Intersectional Disparities in Digital Health and Mental Health Service Use Among US Youth During the COVID-19 Pandemic: Cross-Sectional Analysis of a National Survey.

backgroundSexual minority youth, particularly sexual minority youth of color, report elevated mental health challenges and persistent barriers to care. The COVID-19 pandemic exacerbated these disparities and catalyzed a shift toward digital health and digital mental health services. This rapid transition has made it challenging to understand digital exclusion and the digital divide.

objectiveThis cross-sectional study identified the prevalence of digital health and digital mental health service use among US adolescents during the COVID-19 pandemic and examined heterogeneity by sexual orientation, race and ethnicity, and their intersection.

methodsNationally representative data were obtained from the 2021 Adolescent Behaviors and Experiences Survey (N=7705). Weighted distributions of digital health and digital mental health use were calculated, and modified Poisson regression models estimated adjusted prevalence ratios (aPRs) by sexual orientation, race and ethnicity, and their intersection.

resultsAcross the sample, digital health and digital mental health use were 25.8% and 8.5%, respectively. (All percentages reported are weighted estimates.) Digital mental health use was 5.6% among heterosexual participants and 18.1% among all sexual minority youth. In adjusted models, sexual minority subgroups had higher prevalence of digital mental health use than heterosexual peers (lesbian, gay, and bisexual [LGB]: aPR 2.60; sexually diverse: aPR 2.41; all P≤.05). This pattern held among White, Black or African American, and multiracial LGB participants. Digital mental health use was 10.2% among White participants and ranged from 4.8% to 15% among racially or ethnically minoritized participants. Black or African American, Hispanic or Latino, and Asian or Pacific Islander participants had lower prevalence of digital mental health use than White peers overall (Black or African American: aPR 0.70; Hispanic or Latino: aPR 0.55; Asian or Pacific Islander: aPR 0.48; all P≤.05) and among sexual minority youth (Black or African American: aPR 0.60; Hispanic or Latino: aPR 0.35; Asian or Pacific Islander: aPR 0.23; all P≤.05). Racial and ethnic disparities in digital mental health use were pronounced among LGB (Hispanic or Latino: aPR 0.52; P≤.05) and sexually diverse participants (Black or African American: aPR 0.36; Hispanic or Latino: aPR 0.17; Asian or Pacific Islander: aPR 0.10; all P≤.05), but not heterosexual participants. Digital health use did not differ by sexual orientation. However, Black or African American and Hispanic or Latino participants had lower prevalence of digital health use than White peers (28.8%) overall (Black or African American: aPR 0.76; Hispanic or Latino: aPR 0.78; all P≤.05) and among heterosexual (Black or African American: aPR 0.73; Hispanic or Latino: aPR 0.80; all P≤.05) and sexual minority youth participants (Hispanic or Latino: aPR 0.75).

conclusionsDigital platforms offer promise for expanding access to mental health care among sexual minority youth, but persistent inequities must be addressed. Cocreation with lived-experience experts may be critical to ensure digital services are trusted, inclusive, and accessible for all youth.