Mental Health Care Use Among Adolescent Sexual Minority Males Before and During COVID-19

Adolescent (cisgender) sexual minority males (ASMM) face multiple mental health disparities. Yet surprisingly little is known about use of mental health care among ASMM. The current study examined mental health care use among ASMM, both lifetime use and during the COVID-19 pandemic. ASMM (N = 154, ages 14-17 years) enrolled in Spring 2020 for a pilot randomized controlled trial of an online sexual health intervention. Participants were assessed at baseline and 3-month follow-up. Participants reported lifetime (at baseline) and recent (at follow-up) mental health care use. Anxiety and depressive symptoms were assessed at both timepoints. Differences in care use by sociodemographics, health care access, and mental health symptoms were established. More than half of participants reported clinically significant anxiety and depressive symptoms at baseline and at follow-up. Of those youth, 53 percent reported lifetime mental health care use, whereas only 28% reported recent care at follow-up. Being out to an accepting guardian (aOR = 4.0, 95% CI [1.9, 8.4]), having a primary care physician (aOR = 2.6, 95% CI [1.0, 6.7]), and having clinically significant symptoms (aOR = 3.1, 95% CI [1.5, 6.5]) were each independently associated with greater odds of having received lifetime mental health care. Findings indicate that many ASMM in the sample received mental health care in their lifetimes. However, more participants endorsed clinically significant anxiety/depressive symptoms than received care at both timepoints. This disparity was even more pronounced approximately 5 months into the COVID-19 pandemic. Research and practice efforts must reduce care barriers and augment facilitators for all ASMM, with particular urgency during COVID-19 and its aftermath. Public Significance Statement Mental health disparities are well documented among sexual minority adolescents, although little is known about their use of mental health care. We found that many adolescent sexual minority males use mental health care, but more youth reported psychological distress than received care, and use of care declined during the COVID-19 pandemic.