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Same-sex-attracted adolescents in rural Australia: stressors, depression and suicidality, and barriers to seeking mental health support.

INTRODUCTION
To address the lack of Australian data examining mental health in same-sex attracted rural adolescents compared with their rural heterosexual peers, this study examined experiences of stressors, symptoms of depression and suicidality, and perceptions of barriers to seeking mental health support, comparing same-sex attracted adolescents with heterosexual adolescents living in rural Australia.


METHODS
Respondents were recruited through high schools in rural South Australia and completed a questionnaire that included demographic questions, the Kutcher Adolescent Depression Scale (KADS-6) and measures of stressors and perceptions of barriers to seeking mental health support. Participants were 531 adolescents (55% female, 43% male), aged 13 to 18, 31 of whom identified as same-sex attracted.


RESULTS
Same-sex attracted adolescents reported significantly more depression symptoms (mean=6.1, standard deviation (SD)=3.9) compared to other adolescents (mean=2.9, SD=3.2, U=2867, p<0.001, r=0 .16). More adolescents who were same-sex attracted screened positive for depression (54.8% vs 15.9%) and there was a significant difference in responses to the item assessing suicidality between same-sex attracted and other adolescents (mean=1.1, SD=1.1; mean=0.3, SD=0.7, χ2 (1, N=531)=27.10, p<0.001, phi=0.24). Same-sex attracted adolescents reported more experiences of stressors relating to relationships, bullying and physical assault than heterosexual adolescents but, contrary to expectations, did not report perceiving more barriers to seeking mental health support (total barriers: same-sex attracted adolescents mean=2.5 (1.8), other adolescents mean=2.5 (1.9), t(527)=0.06, p=0.95, d=0.00).


CONCLUSIONS
Adolescents who identified as being same-sex attracted are at much greater risk of depression and suicidality than other adolescents in rural South Australia. The finding that same-sex attracted adolescents experienced a higher number of relationship stressors, bullying and assault underscores the need for more focus on addressing these issues for this group of vulnerable adolescents. While same-sex attracted adolescents did not perceive more barriers to seeking mental health support, greater understanding of same-sex attracted adolescents' access to appropriate services in rural areas is needed to be able to improve mental health functioning in this population. In addition, addressing the wider issues (eg stigma) contributing to the greater number of stressors, including victimisation, faced by same-sex attracted adolescents should be a priority.