Differences among sexual orientation groups
Sexual minorities reported higher rates of mental health and substance use disorders (see ). Lesbian/bisexual women had the highest prevalence of mood/anxiety disorders (38.1%), followed by gay and bisexual males, heterosexual females, and heterosexual males. Gay and bisexual males had the highest prevalence of substance use disorders (17.7%), followed by lesbian/bisexual women, heterosexual males, and heterosexual females.
Characteristics of the 2004-2005 Cal-QOL survey sample by gender and sexual orientationa
With regard to socio-demographic characteristics, there were significant differences among the groups on age, race/ethnicity, education, employment status, and marital/cohabitation status. The sexual minority groups had higher proportions of whites and lower proportions of Hispanics and those of “other” ethnic groups, higher levels of education, and lower rates of marriage or cohabitation. Gay and bisexual males were also significantly older than heterosexual males. Regardless of sexual orientation, a greater proportion of men than women were employed in the past year.
Treatment status by disorder, gender, and sexual orientation
The three treatment-related outcomes were examined by gender, sexual minority, and disorder status (see ). As expected, a greater proportion of those who had a mental health or substance use disorder perceived a need for treatment. Among those with at least one of these disorders, lesbian and bisexual women had the highest proportion reporting a need for treatment (70.5%), followed by heterosexual women, gay and bisexual men, and heterosexual men. Similarly, among those without any disorder, lesbian/bisexual women had the highest proportion who reported a need for treatment (26.1%), followed by gay and bisexual men, heterosexual women, and heterosexual men.
Rates of perceived need for treatment, treatment received, and unmet need for treatment among a 2004-2005 Cal-QOL samplea by disorder, gender, and sexual orientation
Overall, approximately 22% of the sample reported having received some form of treatment for a mental health and/or substance use problem in the past year. A higher proportion of those with disorders reported having received treatment compared to those without a disorder. Among those with and without disorders, lesbians and bisexual women had the highest rates of treatment received, whereas heterosexual men had the lowest.
About 41% of those expressing a need for treatment met the criterion for unmet need for treatment. Unmet need was highest among heterosexual men and women without disorders and lowest among lesbian/bisexual women regardless of disorder status. About 40% of gay and bisexual men regardless of disorder status had an unmet need for treatment.
Logistic regression models of unmet need for treatment
Unmet need for treatment was modeled in a logistic regression in which interactions among disorder status, gender, and sexual orientation were examined. All models were adjusted for the effects of age, race/ethnicity (white vs. Non-white), and education level.
Using the specified levels approach, we examined the effect of sexual orientation within gender categories, and the effects of sexual orientation and gender within disorder categories. The results indicated that lesbian/bisexual women had about half the odds of unmet need for treatment compared to exclusively heterosexual women (OR = 0.47, CI: 0.22, 0.99; see , 1st column). However, there were no significant effects of sexual orientation for men on unmet need for treatment. Among those with no disorder, sexual minorities had about one third the odds of heterosexuals of unmet need for treatment (OR = 0.35, CI: 0.15, 0.85; see , 2nd column). There was no significant interaction of gender and disorder status on unmet need for treatment (, 3rd column).
Interactive effects of sexual orientation, gender, and presence of mental health or substance use disorder on unmet need for treatment among a 2004-2005 Cal-QOL sample (unweighted N = 515; weighted N = 451.9)
We also estimated this model without interaction terms in order to examine the main effects of gender, sexual orientation, and presence of a disorder (these data not shown). Findings indicated that men had higher odds than women of having unmet need (OR = 1.69, CI: 1.10, 2.58, p < .05) and those with a disorder had lower odds of having unmet need than those without a disorder (OR = 0.57, CI: 0.37, 0.87, p < .05). However, there was no significant main effect of sexual orientation on unmet treatment need. Also, consistent with prior research (41
), older individuals and whites had lower odds of having unmet need for treatment than their respective counterparts.