Barriers to Accessing Mental Healthcare for Gay and Bisexual Men Living in Oklahoma

  • Joseph M. Currin
  • Randolph D. Hubach
  • Hugh C. Crethar
  • Tonya R. Hammer
  • Hang-Shim Lee
  • Mary Larson


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.


LGBT 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.

Ethical Approval

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

Informed consent was obtained from all individual participants included in the study.


  1. Andersen, R. M. (1995). Revisiting the behavioral model and access to medical care: Does it matter? Journal of Health and Social Behavior, 36(1), 1–10. Scholar
  2. Andersen, R. M. (2008). National health surveys and the behavioral model of health services use. Medical Care, 46(7), 647–653. Scholar
  3. Andersen, R. M., & Anderson, O. W. (1967). A decade of health services. Chicago: University of Chicago Press.Google Scholar
  4. 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
  5. Beehler, G. P. (2001). Confronting the culture of medicine: Gay men’s experiences with primary care physicians. Journal of Gay and Lesbian Medical Association, 5(4), 135–141.CrossRefGoogle Scholar
  6. Bowen, A. (2005). Internet sexuality research with rural men who have sex with men: Can we recruit and retain them? The Journal of Sex Research, 42(4), 317–323. Scholar
  7. Brunn, S. D., Webster, G. R., & Archer, J. C. (2011). The Bible Belt in a changing south: Shrinking, relocating, and multiple buckles. Southeastern Geographer, 51(4), 513–549.CrossRefGoogle Scholar
  8. 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.
  9. Cochran, S. D. (2001). Emerging issues in research on lesbians’ and gay men’s mental health: Does sexual orientation really matter?. American Psychologist 56(11), 931–947.CrossRefPubMedGoogle Scholar
  10. Currin, J. M., Hubach, R. D., Brown, C., & Farley, S. (2016). Impact of non-heterosexual impulses on heterosexuals’ attitudes towards monogamy and casual sex. Psychology & Sexuality, 7(3), 197–210. Scholar
  11. 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. Scholar
  12. 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. Scholar
  13. 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
  14. Fisher, C. M., Irwin, J. A., & Coleman, J. D. (2013). LGBT health in the midlands: A rural/urban comparison of basic health indicators. Journal of Homosexuality, 61(8), 1062–1090. Scholar
  15. 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
  16. Halkitis, P. N., Siconolfi, D., Fumerton, M., & Barlup, K. (2008). Facilitators of barebacking among emergent adult gay and bisexual men: Implications for HIV prevention. Journal of LGBT Health Research, 4(1), 11–26. Scholar
  17. 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. Scholar
  18. 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. Scholar
  19. 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. Scholar
  20. Hollander, D. (2013). Men who do not disclose same-sex behavior may miss chances to get recommended care. Perspectives on Sexual and Reproductive Health, 45(2), 110–111. Scholar
  21. 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.
  22. Hubach, R. D., DiStefano, A. S., Wood, M. M. (2012). Understanding the Influence of Loneliness on HIV Risk Behavior in Young Men Who Have Sex with Men. Journal of Gay & Lesbian Social Services, 24(4), 371–395.CrossRefGoogle Scholar
  23. 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. Scholar
  24. 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. Scholar
  25. Human Rights Campaign (2017). State Equality Index. Retrieved from Accessed on 8/6/2017.
  26. 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. Scholar
  27. Kelly, B. C., Bimbi, D. S., Izienicki, H., & Parsons, J. T. (2009). Stress and coping among HIV-positive barebackers. AIDS and Behavior, 13(4), 792–797. Scholar
