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The AFFIRM open pilot feasibility study: A brief affirmative cognitive behavioral coping skills group intervention for sexual and gender minority youth
Abstract
This pilot study sought to evaluate the feasibility and effectiveness of a brief, eight module affirmative cognitive behavioral coping skills group intervention (AFFIRM) with sexual and gender minority youth (SGMY) developed through community partnerships. A diverse sample of SGMY (n = 30) participated in the AFFIRM pilot and completed reliable measures of depression, reflective coping, and stress appraisal at three time points. Over the study duration, significant reductions were found in depression and appraising stress as a threat. Significant increases were found in reflective coping and perceiving stress as a challenge. Participants found the intervention to be valuable and reported high levels of acceptability and skills acquisition. These promising findings suggest that AFFIRM has potential effectiveness as a community-based intervention for SGMY. Implications for practice and research are provided.
... Consistent with this framework, Craig and Austin (2016) used an eight module affirmative cognitive behavioral coping skills group intervention (AFFIRM) delivered in a weekend retreat format to 30 sexual and gender diverse 15-18 year olds, eight of whom self-identified as TNB. ...
... The current study tested the effectiveness of using this video as a brief online positive-identity intervention to promote well-being in transgender individuals in the Midwest/Southeastern United States. Drawing on reseach that suggests increasing identityrelated community connectedness (e.g., Puckett et al., 2019;Budge et al., 2020) and TNB affirming interventions (e.g., Clements et al., 2021;Craig & Austin, 2016;Kuntson et al., 2020) POSITIVE IDENTITY INTERVENTION FOR TRANS INDIVIDUALS 6 can increase positive outcomes and decrease negative outcomes in TNB individuals, we hypothesized that TNB individuals who watched the video of other TNB individuals sharing their own positive identity narratives would report significantly higher levels of positive transgender identity, psychological well-being, positive affect, and lower depression and negative affect compared to a control group who watched a general informational video. ...
... Depressive symptoms were significantly lower in the intervention group at the two-week follow up. This finding is consistent with the effects of CBT-based behavioral coping skills interventions for sexual and gender minority youth (Craig & Austin, 2016;Knutson et al., 2020). ...
... In total, we identified three studies in the field of mood disorders [56][57][58], all studies (n = 3) targeted SGM youth of diverse sex and gender. One study each was conducted in a community [56], family [57] and individual setting [58]. ...
... In total, we identified three studies in the field of mood disorders [56][57][58], all studies (n = 3) targeted SGM youth of diverse sex and gender. One study each was conducted in a community [56], family [57] and individual setting [58]. All interventions were treatments for depression/suicidality [56][57][58]. ...
... One study each was conducted in a community [56], family [57] and individual setting [58]. All interventions were treatments for depression/suicidality [56][57][58]. ...
Gender differences in mental health emerge as early as in childhood and adolescence, highlighting the potential need for gender-specific child and adolescent mental health care. However, it is unclear how gender-specific child and adolescent mental health care is implemented and whether its’ approaches are useful. Therefore, this study reviews gender-specific interventions and their effectiveness for child and adolescent mental health. Five databases were searched for articles published between 2000 and 2021. In total, 43 studies were included. Most interventions were conducted in school (n = 15) or community settings (n = 8). Substance-related disorders (n = 13) and eating disorders (n = 12) were addressed most frequently. Most interventions targeted girls (n = 31). Various gender-specific aspects were considered, including gender-specific risk and protective factors (n = 35) and needs (n = 35). Although most interventions yielded significant improvements in mental health outcomes (n = 32), only few studies reported medium or large effect sizes (n = 13). Additionally, there was a lack of strong causal evidence derived from randomized controlled trials, calling for more rigorous trials in the research field. Nevertheless, our findings indicate that gender-specific mental health care can be a promising approach to meet gender-specific mental health needs.
... Counseling; cognitive-behavioural therapy; trauma-focused; affirmative counseling; trauma; transgender; minority stress; victimization; gender diverse It is well documented that transgender and gender diverse (TGD) individuals are at increased risk for negative mental health outcomes relative to cisgender individuals, including higher rates of mood and anxiety disorders, posttraumatic stress disorder (PTSD), substance use disorders, eating disorders, self-harm, and suicidality (Becerra-Culqui et al., 2018;Carmel & Erickson-Schroth, 2016;Coker et al., 2010;Connolly et al., 2016;Olson et al., 2016;Reisner et al., 2015;Veale et al., 2017). This heightened vulnerability is due in part to the marginalizing nature of the social environment in which many TGD individuals live, involving disproportionate rates of discrimination and victimization across societal, institutional, and interpersonal domains (Chodzen et al., 2019;Craig & Austin, 2016;J€ aggi et al., 2018;Tan et al., 2020). Further, TGD individuals are over-represented among those impacted by social stressors such as poverty and homelessness, which in turn increases their risk for experiencing violence, marginalization, and adverse mental health outcomes (Shelton et al., 2018). ...
... Although the negative impact of minority stressors on mental wellbeing is well documented, adequate treatment options to address the consequences of minority stress experiences remain scarce (Busa et al., 2018). Recent investigations of adapted versions of cognitive-behavioral therapy (CBT) with a minority stress framework have shown some promising results, such as improvements in depressive symptoms, hope, and general emotional coping post-treatment, among sexual minorities (Flentje, 2020;Pachankis et al., 2015) and preliminarily among gender minorities (Craig et al., 2021;Craig & Austin, 2016). With regard to gender minorities in particular, these adaptations primarily included psychoeducation on general minority stress theory (Meyer, 2003) combined with general CBT strategies aimed at reducing psychosocial distress, including cognitive (e.g., challenging negative automatic thoughts) and behavioral (e.g., behavior activation) strategies, as well as a focus on increasing social supports (e.g., building and maintaining social connections; Craig & Austin, 2016) in a sample of adolescents and young adults. ...
... Recent investigations of adapted versions of cognitive-behavioral therapy (CBT) with a minority stress framework have shown some promising results, such as improvements in depressive symptoms, hope, and general emotional coping post-treatment, among sexual minorities (Flentje, 2020;Pachankis et al., 2015) and preliminarily among gender minorities (Craig et al., 2021;Craig & Austin, 2016). With regard to gender minorities in particular, these adaptations primarily included psychoeducation on general minority stress theory (Meyer, 2003) combined with general CBT strategies aimed at reducing psychosocial distress, including cognitive (e.g., challenging negative automatic thoughts) and behavioral (e.g., behavior activation) strategies, as well as a focus on increasing social supports (e.g., building and maintaining social connections; Craig & Austin, 2016) in a sample of adolescents and young adults. ...
This article describes an innovative, trauma-focused cognitive behavioral protocol, Transcending, to address the effects of minority stress on mental health among transgender and gender diverse individuals. The protocol merges minority stress and cognitive behavioral therapy models to provide a framework for (a) understanding the impact of minority stress (i.e., distal and proximal stressors) and (b) developing skills to address maintenance factors of associated psychological distress. The Transcending protocol is intended to provide a structured approach to filling an important gap in counseling services and increasing therapeutic competence with transgender and gender diverse individuals.
... enhances connection to and support from peer and adult allies. . . " [34] (p. 138), such as identifying a plan for building a supportive social network for SGMYs [34]. ...
... " [34] (p. 138), such as identifying a plan for building a supportive social network for SGMYs [34]. ...
... Specific examples included highlighting ". . . the connection between experiencing a stressor, emotional reactions, and behavioral responses" [24] (p. 11) and "Understanding the impact of anti-LGBTQ attitudes and behaviors on stress" [34] (p. 139). ...
Robust population-based research has established that sexual and gender minority youths (SGMYs) are at an increased risk of mental ill-health, but there is a dearth of literature that seeks to explore how to best support SGMY mental wellbeing. This scoping review aims to identify findings related to coping strategies and/or interventions for building resilience and/or enhancing the mental wellbeing of SGMYs. PRISMA extension for scoping review (PRISMA-ScR) guidelines was utilized for this review. Studies were included if they were peer-reviewed papers containing primary data; reported psycho-social coping strategies for SGMY; were conducted with SGMYs in the adolescent age range; and were published in English. MEDLINE, Embase, and PsycINFO databases were searched. Of the 3692 papers initially identified, 68 papers were included with 24 intervention-focused studies of 17 unique interventions found. The most commonly cited therapeutic modality was cognitive behavioral therapy (CBT) (n = 11 studies). Despite the need to support the mental wellbeing of SGMYs, few interventions focused on this area and unique populations have been reported upon in the peer-reviewed literature. As a result, there is considerable potential to develop supports for SGMYs.
... Built upon the core components of CBT, AFFIRM was developed in response to the significant mental health disparities of SMYP and the need for evidence-based programmes to address their specific needs (Craig et al., 2013). AFFIRM is an 8-session, manualised psychosocial intervention (see Table 1) aimed at improving coping skills and reducing psychosocial distress among SMYP (Craig & Austin, 2016;Craig et al., 2019). The results of an open pilot feasibility study (Craig & Austin, 2016) and a randomised clinical trial that included large populations of Asian SYMP identified significant outcomes such as a reduction in depression and threat appraisal and improvement of hope, challenge and resource appraisals and coping with medium to large effect sizes. ...
... AFFIRM is an 8-session, manualised psychosocial intervention (see Table 1) aimed at improving coping skills and reducing psychosocial distress among SMYP (Craig & Austin, 2016;Craig et al., 2019). The results of an open pilot feasibility study (Craig & Austin, 2016) and a randomised clinical trial that included large populations of Asian SYMP identified significant outcomes such as a reduction in depression and threat appraisal and improvement of hope, challenge and resource appraisals and coping with medium to large effect sizes. SMYP also reported high levels of intervention acceptability and skills acquisition. ...
