Content uploaded by Kelly A Williams
Author content
All content in this area was uploaded by Kelly A Williams on Jul 22, 2014
Content may be subject to copyright.
A preview of the PDF is not available
Comparing Health and Mental Health Needs, Service Use, and Barriers to Services among Sexual Minority Youths and Their Peers
Abstract and Figures
Using a representative national sample (N = 20,745), this article explores health and mental health needs, service use, and barriers to services among sexual minority
youths (SMYs) and heterosexual peers. SMYs were defined by ever having a same-sex romantic attraction or having a recent same-sex romantic relationship or sexual partner.
SMYs accounted for 7.5 percent of the sample. Data were analyzed to ascertain prevalence of risks and explore group differences.
Compared with peers, SMY self-reports indicated higher prevalence rates on all indicators of health and mental health need.
SMYs reported more sexual activity, more sexually transmitted disease diagnoses, a higher perceived risk for HIV/AIDS, and
more forgone medical care than peers. Also compared with peers, SMYs reported higher levels of anxiety, depression, suicidality,
and physical and sexual victimization and higher rates of unmet mental health need. SMYs also reported greater concerns about
confidentiality and were less likely to use school-based services. The majority of SMYs reported same-sex attraction only.
Social work and other helping professionals should incorporate same-sex attraction questions into assessment protocols to
target services for this population. School- and office-based providers must consider whether their services are welcoming
and offer sufficient assurances of confidentiality to facilitate access by SMYs.
Figures - uploaded by Kelly A Williams
Author content
All figure content in this area was uploaded by Kelly A Williams
Content may be subject to copyright.
... (10) Despite the disparities in mental health outcomes for LGBTQ+ young people, this population also have elevated unmet mental health needs compared to their cis-heterosexual peers and underuse mental health services. (11)(12)(13)(14)(15) Findings from a UK study, indicated that in a sample of 789 LGBTQ+ young people, only one h of participants had sought help for their mental health di culties. (14) Through interviews and survey data, the study found that LGBTQ+ young people were reluctant to access statutory or third sector mental health services because of experiences of homophobia, biphobia and transphobia; cis-heteronormativity (fear their sexual orientation or gender identity would be scrutinised or blamed for their mental health problems); di culties disclosing their sexual and/or gender identity; fears of being misunderstood or judged by adults because they were young; and stigma related to having mental health problems. ...
... (14,19) In addition to the hesitancy to seek help, research suggests LGBTQ+ youth have a poor overall experience of mental health services and support. (6,8,11,12,16,20) Problems highlighted are the limited sta understanding of LGBTQ+ issues and minority stresses, fear of being 'outed', and exclusion from the decisions made about their care. (11,13,21) Research suggests the competence of health care sta to provide appropriate care to LGBTQ+ young people is a vital factor in ensuring access. ...
... (6,8,11,12,16,20) Problems highlighted are the limited sta understanding of LGBTQ+ issues and minority stresses, fear of being 'outed', and exclusion from the decisions made about their care. (11,13,21) Research suggests the competence of health care sta to provide appropriate care to LGBTQ+ young people is a vital factor in ensuring access. For example, an EU study found that the barriers to healthcare for LGBTQ+ people are exacerbated by two related assumptions held by healthcare professionals. ...
... This review is consistent with evidence highlighting living with a rare disease is an ongoing learning experience for affected children, young people, and their families and is often associated with psychosocial impacts such as experiences of stigmatization, self-consciousness, restrictions in independent living, challenges in developing resilience and coping strategies, psychological and emotional impact, social impact versus social connectedness, and their transition experience (Abma and Schrijver (2019) Stigma is a universal phenomenon (Saylor et al., 2008) and has many facets, ranging from personal characteristics that deviate from societal norms to social stereotyping or categorization (Goffman, 1963). Reportedly, stigmatization attached to many illnesses and impairments, and evidence from the review is consistent with the literature (O'Donnell and Habenicht, 2022;Williams and Chapman, 2011) suggests that stigmatization can have devastating effects on the mental health and wellbeing of children and young people living with rare diseases (Bogart, 2014;Branch-Smith et al., 2018;Hanson et al., 2017). Abma and Schrijver (2019) urge researchers to offer children the autonomy to identify and express an important issue and offer them a 'playful' mindset and methods fitting children's needs. ...