  28. Kennedy, M. (2010). Rural men, sexual identity and community. Journal of Homosexuality, 57(8), 1051–1091. Scholar
  29. Kinsey, A. C., Pomeroy, W. B., & Martin, C. E. (1948). Sexual behavior in the human male. Bloomington: W. B. Saunders Company.Google Scholar
  30. 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
  31. 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. Scholar
  32. Klitzman, R. L., & Greenberg, J. D. (2002). Patterns of communication between gay and lesbian patients and their health care providers. Journal of Homosexuality, 42(4), 65–75. Scholar
  33. 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. Scholar
  34. 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
  35. Link, B., & Haztenbuehler, M. (2016). Stigma as an unrecognized determinant of population health: Research and policy implications. Journal of Health Politics, Policy and Law, 41(4), 653–673. Scholar
  36. 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. Scholar
  37. Mathy, R. M., Schillace, M., Coleman, S. M., & Berquist, B. E. (2002). Methodological rigor with internet samples: New ways to reach underrepresented populations. Cyberpsychology & Behavior, 5(3), 253–266. Scholar
  38. 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. Scholar
  39. Meidlinger, P. C., & Hope, D. A. (2014). Differentiating disclosure and concealment in measurement of outness for sexual minorities: The Nebraska Outness Scale. Psychology of Sexual Orientation and Gender Diversity, 1(4), 489–497. Scholar
  40. Meyer, I. H. (1995). Minority stress and mental health in gay men. Journal of Health and Social Behavior, 36(1), 38–56. Scholar
  41. Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. Scholar
  42. Meyer, I. H., Dietrich, J., & Schwartz, S. (2008). Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. American Journal of Public Health, 98(6), 1004–1006. Scholar
  43. 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. Scholar
  44. 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. Scholar
  45. National Center for PTSD (2014). Using the PTSD Checklist Retrieved June 5, 2015, from
  46. Newcomb, M. E., & Mustanski, B. (2010). Internalized homophobia and internalizing mental health problems: A meta-analytic review. Clinical Psychology Review, 30(8), 1019–1029. Scholar
  47. Obergefell v. Hodges, 135 S.Ct. 2071 (2015).Google Scholar
  48. Oswald, R. F., & Culton, L. S. (2003). Under the rainbow: Rural gay life and its relevance for family providers. Family Relations: An Interdisciplinary Journal of Applied Family Studies, 52(1), 72–81. Scholar
  49. Pachankis, J. E., & Goldfried, M. R. (2010). Expressive writing for gay-related stress: Psychosocial benefits and mechanisms underlying improvement. Journal of Consulting and Clinical Psychology, 78(1), 98–110. Scholar
  50. Pachankis, J. E., Goldfried, M. R., & Ramrattan, M. E. (2008). Extension of the rejection sensitivity construct to the interpersonal functioning of gay men. Journal of Consulting and Clinical Psychology, 76(2), 306–317. Scholar
  51. Peduzzi, P., Concato, J., Kemper, E., Holford, T. R., & Feinstein, A. R. (1996). A simulation study of the number of events per variable in logistic regression analysis. Journal of Clinical Epidemiology, 49(12), 1373–1379. Scholar
  52. Pickett, J. (2010). Addressing gay men’s health: The script needs a rewrite. Virtual Mentor, 12(8), 668–672.CrossRefPubMedGoogle Scholar
  53. 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. Scholar
  54. 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. Scholar
  55. Preston, D. B., D'Augelli, A. R., Kassab, C. D., & Starks, M. T. (2007). The relationship of stigma to the sexual risk behavior of rural men who have sex with men. AIDS Education and Prevention, 19(3), 218–230. Scholar
  56. Protecting a Counselor’s Religious Liberty Act, TN Stat. Ann. Code §§ SB1556/HB1840. Retrieved on August 10, 2016 from
