Affirmative Supportive Safe and Empowering Talk (ASSET): Leveraging the Strengths and Resiliencies of Sexual Minority Youth in School-Based Groups

Effects of sexual and gender minority stress on depressive symptoms among adolescents of color in the United States

OBJECTIVE

There is a need for more research on minority stress theory (MST) with sexual and gender minority (SGM) adolescents of color, because of their disproportionate risk for depression.

METHOD

We recruited 1,627 SGM adolescents of color in the United States to complete measures assessing lesbian, gay, bisexual, transgender, and queer (LGBTQ) climate, LGBTQ microaggressions within one's ethnoracial community, internalized LGBTQ stigma, stress management ability, and depressive symptoms. Using structural equation modeling, a hybrid measurement-structural model was tested, indicating good model fit.

RESULTS

Multiple significant indirect pathways linking LGBTQ climate and depressive symptoms emerged. A less positive LGBTQ climate was associated with more microaggression-related stress, more internalized LGBTQ stigma, and worse stress management ability, all of which were associated with greater depressive symptoms. A serial mediation with more microaggression-related stress being associated with greater internalized LGBTQ stigma approached significance.

CONCLUSIONS

Our findings generally support MST processes in terms of depressive symptoms in SGM adolescents of color, suggesting that psychosocial interventions targeting these processes may have meaningful implications for the mental health of this vulnerable group. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Sexual orientation and mental health in a US cohort of children: a longitudinal mediation study

BACKGROUND

Sexual minorities, including children, are at increased risk for adverse mental health outcomes compared to their heterosexual peers, but longitudinal studies are needed to determine the factors that explain the associations between sexual minority identification and adverse mental health outcomes during this developmental period. We examined longitudinal associations between sexual orientation and mental health over 2 years in a US cohort of children (aged 9-10 at baseline) and two explanatory factors (increased social problems such as getting teased and decreased perceived school safety). We hypothesized that beginning to identify as gay/bisexual and consistently identifying as gay/bisexual would be associated with increases in internalizing (e.g. depression, anxiety) and externalizing (e.g. aggression) problems compared to consistently identifying as heterosexual, and these associations would be partially explained by increased social problems and decreased perceived school safety.

METHODS

We used data from Waves 1-3 of the Adolescent Brain Cognitive Development study. The analytic sample included 5,574 children (46.0% female; 55.1% non-Hispanic White).

RESULTS

Beginning to identify as gay/bisexual was associated with increased internalizing/externalizing problems, and consistently identifying as gay/bisexual was associated with increased internalizing problems, compared to consistently identifying as heterosexual. For those who consistently identified as gay/bisexual, increased disparities in internalizing problems were partially explained by increased social problems and decreased perceived school safety, and increased disparities in externalizing problems were partially explained by increased social problems.

CONCLUSIONS

These findings suggest the health disparities affecting sexual minority children include both internalizing and externalizing problems, and social problems and feeling unsafe at school may be contributing factors.

The Development of Proud & Empowered: An Intervention for Promoting LGBTQ Adolescent Mental Health

Sexual and gender minority adolescents (SGMA) experience higher rates of internalizing psychopathology, including depression, anxiety, self-harm, and posttraumatic stress disorder. The primary explanation for these mental health disparities is minority stress theory, which suggests that discrimination, violence, and victimization are key drivers of chronic minority stress and place SGMA at higher risk of mental health concerns. To help address these concerns, the authors undertook a nearly 8-year process of developing Proud & Empowered, a school-based intervention to help SGMA cope with minority stress experiences. This manuscript details the intervention development process, including: (a) identifying the mechanisms of change (Stage 0), (b) building the intervention (Stage 1A, Part 1), (c) acceptability testing and program revision (Stage 1A, Part 2), (d) feasibility and pilot testing (Stage 1B, Part 1), (e) modification of the intervention to improve implementability (Stage 1B, Part 2), and (f) the final intervention.

