2 - (SYM 40) Sexual Orientation Moderates the Association Between Healthcare Utilization-related Factors and Mental Health Service Non-utilization Among United States Military Veterans

Background: Although sexual minority veterans experience substantial mental health disparities, little is known about whether mental health treatment disparities exist. This study examined mental health treatment non-utilization among sexual minority versus heterosexual veterans with demonstrated psychiatric need.

Methods: 820 veterans with psychiatric need (i.e., positive screen for current major depressive disorder, posttraumatic stress disorder, alcohol use disorder, and/or drug use disorder) completed surveys for the nationally representative National Health and Resilience in Veterans Study.

Results: Current mental health service non-utilization did not differ between sexual minority versus heterosexual veterans (70.5% vs. 74.0%). However, sexual orientation significantly interacted with sex assigned at birth, primary source of healthcare (Veteran Affairs [VA] vs. non-VA), and beliefs that peers would blame them for their mental health problems in analyses predicting non-utilization. Most notably, among veterans who used VA as their primary source of healthcare, sexual minority Veterans were less likely than heterosexual veterans to engage in mental treatment; among those primarily using non-VA care, this pattern was reversed. Among heterosexual veterans, veterans assigned male at birth were less likely than those assigned female at birth to be currently engaged in mental health treatment; among sexual minority veterans, non-utilization did not differ by sex assigned at birth. Lastly, heterosexual veterans demonstrated similarly high rates of non-utilization regardless of beliefs about peer blame; in contrast, sexual minority veterans believed that others would blame them had lower rates of non-utilization.

Conclusions: Results of this study suggest high rates of mental health non-utilization among both sexual minority and heterosexual veterans with psychiatric need. They further suggest that certain factors linked to non-utilization of mental health treatment may differ by sexual orientation, thus highlighting the need to understand and address nuanced barriers to mental health treatment for sexual minority veterans. Potential strategies to reduce mental health utilization disparities are discussed, such as targeted campaigns to engage underserved subgroups (e.g., heterosexual male veterans, sexual minority veterans receiving care at the VA), psychoeducation about the separation between Department of Defense and VA, and policies that minimize discrimination and increase inclusivity.