  57. 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. Scholar
  58. Sherman, M. D., Kauth, M. R., Shipherd, J. C., & Street Jr., R. L. (2014). Communication between VA providers and sexual and gender minority veterans: A pilot study. Psychological Services, 11(2), 235–242. Scholar
  59. Shernoff, M. (2005). Condomless sex: Considerations for psychotherapy with individual gay men and male couples having unsafe sex. Journal of Gay & Lesbian Psychotherapy, 9(3–4), 149–169. Scholar
  60. Simpson, T. L., Balsam, K. F., Cochran, B. N., Lehavot, K., & Gold, S. D. (2013). Veterans administration health care utilization among sexual minority veterans. Psychological Services, 10(2), 223–232. Scholar
  61. Stein, G. L., & Bonuck, K. A. (2001). Physician-patient relationships among the lesbian and gay community. Journal of the Gay & Lesbian Medical Assn, 5(3), 87–93. Scholar
  62. Tabachnick, B. G., & Fidell, L. S. (1996). Using multivariate statistics (3rd ed.). New York: Harper Collins.Google Scholar
  63. Traeger, L., O’Cleirigh, C., Skeer, M. R., Mayer, K. H., & Safren, S. A. (2012). Risk factors for missed HIV primary care visits among men who have sex with men. Journal of Behavioral Medicine, 35(5), 548–556. Scholar
  64. Tweedie, S. W. (1978). Viewing the bible belt. The Journal of Popular Culture, 11(4), 865–876.CrossRefGoogle Scholar
  65. United States Census Bureau (2010). Census Regions and Divisions of the United States. Retrieved from
  66. Vrangalova, Z., & Savin-Williams, R. C. (2012). Mostly heterosexual and mostly gay/lesbian: Evidence for new sexual orientation identities. Archives of Sexual Behavior, 41(1), 85–101. Scholar
  67. Waldorf, B. (2007). Measuring rurality. In Context, 8(1), 5–8.Google Scholar
  68. 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
  69. Walls, N. E., Wisneski, H., & Kane, S. (2013). School climate, individual support, or both? Gay-straight alliances and the mental health of sexual minority youth. School Social Work Journal, 37(2), 88–112. Scholar
  70. Whitehead, J., Shaver, J., & Stephenson, R. (2016). Outness, stigma, and primary health care utilization among rural LGBT populations. PLoS One, 11(1), e0146139. Scholar
  71. Whitlock, R. U. (2013). Landscapes of education: Queer south rising: Voices of a contested place. Charlotte: Information Age Publishing.Google Scholar
  72. Willging, C. E., Israel, T., Ley, D., Trott, E. M., DeMaria, C., Joplin, A., & Smiley, V. (2016). Coaching mental health peer advocates for rural LGBTQ people. Journal of Gay & Lesbian Mental Health, 20(3), 214–236. Scholar
  73. Willging, C. E., Salvador, M., & Kano, M. (2006). Pragmatic help seeking: How sexual and gender minority groups access mental health care in a rural state. Psychiatric Services, 57(6), 871–874. Scholar
  74. Worthington, R. L., & Reynolds, A. L. (2009). Within-group differences in sexual orientation and identity. Journal of Counseling Psychology, 56(1), 44–55. Scholar
  75. Yudko, E., Lozhkina, O., & Fouts, A. (2007). A comprehensive review of the psychometric properties of the drug abuse screening test. Journal of Substance Abuse Treatment, 32(2), 189–198. Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Joseph M. Currin
    • 1
    • 2
  • Randolph D. Hubach
    • 3
  • Hugh C. Crethar
    • 1
  • Tonya R. Hammer
    • 4
  • Hang-Shim Lee
    • 1
  • Mary Larson
    • 5
  1. 1.School of Community Health Sciences, Counseling, and Counseling PsychologyOklahoma State UniversityStillwaterUSA
  2. 2.Department of Psychological SciencesTexas Tech UniversityLubbockUSA
  3. 3.Rural HealthOklahoma State University Center for Health SciencesTulsaUSA
  4. 4.School of Community Health Sciences, Counseling, and Counseling PsychologyOklahoma State University-TulsaTulsaUSA
  5. 5.Edmon Low LibraryOklahoma State UniversityStillwaterUSA

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