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Same-sex spouses more likely to use behavioral health services

Behavioral health service use and treatment patterns varied between same- and different-gender marriages and partnerships, with same-sex marriage partners having higher rates of behavioral service use, according to findings published in Psychiatric Services.

“In-depth information on behavioral health utilization patterns, such as duration and type of services received, among [lesbian, gay and bisexual] adults remains largely unknown,” Linda Diem Tran, MSS, department of health policy and management, Johnathan and Karin Fielding School of Public Health UCLA, and colleagues wrote. “Previous studies that examined this subject relied on self-reported service use in population surveys, which are subject to numerous potential reporting biases. In addition, earlier studies did not focus on the potential impacts of partnership status of couples on behavioral health treatment.”

Researchers studied data from behavioral health service claims from 2008 to 2013 to determine specialty behavioral health treatment patterns among employer-insured adults in same- and different-gender domestic partnerships and marriages. They estimated gender-stratified rates of behavioral health service use by couple type and partnership status among partnered adults (n = 12,727,292 person-years) and analyzed levels of use among those who had used these services before. Adjustments were made for age, employer, plan characteristics, provider supply and sociodemographic factors.

Overall, about 8% of 6.35 million women and 5% of 6.37 million men received a specialty behavioral health service during any year of the study period. Lesbian, gay and bisexual adults in same-gender legal unions and sharing insurance coverage received specialty behavioral health services more often than those in heterosexual relationships. Specifically, those in same-gender domestic partnerships or marriages were more likely to have behavioral health comorbidities and to use outpatient individual psychotherapy, medication management and diagnostic evaluation compared with those in different-gender marriages or domestic partnerships. Researchers also found that adults with same-gender partners who lived in states with fewer legal protections for LGBT people were less likely to receive behavioral health treatment than those in LGBT-friendly states. Women and men in same-gender legal unions also had more individual psychotherapy visits.

"Our study shows that lesbians, gay men and bisexual people are seeking support," Tran told Healio Psychiatry. "Treatment that is affirming of the whole person and responsive to the experiences [and] culture of clients are more effective."

Among women who received a behavioral health service, generalized anxiety disorder and comorbid disorders were more common for those in same-gender marriages. Men in same-gender legal unions also had greater out-of-pocket, plan and total behavioral health expenditures than those in heterosexual legal unions. Although rates of service use were similar for women regardless of their spouse’s gender, men in same-gender domestic partnerships were more likely than men in same-gender marriages to receive diagnostic evaluation, individual psychotherapy and medication management, and had more individual psychotherapy visits.

“Studies suggest that services available to [lesbian, gay and bisexual] individuals with mental illnesses are inadequate, and treatment for this population should be tailored to reflect and incorporate the culture and language of lesbian, gay and bisexual clients,” Tran and colleagues wrote. “Providers and advocates should also conduct outreach to [lesbian, gay and bisexual] persons living in less LGBT-friendly states, who may have unmet behavioral health service needs.” – by Savannah Demko

Disclosures: Tran reports no relevant financial disclosures. Please see the full study for all other authors’ relevant financial disclosures.