Problem
Rare diseases are any disease affecting fewer than five people in 10,000. More than 8000 rare diseases and 50–75% of all rare diseases affect children. The purpose of this review was to critically appraise and synthesize existing literature relating to the impact of rare diseases on children's day-to-day lives.
Eligibility criteria
An integrative literature review was conducted using the CINAHL Plus, PsycINFO, and PubMed databases. Studies were included if they were a primary source was published between the years 2005 and 2019 and written in the English language.
Sample
Eight primary sources met the inclusion criteria.
Results
Seven main themes emerged from the review as follows: (i) the experience of stigmatisations, (ii) self-consciousness, (iii) restrictions in independent living, (iv) developing resilience/coping strategies, (v) psychological and emotional impact, (vi) social impact vs social connectedness and (vii) transition challenges.
Conclusions
The experience of having a rare illness differed across different age groups. Children (typically aged 3–10) with rare diseases generally view themselves and their lives the same way like their healthy peers. They were more likely to report being adaptive and resilient than those aged 12 or older. Young people reported being different compared to young children, and they faced numerous challenges related to their illness.
Implications for practice
To provide the best possible level of care for children and families with rare disorders, health services must be informed and equipped to provide the necessary supports specific to the unique needs of children and young people living with rare diseases.
... We found that gay men had the highest rate of access to free contraceptives and were more likely to seek medical treatment for reproductive health problems compared to heterosexual men, consistent with findings from the 2016 national survey on SMY in China, which reported that a lower proportion of SMY encountered difficulties when receiving health care services [30]. However, previous studies have reported that SMY were more likely to have less access to SRH services, resulting in low health service utilization [31]. Concerns with privacy and confidentiality may also deter SMYs from discussing their sexuality with healthcare providers [32]. ...
Background
Little is known about the access to measures of sexual and reproductive health (SRH) services among sexual minority communities in China, where sexuality-related stigma and discrimination remains high. The aim of this study is to investigate access to measures of SRH services among Chinese sexual minority youths (SMY) aged 17 to 24 years old.
Methods
This cross-sectional study utilizes data on 54,580 youths from the 2019–2020 National College Student Survey on Sexual and Reproductive Health, conducted across 31 provinces in mainland China. Multivariable logistic regression modelling was utilized to assess the access to SRH services among Chinese youth with different self-reported sexual orientation.
Results
The majority of respondents identified as heterosexual (77.6%). The remaining respondents identified as bisexual (9.0%), lesbian or gay (2.8%), others (3.02%), or unknown (7.51%). Gay men reported greater access to free contraceptives at health centers (OR 1.62, 95% CI: 1.32–1.99) and were more likely to have receive medical treatment for sexual and reproductive issues (OR 1.83, 95% CI: 1.26–2.63) compared to heterosexual men. Gay and bisexual men were also more likely to use condom at first sexual intercourse compared to heterosexual men (gay men: OR 1.38, 95% CI: 1.13–1.68; bisexual men: OR 1.33, 95% CI: 1.03–1.71). However, the associations were reversed among women (lesbians: OR 0.05, 95% CI: 0.03 to 0.08; bisexuals: 0.75, 95% CI: 0.65 to 0.86).
Conclusions
Although SMY reported higher utilization of SRH services compared to their heterosexual counterparts, access to SRH services remains low among Chinese youths. Greater focus should be placed on improving access to SMY-friendly SRH services among Chinese youths.
... Furthermore, YMSM may still face rejection and abandonment from their families as they navigate their sexual identities, which impacts, among other things, their likelihood of accessing routine preventive care. 18,35 Some YMSM report difficulties accessing routine health care settings. 6,7 We found that reduced health care utilization among YMSM occurred in the context of structural factors, including geographic region of residence 36,37 and a reliance on urgent care settings, rather than routine care through a traditional health care setting. ...
