Crisis line use and mental health care access among LGBTQ+ young people in the United States.

Youth who are lesbian, gay, bisexual, transgender, queer or questioning, and other diverse sexual and gender identities (LGBTQ+) experience disproportionately high rates of suicidal thoughts and behaviors compared to heterosexual and cisgender peers, yet many face barriers to care. Data came from a national online survey of 18,663 LGBTQ+ youth aged 13-24 years in the United States (September-December 2023). Analyses focused on participants who reported wanting mental health care in the past year and assessed access, barriers, service modalities and suicidal ideation/attempts. Half of LGBTQ+ youth who wanted mental health care did not receive it. The most common barrier was fear of talking about mental health concerns (42%). Among those who received care, one-on-one therapy was most common (69% in-person and 53% online). Suicidal ideation was lower among youth in therapy (46% in-person and 40% online) compared to those using crisis lines (75%). After adjusting for demographics, hotline use remained strongly associated with elevated risk: adjusted odds ratio (aOR) = 3.77 (95% confidence interval [CI]: 3.11-4.56) for suicidal ideation; aOR = 3.21 (95% CI: 2.62-3.94) for attempts. Despite strong willingness to seek care, structural and identity-related barriers leave many needs unmet. Expanding culturally competent services is essential to reducing suicide risk.