Midlife and older gay men and their use of physical and mental health services: Exploring the effects of health enablers, health need, psychosocial stress and individual health coping.

摘要

Older gay men and lesbians, out of fear of discrimination, are five times less likely to access health care and social services. There are a few studies that have explored usage rates and factors that influenced non use of these services. This investigator examined the physical and mental health care service use for gay men 45 years of age and older. A cross-sectional study design employed the use of a web based survey. A sample of 260 participants from across the United States was collected within a 3-month collection timeframe. Participants for this study were obtained using gay choruses and an older gay men's social group called the Prime Timers.;A conceptual framework developed for this study drew upon the combined contribution from the Andersen-Newman's Behavioral Model of Health Service Use (1973), and the Minority Stress Conceptual Framework proposed by Meyer (Meyer, 1995). The goals of this study was to understand whether enablers defined by Anderson and Newman (1974) and psychosocial stress and individual health coping factors identified by Meyer (1995) were influential on the use of physical and mental health service use. Regression analysis was used to analyze the relationships based on correlational interactions between enabling, psychosocial stressors, and individual health coping variables on service use. Additionally, researchers have found that 51% to 82% of lesbians and gay men do not disclose their sexual orientation to health and social service providers. Independent sample t-test was used to identify the significance of sexual identity disclosure on use of both physical and mental health service use.;The results of this study found that for mental health service use, community support and resiliency were significant predictors of service use. Physical health visits were found to be significantly influenced by support from friends, internalized homophobia and mental health distress. Discrimination was a significant factor in use of physical health visits, and it was found to decrease physical health service use. Physical health status and mental health distress were significant in seeking both physical and mental health services.;The importance of understanding the connection between physical health status and mental health distress was found increasing the need for interventions that incorporate both in the scope of service. More importantly, the effects of discrimination for midlife and older gay men is further understood and discussed with implications on physical health visits. The outcomes of this study provide a starting point to understand factors that affect how midlife and older gay men on the use of health services. The promotion of more effective policies and programs as well as, interventions within a community based support model would increase the health and well-being of this population. The study highlights the importance of social workers affirming a gay identity to increase one's self confidence in seeking health services through direct intervention and policy changes.