Purpose: This study examined factors associated with past-year health care utilization among young gay, bisexual, and other men who have sex with men (YMSM) using Andersen's behavioral model of health service use. Methods: From 2018 to 2020, 751 YMSM (aged 13-18) recruited online and offline for the MyPEEPS mHealth HIV prevention study completed an online survey. Hierarchical logistic regression models assessed associations between past-year health care utilization (i.e., routine checkup) and predisposing (parental education, race/ethnicity, age, and internalized homonegativity), enabling (health literacy, health care facility type, U.S. Census Divisions), and need factors (ever testing for HIV). Results: The sample included 31.8% Hispanic, 23.9% White, and 14.6% Black YMSM; median age was 16. Most (75%) reported past-year health care utilization, often from private doctor's offices (29.1%); 6% reported no regular source of care. In the final regression model, higher odds of past-year health care utilization were found for younger participants (age 13-14, adjusted odds ratio [AOR] = 1.91; 95% confidence interval [CI]: 1.07-3.43; age 15-16 AOR = 1.55; 95% CI: 1.04-2.30; reference: 17-18) and those with increasing health literacy (AOR = 1.71; 95% CI: 1.36-2.16). YMSM with lower parental education had lower odds of past-year health care utilization (AOR = 0.56; 95% CI: 0.38-0.84), as did those relying on urgent care facilities (AOR = 0.60; 95% CI: 0.41-0.87; reference: routine care facilities) and those who identified as Mixed/Other race (AOR = 0.50; 95% CI: 0.28-0.91; reference: White). Conclusions: Findings highlight opportunities to intervene in YMSM's health risk trajectory before age 17 to reduce drop-off in routine health care utilization. Interventions to improve routine health care utilization among YMSM may be strengthened by building resilience (e.g., health literacy) while removing barriers maintained through structural disadvantage, including equity in education. Clinical Trial Registration Number: NCT03167606.
... The needs for treatment in young people should be evaluated considering risks factors such as the higher prevalence of psychological, physical, and sexual abuse compared with heterosexual cisgender adolescents (Dunbar et al., 2017;Thoma et al., 2021). These factors contribute to disproportionate mental health problems observed within this population (Williams & Chapman, 2011. ...
Lesbian, gay, bisexual, transgender, intersex, queer people and minority gender identities and sexualities (LGBTIQ+) are often stigmatized and experience discrimination in health care settings, leading to poorer mental health outcomes and unmet needs compared to heterosexual and cisgendered peers. It is thus imperative that mental health providers consider and address structural challenges in order to reduce mental health inequalities of this population. This narrative review assessed the barriers that may prevent access to care and the pathways for care in LGBTIQ + communities. PubMed, PsycInfo, Embase, and Scopus were searched for papers published between December 2021 and February 2022. A total of 107 papers were included with studies reflecting five themes: (1) Unmet mental health needs; (2) Young people; (3) Substance abuse and addiction; (4) Barriers and pathways to care; and (5) Interventions. Findings demonstrate that LGBTIQ + people experience stigmatization and higher rates of substance misuse and mental ill health, which may lead to barriers in accessing health care services, and fewer tailored interventions being provided. These findings have implications for policy, health care screening, and how specialist services are structured. Substantial gaps in the evidence-base exist, and future research should examine how mental health care providers can challenge social issues that maintain discriminatory and stigmatizing practices, and support LGBTIQ + individuals to sustain their resilience.
... In the past decade, there has been an increasing interest in the use of the Internet for mental health promotion and information dissemination (Clarke et al. 2015). Accessing mental health information online may offer youth increased privacy and anonymity (Clarke et al. 2015), which are major concerns for help-seeking youth (Williams and Chapman 2011). Online platforms may also provide minority and rural/remote populations with a cost-effective and accessible means of accessing services (Barak and Grohol 2011). ...
A lack of mental health literacy may impact youths' ability to advocate for themselves as they seek to access and navigate the mental healthcare system. Recognizing this, members of the National Youth Action Council at the Centre for Addiction and Mental Health in Toronto, ON, developed the Youth Wellness Quest resource. This health literacy resource informs youth of possible available services, increasing their capacity to make informed mental healthcare decisions. The youth-led process of creating this resource, from development to dissemination, is described within this paper, showcasing how youth can lead the development of tools designed for youth.
