The Effect of State Changes in the Availability of LGBT-specific Mental Health Services on LGBT Mental Health Outcomes, 2015-2018 Público

Abstract

Purpose: LGBT individuals experience poorer mental health status and worse outcomes across multiple health indicators than their non-LGBT counterparts. LGBT individuals also face other access barriers to mental health services particularly due to discrimination, stigma, and prejudice. Available LGBT-specific mental health services may improve LGBT individuals’ mental health status through employing evidence-based treatment modalities and decreasing access barriers to use mental health services. We examined the population-level impact of LGBT-specific mental health services through available national health survey data.

Methods: The study merged 2015-2018 data from the National Mental Health Services Survey (NMHSS) and Behavioral Risk Factor Surveillance System (BRFSS). We determined how state availability of LGBT-specific services changed across twelve study states. Next, we conducted difference-in difference-in-difference (DDD) regressions to estimate the effect of these changes on mental health outcomes of LGBT individuals (N=18,415) in study states.

Results: LGBT individuals experienced worse outcomes across all reported mental health indicators. Compared to non-LGBT participants, LGBT participants also reported disparities in key social determinants of health and healthcare utilization. Specifically, LGBT participants compared with non-LGBT respondents reported disparities related to insurance access (84.15% [82.96%, 85.35%] vs. 89.37% [89.11%, 89.62%]; p=<0.0001), income (14.50% [13.45%, 15.54%] vs. 8.62% [8.40%, 8.83%] more likely to make <$15,000 a year and 39.54% [38.11%, 40.97%] vs. 52.30% [51.96%, 52.65%] less likely to make $50,000+ a year; p=<0.0001), education level (16.90% [15.64%, 18.15%] vs. 11.50% [11.23%, 11.77%] more likely to not graduate from high school and 25.22% [24.22%, 26.23%] vs. 28.18% [27.93%, 28.43%] less likely to graduate from college or technical school; p=<0.0001), and employment status (48.39% [46.98%, 49.80%] vs. 49.19% [48.87%, 49.52%] less likely to be employed for wages, 3.90% [3.14%, 4.66%] vs. 2.44% [2.33%, 2.55%] more likely to be out of work for >1 year and 8.34% [7.61%, 9.07%] vs. 6.16% [6.00%, 6.31%] unable to work; p=<0.0001). From 2015 to 2018, there was a statistically significant increase in the percentage of clinics offering LGBT-specific mental health services (p=<0.0001). However, DDD estimates showed no statistically significant effect of state LGBT-specific mental health services and number of mentally unhealthy days (b=-.03 [-0.54,.47]), physically unhealthy days (b=0.01 [-0.43, 0.45]), having a routine check-up in the past year (OR=1.10 [0.97, 1.24]), or self-rated health (OR=1.02 [0.89, 1.16]). 

Conclusions: With increasing LGBT-specific mental health services availability, policies or healthcare institution practice modifications should address social determinants that underlie a need for LGBT-specific mental health services and prevent LGBT individuals from accessing mental health services. Moreover, more states should report LGBT health data to national surveys to improve LGBT mental health policy making.   

Table of Contents

Chapter 1: Introduction    1

Problem Statement    3

Purpose Statement and Research Questions        4

Theoretical Framework      4

Significance Statement       5

Chapter 2: Literature Review     6

Overview of LGBT Mental Health Status and Mental Health-related Health Outcomes        6

The Social Environment Creates Poor Mental Health Outcomes for LGBT Individuals       7

Multi-Level Barriers Impact Access to Mental Health Services Among LGBT Individuals   8

Access Barriers Impact the Utilization of Mental Health Services by LGBT Individuals       11

LGBT-Affirming Services May Decrease Access Barriers that LGBT Individuals Confront to Use Mental Health Services and Improve LGBT Individuals’ Mental Health Needs 12

Understanding Mental Health Effects of LGBT-affirming Mental Health Services Based On Their Availability May Support Improving Access to These Services        13

Chapter 3: Student Contribution       14

Chapter 4: Manuscript      16

Abstract   17

Introduction     18

Methods   20

Data 20

Design      21

Measures  21

Regression analyses    23

Results     24

Discussion 26

Conclusion        28

References 29

Chapter 5: Public Health Implications 33

References 36

Tables      44

TABLE 1. SOCIODEMOGRAPHICS FOR LGBT AND NON-LGBT BRFSS RESPONDENTS 2015-2018    44

TABLE 2. RESULTS OF DIFFERENCE- IN DIFFERENCE- IN DIFFERENCE ANALYSES FOR OUTCOMES BASED ON STATE INCREASES IN LGBT-SPECIFIC MENTAL HEALTH SERVICES 48

Figures     49

FIGURE 1. STATE CHANGES IN THE PERCENTAGE OF MENTAL HEALTH TREATMENT PROGRAMS THAT ARE LGBT-SPECIFIC, YEARS 2015-2018 49

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Palavra-chave	Mental Health LGBT-specific mental health services NMHSS BRFSS
Committee Chair / Thesis Advisor	Livingston, Melvin, Emory University
Committee Members	Walker, Elizabeth, Emory University

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