Substance Use and Depressive Symptoms Are Mediators of Foregone Medical Care among Female Sexual Minorities in the U.S.

Shoshana K. Goldberg, University of North Carolina at Chapel Hill
Amy H. Herring, University of North Carolina at Chapel Hill
Carolyn Tucker Halpern, University of North Carolina at Chapel Hill

Research suggests that sexual minority (SM) emerging adult females may be at a higher risk for medical care underutilization than their exclusively heterosexual (EH) peers. We assessed whether four health risk variables (depressive symptoms, tobacco use, illegal drug use, and heavy drinking) mediated the association between Sexual Minority Status (SM vs. EH) and prior-year forgone care, among 6,701 female respondents in Wave III of The National Longitudinal Study of Adolescent Health, using Baron and Kenny causal mediation testing and bias-corrected bootstrap confidence intervals. After adjusting for covariates, SM females were significantly more likely than EH to report forgone care (OR=2.01; 95% CI=1.70-2.37). Depressive symptoms was a strong mediator (Indirect effect [IE]=.035; bias corrected CI [bcCI]= .026-.045), whereas drug use was a significant, but weak mediator (IE=.01; bcCI= .003 -.018), such that the total effect of SMS on forgone care (Total effect=.125 bcCI =.091-.158) was mediated by 28.3%, and 8.14%, respectively