Barriers to Accessing Mental Healthcare for Gay and Bisexual Men Living in Oklahoma
The American College of Physicians has recently called for research to understand the potential causes of LGBT health disparities that exist when compared to their heterosexual counterparts. Barriers to accessing mental health care can be a cause of this disparity. To address this, the current study asked participants (N = 209) if they had received mental health care (MHC) over the past year and during their lifetime. Andersen’s (1967) behavioral health model was used to predict healthcare utilization. A hierarchical logistic regression was conducted to predict MHC, in the past year (12) and during their lifetime (L). Both models were significant: for MHC-L, (χ 2 (6) = 41.57, p < .001), and for MHC-12 (χ 2 (6) = 53.26, p < .001). Both models had previous mental health diagnosis and disclosure of sexual orientation status as significant predictors. Individuals who more openly disclosed sexual orientation status were more likely to have used mental health services. Implications and limitations to the study are discussed.
KeywordsLGBT mental health LGBT health disparities Stigmatization and mental health Sexual orientation disclosure and mental health LGBT rural health
Compliance with Ethical Standards
Conflict of Interest
The authors declare they have no conflict of interests.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
- Andersen, R. M., & Anderson, O. W. (1967). A decade of health services. Chicago: University of Chicago Press.Google Scholar
- Barton, B. C. (2012). Pray the gay away: The extraordinary lives of Bible Belt Gays. New York: New York University Press (NYU Press).Google Scholar
- Burns, M. N., Ryan, D. T., Garofalo, R., Newcomb, M. E., & Mustanski, B. (2014). Mental health disorders in young urban sexual minority men. The Journal of Adolescent Health. https://doi.org/10.1016/j.jadohealth.2014.07.018.
- Daniel, H., & Butkus, R. (2015). Lesbian, gay, bisexual, and transgender health disparities: Executive summary of a policy position paper from the American College of Physicians LGBT health disparities. Annals of Internal Medicine, 163(2), 135–137. https://doi.org/10.7326/M14-2482.CrossRefPubMedGoogle Scholar
- Driskell, J. R., O'Cleirigh, C., Covahey, C., Ripton, J., Mayer, K., Perry, D. H., et al. (2010). Building program acceptability: Perceptions of gay and bisexual men on peer or prevention case manager relationships in secondary HIV prevention counseling. Journal of Gay & Lesbian Social Services: The Quarterly Journal of Community & Clinical Practice, 22(3), 269–286. https://doi.org/10.1080/10538720903426388.CrossRefGoogle Scholar
- Eaton, W. W., Smith, C., Ybarra, M., Muntaner, C., & Tien, A. (2004). Center for Epidemiologic Studies Depression Scale: Review and revision (CESD and CESD-R). In M. Maruish (Ed.), The use of psychological testing for treatment planning and outcomes assessment (3rd ed., pp. 363–377). Mahwah: Lawerence Erlbaum.Google Scholar
- Golub, S. A., & Gamarel, K. E. (2013). The impact of anticipated HIV stigma on delays in HIV testing behaviors: Findings from a community-based sample of men who have sex with men and transgender women in New York City. AIDS Patient Care and STDs, 27(11), 621–627.CrossRefPubMedPubMedCentralGoogle Scholar
- Hasin, D. S., Goodwin, R. D., Stinson, F. S., & Grant, B. F. (2005). Epidemiology of major depressive disorder: Results from the national epidemiologic survey on alcoholism and related conditions. Archives of General Psychiatry, 62(10), 1097–1106. https://doi.org/10.1001/archpsyc.62.10.1097.CrossRefPubMedGoogle Scholar
- Hatzenbuehler, M. L., O’Cleirigh, C., Grasso, C., Mayer, K., Safren, S., & Bradford, J. (2012). Effect of same-sex marriage laws on health care use and expenditures in sexual minority men: A quasi-natural experiment. American Journal of Public Health, 102(2), 285–291. https://doi.org/10.2105/AJPH.2011.300382.CrossRefPubMedPubMedCentralGoogle Scholar
- Hatzenbuehler, M. L., O’Cleirigh, C., Mayer, K. H., Mimiaga, M. J., & Safren, S. A. (2011). Prospective associations between HIV-related stigma, transmission risk behaviors, and adverse mental health outcomes in men who have sex with men. Annals of Behavioral Medicine, 42(2), 227–234. https://doi.org/10.1007/s12160-011-9275-z.CrossRefPubMedPubMedCentralGoogle Scholar
- Holloway, I. W., Padilla, M. B., Willner, L., & Guilamo-Ramos, V. (2014). Effects of minority stress processes on the mental health of latino men who have sex with men and women: A qualitative study. Archives of Sexual Behavior. https://doi.org/10.1007/s10508-014-0424-x.
- Hubach, R. D., Dodge, B., Li, M. J., Schick, V., Herbenick, D., Ramos, W. D., et al. (2015). Loneliness, HIV-related stigma, and condom use among a predominantly rural sample of HIV-positive men who have sex with men (MSM). AIDS Education and Prevention, 27(1), 72–83. https://doi.org/10.1521/aeap.2015.27.1.72.CrossRefPubMedGoogle Scholar
- Hubach, R. D., Dodge, B., Schick, V., Ramos, W. D., Herbenick, D., Li, M. J., et al. (2015). Experiences of HIV-positive gay, bisexual and other men who have sex with men residing in relatively rural areas. Culture, Health & Sexuality, 17(7), 1–15. https://doi.org/10.1080/13691058.2014.994231.CrossRefGoogle Scholar
- Human Rights Campaign (2017). State Equality Index. Retrieved from http://assets.hrc.org//files/assets/resources/SEI-2017-Categories.pdf?_ga=1.97662043.53134369.1488035073 Accessed on 8/6/2017.
