A rapid realist review of universal interventions to promote inclusivity and acceptance of diverse sexual and gender identities in schools

Co-producing school-based mental health interventions with young people, teachers, and schools: a case study

BACKGROUND

Schools are a prime setting for the delivery of universal and targeted mental health interventions. Current school-based mental health interventions may not be developed to fully meet student mental health needs and co-production is needed to understand what young people really want. Despite this, research on school-based mental health interventions does not consistently engage in co-production, involving stakeholders, such as young people and schools, in the decision-making, development, evaluation and/or implementation stages. This highlights that transforming the development of school-based mental health interventions is crucial to meeting all stakeholders' needs. In this paper, we aim to briefly review an approach to co-production that can be used when conducting research on school-based mental health interventions that centre stakeholder voices to drive meaningful change. We describe a case study to showcase this approach.

MAIN BODY

We highlight recommendations and important elements to consider for each stakeholder when engaging in different levels of co-production, including young people, teachers, and schools. We provide practical examples of how this may look like in practice, theoretical underpinnings, and impact on outcomes. Our case study of co-producing a talk to improve mental health literacy in secondary school students is highlighted to demonstrate how a group of young people, teachers, epidemiologist, psychiatrist, and researchers can work together to develop school-based mental health interventions.

CONCLUSION

Co-production can be successfully conducted amongst researchers and stakeholders to develop school-based mental health interventions. Changes made to the talk were guided by synthesis of feedback that aligned with the balanced needs, perspectives, and opinions of all stakeholders. The use of this co-production approach in research on school-based mental health interventions with young people, teachers, and schools has important implications for research, service provision, and stakeholder empowerment.

Which LGBTQ+ Inclusive School Strategies Support LGBTQ+ Student, Staff and Parent Perceptions of School Climate? A Latent Class Analysis

Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ+) students, LGBTQ+ staff and LGBTQ+ parents report schools can be unsafe and unwelcoming environments. Yet few studies have explored LGBTQ+ student, LGBTQ+ staff and LGBTQ+ parent perceptions of the school climate simultaneously or adopted person-centered perspectives. The present study sought to identify LGBTQ+ related strategies adopted by schools, and whether these were differentially related to perceptions of school safety and community. Data were collected in 2021 via online sampling of the current Australian school (1,937) students, (124) staff and (75) parents. Four distinct inclusion strategy profiles were identified via latent class analysis: Comprehensive Inclusion, Curriculum & Pedagogical Inclusion, Extracurricular Inclusion and Limited Inclusion. Just under half (48.2%) of schools lacked LGBTQ+ strategies, with participants from these schools reporting greater safety concerns. Our findings suggest that curriculum and pedagogical strategies are likely the most effective and should be a key focus for improving the school climate. Schools that employed LGBTQ+ affirming practices and included LGBTQ+ resources and activities, like Gay-Straight Alliances (GSAs), saw improved perceptions of safety and community.

Gender Sexuality Alliances and School Safety: Who Benefits Most, and Do Additive School-Led Practices Strengthen the Link?

While Gender and Sexuality Alliances (GSAs) are associated with higher acceptance of sexual diversity and lower bullying-victimization, it is unclear which individual and school-level attributes strengthen these associations. Nationally representative data (N = 1,567 students; Mage = 15.4, SD = 0.16; 34% boys, 66% girls, 51% heterosexual, 49% sexually-diverse after propensity score matching) in 139 Dutch secondary schools were used. Multilevel regression analyses revealed that GSA presence was linked to more inclusive attitudes about sexual diversity and a safer disclosure climate among sexually-diverse students, and lower general bullying-victimization when the school had a GSA combined with school practices to tackle bullying. School professionals and researchers are recommended to recognize the significance of individual and school-level factors that affect GSA correlates.

It's time for change: inequities and determinants of health-related quality of life among gender and sexually diverse young people in Australia

PURPOSE

This study was guided by three research aims: firstly, to examine the longitudinal trends of health-related quality of life (HR-QoL) among gender and sexuality diverse (LGBTQA2S+) young people through adolescence (ages 14-19); secondly, to assess longitudinal associations between poor mental health and HR-QoL among LGBTQA2S+ young people through adolescence; and thirdly, to examine differences in HR-QoL among LGBTQA2S+ young people during early adolescence (ages 14 and 15) depending on select school-, peer-, and parent-level factors.