... The paucity of evidence-based programmes for SMYP in Chinese societies warrants the development of culturally congruent interventions or cultural adaptation of existing Westerndominant interventions (Sun, Pachankis, et al., 2020). As the first evidence-based intervention for SMYP, AFFIRM was created and tested primarily in Canada and the United States, albeit with diverse participants of various age ranges, ethnic/racial backgrounds (including a large number of Chinese Canadians), and sexual and gender identities (Craig & Austin, 2016;Craig et al., 2021). However, the key considerations for interventions with Chinese SYMP in Eastern contexts remain uncertain. ...
Although cognitive-behavioural therapy has demonstrated effectiveness in improving mental health outcomes for sexual minority young people (SMYP), existing interventions are primarily designed and evaluated in Western contexts, and their acceptability and responsiveness to culturally relevant issues in the Chinese contexts is uncertain. This study aimed to address this gap by exploring how a manualised community-based cognitive-behavioural intervention (AFFIRM) could be culturally reconsidered for SMYP in Taiwan and Hong Kong and suggest recommendations for future adaptation. Following an empirical, community-based participatory approach, qualitative data were collected between August and September 2018 through five focus groups with 15 SMYP and 18 frontline practitioners in Taiwan and Hong Kong. Thematic analysis revealed that at the surface structural level, translation and examples, and promotion strategies can be fine-tuned to better fit the Chinese context. On the deep structural level, self-differentiation and a pragmatic plan to come out to parents were identified as two concerns of cultural importance for Chinese SMYP. This study exemplifies an empirical, collaborative approach to identifying areas of cultural adaptation for mental health intervention for SMYP in the Chinese cultural milieu. The rationale and strategy for adapting existing intervention protocols to accommodate divergent cultural values are described.
... In adapting CBT with SGMY, Craig and Austin (Austin & Craig, 2015;Craig & Austin, 2016) emphasized the principles of CBT (e.g., Socratic method; cognitive model) while ensuring the intervention was contextualized by intersectional and culturally specific needs (e.g., validation and celebration of SGM identities, understanding intersectional minority stressors in participants' lives, utilizing culturally specific terms and definitions) of diverse SGMY. LGBTQ+ affirming mental health interventions can play an important role in the mental health of SGMY (Craig et al., 2021a). ...
... LGBTQ+ affirming mental health interventions can play an important role in the mental health of SGMY (Craig et al., 2021a). While an evidence base is actively being developed toward the systematic investigation of affirmative cognitive-behavioral interventions for SGMY (see Craig & Austin, 2016;Craig et al., 2021a), developing and expanding the range of SGMY mental health interventions, such as developing an affirmative MBI, will contribute to the mental health field's repertoire of empirically supported interventions to meet the needs of SGMY (Finlay-Jones et al., 2021). ...
... Affirmative practice is an approach that informs mental health practice with LGBTQ+ populations, including SGMY (Craig & Austin, 2016). Affirmative practice provides guidance to clinicians working with SGMY and aims to (1) affirm and celebrate LGBTQ+ identity and (2) contextualize mental health and other psychosocial challenges within an understanding of minority stress and anti-LGBTQ+ discrimination (Van Den Bergh & Crisp, 2004). ...
Objectives
Sexual and gender minority youth (SGMY) experience disproportionate mental health disparities, and are often overlooked in mental health practice and research. Mindfulness and self-compassion interventions have been shown to improve mental health among youth, including anxiety and depression. This study sought to examine the utility of an adapted LGBTQ+-affirmative mindfulness-based intervention (MBI) for SGMY, introducing core mindfulness and self-compassion skills within a simulated MBI, and developing an adapted MBI.MethodsSGMY (n = 30) provided feedback on the development of an adapted affirmative MBI via four focus groups and six individual interviews. Grounded theory was used to determine which specific adaptations to mindfulness and self-compassion practices would be beneficial.ResultsThree major themes emerged: (1) The importance of practicing mindfulness in an LGBTQ+-affirming context; (2) the importance of psychological safety when practicing mindfulness; (3) maintaining an explicit focus on self-compassion is essential for an LGBTQ+ youth affirmative mindfulness program.ConclusionsSGMY found mindfulness and self-compassion practices beneficial and acceptable. Overarching themes suggest that (1) SGMY may benefit from an affirmative MBI and (2) they would like to make use of mindfulness to address stressors and foster self-compassion.
... Appraising stress as a threat suggests the potential for harm has been linked to maladaptive coping, posttraumatic stress symptoms and depression [24]. Although appraisals and coping strategies utilised by SGMY have only recently come under investigation, they have particular relevance for interventions addressing mental health [25,26]. As SGMY experience persistent minority stressors, attending to cognitive appraisals associated with experiences of discrimination may have a notable impact on overall psychosocial functioning [27,28]. ...
... As SGMY experience persistent minority stressors, attending to cognitive appraisals associated with experiences of discrimination may have a notable impact on overall psychosocial functioning [27,28]. Affirmative interventions that mobilise SGMY coping skills to help them identify, evaluate, and interrupt the influence of minority stress on their behavioural health are increasingly influential [20,25], yet research with large, community-based samples is needed. ...
... Building on the efficacy of cognitive behavioural therapy (CBT) to treat adolescent mental health problems [44,45], affirmative CBT, which actively validates stigmatised identities by acknowledging the impact of interpersonal and structural sources of SGM identity-based stigma and targets cognitive, affective and behavioural processes, is a promising approach to combatting the increased rates of psychosocial distress in young gay and bisexual men [20] and SGMY ages 15-18 [25]. For example, the Effective Skills to Empower Effective Men (ESTEEM) CBT curriculum significantly reduced depressive symptomology (d = 0.55) through its impact on universal factors such as social support and rumination in a sample of gay and bisexual men aged 18-35 [20]. ...
Objective: This study tested the efficacy of AFFIRM, a brief affirmative cognitive-behavioural group intervention tailored to reduce psychosocial distress and improve coping among sexual and gender minority adolescents and young adults (SGMY).
Method: SGMY (n = 138; M age = 22.44) were allocated to immediate 8-week AFFIRM intervention delivered at 12 community-based organisations or an 8-week waitlisted control. At baseline, post-intervention or post-waitlist, participants completed self-reported assessments of depression, hope, coping, and stress appraisal. Implementation outcomes of feasibility and acceptability were also assessed.
Results: Compared to waitlist, SGMY in the intervention condition significantly reduced their depressive symptoms (b = − 5.79, p = .001) as well as increased reports of hope (agency: b = 0.84, p = .001; pathway: b = 0.79, p = .001), and coping by emotional support (b = 0.59, p < .001), instrumental support (b = 0.67, p < .001), positive framing (b = 0.59, p < .001), humour (b = 0.36, p = .014), planning (b = 0.49, p < .001) as well as reflective coping (b = 0.27, p = .009). Intervention participants were also less likely to perceive stress as a threat (b = − 0.43, p = .001), and more likely to perceive stress as challenge (b = 0.67, p < .001) and have the resources to deal with that stress (b = 0.38, p = .016) in comparison to waitlisted control participants. All outcomes had medium to large effect sizes. AFFIRM participants reported low attrition (8.5%) and high levels of engagement and acceptability (e.g. 99% agreed intervention was relevant to their lives). Over 63% of the community organizations that participated in the training hosted AFFIRM at least once during the study.
Conclusions: Results demonstrate efficacy for the community-based implementation of an affirmative clinical intervention designed for SGMY to address depression and foster coping with universal and minority stressors.
... TIC may not seem all that different from good clinical practices in which therapists listen with non-judgmental compassion while emphasizing client strengths and resilience, or affirmative practices that allow LGBTQ+ clients to authentically explore, share, and express all aspects of themselves and their lives. Affirmative evidence-based treatments exist to help LGBTQ+ clients cope with minority stress and achieve selfacceptance by validating their distress, empowering their authenticity, and encouraging them to embrace a more positive construct of personal identity (Austin & Craig, 2015;Craig & Austin, 2016;Crisp & McCave, 2007;Panchankis, 2014). These ideas are concordant with the goals of TIC, as affirmation is an essential aspect of fostering safety and trust. ...
... Creating psychological safety begins with making it clear that the provider is comfortable working across the spectrum of sexual orientations and gender identities. Once sufficient rapport and safety have been established, the trauma-informed and affirmative therapist should support disclosures and explore minority stressors such as bullying, discrimination, and harassment (Craig & Austin, 2016). The emergence of gay/straight alliances in school settings exemplified how heterosexual and cisgender allies should project support and advocacy for the oppressed group and also for human rights in general (Goldstein & Davis, 2010). ...
... Mentoring by those farther along in their healing journey enhances self-efficacy and self-confidence, especially for individuals who have spent years feeling incredibly alone with their experiences and identities. Groups also facilitate sharing of information, which can expand one's repertoire of available resources, especially for those who are cautiously venturing into an LGBTQ+ world which is new to them (Craig & Austin, 2016;Dietz & Dettlaff, 1997). Yalom (1995) also described the catharsis that occurs when suppressed emotions are revealed, empowering acceptance of life circumstances and the search for meaning. ...
