabling factors, we found social support to be associated with lower mental health service use in the depression model only (aOR:0.99, 95% CI:[0.97,1.00]). Lastly, greater need, indicated by meeting criteria for mental distress (PC-PTSD or PHQ-8) was associated with greater mental health service use; PTSD (aOR:1.41, 95% CI:[1.17,1.70]) and depression (aOR:1.05, 95% CI:[1.00,1.11]).

Conclusion and Implications: Understanding factors associated with mental health service use can help address gaps in help-seeking. Foreign-born Black and Latinx YEA living with HIV, in particular, are significantly less likely to seek mental health services, which suggests need for psychoeducation/outreach expressly designed for these youth. Furthermore, greater mental health symptomology (depression and PTSD) was associated with increased service use. Social support; however, seems to play a complex role when considering service use, and needs further investigation. Future studies should examine barriers and facilitators associated with receipt of mental health use to address gaps in mental health utilization for both U.S. and Foreign-born Black and Latinx YEA living with HIV.