... Other research has shown that loneliness is a key mediating role in bisexual-specific minority stress and suicidality in bisexual+ people (Mereish et al., 2017). Online services, including social media, may circumvent common barriers to support, including knowledge, stigma, financial and geographical limitations (Smith et al., 2014;Wagaman, 2014;Williams & Chapman, 2011). Online spaces can provide safe spaces to subvert monosexism, however normative ideals and identity policing which are born from internalized stigma, can still occur in these environments (Maliepaard, 2017). ...
Multi-gender attracted (bisexual+) youth experience a high risk for suicide and mental health problems, but little is known about their protective factors.
This study explored the challenges and supporting factors for wellbeing in a sample of diverse bisexual+ young people through semi-structured qualitative interviews. Participants (n = 15) were aged 17–25 years and were multi-gender attracted. The sample included young people who were transgender and gender diverse (TGD), culturally and linguistically diverse (CALD), Aboriginal, living in regional areas, and on the asexual spectrum.
This research demonstrated unique challenges and protective factors for bisexual+ wellbeing compared to other sexual minority youth. In particular, the findings highlight the exclusion and stigmatization that many bisexual+ young people face, including from within the LGBTQIA+ community. These experiences were more pronounced for some bisexual+ youth, including TGD or CALD young people. Consequently, bisexual+ youth often had limited social support and a sense of belonging, which can buffer against the impact of marginalization among lesbian and gay youth. Despite these challenges, young people were resilient, empathetic and tolerant of others. Those who had access to supportive environments, visibility, and information on their diversity found these healing.
Wellbeing in bisexual+ youth was impacted by a myriad of intersecting aspects of identity and experience, highlighting the importance of intersectional approaches in understanding minority experiences. The findings underscore the need for targeted and intersectional services for sexually diverse youth to address the wellbeing needs of this diverse group.
... This finding aligns with previous research demonstrating that adolescents with sexual and gender minority identities report positive attitudes towards brief online mental health interventions (McDanal et al., 2021). This result is encouraging, given the barriers to traditional (face-to-face) mental health treatment that TGD and LGBQ+ adolescents often face (Cwinn et al., 2021;Sims and Nolen, 2021;Gridley et al., 2016;Rees et al., 2021;White and Fontenot, 2019;Williams and Chapman, 2011). ...
Objective
Many adolescents struggle to access appropriate mental health care due to structural or psychological barriers. Although traditional barriers to participation (e.g., location, cost) are hypothetically reduced or removed in internet interventions, low retention reduces the likelihood that adolescents will receive the intervention dosage intended to produce beneficial effects. It is therefore key to determine what factors are associated with dropout in digital mental health interventions with adolescents both within and beyond the context of research studies.
Methods
We compare completion rates from two projects evaluating self-guided, online single-session mental health interventions (SSIs) for adolescents. One was a randomized controlled trial (RCT) in which participants were paid for participation. The other was a program evaluation project in which participants were not paid for participation. We additionally compare SSI completion rates across various demographic groups and across baseline hopelessness levels.
Results
There was a statistically significant difference in SSI completion status between the RCT (84.75% full-completers) and the program evaluation (36.86% full-completers), X² (2, N = 2436) = 583.5, p < 0.05. There were no significant differences in the baseline hopelessness scores across completion statuses in either study. There were no significant differences in full-completion rates across demographic groups in either project.
Conclusion
Adolescents may be more likely to complete a brief digital mental health intervention in a paid, research-based context than in an unpaid, naturalistic context. Additionally, it is possible that the brevity of SSIs reduces demographic disparities related to retention by minimizing the time required to complete an intervention.
Youth loneliness is a risk factor for myriad adverse psychosocial outcomes, making it a potentially informative construct for assessment and treatment research. Minority stressors may place LGBTQ+ (lesbian, gay, bisexual, transgender, and queer) youths at high risk of loneliness. However, the prevalence of loneliness across gender and sexual identities cannot be precisely estimated or compared without establishing that common measures assess the construct equivalently across groups. In a preregistered study, we determined the optimal structure of the UCLA Loneliness Scale and investigated whether it showed invariance across gender and sexual identities in a national U.S. sample of adolescents with elevated depressive symptoms ( N = 2,431; https://osf.io/52ctd ). Results supported strict invariance, indicating that loneliness scores can be meaningfully compared across groups in this sample. Exploratory analyses indicated that loneliness levels and LGBTQ+ identity predicted levels of depression and anxiety. We discuss implications for research on loneliness, health disparities, and psychopathology in high-symptom youths.