People with diverse sexual orientations, gender identities, and gender expression are at greater risk for trauma, discrimination, and victimization than heterosexual and cisgender populations. Trauma-informed care (TIC) provides a framework for providing lesbian, gay, bisexual, transgender, queer/questioning (LGBTQ +) mental health services. Substance Abuse and Mental Health Services Administration (SAMHSA)'s principles of TIC guide practitioners to create safety, trust, transparency, collaboration, and empowerment in helping relationships, and to ensure that services have cultural and gender relevance. This article first explores the role of trauma in contributing to behavioral health concerns presented by LGBTQ + clients. The application of TIC to mental health counseling and social services for LGBTQ + clients will then be described, with specific suggestions for translating TIC principles into affirmative practice. Through the lens of trauma, clinicians can improve clinical case conceptualization and effective treatment strategies for LGBTQ + clients. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
... After full-text screening, one study was excluded because it concerned a training course for LGBTQIAP+ military personnel. Two studies cited by the selected articles were also analyzed and described only in the section Topics covered during training, because they are detailed descriptions of interventions (Craig & Austin, 2016;McGeorge & Carlson, 2011). These studies were not included in other sections because they did not assess any affirmative therapy training program. ...
... For an analysis of the training approaches reported in the reviewed studies, the descriptions provided in the two studies in which affirmative therapy courses were taught by the authors themselves were used (Craig et al., 2021;Pepping et al., 2018), as well as the implications for clinical training indicated by studies assessing existing couple and family therapy courses (Carlson & McGeorge, 2012;McGeorge et al., 2015;Rock et al., 2010). Two additional studies cited in the reviewed articles were also used, because they described important aspects to be considered in training (Craig & Austin, 2016;McGeorge & Carlson, 2011). ...
Stressors stemming from the prejudice against the LGBTQIAP+ population have been associated with psychological disorders which lead these people to seek healthcare services. However, the qualification of professionals to accommodate this population appears to be deficient. Affirmative therapy has been considered a major strategy which can be deployed by healthcare professionals in the care of this public. This work was aimed at reviewing inquiries evaluating affirmative therapy trainings. Six studies were selected, then assessed regarding subjects' characteristics, employed measures, contingencies of reinforcement involved in this type of therapy, strategies adopted in the training, self-assessment of the therapist regarding their own sexual prejudices, topics addressed in the course, limitations of the studies, and suggestions by the authors. The results indicated that the teaching of affirmative therapy must involve the identification of aversive contingencies present in the environment where the LGBTQIAP+ population lives, the programming of reinforcement contingencies which allow people to disclose themselves as belonging to this population, and the validation of this population's sexual orientation and gender identity as healthy. In these trainings, it is also suggested that therapists encourage LGBTQIAP+ people to seek support groups. Another important issue identified in the analyzed trainings is the instruction for the therapist to continually observe their own responses to LGBTQIAP+ people, in order to avoid reproducing LGBTphobia in their service.
... According to prior research with other minoritized communities, pride in one's identity supports positive mental health and promotes healthy behaviors [40]. Burgeoning clinical research indicates that such minority stressors, like internalized transphobia, can be addressed through genderaffirmative therapy with youth and families [41]; specifically, as a component of interventions to address internalized stigma and transphobia [10,42]. For instance, a brief online cognitivebehavioral therapy intervention for LGBTQ þ youth that focused on addressing multiple minority stressors, including stigma and discrimination, and promoting resilience (i.e., reflective coping, adaptive stress appraisal) was found to significantly reduce depression and increase use of positive coping strategies [10,42]. ...
... Burgeoning clinical research indicates that such minority stressors, like internalized transphobia, can be addressed through genderaffirmative therapy with youth and families [41]; specifically, as a component of interventions to address internalized stigma and transphobia [10,42]. For instance, a brief online cognitivebehavioral therapy intervention for LGBTQ þ youth that focused on addressing multiple minority stressors, including stigma and discrimination, and promoting resilience (i.e., reflective coping, adaptive stress appraisal) was found to significantly reduce depression and increase use of positive coping strategies [10,42]. ...
Purpose:
Prior studies have identified a significant relationship between internalized transphobia and poor mental health among transgender and gender-diverse (TGD) adults; however, this relationship has not been extensively examined among youth. Further, little research has sought to explore protective factors, such as identity pride, and their influence on this relationship. We examined the association between internalized transphobia and depression and anxiety symptoms among TGD youth and explored the moderating role of gender identity pride on these associations.
Methods:
Participants were 315 TGD youth ages 12-20 years (mean = 16; standard deviation = 1.89) seeking gender-affirming hormone treatment at one of four major pediatric hospitals across the United States. At the time of enrollment, participants were naïve to gender-affirming hormone treatment. Participants self-reported mental health, internalized transphobia, and identity pride. Multiple regression models were used with depression and anxiety symptoms as outcomes and age, designated sex at birth, and perceived parental support included as covariates.
Results:
Greater internalized transphobia was associated with greater depressive symptoms, and gender identity pride moderated this relationship, such that greater gender identity pride was associated with fewer depressive symptoms. Greater internalized transphobia was significantly associated with greater anxiety symptoms; no moderation effect was observed for this relationship.
Discussion:
Gender identity pride influenced mental health symptoms for youth experiencing internalized transphobia and represents a potential key protective factor. These results support efforts to further develop, test, and implement clinical inventions to bolster identity pride for TGD youth.
... Given that more than half of TGD youth report ever considering suicide (with almost one in three reporting a suicide attempt), health professionals, school personnel, community organizations, and families should recognize, protect, and provide support to this vulnerable population [58]. For young TGD individuals, affirmative approaches can aid in creating a positive self-narrative, counteracting social stigma, and achieving self-acceptance [111,129]. Clinicians can thus validate these persons' experiences and help them empower their authenticity by constructing a new personal identity [56]. Ultimately, prevention strategies should not concentrate on a singular etiology [71], but take into account the complex variety of factors influencing the health and well-being of TGD youth. ...
... These individuals can find help in school and clinical contexts, such as mental and sexual health providers, who might use trauma-informed, healing-focused, and affirming approaches to this issue. Spotting trauma in the TGD population might indeed aid in providing care based on an ecological, trauma-informed approach [130], which can support TGD youth to achieve resilience and post-traumatic growth [129]. Overall, more research is needed to disentangle the mutual interactions between mental health issues, traumatic experience such as ACEs, emotional well-being, minority stressors and resilience factors, and gender felt pressure, in that they might have different consequences on the person's quality of life [56]. ...
Although capable of mobilizing significant resilience factors to face stigma and discrimination, transgender and gender diverse (TGD) children and adolescents tend to suffer from more adverse mental health outcomes compared to their cisgender counterparts. The minority stressors that this population faces are mainly due to the gender-based pressure to conform to their assigned gender. This systematic review was aimed at assessing the potential mental health issues that affect the TGD population. The literature search was conducted in three databases; namely, Scopus, PubMed, and Web of Science, based on the PRISMA guidelines. The 33 articles included in the systematic review pointed out how TGD children and adolescents experience high levels of anxiety and depression, as well as other emotional and behavioral problems, such as eating disorders and substance use. Resilience factors have been also pointed out, which aid this population in facing these negative mental health outcomes. The literature review highlighted that, on the one hand, TGD individuals appear to exhibit high levels of resilience; nonetheless, health disparities exist for TGD individuals compared with the general population, which are mainly attributable to the societal gender pressure to conform to their assigned gender. Considerations for research and clinical practice are provided.
... Though most treatments of this kind were developed for sexual minority and/or transgender clients (for a review, see Layland et al., 2020), promising interventions targeting internalized and interpersonal stigma related to race (e.g., Anderson et al., 2019), ethnicity (Kennard et al., 2020), and girl/woman identity (Bryant-Davis, 2019) have been developed more recently. Treatments in this category may be entirely novel treatment protocols (e.g., EMBRace; Anderson et al., 2019) or adapted from existing treatments (e.g., AFFIRM; Austin et al., 2018;Craig, Eaton et al., 2021;Craig & Austin, 2016;EQuIP;Pachankis et al., 2015). ...
... These treatments are often rooted in minority stress theory (Brooks, 1981;Meyer, 2003), which posits that stigmatized individuals' heightened risk for mental health concerns are attributable to chronic stigmarelated stressors (e.g., discrimination, victimization) and stress processes (e.g., expectations of rejection). Examples of treatment components include psychoeducation on individual, interpersonal, and structural stigma and their mental health consequences (e.g., Craig & Austin, 2016), cognitive strategies to challenge internalized stigma (Austin et al., 2018), expressive writing and self-affirmation to address the effects of interpersonal stigma (e.g., family rejection, victimization; Pachankis et al., 2020), coping skills for actively attending to feelings during stigma encounters (e.g., mindfulness; Anderson et al., 2019), and assertiveness training for interpersonal stigma experiences (e.g., Pachankis et al., 2015). ...
Stigma refers to societally-deemed inferiority associated with a circumstance, behavior, status, or identity. It manifests internally, interpersonally, and structurally. Decades of research indicate that all forms of stigma are associated with heightened risk for mental health problems (e.g., depression, PTSD, suicidality) in stigmatized youth (i.e., children, adolescents, and young adults with one or more stigmatized identities, such as youth of Color and transgender youth). Notably, studies find that stigmatized youth living in places with high structural stigma – defined as laws/policies and norms/attitudes that hurt stigmatized people – have a harder time accessing mental health treatment and are less able to benefit from it. In order to reduce youth mental health inequities, it is imperative for our field to better understand, and ultimately address, stigma at each of these levels. To facilitate this endeavor, we briefly review research on stigma and youth mental health treatment, with an emphasis on structural stigma, and present three future directions for research in this area: (1) directly addressing stigma in treatment, (2) training therapists in culturally responsive care, and (3) structural interventions. We conclude with recommendations for best practices in broader mental health treatment research.
