Structural Correlates of Mental Health Support Access among Sexual Minority Youth of Color during COVID-19

ABSTRACT

Many youth with mental health needs cannot access treatment, with multiply-marginalized youth, such as sexual minority youth of Color (SMYoC), experiencing both structural and identity-related barriers to care. The COVID-19 pandemic threatens to exacerbate multi-level treatment access barriers facing SMYoC youth nationwide. However, little large-scale research has examined access to mental health care among SMYoC across the United States, either during or prior to the pandemic. Such work is critical to understanding and ameliorating barriers in this domain. Using data from adolescents who self-identified as SMYoC and who endorsed a desire for mental health support during the COVID-19 pandemic (N = 470, ages 13–16, from 43 U.S. states), we examined associations between state-level, structural factors (income inequality; mental health-care provider shortage; anti-Black racism; homophobia; and the interaction between anti-Black racism and homophobia) and SMYoC mental health treatment access. Multinomial logistic regressions revealed state-level mental health-care provider shortage as the only significant predictor of SMYoC reporting they never (versus always) accessed mental health support during the COVID-19 pandemic. SMYoC living in areas with both lower homophobia and lower anti-Black racism were more likely to report always (versus sometimes) accessing mental health treatment. Results highlight the critical importance of considering diverse structural factors and applying an intersectional lens when exploring barriers to mental health treatment among multiply-marginalized youth. In locations where provider shortages are less severe, cultural stigma – including anti-Black racism and homophobia – may still pose challenges for SMYoC in need of mental health care.

Disclosure Statement

No potential conflict of interest was reported by the author(s).

Supplemental data

Supplemental material for this article can be accessed online at https://doi.org/10.1080/15374416.2022.2034633.

Notes

¹ The term sexual minority (SM) is used in this research as an umbrella term that broadly captures sexual orientations of people who experience societal stigma and oppression (DeBord et al., 2017).

² Cultural racism: the instillation of the ideology of inferiority in the values, language, imagery, symbols, and unstated assumptions of the larger society (Williams et al., 2019).

Additional information

Funding

This work was supported by the NIH Office of the Director [DP5OD028123].