Disparities in Suicidal Ideation and Planning and Unmet Need for Mental Health Services Between Heterosexual and Sexual Minority Adults in the United States

OBJECTIVE: Suicidal ideation and planning affect ∼10.6 million and 3.1 million adults in the United States annually, respectively, with sexual minority individuals experiencing disproportionately higher rates. Despite greater mental health service utilization, sexual minority individuals experience greater unmet need due to additional barriers to care, including stigma and a lack of practitioner cultural competency, compared to heterosexual individuals. Unmet need for mental health services is a known risk factor for suicidal ideation, planning, and attempts, and may contribute to disparities in suicidality between heterosexual and sexual minority individuals. The current study aims to explore how unmet need and service utilization interact with sexual orientation in relation to past-year suicidal ideation and planning. METHOD: Using a cross-sectional nationally representative sample of 41,806 respondents, the current study used logistic regression to examine past-year suicidal ideation and planning in relation to sexual orientation, unmet need, reasons for unmet need, service utilization, and the interactions between sexual orientation and both unmet need and service utilization. RESULTS: Results indicated that sexual minority status, unmet need, and service utilization were independently associated with higher odds of suicidal ideation and planning. Interaction analyses revealed that sexual minority individuals were more likely than heterosexual individuals to report suicidal ideation and planning among those with unmet need or service utilization. CONCLUSIONS: These findings suggest that factors beyond service access, such as stigma, may contribute to suicidal outcomes among sexual minority individuals, highlighting the need for tailored interventions addressing their specific barriers.