- Kano, M., Silva-Bañuelos, A. R., Sturm, R., & Willging, C. E. (2016). Stakeholders' recommendations to improve patient-centered “LGBTQ” primary care in rural and multicultural practices. The Journal of the American Board of Family Medicine, 29(1), 156–160. https://doi.org/10.3122/jabfm.2016.01.150205.CrossRefPubMedGoogle Scholar
- Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Bloomington: W. B. Saunders Company.Google Scholar
- Klein, F., Sepekoff, B., & Wolf, T. J. (1985). Sexual orientation: A multi-variable dynamic process. Journal of Homosexuality, 11(1–2), 35–49.Google Scholar
- Klitzman, R. L., Exner, T., Correale, J., Kirshenbaum, S. B., Remien, R., Ehrhardt, A. A., et al. (2007). It's not just what you say: Relationship of HIV disclosure and risk reduction among MSM in the post-HAART era. AIDS Care, 19(6), 749–756. https://doi.org/10.1080/09540120600983971.CrossRefPubMedGoogle Scholar
- Lelutiu-Weinberger, C., Pachankis, J. E., Golub, S. A., Walker, J. N. J., Bamonte, A. J., & Parsons, J. T. (2013). Age cohort differences in the effects of gay-related stigma, anxiety and identification with the gay community on sexual risk and substance use. AIDS and Behavior, 17(1), 340–349. https://doi.org/10.1007/s10461-006-9137-z.CrossRefPubMedPubMedCentralGoogle Scholar
- Liang, B., Taylor, C., WIlliams, L. M., Tracy, A. J., Jordan, J. V., & Baker-Miller, J. (1998). Relational health indicees: An exploratory study (work in progress no. 293). Wellesley: Stone Center Working Paper Series.Google Scholar
- Maisto, S. A., Carey, M. P., Carey, K. B., Gordon, C. M., & Gleason, J. R. (2000). Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychological Assessment, 12(2), 186–192. https://doi.org/10.1037/1040-3518.104.22.168.CrossRefPubMedGoogle Scholar
- McDavitt, B., Iverson, E., Kubicek, K., Weiss, G., Wong, C. F., & Kipke, M. D. (2008). Strategies used by gay and bisexual young men to cope with heterosexism. Journal of Gay & Lesbian Social Services: Issues in Practice, Policy & Research, 20(4), 354–380. https://doi.org/10.1080/10538720802310741.CrossRefGoogle Scholar
- Mosack, K. E., Brouwer, A. M., & Petroll, A. E. (2013). Sexual identity, identity disclosure, and health care experiences: Is there evidence for differential homophobia in primary care practice? Womens Health Issues, 23(6), e341–e346. https://doi.org/10.1016/j.whi.2013.07.004.CrossRefPubMedPubMedCentralGoogle Scholar
- Mustanski, B., Garofalo, R., & Emerson, E. M. (2010). Mental health disorders, psychological distress, and suicidality in a diverse sample of lesbian, gay, bisexual, and transgender youths. American Journal of Public Health, 100(12), 2426–2432. https://doi.org/10.2105/AJPH.2009.178319.CrossRefPubMedPubMedCentralGoogle Scholar
- National Center for PTSD (2014). Using the PTSD Checklist Retrieved June 5, 2015, from www.ptsd.va.gov/professional/pages/assessments/assessment-pdf/PCL-handout.pdf.
- Obergefell v. Hodges, 135 S.Ct. 2071 (2015).Google Scholar
- Politi, M. C., Clark, M. A., Armstrong, G., McGarry, K. A., & Sciamanna, C. N. (2009). Patient-provider communication about sexual health among unmarried middle-aged and older women. Journal of General Internal Medicine, 24(4), 511–516. https://doi.org/10.1007/s11606-009-0930-z.CrossRefPubMedPubMedCentralGoogle Scholar
- Preston, D. B., D'Augelli, A. R., Kassab, C. D., Cain, R. E., Schulze, F. W., & Starks, M. T. (2004). The influence of stigma on the sexual risk behavior of rural men who have sex with men. AIDS Education and Prevention, 16(4), 291–303. https://doi.org/10.1521/aeap.16.4.291.40401.CrossRefPubMedGoogle Scholar
- Protecting a Counselor’s Religious Liberty Act, TN Stat. Ann. Code §§ SB1556/HB1840. Retrieved on August 10, 2016 from http://i2.cdn.turner.com/cnn/2016/images/04/27/tn.sb.1556.language.pdf.
- Saunders, J. B., Aasland, O. G., Babor, T. F., de la Fuente, J. R., & Grant, M. (1993). Development of the alcohol use disorders identification test (AUDIT): WHO collaborative project on early detection of persons with harmful alcohol consumption: II. Addiction, 88(6), 791–804. https://doi.org/10.1111/j.1360-0443.1993.tb02093.x.CrossRefPubMedGoogle Scholar
- Tabachnick, B. G., & Fidell, L. S. (1996). Using multivariate statistics (3rd ed.). New York: Harper Collins.Google Scholar
- United States Census Bureau (2010). Census Regions and Divisions of the United States. Retrieved from https://www2.census.gov/geo/pdfs/maps-data/maps/reference/us_regdiv.pdf.
- Waldorf, B. (2007). Measuring rurality. In Context, 8(1), 5–8.Google Scholar
- Waldorf, B., & Kim, A. (2015). Defining Rurality in the US: Alternatives to the ERS Classifications. Paper presented at the Workshop on Rationalizing Rural Area Classifications, National Academy of Sciences, Committee on National Statistics, Washington, DC, April 16–17, 2015.Google Scholar
- Whitlock, R. U. (2013). Landscapes of education: Queer south rising: Voices of a contested place. Charlotte: Information Age Publishing.Google Scholar