METHODS

This study used three of nine available waves of data from a large population-level, probability sample-based, longitudinal cohort study, namely the K' cohort: children aged 4-5 years old at time of study enrolment followed-up biennially (~ 61% retention rate). HR-QoL weighted means and standard deviations were calculated using Child Health Utility 9D (CHU-9D) scores for LGBTQA2S+ participants at ages 14 and 15 (Wave 6), ages 16 and 17 (Wave 7), and ages 18 and 19 (Wave 8). To strategically identify policy-relevant modifiable behavioural factors suitable for prevention and early intervention, non-parametric Wilcoxon signed-rank tests tested differences in mean CHU-9D ranks at ages 14 and 15 (Wave 6) between groups (gender identity: trans vs. cis; identity-level sexuality: gay, lesbian, bisexual, or other diverse sexuality vs. heterosexual; group-level sexuality: sexually diverse vs. not sexually diverse) and selected school factors (school acceptance, belonging, freedom of expression), peer factors (peer relationship quality, trust, respect), and family factors (parental acceptance, understanding, trust), with Hedge's g correction statistics computed for effect sizes. Longitudinal associations between gender, sexuality, and poor mental health (depressive symptoms, anxiety, symptoms, self-harm thoughts/behaviour, and suicidal thoughts/behaviour) and HR-QoL were tested using mixed-effects models with random intercepts and random slopes for nested clustering (participants within postcodes).

RESULTS

HR-QoL disparities disproportionately affecting LGBTQA2S+ groups relative to their cisgender, heterosexual peers, were well-established by age 14 to 15 relatively steeper reductions in HR-QoL were observed throughout adolescence among all LGBTQA2S+ groups, with HR-QoL widening the most for trans participants. Poor mental health was significantly associated with HR-QoL declines. LGBTQA2S+ participants with positive school- and parent factors related to feelings of acceptance, belonging, and freedom of self-expression, reported significantly higher HR-QoL during early adolescence.

CONCLUSION

Evidence-based public health policy responses are required to address the dire HR-QoL inequities among LGBTQA2S+ young people, particularly trans young people. Prioritising the promotion of school- and family-based interventions which foster LGBTQA2S+ inclusivity, acceptance, and a sense of belonging from early adolescence through young adulthood, represents a feasible, evidence-based, and cost-effective response to address these HR-QoL disparities.

The influence of minority stress-related experiences on mental wellbeing for trans/gender-diverse and cisgender youth: a comparative longitudinal analysis

Trans and gender-diverse (TGD) adolescents are likely to experience poorer mental health and wellbeing than their cisgender peers. Minority stress theory has developed as a possible explanation for some of this disadvantage: factors such as increased bullying and discrimination lead to excess stress and reduced wellbeing. However, the evidence base remains limited. This study drew on secondary data analysis of the #BeeWell longitudinal cohort over 2 years (N = 26 042, aged 12-13 at time one, T1). We report two unregistered hypotheses relating to T1 (autumn 2021) data which was available at the time of stage-one submission: H1, mean differences in T1 wellbeing; H2, mean differences in T1 minority-related stressors. These are followed by two registered hypotheses relating to T2 (autumn 2022) data: H3, replication of T1 mean differences in T2 wellbeing; H4, predictions were made about the strength of the association between T1 minority-related stressors, controlling for sexuality and T2 wellbeing across T1 gender identity groups. At both time points cis-females, TGD and those who preferred not to say their gender had lower wellbeing than cis-males (CM), with the largest effect evident for the TGD group. TGD adolescents also showed the largest disadvantage (mean difference) compared with CM for minority stressors. Counter to H4 and minority stress theory, gender was not found to moderate the effect of minority stressors on later wellbeing. Our findings highlight the vulnerability of the TGD group in terms of wellbeing and minority stressors and are discussed with relevance for policy and future research.