Behavioral Health Outcomes and Access to Behavioral Health Treatment Among Sexual Minority Youth Transitioning from Foster Care In California

Background and Purpose

Lesbian, gay, bisexual, and other sexual minority youth (SMY) are overrepresented in foster care in the United States, with rates more than double compared to youth in the general population. SMY often experience rejection, social exclusion, and discrimination, which may result in behavioral health challenges. The risk of adverse behavioral health outcomes may be especially high during the period of transition to adulthood; however, research focused on transition-age SMY has been sparse. The current study aims to address this gap by comparing the prevalence rates of behavioral health disorders and treatment utilization between SMY and heterosexual youth transitioning from foster care in California.

Methods

We analyzed data from the California Youth Transitions to Adulthood Study (CalYOUTH), which included a representative sample of youth who had been in California foster care for at least six months (n=727). Interviews with youth were conducted when they were approximately age 17, 19, 21, and 23. The present analysis was limited to ages 19-23, due to our focus on the transition to adulthood. At each wave, participants reported on their sexual orientation, and were screened for current mental health and substance use disorders using the Mini International Neuropsychiatric Interview for Adults [MINI]. We compared SMY and heterosexual youth on the prevalence of major depression, posttraumatic stress disorder, and anxiety disorder, as well as any current mental health disorder, substance use disorder (SUD; alcohol or drugs), dual diagnosis (i.e., mental health and substance use disorder), and any behavioral health problem. We also compared participants’ past-year treatment utilization (i.e., counseling, psychotropic medication, and substance use treatment) at ages 19, 21, and 23. Chi-square tests were used to identify statistically significant differences (p<.05).

Results

SMY had significantly higher rates of current mental health and substance use disorders at each point, with larger disparities observed at age 23. Prevalence rates for any mental health disorder among SMY were 41% at age 19, 42% at age 21, and 57% at age 23 - about twice as high as their heterosexual peers. Regarding specific disorders, SMY presented higher rates of depression, anxiety, and PTSD, particularly at ages 21 and 23. For SUD, prevalence rates for SMY were two-to-three times higher than those of heterosexual youth. Disparities in dual diagnosis were particularly high, with over 25% of SMY screening positive for mental health and substance use disorder at age 23 (vs. 5% for heterosexual youth). Overall, nearly half of SMY screened positive for any behavioral health disorder at ages 19 and 21, with rates increasing to over 60% at age 23. SMY were more likely to use psychological counseling and psychotropic medication than heterosexual youth; however, rates of substance use treatment were generally low and comparable to heterosexual peers.

Conclusion and Implications

SMY had disproportionately high rates of behavioral health disorders as they transitioned to adulthood. Moreover, treatment utilization for SMY declined between the ages 19-23, although their rates of behavioral health concerns increased during this period. Implications for practice and future directions for research will be discussed.