Qualitative exploration of PCPs’ mental health role for LGBT youth in Baltimore: a socio-ecological lens

Abstract

LGBT youth experience disproportionate rates of mental health diagnoses, including depression and anxiety. Using qualitative interviews of LGBT youth (n = 14) and primary care providers (n = 12), we sought to identify whether mental health discussions with a primary care provider were perceived as overall beneficial. Most LGBT youth felt comfortable being asked about depression, anxiety, or other mental health conditions by their primary care provider. All felt it appropriate to provide this information by survey or tablet. However, youth participants’ comfort depended on feeling connected with and accepted by their provider. Those that did feel comfortable, perceived a benefit when these conversations did happen. Providers unanimously described wanting to address mental health needs in LGBT youth, either in terms of societal advancement, or clinic-based changes. Both LGBT youth and primary care providers appeared to want more mental health discussions during visits. However, more connectedness may be needed to improve willingness to engage in care; and providers may require specific support to successfully fill this need.

Keywords:

• Primary care provider
• LGBT youth
• mental health

Acknowledgments

Thank you to the participants who shared their stories. We are grateful to the Primary Care Consortium for funding this study. DA led the writing of the manuscript. RAS, AM and JR led the proposal and protocol development. RAS, AM, MW and JR contributed to clinical and logistical aspects of protocol development. JR and MW led data collection. RAS, AM, TD, RS, JR and SM assisted in the writing of the manuscript. All named authors adhere to the authorship guidelines of Journal of LGBT Youth. All authors have approved the final manuscript and agreed to publication.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Additional information

Funding

JR was supported by National Institute of Allergy and Infectious Diseases training grant (T32AI102623), by the National Institute of Mental Health (K01MH116817), and the Johns Hopkins University Center for AIDS Research (P30AI094189). RAS was supported by the National Institute on Drug and Abuse (R01DA043089) during collection of this data.

Notes on contributors

Daniel Akinbolue

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Julia R. Raifman

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Julia R. Raifman is an assistant professor at the Boston University School of Public Health, where Julia conducts research on how health and social policies drive population health and health disparities.

Tanika Day

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Anthony Morgan

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Anthony Morgan is a clinical research project manager who has dedicated over two decades to generating new knowledge towards the goals of improving health outcomes among racial, sexual and gender minority adolescents and emerging adults.

Shivani Mehta

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Mitchell Wharton is an Associate Professor of Clinical Nursing and the Associate Dean for Equity and Inclusion at the University of Rochester School of Nursing. His research scholarship is focused on identifying asset-based modalities of HIV prevention, care, and health maintenance in marginalized populations.

Rosalyn Walker Stewart

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Shivani Mehta is a medical student at the UC San Diego School of Medicine and Fulbright Scholar. Her research goals are centered around identifying systemic barriers that can help inform public health and infrastructural policies around infectious disease epidemics.

Mitchell J. Wharton

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Rosalyn W. Stewart is a professor at Johns Hopkins School of Medicine, is board certified in both internal medicine and pediatrics. She is a leader in the development, improvement and delivery of care for individuals with health disparities.

Steven J. Kravet

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Steven Kravet is associate professor of medicine and president of Johns Hopkins Community Physicians. His research interests include primary care delivery, quality and safety, and medical education.

Renata Arrington-Sanders

Daniel Akinbolue is a Medical Student at George Washington University with a Masters degree in Mental Health from Johns Hopkins School of Public Health. His research background largely focuses in health disparities for racial, sexual and gender minority populations in medicine.

Renata Arrington-Sanders is an Associate Professor at Johns Hopkins School of Medicine, Division of Adolescent and Young Adult Medicine. Dr. Sanders work focuses on developing multi-level interventions for Black and Latinx LGBTQ youth who are at-risk for and living with HIV.