Discrimination, Depression, and Anxiety Among Sexual Minority and Heterosexual Young Adults: The Role of Self-Compassion

Purpose: The objectives of this study were to examine whether self-compassion may be a protective coping resource against depression and anxiety symptoms for young adults experiencing discrimination and to explore the protective influence of self-compassion among sexual minority young adults (SMYAs) relative to heterosexual peers. Methods: Undergraduate college students (N = 251; 189 heterosexual and 62 sexual minority individuals) completed online self-report questionnaires related to discrimination experiences, depression, anxiety, and self-compassion. Two moderated moderation analyses were conducted to (1) identify whether self-compassion buffered the relationship between discrimination and depression and between discrimination and anxiety and (2) whether this buffering effect varied by sexual identity (i.e., heterosexual vs. sexual minority). Results: Self-compassion significantly moderated the relationship between discrimination and depression for the full sample. Further examination revealed that self-compassion significantly moderated the relationship between discrimination and depression among SMYAs, but not among heterosexual young adults. SMYAs with higher self-compassion reported fewer depression symptoms than SMYAs with lower self-compassion, even when reporting more frequent experiences of discrimination. Self-compassion did not moderate the relationship between discrimination and anxiety for the full sample, nor did this relationship vary by sexual identity. Conclusions: Self-compassion may be a particularly important coping resource to protect against depression symptoms among SMYAs experiencing discrimination. These findings provide an impetus for SMYA-tailored intervention and prevention efforts that incorporate cultivating self-compassion as a protective coping resource to buffer deleterious effects of discrimination.

Reducing behavioral health symptoms by addressing minority stressors in LGBTQ adolescents: a randomized controlled trial of Proud & Empowered

Background

Minority stress may lead to poorer mental health for sexual and gender minority adolescents, yet no interventions have been tested through an RCT to address these concerns.

Methods

We report on an RCT of an intervention—Proud & Empowered—with four high schools. Measures assess the intervention’s impact on mental health symptoms.

Results

Compared to the control, participants in the treatment condition reported significant differences in minority stress, anxiety, and depressive symptoms. Moderation analyses showed that the intervention significantly moderated the relationship between minority stress and PTSD (b = -1.28, p = .032), depression (b = -0.79, p = .023), and suicidality (b = 0.14, p = .012) symptoms; those in the intervention condition had mitigated relationships between measures of stress and health outcomes compared to those in the control condition.

Conclusions

Results suggest that Proud & Empowered help reduce mental health symptoms and exposure to minority stressors and build coping strategies.

Trial Registration

The intervention was registered on clinicaltrials.gov on August 1, 2019 under Trial #NCT04041414.

Confirming the Reliability and Validity of the Sexual Minority Adolescent Stress Inventory in a National Sample of Sexual Minority Adolescents

Objective: Sexual minority adolescents (SMA) experience numerous behavioral health disparities, including depression, anxiety, substance use, non-suicidal self-injury, and suicidality. The primary framework to understand these disparities is minority stress theory, which frames this disproportionate burden as the result of discrimination, violence, and victimization in a homophobic culture. Empirical examinations of minority stress among SMA have been limited by lack of diverse samples or validated measures. This study engaged a national community sample of SMA to confirm reliability and validity of the Sexual Minority Adolescent Stress Inventory (SMASI). Method: A national sample of 2,310 SMA aged 14-17 was recruited in the United States through a hybrid social media and respondent-driven sampling approach. Item response theory and confirmatory factor analysis established the psychometric properties of the SMASI in this sample; minority stress was modeled as a latent variable in several regression models to verify criterion and divergent validity. Results: In this national sample (M age = 15.9; 64% female and 60% White), the factor structure of the SMASI and its 11 subscales was confirmed and shown to be invariant by demographic characteristics. Minority stress as measured by the SMASI was significantly associated with all mental and behavioral health outcomes. Conclusions: This study provides evidence that SMASI is a reliable, valid, and important tool for better understanding minority stress and subsequent health and mental health consequences among SMA.

Minority stress, resilience, and health in Italian and Taiwanese LGB+ people: A cross-cultural comparison

The present study, using a moderated mediational model, explored levels of distal/proximal stressors, rumination, resilience, and health in a group of Italian and Taiwanese LGB+ people. The study also examined the role of internalized sexual stigma (ISS) and rumination as mediators between discrimination and health, and resilience as a moderator of the relationship between discrimination and ISS, rumination, and health, respectively. An online survey was administered to 508 LGB+ participants (270 Italian and 238 Taiwanese) whose age ranged from 18 to 70 years (M = 37.93, SD = 13.53). The moderated mediation model was tested through a series of path analyses stratified by group nationality. Italian participants reported higher discrimination and resilience, but lower ISS, rumination, and health problems compared to their Taiwanese counterparts. The only common path between groups was the direct effect of discrimination on health problems. The mediating role of ISS and rumination in the relationship between discrimination and health, as well as the moderating role of resilience, were partly significant only for the Italian group. Conclusions: The findings suggest that mediators and moderators used to evaluate the effects of minority stress on health may differ between groups; further culturally sensitive research in the field of LGB+ health is needed.

