Utilization of Emergency and Outpatient Mental Health Services by LGBTQ Populations

Background Multiple studies have shown high and increasing rates of depression, suicidality, and marginalization of the LGBTQ population. As value-based care is increasingly utilized for healthcare reimbursement, health systems are tasked to manage population-based health for whole populations, including underserved communities. This study examines how LGBTQ+ individuals interact with emergency departments (EDs) and outpatient clinics relative to the control population, specifically in terms of access and utilization for mental health care in rural and semi-rural settings. Methods We performed a retrospective, population-based study using five years of electronic health record (EHR) data from Geisinger Health System's data warehouse. Demographic sexual orientation and gender identity (SOGI) data, as well as ICD-10 diagnostic codes, were used to identify the study population. Inclusion criteria were (1) non-heterosexual orientation and/or non-cis gender identity and (2) at least one contact with the health system between April 2017 and March 2022 (n=10,727). Controls were age- and insurance-matched (n=21,448). Data were summarized and analyzed for statistical significance using SAS. Results Rates of depression were significantly elevated in both TGD (transgender and gender diverse) and LGB (lesbian, gay, and bisexual) groups compared to their respective control populations. This trend was seen in both the adult and minor categories. The LGBTQ group utilized both outpatient clinic services and the ED for crisis care at higher rates when compared to the control population. Conclusions We conclude that despite greater utilization of outpatient services, the LGBTQ population still utilizes the ED more often for mental health crisis care than controls. These findings suggest that outpatient care may fall short in addressing the underlying mental health needs of LGBTQ individuals. This may be attributable to limited access to LGBTQ-informed care in the outpatient setting.