... One such avenue for this research includes exploring an integration between the biosocial model upon which the theory of DBT is predicated, and the gender minority stress model, which theorizes that the increased risk of mental health problems among TGD individuals is a consequence of the marginalizing nature of their social environment (Testa et al., 2015). This marginalization includes heightened rates of discrimination, oppression, microaggressions, non-affirmation and victimization occurring across societal, institutional and interpersonal domains (Chodzen et al., 2019;Craig and Austin, 2016;Jäggi et al., 2018;Tan et al., 2019), which may lead to internalized stigma, identity concealment, and rejection-related cognitions, behaviours and emotions such as shame. Ultimately, these factors create chronic stress, including both external and internal invalidation. ...
... A basic treatment assumption is that patients with BPD struggle to navigate their world due to a lack of intrapersonal and interpersonal skills, and treatment is focusedin parton ameliorating these deficits to help patients navigate the world more effectively (Chapman, 2006). Preliminary studies of cognitive behavioural approaches incorporating a minority stress framework have shown promising results in sexual and gender minorities (Craig and Austin, 2016;Flentje, 2019;Pachankis et al., 2015). Sloan et al. (2017) have proposed a framework for tailoring DBT to TGD individuals, including adapting both acceptance and change strategies, as a preliminary step in addressing treatment gaps for gender-diverse individuals, although further empirical evaluation and support is needed. ...
Borderline personality disorder (BPD) is a mental health condition characterized by emotion dysregulation, interpersonal impairment, and high suicidality. Dialectical behaviour therapy (DBT) is the most widely studied psychotherapeutic treatment for BPD. To date, the vast majority of DBT research has focused on cisgender women, with a notable lack of systematic investigation of sex and/or gender differences in treatment response. In order to encourage effective, equitable treatment of BPD, further investigation into treatment targets in this population is critical. Here, we employed a systematic strategy to delineate gaps in the DBT literature pertaining to sex and gender differences and propose directions for future research. Findings demonstrate a significant discrepancy in measurement of sex and gender, particularly among gender-diverse individuals. Exploring DBT treatment response across the full spectrum of genders will facilitate the provision of more tailored, impactful care to all individuals who suffer from BPD.
Key learning aims
(1) To date, DBT treatment literature has focused almost exclusively on cisgender women, with only two of 253 DBT studies in current literature accounting for transgender and gender diverse (TGD) individuals.
(2) Recognize how gender minority stress may impact the prevalence of BPD among TGD individuals.
(3) Learn how future research initiatives can be employed to rectify this gap in the DBT literature.
... There has been a recent interest in investigating whether adapting existing suicide prevention treatments for LGBTQ populations could help reduce suicide in this group (Mustanski & Espelage, 2020). Additionally, outside of the realm of suicide prevention research, there have already been promising findings for cognitive behavioral interventions for LGBTQ youth (Craig & Austin, 2016;Pachankis et al., 2015). For instance, Craig and Austin (2016) successfully created an intervention in the form of an affirmative cognitive behavioral coping skills group for sexual and gender minority youth that demonstrated reductions in depressive symptoms and the appraisal of stress as a threat while improving reflective coping skills and teaching youth to instead view stress as a challenge. ...
... Additionally, outside of the realm of suicide prevention research, there have already been promising findings for cognitive behavioral interventions for LGBTQ youth (Craig & Austin, 2016;Pachankis et al., 2015). For instance, Craig and Austin (2016) successfully created an intervention in the form of an affirmative cognitive behavioral coping skills group for sexual and gender minority youth that demonstrated reductions in depressive symptoms and the appraisal of stress as a threat while improving reflective coping skills and teaching youth to instead view stress as a challenge. Pachankis et al. (2015) have developed a transdiagnostic cognitive behavioral intervention for young gay and bisexual men with effects on a variety of outcomes, including depressive symptoms, alcohol use problems, and risky sexual behavior. ...
Lesbian, Gay, Bisexual, Transgender, and Queer or Questioning (LGBTQ) youth are at elevated risk for suicide. Despite this, there is limited information on how to optimize care for suicidal LGBTQ youth. Qualitative interviews were conducted with LGBTQ youth with a history of mental health treatment to identify treatment recommendations and barriers to care for this vulnerable population through the lens of a quality improvement approach. Individual qualitative interviews (n=20) and focus groups (n=21 participants) were conducted. Key findings included the critical role of receiving emotional support from caregivers related to LGBTQ identity, youth’s concern about whether it was safe to share LGBTQ identity with a mental health provider due to uncertainty about how this information would be received, the use of self-report measures early in care for self-disclosure, using clear symbols such as the rainbow pride flag indicating support for the LGBTQ community, and the importance of confidentiality in terms of both suicidality and LGBTQ identity. Youth also described being unaware of existing mental health resources designed for LGBTQ youth and emphasized the importance of educating youth directly on the availability of these resources. These findings underscore the importance of attending to the role of the family in supporting suicidal LGBTQ youth and designing clinic spaces where these youth feel comfortable seeking services. This study is one of the first to elicit direct feedback from LGBTQ youth themselves to inform quality improvement of suicide-prevention care for this population.
... This evidence stems from relatively small trials of LGBTQ-affirmative CBT delivered across diverse formats, including inperson, group telehealth, and digital games. For instance, an open trial with 30 youth found significant reductions in depression three months after receiving eight in-person sessions of LGBTQ-affirmative CBT (Craig & Austin, 2016). A trial with 96 sexual minority youth found that eight sessions of LGBTQ-affirmative CBT delivered to small groups of youth via telehealth and in-person were associated with significantly greater reductions in depression compared to waitlist . ...
... Indeed, recent gender-affirming treatment models have been developed for this purpose and incorporate content related to addressing internalized stigma and minority stress. 45 Results of the present study highlight the need for rigorous examination of these models of care to evaluate their utility in addressing risk for SITBs. ...
Objective:
Suicide is a leading cause of death among youth in custodial settings. Prior research investigating risk factors for suicide among system-involved youth fail to incorporate an intersectional framework to contextualize suicide risk among system-impacted girls of color.
Method:
Profiles of risk for self-injurious thoughts and behaviors (SITBs) were investigated in a sample of 240 racially and ethnically diverse system-involved girls (mean [SD] age = 14.5 [1.7] years, Hispanic/Latinx 49.6%, Black 37.1%). Participants completed self-report measures evaluating traditional risk factors for suicide (mental health symptoms, trauma exposure) as well as assessments of minority stress (eg, daily discrimination) and recent engagement in SITBs at baseline and 3-month follow-up.
Results:
Latent profile analysis revealed 3 distinct profiles: low-risk, characterized by relatively low levels of suicide risk indicators (n = 102); high-risk internalizing, characterized by elevations in internalizing symptom indicators (n = 96); and high-risk comorbid, characterized by relatively high levels of suicide risk indicators (n = 42). Girls in the high-risk profiles reported more SITBs at baseline and 3-month follow-up than girls in the low-risk profile.
Conclusion:
Results suggest that indicators of suicide risk can be used to classify system-involved girls into profiles that differ concurrently and prospectively on SITBs. Findings could be used to inform more accurate risk and referral assessments for system-impacted girls of color, whose SITB-related challenges may be overlooked or framed as criminal. These findings highlight the continued need for assessments evaluating multiple indicators of risk for SITBs in the juvenile legal system.
Diversity & inclusion statement:
We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.
... Accordingly, recently developed prejudice reduction interventions, which are brief and highly scalable, may represent a promising approach to facilitate changes in state laws/policies if widely deployed [74]. In turn, the implementation of supportive state laws/policies (e.g., nondiscrimination protections specific to gender identity) has been shown Training mental health providers in gender-affirming care [75][76][77], and adapting psychological interventions to meet the specific needs of transgender clients [78,79], may similarly benefit transgender individuals. Our study underscores a particularly high need for these multifaced solutions in US states with highly transphobic laws/policies and attitudes. ...
Purpose
Transgender adults face increasingly discriminatory laws/policies and prejudicial attitudes in many regions of the United States (US), yet research has neither quantified state-level transphobia using indicators of both, nor considered their collective association with transgender adults’ psychological wellbeing, hindering the identification of this potential social determinant of transgender mental health inequity.
Methods
We therefore used factor analysis to develop a more comprehensive structural transphobia measure encompassing 29 indicators of transphobic laws/policies and attitudes at the state level, which we linked to individual-level mental health data from a large national sample of 27,279 transgender adults (ages 18–100) residing in 45 US states and the District of Columbia (DC).
Results
Controlling for individual- (i.e., demographics), interpersonal- (i.e., perceived discrimination), and state- (i.e., income inequality, religiosity) level covariates, transgender adults from US states with higher (vs. lower) levels of structural transphobia reported more severe past-month psychological distress and were more likely to endorse past-year and lifetime suicidal thoughts, plans, and attempts.
Conclusion
Findings provide novel evidence that state-level transphobic laws/policies and attitudes collectively shape a range of important mental health outcomes among transgender adults in the US. Multilevel intervention strategies, such as affirming mental health treatments, provider-training interventions, and supportive legislation, are needed to address structural transphobia’s multifaceted nature and negative mental health consequences.
