Sexual orientation differences in mental health service use and unmet mental health care needs: a cross-sectional population-based study of young adults.

Purpose: This study aims to examine sexual orientation differences in mental health services use and unmet mental health care needs, and to explore associated sociodemographic factors in a populational-based sample of Swedish young adults (aged 18-34).

Methods: Data from the Pathways to Longitudinally Understanding Stress (PLUS) study were used (2019, N = 2,126, participation rate of 37.8%). We performed logistic regressions to model mental health services use and unmet mental health service needs, followed by a subgroup analysis among those with perceived need for mental health services. We also examined if associations between sociodemographic factors (gender, age, educational level, income, employment status, household composition, urbanicity and country of birth) and these outcomes varied by sexual orientation.

Results: Around one-third (35.0%) of sexual minority individuals had used mental health services the previous year, versus 20.2% of heterosexuals (OR = 1.52, 95%CI = 1.17-1.96, p = 0.002). Unmet needs were more likely among sexual minority individuals (17.6%) than heterosexuals (11.8%, OR = 1.47, 95%CI = 1.09-2.00, p = 0.013), with no significant sexual orientation differences among participants perceiving a need for mental health services. Among those with perceived need for mental health services, it was estimated that 56% of sexual minority males had unmet needs (vs. 37% of heterosexual); no such difference existed among women. Other than gender, there were not significant interactions between sociodemographic factors and sexual orientation.

Conclusion: Sexual minority individuals' higher mental health services use highlights the need for high-quality, culturally sensitive services. Future research should identify reasons for the greater proportion of unmet mental health service needs among sexual minority men.