Major strides have been made in understanding the impact of intersectionality in everyday life. However, there is a significant gap in the research literature on how individuals with multiple minority statuses must uniquely interact and navigate health services. We carried out an exploratory qualitative study with twenty sexual minority gender expansive women of Latinx and African American descent to explore participants’ access to health services and the impact of cultural factors on their health decisions and behaviors. Participants described long-term challenges with accessing health services that were primarily tied to income and discriminatory treatment on the part of health providers. Participants also shared regular discouragement from family members to engage with U.S./Western medicine and health traditions. Together, participants’ early life experiences and the continued messages from family members, influenced their health behaviors (e.g., delaying care). Implications for future research and health services are discussed.
Lesbian, gay, and bisexual youths (aged 15–21 yrs) were studied to determine the impact of verbal abuse, threat of attacks, and assault on their mental health, including suicide. Family support and self-acceptance were hypothesized to act as mediators of the victimization and mental health-suicide relation. Structural equation modeling revealed that in addition to a direct effect of victimization on mental health, family support and self-acceptance in concert mediated the victimization and mental health relation. Victimization was not directly related to suicide. Victimization interacted with family support to influence mental health, but only for low levels of victimization. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Lesbian and gay adolescents begin to explore their social and sexual identities in environments which are generally unfavorable to the development of positive self-esteem. Little is known about how these adolescents face this challenge. This survey of lesbian and gay adolescents explores the nature and extent of their psychosocial problems and the persons and resources to whom they turned for help. Social service needs centered on the issues of identity management, depression, limited resources for getting help, and getting along with family members.
Using a qualitative research method, this study investigates the ways in which homophobia and heterosexism constitute barriers to treatment for lesbian and gay youth in need of addictions services. Seventeen lesbian and gay youth were interviewed regarding their experiences in addictions services. The major barriers that they report include marginalization, avoidance of gay and lesbian issues, ignoring sexual orientation as an issue, deflection and contradiction, outing, harassment, early discharge, and misinformed staff. Recommendations are made for making addictions services more appropriate and accessible for lesbian and gay youth.
The CES-D scale is a short self-report scale designed to measure depressive symptomatology in the general population. The items of the scale are symptoms associated with depression which have been used in previously validated longer scales. The new scale was tested in household interview surveys and in psychiatric settings. It was found to have very high internal consistency and adequate test- retest repeatability. Validity was established by pat terns of correlations with other self-report measures, by correlations with clinical ratings of depression, and by relationships with other variables which support its construct validity. Reliability, validity, and factor structure were similar across a wide variety of demographic characteristics in the general population samples tested. The scale should be a useful tool for epidemiologic studies of de pression.
The teenage years can be particularly challenging due to the multitude of developmental and environmental changes that occur in tandem. It is a crucial time for mental health intervention because several behavioral and emotional difficulties increase from childhood to adolescence. The mental health of adolescents depends heavily on the ways they cope with the developmental changes they face during this transitional period. Seeking help and advice is one type of coping strategy that has been associated with better adjustment. This article discusses help-seeking in the context of adolescent coping behaviors and explores the questions of who youth turn to for help, and why some youth are unable to seek help.
This chapter considers the substance use and abuse and mental health of sexual-minority youths. Attention is first given to barriers in research that have limited our understanding of the lives of sexual-minority youths, including measurement and sampling challenges. Past research on adolescent sexual orientation, substance use and abuse, and mental health is then reviewed, with a focus on recent population-based studies that have included attention to these concerns. Finally, analyses from the National Longitudinal Study of Adolescent Health (the Add Health study) are presented. The Add Health study is the first nationally representative study of U.S. adolescents that incorporates questions relevant to adolescent sexual orientation. Results from analyses of adolescents' reports of same-sex romantic attractions and relationships and their associations with indicators of substance use and abuse and mental health are then presented. (PsycINFO Database Record (c) 2012 APA, all rights reserved)