Romanelli, Meghan (2019). How do LGBT help-seekers reach mental health treatment, interact with service providers, and use informal care options? An examination of health care access and mental health outcomes among LGBT adolescents and adults.
Sexual and gender minority (SGM) individuals experience increased risk of depression due to chronic exposure to stressors, such as structural and interpersonal discrimination. These elevated rates of depression render access to effective treatment as imperative; however, SGM communities remain underserved in health care environments and report unmet mental health (MH) needs. Using a three-paper dissertation format, three interrelated studies examined how SGM individuals: 1) reach care (Study 1); 2) are treated by providers once they reach care (Study 2), and; 3) stay healthy if they do not reach care (Study 3). Study 1: Using structural equation modeling (SEM) and multiple group solutions, Study 1 compared differences in facilitators of MH service use (e.g., mother-child communication and closeness; adolescent decision-making styles around problems; depression severity) between depressed sexual minority youth (SMY) and depressed heterosexual respondents of Add Health. Findings indicated that for both heterosexual and SMY respondents, higher levels of maternal closeness associated with increased rates of talking about problems with one’s mother, which was in-turn associated with increased likelihood of counseling receipt. This association, however, appeared to be stronger among SMY. Depression severity also predicted counseling receipt for heterosexual respondents, but not SMY respondents. This may be because SMY seek counseling for a myriad of reasons outside of depression, for example for family issues, sexual minority stress, coming out information/support, support while questioning sexual identity, peer support, or dating/relationship help. Study 2: Because past research has found that transgender people are likely to experience more than one form of discrimination during health care encounters, Study 2 employed Latent Class Analysis (LCA) and data from the 2015 U.S. Transgender Survey to examine: a) patterns of health care discrimination among transgender help-seekers, and; b) predictors of class membership to identify subpopulations that might be at risk for certain typologies of health care discrimination. Results showed that experiences of health care discrimination are not homogenous across transgender communities, as three distinct classes were found: Class 1 experienced both overt discrimination and provider competency issues; Class 2 experienced provider incompetence only, and; Class 3 did not experience overt discrimination or provider competency issues. Respondents who were older, out as trans to their providers, reported suicidal thoughts, had psychological distress that interfered with life, and disabled were more likely to be members of Class 1 or 2, rather than Class 3. Low-income, Biracial, Native Alaskan/Native American, and Middle Eastern/North African respondents were more likely to be members of Class 1, rather than 3. Study 3: Using SEM, multiple group solutions, and the Add Health data, Study 3 examined if sexual minority young adults (SMYA) with depression can attain wellness through the reliance on informal care networks when they do not seek MH care. Specifically, Study 3 explored if having a mentor weakened the influence of untreated depression on later life MH. Results indicated that mentorship may act as an effective supplement to psychological counseling, but not as a compensatory resource. Depressed SMYA who received counseling and had mentorship support showed better long-term depression and psychological distress outcomes than: 1) depressed SMYA without counseling and without a mentor; 2) depressed SMYA without counseling and with a mentor, and; 3) depressed SMYA with counseling and without a mentor. Discussion and limitations of this research and implications for practice, policy, and research are discussed throughout these papers, as well as the overall dissertation conclusion.
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Lindsey, Michael A.
New York University
City of Publication