Frequencies and patterns of adverse childhood events in LGBTQ+ youth

BACKGROUND

Trauma, specifically adverse childhood experiences (ACEs), predicts significant health and mental health disparities, yet there is a paucity of research with LGBTQ + youth.

OBJECTIVE

This study explored ACE prevalence in a large sample of LGBTQ+ youth; examined ACE patterns within and across subgroups; and compared results with the general population.

PARTICIPANTS AND SETTING

Participant (n = 3,508) ages ranged between 14-18 (x̄ = 16.02) and represented a range of sexual orientations: pansexual (33.9 %), bisexual (26.6 %), and queer (16.2 %), and gender identities: female (39.9 %), non-conforming (38 %), male (14.9 %), and transgender (16.6 %).

METHODS

An online cross-sectional survey was conducted with LGBTQ+ youth ages 14-18 that self-identified as LGBTQ+ and resided in the US or Canada. Descriptive statistics generated the prevalence of ACEs, and ANOVAs and post-hoc tests were run for comparisons.

RESULTS

Participants reported multiple ACEs (M = 3.14, SD = 2.44) with emotional neglect (58 %), emotional abuse (56 %), and living with a family member with mental illness (51 %) as the most prevalent. Notably, 43 % of participants experienced 4+ ACEs, considered to be a high level of trauma exposure. Compared to national samples, LGBTQ + youth demonstrated unique patterns of ACEs and were higher in 9 of 10 categories. Significantly high (all p < .001) ACEs were found in pansexual (t = 7.67), transgender and gender non-conforming (t = 5.19), American-Indian (t = 6.42), Latinx (t = 2.83) and rural youth (F = 12.12) while those with highly educated parents (F = 83.30, p < .001), lived with a parent (t = 6.02), and in Canada (t = 6.14) reported fewer ACEs.

CONCLUSION

LGBTQ+ youth experience significant childhood trauma with potential impact on their mental health. This study identifies implications for trauma-informed practice and research.

Learnings From SAAHAS—A Queer Affirmative CBT-Based Group Therapy Intervention for LGBTQIA+ Individuals in Mumbai, India

Background: There are few published research studies documenting intervention modalities used with LGBTQIA+ individuals in India. This is a pilot study documenting possibly the first of its kind therapy group named SAAHAS based in Mumbai.

Methodology: SAAHAS was a free, open group for therapy meant for queer individuals. The therapeutic approach used was queer affirmative cognitive behavior therapy. Facilitators were queer psychologists. A survey was conducted to assess the needs of potential participants. Recruitment protocol, group, and session formats and structures are described here. Evaluation was primarily through anonymous participant feedback.

Results: A total of 71 participants completed the intake survey, 28 participants attended at least one group session, and 78% of these were cis-gay men, with low representation of lesbian, bisexual women and transgender and gender nonconforming individuals. Over one year, 12 monthly sessions were conducted. Feedback suggested that the participants liked the group, found it to be a safe space, and reported an improvement in mental health, reduction of distress, reduction of feelings of isolation, and acquisition of knowledge and skills to tackle problems faced by queer people. Peer support, safe space, expert-cum-peer facilitator stance, and queer affirmative cognitive behavior therapy-based therapeutic approach may have contributed to group efficacy.

Conclusion: The SAAHAS therapy group experience provides a useful low-cost therapeutic framework for queer individuals in India.

An Affirmative Coping Skills Intervention to Improve the Mental and Sexual Health of Sexual and Gender Minority Youth (Project Youth AFFIRM): Protocol for an Implementation Study

BACKGROUND

Sexual and gender minority youth (SGMY, aged 14-29 years) face increased risks to their well-being, including rejection by family, exclusion from society, depression, substance use, elevated suicidality, and harassment, when compared with their cisgender, heterosexual peers. These perils and a lack of targeted programs for SGMY exacerbate their risk for HIV and other sexually transmitted infections. Cognitive behavioral therapy (CBT) interventions support clients by generating alternative ways of interpreting their problems and beliefs about themselves. CBT, tailored to the experiences of SGMY, may help SGMY improve their mood and coping skills by teaching them how to identify, challenge, and change maladaptive thoughts, beliefs, and behaviors. Based on the promising results of a pilot study, a CBT-informed group intervention, AFFIRM, is being tested in a pragmatic trial to assess its implementation potential.

OBJECTIVE

The aim of this study is to scale-up implementation and delivery of AFFIRM, an 8-session manualized group coping skills intervention focused on reducing sexual risk behaviors and psychosocial distress among SGMY. Our secondary aim is to decrease sexual risk taking, poor mental health, and internalized homophobia and to increase levels of sexual self-efficacy and proactive coping among SGMY.

