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.

摘要

许多有心理健康需求的青少年无法获得治疗，而多重边缘化的青少年，例如有色人种性少数青少年 (SMYoC)，在护理方面遇到了结构性和身份相关的障碍。COVID-19 大流行可能会加剧全国 SMYoC 青年面临的多层次治疗获取障碍。然而，很少有大规模研究调查了美国各地 SMYoC 在大流行期间或之前获得心理保健的情况。此类工作对于理解和消除该领域的障碍至关重要。使用自认为是 SMYoC 并赞同在 COVID-19 大流行期间寻求心理健康支持的青少年的数据 ( N= 470 名，年龄 13-16 岁，来自美国 43 个州），我们研究了州一级的结构性因素（收入不平等、精神卫生保健提供者短缺、反黑人种族主义、恐同症以及反黑人种族主义之间的相互作用）之间的关联和恐同症）和 SMYoC 心理健康治疗机会。多项逻辑回归显示，州级精神卫生保健提供者短缺是 SMYoC 报告他们在 COVID-19 大流行期间从未（相对于总是）获得精神卫生支持的唯一重要预测因素。生活在同性恋恐惧症和反黑人种族主义较低地区的 SMYoC 更有可能总是报告（而不是有时）) 接受心理健康治疗。结果强调，在探索多重边缘化青年心理健康治疗的障碍时，考虑不同的结构因素并应用交叉视角至关重要。在医疗服务提供者短缺不太严重的地区，文化耻辱——包括反黑人种族主义和恐同症——可能仍然会给需要心理健康护理的 SMYoC 带来挑战。