title: Mental health help seeking patterns and associations among Australian same sex attracted women, trans and gender diverse people: a survey-based study.
abstract: Same sex attracted women (SSAW) are disproportionately affected by depression and anxiety, due to experiences of sexuality and gender based discrimination. They access mental health services at higher rates than heterosexual women, however with lower levels of satisfaction. This study examined the range of professional and social help seeking by same-sex attracted women, and patterns according to sexual orientation and gender identity subgroup.
  
  
  
  Eight key stakeholders were interviewed, and a convenience sample of 1628 Australian SSAW completed an online survey in 2015. This included several scales to measure mental health, community connectedness and resilience; and measured past 12 month help seeking behaviour, enablers, barriers and preferences for mental health care. Chi-square analyses and binary logistic regression analyses examined demographic associations with mental health. Correlations between help seeking, mental and physical health, and connectedness were run.
  
  
  
  A high proportion (80 %) of the total sample had perceived mental health problems over the past 12 months. Over half had depression, and over 96 % had anxiety. Trans and gender diverse participants were twice as likely as female participants to have mental health problems, and lesbians were least likely. High levels of past 12 month help seeking included 74.4 % seeing a GP, 44.3 % seeing a psychologist/counsellor, 74.7 % seeking family/friends support and 55.2 % using internet based support. Professional help was prioritised by those with higher mental health need. Trans participants were most likely to have sought professional help and participated in support groups, but least likely to have sought help from friends or family. The most common barriers to help seeking were discrimination and lack of LGBTI sensitivity of services, particularly for gender diverse, queer and pansexual participants. Enablers included mainstream community connectedness, having a trustworthy GP, and encouragement by friends.
  
  
  
  Mental health services need to be LGBTI inclusive and to understand the emerging diverse sexual and gender identities. Peer support is an important adjunct to professional support, however may not be fully meeting the needs of some identity sub-groups. Mental health promotion should be tailored for diverse sub-groups to build mental health literacy and resilience in the face of ongoing discrimination.
authors.affiliation: Department of General Practice, University of Melbourne, 200 Berkeley St, Carlton, 3053, Victoria, Australia. r.mcnair@unimelb.edu.au.
authors.forename: Ruth P
authors.identifier: 0000-0002-4738-8781
authors.initials: RP
authors.lastname: McNair
authors.affiliation: School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood, 3125, Australia.
authors.forename: Rachel
authors.initials: R
authors.lastname: Bush
mesh_terms: D000328:Adult; D001315:Australia / Q000453:epidemiology; D003863:Depression / Q000453:epidemiology; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008605:Mental Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000523:psychology*; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D012944:Social Support; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: Barriers; Enablers; Gender identity; Help-seeking; Mental health; Peer support; Sexual orientation