A digital intake platform for behavioral health screening identified SGM at risk for depression and substance use challenges within a sexual health clinic, and was able to identify subpopulations at higher risk for these disorders, increasing opportunities for recognition and response.
Key Findings
Results
Among 1,277 patients presenting to a sexual health clinic, 11% screened positive for a depressive disorder, 50% for hazardous drinking, and 26% for illicit substance use.
Total sample size was N=1,277 people who presented for care between March 2021 and April 2023.
Screening used a digital intake platform incorporating validated behavioral health screenings for depression, hazardous drinking, and illicit substance use.
The clinic served sexual and gender minority (SGM) individuals.
13% reported a sexually transmitted infection in the past 12 months.
Results
Transgender and gender diverse individuals had 1.93-fold greater odds of depression compared to cisgender men.
Odds ratio for depression among transgender/gender diverse individuals versus cisgender men was 1.93.
Individuals aged 18-39 years were more likely to be depressed than adults aged 40 and older.
12% of the sample identified as transgender/gender diverse.
Results
Cisgender men had 2.42-fold greater odds of illicit substance use compared to cisgender women.
Odds ratio for illicit substance use among cisgender men versus cisgender women was 2.42.
Overall, 26% of the sample screened positive for illicit substance use.
These associations were identified through evaluation of relationships between demographic and sexual health factors and substance use outcomes.
Results
Lesbian/gay individuals had 5.08-fold increased odds of illicit substance use compared to heterosexual individuals.
Odds ratio for illicit substance use among lesbian/gay individuals versus heterosexual individuals was 5.08.
28% of the sample identified as gay/lesbian.
30% identified as bisexual+ (attracted to more than one gender).
Results
The sample demonstrated high rates of sexual and gender minority representation, with 50% screening positive for hazardous drinking.
28% of patients identified as gay/lesbian, 30% as bisexual+, and 12% as transgender/gender diverse.
50% of the total sample screened positive for hazardous drinking.
The study period ran from March 2021 through April 2023.
The digital intake platform was used to screen all patients presenting for care.
Methods
A digital intake platform was successfully implemented for routine behavioral health screening at a sexual health clinic serving SGM individuals.
The platform screened for depression, hazardous drinking, and illicit substance use.
The implementation allowed identification of subpopulations at higher risk for behavioral health disorders.
The approach was evaluated for its ability to identify SGM subpopulations most in need of services.
The protocol was described as increasing 'opportunities for recognition and response.'
What This Means
This research suggests that sexual and gender minority (SGM) people who visit sexual health clinics face substantial mental health and substance use challenges, and that a digital check-in system can effectively identify who is most at risk. In a study of 1,277 patients at a Rhode Island sexual health clinic over two years, half screened positive for hazardous drinking, more than a quarter for illicit drug use, and about one in nine for depression. Transgender and gender diverse patients were nearly twice as likely to screen positive for depression as cisgender men, while gay and lesbian patients were about five times more likely to report illicit substance use than heterosexual patients.
The study also found that younger adults (18-39) were more likely to screen positive for depression than older adults, and cisgender men were more than twice as likely as cisgender women to report illicit substance use. These patterns point to specific groups within an already vulnerable population who may need the most support.
This research suggests that integrating a digital behavioral health screening tool into the routine intake process at a sexual health clinic is a practical way to identify people who may be struggling with depression or substance use — people who might not otherwise be asked about these issues during a visit focused on sexual health. By identifying at-risk individuals within clinical settings they already use, this approach could help connect more SGM people with mental health and substance use services.
Fenn N, Nunn A, Malyuta Y, Salhaney P, Erbe M, Cancilliere M, et al.. (2026). Implementing Mental Health and Substance Use Screening at a Sexual Health Clinic.. Rhode Island medical journal (2013). https://pubmed.ncbi.nlm.nih.gov/42647833/