Implementing Mental Health and Substance Use Screening at a Sexual Health Clinic

Sexual and gender minority (SGM) individuals experience heightened mental health problems and substance misuse. Improved approaches to screening for behavioral health in this population are needed. We evaluated the implementation of a digital intake platform incorporating behavioral health screenings at a sexual health clinic serving SGM individuals.

Patients presenting to a sexual health clinic March 2021 through April 2023 were screened for depression, hazardous drinking, and illicit substance use using a digital intake platform. To identify SGM subpopulations most in need of services, we evaluated relationships between demographic and sexual health factors and depression, hazardous drinking, and illicit substance use.

In total, N=1,277 people presented for care; 28% identified as gay/lesbian, 30% as bisexual+ (attracted to more than one gender), and 12% as transgender/gender diverse. Thirteen percent reported a sexually transmitted infection in the past 12 months, 11% screened positive for a depressive disorder, 50% for hazardous drinking, and 26% for illicit substance use. Individuals 18-39 years were more likely to be depressed than adults 40+, and transgender/gender diverse individuals had 1.93-fold greater odds of depression than cisgender men. Regarding substance use, cisgender men had 2.42-fold greater odds of use compared to cisgender women, and lesbian/gay individuals had 5.08-fold increased odds compared to heterosexual individuals.

A digital intake platform for behavioral health screening identified SGM at risk for depression and substance use challenges within a sexual health clinic. This protocol was able to identify subpopulations at higher risk for these disorders, increasing opportunities for recognition and response.