... These experiences, along with a higher prevalence of mental health issues that are endemic among TGD AYA, indicate an imperative need to develop gender-affirming approaches to mental health treatment. While there are increasing interventions developed to meet the needs of LGBTQ + youth (e.g., Project Youth AFFIRM; Craig & Austin, 2016) and transgender individuals (e.g., Trans-Affirmative Cognitive Behavioral Therapy; Austin & Craig, 2015), there remains a paucity of studies on the development and evaluation of evidence-based trauma treatments for TGD AYA. ...
Purpose
There is limited information available regarding the use of trauma modalities within the transgender and gender diverse community (TGD) to address gender-based trauma, including discrimination and invalidation, particularly for adolescents and young adults (AYA). The purpose of this paper is to describe a novel treatment approach to addressing post-traumatic stress disorder (PTSD) symptoms within TGD AYA, inclusive of gender-based trauma.
Methods
Narrative Exposure Therapy (NET) was implemented as a brief intervention for TGD AYA who had a positive screening for PTSD symptomatology. Measures were used to assess PTSD symptoms, as well as changes in self-perceived resilience and positive well-being. Two case vignettes are provided to demonstrate the adaptations made to be responsive to the unique needs of TGD AYA for trauma processing.
Results
Preliminary outcomes from two case studies indicate the strength of NET when working with TGD AYA who face multiple traumatic events and continue to experience invalidation.
Conclusion
NET shows promise as an effective brief intervention to reduce PTSD symptomology and increase resiliency in TGD AYA.
... Specifically, EBPs adapted for transgender and sexual minority youth (i.e., who do not identify as heterosexual; e.g., lesbian, bisexual) evidenced positive effects in pilot trials. 35,36 In contrast, psychotherapy that is not genderaffirming is associated with lower treatment satisfaction, 37 worse therapeutic alliance, 38 and psychotherapy termination. 34 Finally, RCTs examining adapted EBPs using similar affirming practices for sexual minority youth demonstrate preliminary efficacy in several RCTs, [39][40][41][42] and are associated with treatment engagement. ...
Background: In recent years, the United States has witnessed increased transphobic rhetoric and legislation aimed at restricting the rights of transgender youth, ranging from banning transgender youth from school sports, to denying access to gender-affirming care. This climate has a detrimental impact on the mental health of transgender youth - a community that already experiences profound mental health risks due to their exposure to transphobia across multiple levels and in myriad settings. To combat transphobia and its negative effects on transgender youth’s mental health, scientific studies and methods addressing multiple levels and forms of transphobia are needed.Discussion: We review research on negative impacts of multilevel transphobia on transgender youth mental health, the benefits of gender-affirming psychotherapy practices, and argue that these practices should be re-defined as evidence-based practices (EBP). We then describe how dissemination and implementation (D&I) science—the scientific study of multilevel strategies and methods that facilitate the uptake of EBP —can be used to promote the mental health of transgender youth. We call for increased D&I research to support the mental health needs of transgender youth. We recommend two broad domains of D&I research: (1) identify, test, and scale EBPs for transgender youth and (2) address contextual barriers to implementing these EBPs - specifically, state-level laws/policies, and lack of access to gender-affirming psychotherapy. Methodological recommendations and example studies are included in each domain.Conclusions: To enhance mental health equity for transgender youth, we must leverage D&I science to identify, test and scale EBPs for transgender youth, which we define as practices that have been shown to be effective and acceptable for transgender people based on qualitative data, observational research, and/or pilot studies. These research efforts must also address law/policy barriers through advocacy and policy dissemination research, and overcome lack of access to appropriate care via online/mobile interventions.
... Each of the seven items can be found in Table 1. Although items were developed for the purpose of the current research, items were adapted from the AFFIRM acceptability scale which includes items on intervention appropriateness, enjoyment, and usefulness [31]. ...
Widespread adolescent involvement in organized sport means that sport contexts are well-suited to ‘actively’ integrate prevention programs that may promote population-level change. This mixed methods study aimed to evaluate the feasibility and acceptability of a peer-based mental health literacy intervention. The intervention (i.e., Team Talk) was presented to eleven adolescent sport teams in the United States, with a total of 174 participants. Athlete participants completed surveys immediately before and after the intervention—including measures of workshop acceptability, social identity, and help-seeking behaviors. Semi-structured interviews were also conducted with a subset of five athletes, nine parents, and two coaches. With respect to recruitment as an indicator of feasibility, club-level adoption of the intervention was low, with difficulty recruiting clubs for intervention delivery. This signals that feasibility of the intervention–as it is currently designed and implemented by the research team–is low when considering similar competitive adolescent sport clubs and delivered as team-level workshops. Meanwhile, participants reported high acceptability of the intervention, and acceptability levels across participants was predicted by contextual factors related to implementation such as session duration. Regarding limited efficacy testing with measures completed before and after the intervention session: (a) social identity scores increased following the intervention, and (b) significant differences were not identified regarding efficacy to recognize symptoms of mental disorders. Athlete, coach, and parent interview responses also described potential adaptations to mental health programs. This research demonstrates the potential utility of peer-based mental health literacy interventions, while also revealing that further implementation research is necessary to adapt mental health literacy interventions to suit diverse adolescent sport contexts.
... These stressors can have detrimental effects on individual mental health (see review, e.g., Pitoňák, 2017) and romantic relationships' outcomes (Gonçalves, Costa, & Leal, 2019;Rosenthal & Starks, 2015). Studies whose findings affirm that effective coping has a positive effect on sexual minority stress (e.g., Craig & Austin, 2016;Ouch & Moradi, 2019;Song et al., 2020) have encouraged the development of coping interventions that aim to increase LGB individuals' abilities to engage in healthier, adaptive coping behaviors. There are few studies, however, in which the factor structure of multidimensional coping has been evaluated in a sexual minority sample. ...
Coping strategies have been studied as protective factors against stress for individuals. However, the psychometric properties of the most widely used coping self-report questionnaires, the Coping Inventory for Stressful Situations (CISS-21), have not been examined in a sexual minority population (men and women that identify as lesbian, gay, or bisexual or LGB). In this study, we conducted exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) simultaneously to assess the factor structure of the CISS-21 questionnaire in LGBs. Also, we tested the measurement invariance of CISS across sex and sexual identity in the LGB sample (N = 2850, 52.00% woman, mean age = 32.46 years). The results show that a four-factor structure consisting of task-oriented coping (TOC), emotion-oriented coping (EOC), distraction-oriented coping (DOC), and social diversion-oriented coping (SOC) explained the data best. The results also show acceptable internal consistency reliability, convergent validity, and discriminant validity. Subsequently, multi-group analyses established measurement invariance across sex and sexual identity. These results indicate that the CISS-21 could be used as a simple, reliable, and valid scale for measuring coping strategies in LGBs, and that it allows valid score comparisons from different sex and sexual identity groups.
... It can be said that reflective coping is a process of individual response in enduring the causes of stress. (Craig & Austin, 2016) Similarly, individual coping behaviors in overcoming threats to unpredictable situations where individuals actively respond to actual actions to overcome threats that lead to anxiety (Straud et al., 2015). The behavior refers to the individual's actions in reacting to upcoming threats by preparing some ways to contend with the possibilities. ...
The study tested the preceding research model to develop theories regarding aspects of authentic leadership and employee coping in public organizations. Researchers conducted a survey on public organizations with 198 respondents whose task is providing services to the community. Researchers used the convenience sampling technique to take samples of respondents who work in public organizations in Bandung, Indonesia. To test the proposed research model, researchers used a non-parametric approach to predict the model of research. The result of this study indicates there is a connection between authentic leadership and psychological vulnerability mediated by proactive coping in uncertain situations, especially during COVID-19. The study result contributes to filling the research gaps, which shows the effectiveness of authentic leadership in encouraging proactive behavior of employees in dealing with stress and reducing the impact of psychological vulnerability on employees of public organizations. The research implication recommends that leaders of public organizations encourage the employees' proactive behavior by providing direct support. Thus, the employees can be more effective in dealing with uncertain situations to decrease the impact of psychological vulnerability. Received: 17 April 2022 / Accepted: 19 August 2022 / Published: 2 September 2022
... Therefore, it is imperative for school intervention programs to comprehensively target distal to proximal identity-related stressors (per MST) in better serving SGM adolescents of color. Some possible school-based interventions that been developed and examined include the affirmative supportive safe and empowering talk (ASSET) program (Craig, 2013) and the affirmative cognitive behavioral coping skills group intervention (AFFIRM) for SGM youth (Craig & Austin, 2016). However, it is unknown the extent to which these programs can be disseminated effectively with fidelity given the constraints of This document is copyrighted by the American Psychological Association or one of its allied publishers. ...
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) 2022 APA, all rights reserved).
... Without such treatments, mental health clinicians lack concrete evidence-based guidance for implementing LGBTQaffirmative professional directives, such as those promulgated by professional organizations (e.g., American Psychological Association, 2015Association, , 2021. Recently, however, such treatments have been developed and tested in small open trials (Budge et al., 2021;Craig & Austin, 2016), nonrandomized trials with a wait-list comparison , and randomized controlled trials (Pachankis et al., 2015(Pachankis et al., , 2020Pachankis, Harkness, et al., 2022); accumulating evidence suggests that these treatments can improve LGBTQ individuals' mental health. The most rigorously examined of these treatments to date, referred to as LGBTQaffirmative cognitive behavioral therapy (CBT; Pachankis, Harkness, et al., in press; Pachankis, Jackson, et al., in press), is based in the cognitive behavioral principles and techniques, as well as adjunctive interventions (e.g., motivational interviewing), contained in the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (Unified Protocol; Barlow et al., 2017). ...