METHODS

SGMY are recruited via flyers at community agencies and organizations, as well as through Web-based advertising. Potential participants are assessed for suitability for the group intervention via Web-based screening and are allocated in a 2:1 fashion to the AFFIRM intervention or a wait-listed control in a stepped wedge wait-list crossover design. The intervention groups are hosted by collaborating community agency sites (CCASs; eg, community health centers and family health teams) across Ontario, Canada. Participants are assessed at prewait (if applicable), preintervention, postintervention, 6-month follow-up, and 12-month follow-up for sexual health self-efficacy and capacity, mental health indicators, internalized homophobia, stress appraisal, proactive and active coping, and hope. Web-based data collection occurs either independently or at CCASs using tablets. Participants in crisis are assessed using an established distress protocol.

RESULTS

Data collection is ongoing; the target sample is 300 participants. It is anticipated that data analyses will use effect size estimates, paired sample t tests, and repeated measures linear mixed modeling in SPSS to test for differences pre- and postintervention. Descriptive analyses will summarize data and profile all variables, including internal consistency estimates. Distributional assumptions and univariate and multivariate normality of variables will be assessed.

CONCLUSIONS

AFFIRM is a potentially scalable intervention. Many existing community programs provide safe spaces for SGMY but do not provide skills-based training to deal with the increasingly complex lives of youth. This pragmatic trial could make a significant contribution to the field of intervention research by simultaneously moving AFFIRM into practice and evaluating its impact.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/13462.

Stress and substance use among sexual and gender minority individuals across the lifespan

Sexual and gender minority (SGM) individuals face marked disparities in substance use. The present narrative review explores research on substance use in SGM communities using a minority stress theory lens. We define the SGM population and minority stress, and explore stresses and substance use disparities in adolescence, adulthood, and older age. Though research on this topic is beginning to highlight the relationship between stress and substance use for SGM individuals, more work is needed on older SGM populations and in translating research findings to effective interventions.

Coping With Sexual Orientation-Related Minority Stress

Little is known about how adolescents cope with minority stressors related to sexual orientation. This study examined 245 lesbian, gay, and bisexual (LGB) young adult's (ages 21-25) retrospective reports of coping in response to LGB minority stress during adolescence (ages 13-19) to test the reliability and validity of a measure of minority stress coping. Further, the study examined associations between LGB minority stress coping and young adult psychosocial adjustment and high school attainment. Validation and reliability was found for three minority stress coping strategies: LGB-specific strategies (e.g., involvement with LGBT organizations), alternative-seeking strategies (e.g., finding new friends), and cognitive strategies (e.g., imagining a better future). LGB-specific strategies were associated with better psychosocial adjustment and greater likelihood of high school attainment in young adulthood, whereas alternative-seeking and cognitive-based strategies were associated with poorer adjustment and less likelihood of high school attainment.

Minority Stress and HERoic Coping Among Ethnoracial Sexual Minority Girls: Intersections of Resilience

This study used a focus group methodology to explore the experiences of stress and coping among 40 Hispanic, Caribbean Black, Haitian, and African American cisgender sexual minority girls living in the southeastern United States. An analysis of the data using grounded theory strategies revealed that participants were part of a cultural context in which few boundaries existed between family, religion, and culture, and that they tended to believe that they were betraying family and culture because of their sexual minority identities. Participants described (a) real or perceived transgressions of gender expectations and roles, (b) violating religious doctrine, and (c) emotional exclusion and taunting by family members. In the same context, the theme of HERoic Coping described participants’ resilience that manifested as (a) serving as the family educator, (b) being “out” in the open with family, and (c) creating safety. This study found that the negotiation of complex family, religious, and community environments is critical to understanding resilience in ethnoracial sexual minority girls.

Cultivating Professional Allies for Sexual Minority Youth: A Community-Based Educational Intervention

Sexual minority youth (SMY) face multiple risks in their daily lives that may influence their need for supportive care. Health and social service providers have unique opportunities to provide culturally competent services to these youth. This article describes a community-based educational intervention created to increase providers' knowledge, skills, and intention to support SMY. Based on the Information-Motivation-Behavioral Skills model, this pilot study found that for a diverse sample of multidisciplinary professionals (n = 2,850), the odds of behavioral intention (BI) to support SMY were significantly higher when trainings were relevant to the professionals' experience (OR = 1.3), were sensitive (OR = 1.3), developed skills (OR = 1.1), and incorporated policy (OR = 1.2). Implications for the delivery of community-based trainings are provided.