Objectives:
This randomized controlled trial examined whether an 11-week synchronous (i.e., real-time) online training in lesbian, gay, bisexual, transgender, queer, and other sexual or gender diverse (LGBTQ)-affirmative cognitive behavioral therapy (CBT) could lead to increased uptake of this practice at LGBTQ community centers across 20 U.S. states and internationally.
Method:
A total of 121 mental health providers (Mage = 37.74; 78.5% LGBTQ; 60.3% non-Hispanic/Latinx White) were randomized to receive the 11-week training either immediately (n = 61) or after a 4-month wait (n = 60). At baseline and 4 and 8 months after baseline, participants self-reported their LGBTQ-affirmative competency, cultural humility, and knowledge of the minority stress theory and practice skills underlying LGBTQ-affirmative CBT. To objectively assess uptake of LGBTQ-affirmative CBT, participants demonstrated, through simulated practice, how they would respond to two video-based clinical vignettes.
Results:
Compared to wait-list, participants in the immediate training condition reported greater improvements in self-reported cultural competence (d = 1.24), minority stress knowledge (d = 0.78), LGBTQ-affirmative CBT knowledge (d = 0.78), and LGBTQ-affirmative CBT skills familiarity (d = 0.91) and use (d = 0.96); effects persisted 8 months postbaseline. Cultural humility showed no significant difference by condition (d = 0.07). In objectively coded assessments of simulated practice, participants in the training condition demonstrated greater uptake of LGBTQ-affirmative practice skills (d = 0.82).
Conclusions:
Findings preliminarily suggest that mental health providers can be trained to deliver LGBTQ-affirmative CBT using the low-cost, efficient reach of online training. This training can help disseminate evidence-based mental health care to LGBTQ individuals and support its implementation across practice settings. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... Finally, future research is needed to determine how to best implement this adaptation model across diverse clients within the LGBQ community. Small open trials of CBT-based treatments have been conducted among transgender youth, some of whom identify as sexual minority (Austin et al., 2018;Craig & Austin, 2016), and sexual minority men of color , with the techniques of those treatments being highly compatible with the principles and approach to case conceptualization offered here. Future research is needed to understand the success of the application of this adaptation model outside of these and other clinical trials and whether any additional principles might be called for or whether particular aspects of the case conceptualization should be further emphasized with distinct populations. ...
The mental health field now possesses clinical trials attesting to the efficacy of affirmative practice with sexual minority individuals. With the goal of efficiently moving the results of these clinical trials into real-world clinical practice, this paper offers a model for adapting existing evidence-based practices originally developed for the general population to be lesbian, gay, bisexual, queer (LGBQ) affirmative. The adaptation model presented here guides clinicians to incorporate six LGBQ-affirmative transtheoretical principles of change into practice. These principles facilitate raising awareness of the impact of minority stress on sexual minority clients’ mental health and on client self-evaluation while drawing upon sexual minority resilience and intersectional experiences to build empowering coping skills and validating relationships. The adaptation model also provides a transtheoretical approach to case conceptualization that directs clinicians to consider the role of early and ongoing minority stress on sexual minority clients’ cognitive, affective, motivational, behavioral, and self-evaluative experiences that maintain current distress. This case conceptualization approach highlights typical associations among these experiences, suggesting clear routes of interventions for many sexual minority client presentations. Case examples from recent clinical trials of LGBQ-affirmative cognitive-behavioral therapy illustrate how these principles and case conceptualization can be effectively utilized in practice. While the principles and case conceptualization are meant to be transtheoretical and therefore applicable across therapeutic techniques, to date they have been tested only in clinical trials for cognitive-behavioral treatments. Therefore, this paper concludes with a call for future research to determine the effectiveness of implementing this adaptation model across diverse therapeutic modalities and client presentations.
... Fourth, existing evidence suggests that cognitive and regulatory mechanisms are the intermediate factors (Argyriou et al., 2021). We can use cognitive behavior therapy (CBT) and interpersonal psychotherapy (IPT) to intervene early in LGB individuals with depressive symptoms (Craig and Austin, 2016). Fifth, we could strengthen the legal protection of the rights and interests of LGB individuals. ...
Background
: Depressive symptoms among the lesbian, gay, bisexual (LGB) in college students have generated worldwide concern in recent decades. This study aimed to estimate the associations between sexual orientation and depressive symptoms among Chinese college students, with a focus on gender differences.
Methods
: A total of 30,733 college students were recruited from 10 Chinese province-level regions with a multistage, stratified cluster, random sampling method between March and June 2019. The 20-item Center for Epidemiologic Studies Depression Scale (CESD-20) was used to measure the depressive symptoms. Sexual orientation was assessed by asking the question, “Which of the following options best describes you?” The responses were categorized as heterosexual, gay/lesbian, bisexual, and unsure.
Results
: In our sample (N = 30,733), the prevalence of depressive symptoms was 6.1%. Among the surveyed Chinese college students, 3.7% self-reported as LGB, and 7.2% were unsure. LGB (gay/lesbian: 14.9% for males and 6.8% for females; bisexual: 9.3% for males and 16.4% for females) had a higher risk of depressive symptoms than heterosexuals. After adjusting for control variables, LGB and unsure college students were more likely to have depressive symptoms than their heterosexual peers. For males, unsure college students reported the highest risk of depressive symptoms; for females, lesbian and bisexual college students reported the highest risk of depressive symptoms.
Limitations
The cross-sectional study design and self-reported depressive symptoms and sexual orientation.
Conclusion
: LGB was associated with increased depressive symptoms among Chinese college students. Furthermore, the associations of LGB sexual orientation with depressive symptoms were more robust for females than males.
... youth homelessness(Begun et al., 2019;Coolhart & Brown, 2017;Côté & Blais, 2019;Maccio & Ferguson, 2016;Mountz & Capous-Desyllas, 2020;Prock & Kennedy, 2017;Rew et al., 2019;Shelton, 2015); sexual exploitation (Hounmen & O'Grady, 2019); the child welfare system and foster care experiences(Goldberg et al., 2019(Goldberg et al., , 2020Scannapieco et al., 2018;Wilson & Kastanis, 2015); bullying and harassment(Barth & Olsen, 2020;; mental health support interventions, resources, and outcomes(Craig & Austin, 2016;Chiang et al., 2018;Richards-Schuster et al., 2013;Scannapieco et al., 2018;Wagaman et al., 2020;Wells et al., 2013); and school safety (Atteberry et al., 2019; Seelman et al. ...
Although Child and Youth Care (CYC) sees itself as a field that embraces diversity and complexity, there is a notable lack of discussion of sexual and gender diversity: queer and trans topics are rarely taken up across CYC research, practice, and pedagogy. Through a systematic literature review of articles published between 2010 and early 2020 in six journals with a focus on CYC practice, research, and theory, this article assesses how queer, trans, Two-Spirit, and nonbinary identities and topics are being discussed in the current CYC literature and reveals a conspicuous absence of publication on these topics. In a 10-year period, across six CYC publications comprising over 4000 published articles, only 36 articles focused on queer and LGBT issues (by covering both sexual and gender diversity) and, of those, only eight articles specifically focused on gender diversity or trans topics. No articles were found within any of the reviewed publications that specifically focused on Two-Spirit identities or topics and only one article mentioned nonbinary identities. Through exploring how and where queer and trans, Two-Spirit, and nonbinary identities and topics are being discussed, this review asks how we as a CYC field might begin to make space for these topics within our field and practice, in order to work towards social change that shifts our field and challenges the cis-heteronormative CYC system.
... To address this gap, there has been an emergence of researchers and clinicians who are focused on developing and testing evidence-based treatments that have been specifically adapted for sexual minority clients (Craig, Austin and Alessi, 2013;Craig and Austin, 2016;Blashill et al., 2017;Brown et al., 2017;Craig et al., 2019;Pachankis et al., 2019Pachankis et al., , 2020. ...
Sexual minority clients are more likely to experience emotional disorders and other psychiatric conditions than the general population. This health disparity is not attributable to an individual's sexual minority identity, but rather, the social milieu that produces a unique set of stigma-related stressors. Therefore, mental health disparities affecting sexual minority communities are best understood through a minority stress framework. This chapter outlines mental health disparities affecting sexual minority communities, tailored evidence-based treatments, and clinical considerations for working with sexual minority clients. We hope this chapter can offer pragmatic guidance on how best to tailor intervention approaches given the unique needs and lived experiences of this population.
... To address this gap, there has been an emergence of researchers and clinicians who are focused on developing and testing evidence-based treatments that have been specifically adapted for sexual minority clients (Craig, Austin and Alessi, 2013;Craig and Austin, 2016;Blashill et al., 2017;Brown et al., 2017;Craig et al., 2019;Pachankis et al., 2019Pachankis et al., , 2020. ...
Sexual minority clients are more likely to experience emotional disorders and other psychiatric conditions than the general population. This health disparity is not attributable to an individual's sexual minority identity, but rather, the social milieu that produces a unique set of stigma-related stressors. Therefore, mental health disparities affecting sexual minority communities are best understood through a minority stress framework. This chapter outlines mental health disparities affecting sexual minority communities, tailored evidence-based treatments, and clinical considerations for working with sexual minority clients. We hope this chapter can offer pragmatic guidance on how best to tailor intervention approaches given the unique needs and lived experiences of this population.
... Such experiences are critical, given that SGMY experience heightened adversity and oppression during their adolescence and young adulthood compared to their heterosexual, cisgender peers (Berghe et al., 2010). Such experiences contribute to social isolation, mental health issues, substance use, and suicidality (McDonald, 2018), which have lasting implications on their physical, emotional, and social selves (Craig & Austin, 2016). SGMY's negative health and mental health outcomes (e.g., depression and suicidality) are attributed to minority stress-the internal and external stressors that are specific to those with a sexual or gender identity that differs from common societal expectations (Meyer, 2003). ...
Purpose: Sexual and gender minority youth (SGMY) experience unique challenges related to identity and disclosure, and cope in vibrant ways. Qualitative research has not yet fulsomely explored the risk, resilience, and identity intersections that impact vulnerable SGMY wellbeing.
Methods: This digital photo-elicitation study (QueerView) recruited thirty SGMY (aged 14-29) from priority populations that had one or more of the following experiences: trans and gender diverse, homelessness, child welfare, and immigration. From submission of fifteen photos representing resilience and a semi-structured interview via web conferencing, constructivist grounded theory was utilized for multimodal analysis of photos, interview video, and interview transcript. Triangulation, an audit trail, and member checking were employed to support trustworthiness.
Results: A visual model emerged showing how participants work towards an integrative self, with themes of reflecting and knowing, discrimination and intersectional challenges, connecting, performing, curating, coping, (re)defining and (re)creating, growing and being. Sub-themes of the impact of family dynamic and values, mental health and trauma, and the cathartic benefit from advocacy and leadership offered insight. Participant images were captured in a digital gallery.
Conclusions: QueerView animates the complex lives of multiply marginalized SGMY and their intersectional strengths and challenges while demonstrating the utility of a digital multimodal approach.
... However, our results underscore the importance of improving SGMY's awareness of trauma-related cognitions (e.g., through promoting emotion regulation and relaxation skills) and developing cognitive coping strategies to bolster SGMY's sense of control, mastery, and self-esteem (e.g., through encouraging positive self-talk; Cohen et al., 2012). For example, recent research highlights the importance of helping SGM populations in general to question the accuracy and utility of their negative thoughts or beliefs (e.g., blaming themselves for experiencing sexual assault) rather than to assume that these thoughts or beliefs are dysfunctional (Craig & Austin, 2016;Scheer et al., under review). Additionally, interventions that provide behavioral opportunities to exercise control and mastery (e.g., through role playing) may assist in helping victimized SGMY to generalize coping skills to future stressors (Cohen et al., 2012;Turner et al., 2017). ...
Reducing substance use and negative mental health outcomes of interpersonal victimization among sexual and gender minority youth (SGMY) represents a critical public health priority. Victimized individuals often develop cognitive schemas, or organized knowledge structures consisting of traits, values, and memories about the self, such as self-concept factors, in response to interpersonal victimization. Prior studies demonstrate the role of self-concept factors (e.g., mastery, control, and self-esteem) in explaining the relationship between victimization and substance use and mental health. However, mastery, control, and self-esteem have not been explored as mediators of interpersonal victimization and health among SGMY. This study is among the first to apply cognitive schema models of trauma-related health symptoms using a large sample of SGMY to examine (a) whether interpersonal victimization is associated with substance use (i.e., alcohol use, cannabis use, and cigarette use) and mental health problems (i.e., depressive symptoms, self-perceived stress, self-rated health issues) and (b) whether diminished sense of mastery and control and lower self-esteem can partially explain elevated rates of substance use and mental health problems in this population. We used the U.S.-based 2017 LGBTQ National Teen Survey ( n = 17,112; M age = 15.57, SD = 1.27); 6,401 (37.4%) identified as gay or lesbian, 7,396 (43.2%) as cisgender women, and 10,245 (59.9%) as White. Substance use and mental health variables were positively associated with interpersonal victimization variables and negatively associated with self-concept factors. Self-concept factors partially mediated the relationship between interpersonal victimization and mental health. This model explained 74.2% of the variance in mental health and 28.4% of the variance in substance use. Cognitive coping may represent an important modifiable factor that can be targeted by trauma-focused interventions in efforts to improve victimized SGMY’s mental health. Findings call for the development of identity-affirmative, evidence-based, and trauma-focused interventions for SGMY to improve this populations’ overall health.
... As a consequence, the paradigm concentrates on individual level interventions such as CBT (Cognitive Behavioural Therapy) e.g. AFFIRM an intervention aimed at trans youth and coping skills (Craig & Austin, 2016) and Rainbow SPARX, an online CBT programme aimed at sexual minority youth and depression (Lucassen, Merry, Hatcher, & Frampton, 2015). Far less attention is paid to wider socio-cultural context of interventions. ...
This meta-narrative review on mental health early intervention support for LGBTQ+ youth aimed to develop a theoretical framework to explain effective mental health support. Using the RAMESES standards for meta-narrative reviews, we identified studies from database searches and citation-tracking. Data extraction and synthesis was conducted through conceptual coding in Atlas.ti. in two stages: 1) conceptual mapping of the meta-narratives; 2) comparing the key concepts across the meta-narratives to produce a theoretical framework. In total, 2951 titles and abstracts were screened and 200 full papers reviewed. 88 studies were included in the final review. Stage 1 synthesis identified three meta-narratives - psychological, psycho-social, and social/youth work. Stage 2 synthesis resulted in a non-pathological theoretical framework for mental health support that acknowledged the intersectional aspects of LGBTQ+ youth lives, and placed youth at the centre of their own mental health care. The study of LGBTQ+ youth mental health has largely occurred independently across a range of disciplines such as psychology, sociology, public health, social work and youth studies. The interdisciplinary theoretical framework produced indicates that effective early intervention mental health support for LGBTQ+ youth must prioritise addressing normative environments that marginalises youth, LGBTQ+ identities and mental health problems.
Despite broad interest in how children and youth cope with stress and how others can support their coping, this is the first Handbook to consolidate the many theories and large bodies of research that contribute to the study of the development of coping. The Handbook's goal is field building - it brings together theory and research from across the spectrum of psychological, developmental, and related sciences to inform our understanding of coping and its development across the lifespan. Hence, it is of interest not only to psychologists, but also to neuroscientists, sociologists, and public health experts. Moreover, work on stress and coping touches many areas of applied social science, including prevention and intervention science, education, clinical practice, and youth development, making this Handbook a vital interdisciplinary resource for parents, teachers, clinical practitioners, social workers, and anyone interested in improving the lives of children.
Innovative approaches addressing the elevated human immunodeficiency virus (HIV) risk among men who have sex with men (MSM) or transgender women (TGW) migrants in South Africa are urgently needed. We sought to present the acceptability, feasibility and preliminary efficacy of 'Externalize and Mobilize!', a multi-session arts- and theatre-based HIV prevention group intervention for MSM and TGW migrants in South Africa. Fourteen participants-MSM (n = 7; 50%), genderqueer/nonbinary persons (n = 4; 29%) and TGW (n = 3; 21%)-in Cape Town were recruited and enrolled in the intervention and administered pre- and post-intervention assessments of HIV knowledge, HIV risk-reduction self-efficacy, stigma and resilience. The intervention, delivered over 4 days, was completed by all 14 participants. Scores on HIV knowledge and HIV risk-reduction self-efficacy were statistically significantly higher at post-intervention compared with pre-intervention. Additionally, participants responded affirmatively (i.e. 'Agree' or 'Strongly agree') on all items assessing intervention acceptability. Findings demonstrate the high acceptability, feasibility and preliminary efficacy of an arts- and theatre-based intervention for increasing HIV knowledge and HIV risk-reduction self-efficacy among MSM and TGW migrants in South Africa. This study provides further support for the use of creative and innovative interventions to address entrenched HIV disparities in South Africa.
Introduction
Sexual and gender minority young people (SGMY) experience mental health disparities and are overlooked in mental health practice and research. Self-compassion is a protective factor that promotes youth psychological well-being. This study examines SGMY perceptions of self-compassion and their experiences participating in self-compassion practices.
Methods
SGMY (n = 30) ages 16–29 participated in empirically supported self-compassion practices. Using grounded theory, researchers uncovered three themes.
Results
SGMY indicated that (1) the practice of self-compassion may help SGMY cope with internal/external homo/bi/transphobia, (2) cultivating self-compassion can enhance well-being, and (3) self-compassion can support coping with difficult thoughts and emotions.
Conclusion
Self-compassion may be a helpful approach for SGMY. Implications for SGMY mental health are explored.
Sexual and gender minority youth (SGMY) experience more significant mental health concerns compared to their cisgender and heterosexual peers, especially within recent years, as a result of the relentless political attacks on the lesbian, gay, bisexual, transgender, queer/questioning, intersex, and asexual+ (LGBTQIA+) community. Given that youth spend the majority of their time in school, it is pertinent that schools invest in prevention and intervention strategies to support LGBTQIA+ youth and address their mental health needs, including strategies to reduce the disproportionate rates of suicide among trans and nonbinary young people. Minority stress theory posits that mental health disparities between LGBTQIA+ youth and non‐LGBTQIA+ youth are a product of structural risk factors, such as discriminatory and homophobic environments, which lead to increased psychological distress among SGM youth. Therefore, in addressing the mental health needs of LGBTQIA+ youth it is imperative that a multitiered system of supports model focuses on systemic changes to enhance the overall school climate through prevention and promotion efforts (tier 1), as well as individualized, direct interventions and coordinated care for students in need of greater support (tiers 2 and 3). To this end, findings from a comprehensive literature review were used to propose a model of tiered school‐based mental health services tailored for LGBTQIA+ youth. Implications for implementation and training focused on prevention and intervention approaches to create LGBTQIA+‐affirming schools for LGBTQIA+ youth are discussed.
Background:
Mental health (MH) and substance use (SU) care supports are often difficult to access for the LGBTQ2S+ population. There is little known on how the shift to virtual care has affected and changed the experiences of LGBTQ2S+ youth within the mental health care system.
Objective:
This study sought to examine how virtual care modalities have affected access to care and quality of care for LGBTQ2S+ youth seeking mental health and substance use services.
Methods:
Researchers used a virtual co-design method to explore this population's relationship with mental health and substance use care supports, focusing on the experiences of 33 LGBTQ2S+ youth and their relationship with MH and SU supports during the COVID-19 pandemic. A participatory design research method was used to gain experiential knowledge of LGBTQ2S+ youth's lived experience with accessing MH & SU care. Thematic analysis was used to examine the resulting audio recorded data transcripts and create themes.
Results:
Themes related to virtual care included accessibility, virtual communication, provision of choice, and provider relationship and interactions. Barriers to care were identified in particular for disabled youth, rural youth, and other participants with marginalized intersecting identities. Unexpected benefits of virtual care were also found, and emphasize the idea that this modality is beneficial for some LGBTQ2S+ youth.
Conclusions:
During COVID-19, a time where mental health and substance use-related problems have increased, programs need to re-evaluate current measures so that the negative effects of virtual care modalities can be reduced for this population. Implications for practice encourage service providers to be more empathetic and transparent when providing services for LGBTQ2S+ youth. It is suggested that LGBTQ2S+ care should be provided by LGBTQ2S+ folks/organizations or service providers who are trained by LGBTQ2S+ community members. Additionally, hybrid models of care should be established in the future so that LGBTQ2S+ youth have the option to access in-person services, virtual ones or both as there can be benefits to virtual care once it has been properly developed. Implications for policy also include moving away from a traditional healthcare team model and developing free and lower-cost services in remote areas.
Cognitive Behaviour Therapy is regarded as one of the most effective intervention modalities for a wide range of mental health concerns. This article explores the potential of combining CBT approaches with queer affirmative practices. In section one, the authors present a content review of forty-four articles on affirmative CBT worldwide, to assess how CBT can be effectively used with LGBTQIA+ individuals, how CBT can be beneficial for LGBTQIA+ individuals and how can CBT be modified to make it queer affirmative. In section two, the authors describe experiences in adapting QA-CBT to the Indian context in individual and group therapy, and present suggestions for making this practice intersectional.
Background: Transgender healthcare is a rapidly evolving interdisciplinary field. In the last decade, there has been an unprecedented increase in the number and visibility of transgender and gender diverse (TGD) people seeking support and gender-affirming medical treatment in parallel with a significant rise in the scientific literature in this area. The World Professional Association for Transgender Health (WPATH) is an international, multidisciplinary, professional association whose mission is to promote evidence-based care, education, research, public policy, and respect in transgender health. One of the main functions of WPATH is to promote the highest standards of health care for TGD people through the Standards of Care (SOC). The SOC was initially developed in 1979 and the last version (SOC-7) was published in 2012. In view of the increasing scientific evidence, WPATH commissioned a new version of the Standards of Care, the SOC-8.
Aim: The overall goal of SOC-8 is to provide health care professionals (HCPs) with clinical guidance to assist TGD people in accessing safe and effective pathways to achieving lasting personal comfort with their gendered selves with the aim of optimizing their overall physical health, psychological well-being, and self-fulfillment.
Methods: The SOC-8 is based on the best available science and expert professional consensus in transgender health. International professionals and stakeholders were selected to serve on the SOC-8 committee. Recommendation statements were developed based on data derived from independent systematic literature reviews, where available, background reviews and expert opinions. Grading of recommendations was based on the available evidence supporting interventions, a discussion of risks and harms, as well as the feasibility and acceptability within different contexts and country settings.
Results: A total of 18 chapters were developed as part of the SOC-8. They contain recommendations for health care professionals who provide care and treatment for TGD people. Each of the recommendations is followed by explanatory text with relevant references. General areas related to transgender health are covered in the chapters Terminology, Global Applicability, Population Estimates, and Education. The chapters developed for the diverse population of TGD people include Assessment of Adults, Adolescents, Children, Nonbinary, Eunuchs, and Intersex Individuals, and people living in Institutional Environments. Finally, the chapters related to gender-affirming treatment are Hormone Therapy, Surgery and Postoperative Care, Voice and Communication, Primary Care, Reproductive Health, Sexual Health, and Mental Health.
Conclusions: The SOC-8 guidelines are intended to be flexible to meet the diverse health care needs of TGD people globally. While adaptable, they offer standards for promoting optimal health care and guidance for the treatment of people experiencing gender incongruence. As in all previous versions of the SOC, the criteria set forth in this document for gender-affirming medical interventions are clinical guidelines; individual health care professionals and programs may modify these in consultation with the TGD person.
Background:
Youth who are lesbian, gay, bisexual, trans, queer, 2-spirit, and of other identities (LGBTQ2S+) experience mental health disparities and higher rates of substance use when compared to their cisgender and heterosexual peers and yet also experience more barriers to access to services. The purpose of this paper is to determine the types of mental health and substance use programs and services exclusive to LGBTQ2S+ youth in Ontario during the pandemic.
Methods:
An environmental scan was conducted to identify existing programs and services in Ontario, Canada that offered exclusive mental health and addiction services to LGBTQ2S+ individuals aged 16-29, either by offering services to all or subgroups within the population. Organizations, services and programs were classified by the geographical distribution of services, populations served, types of programming or services, methods of service delivery, and program criteria.
Results:
In total, 113 organizations and 240 programs and services were identified as providing mental health and substance use services exclusively to LGBTQ2S+ youth. Identified adaptations for the COVID-19 pandemic included cancelling in-person services, increasing online and telephone services, and expansion to province wide from local availability.
Conclusions:
The findings highlight the importance of offering services that provide culturally inclusive care for LGBTQ2S+ youth, and these results can also be used by policy makers to inform policies. In particular, there was a lack of culturally relevant clinical services for youth requiring a greater intensity of treatment.
Introduction
We aimed to examine differences in depression, hopelessness, anxiety, traumatic stress, emotion regulation, suicidality, non-suicidal self-injury (NSSI), and drug use between sexual and gender minority youth (SGMY) and heterosexual, cisgender youth (HCY) admitted to an acute, psychiatric inpatient unit in Texas. We also sought to predict participants’ suicide risk level at hospitalization using psychological and demographic variables.
Methods
Adolescent inpatients completed: a demographic questionnaire; the Center for Epidemiological Studies Scale for Children; the Hopelessness Scale for Children; the Screen for Child Anxiety Related Disorders; the Difficulties in Emotion Regulation Scale–16; the Deliberate Self-Harm Inventory; and the Child Posttraumatic Stress Disorder Symptom Scale–5. The Columbia Suicide Severity Rating Scale–Screener Version, and history of suicide attempts and drug use were extracted from medical records. Data were analyzed using independent t-tests and chi-square tests to determine differences in symptoms between SGMY and HCY. A logistic regression was utilized to predict the likelihood of ‘high’ versus ‘low’ suicide risk.
Results
This study included 348 adolescents, mean age 15.31 years, who identified as primarily female (63.22%) and heterosexual, cisgender (61.30%), with many being Hispanic/Latino (40.23%). Nearly 38% of patients identified as SGMY; 3% identified as transgender. SGMY reported significantly more symptoms of depression, hopelessness, anxiety, and emotional dysregulation, reported significantly more suicide attempts, and were more likely to engage in NSSI than HCY. No differences were found for traumatic stress or drug use. SGMY had double the odds of high suicide risk (OR=2.08, 95% CI,1.14–3.71), even after controlling for depression and suicide attempts.
Conclusions
SGMY, compared to HCY inpatients, were particularly vulnerable to developing psychological symptoms, engaging in self-harm, and attempting suicide.
Sexual minority women (SMW) experience an elevated risk of mental health problems compared to heterosexual women. However, knowledge gaps remain regarding whether cognitive-behavioral therapy (CBT) interventions meet SMW’s mental health needs. Further, virtually no studies have integrated stakeholder (i.e., researchers with content expertise in SMW’s health and clinical providers who work with SMW) and community member (i.e., SMW) perspectives to identify CBT approaches that address SMW-specific issues. This study used qualitative data gathered from 39 SMW who reported depression, anxiety, suicidality, and heavy drinking in the past 3 months and 16 content experts and clinical providers to obtain information relevant to enhancing CBT for SMW. In addition, we used thematic analysis to identify themes related to the adaptation and delivery of CBT for SMW. Building on prior literature, this study’s findings revealed seven considerations for delivering mental health services to SMW: (1) attending to SMW’s diverse gender identities and expressions; (2) focusing on SMW’s nonbinary stressors; (3) formulating SMW’s gender-based stressors within a feminist framework; (4) applying intersectionality frameworks; (5) incorporating issues of diversity, multiculturalism, and social justice; (6) addressing the role of trauma exposure; and (7) addressing the role of alcohol use in SMW’s lives. These considerations are reviewed in terms of their implications for clinical practice, with a focus on enhancing applications of existing CBT interventions, to best respond to the unique needs of this population.
Importance:
Sexual orientation and gender identity change efforts (SOGICE), also called conversion therapy, is a discredited practice attempting to convert lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals to be heterosexual and/or cisgender.
Objectives:
To identify and synthesize evidence on the humanistic and economic consequences of SOGICE among LGBTQ youths in the US.
Design, setting, and participants:
This study, conducted from December 1, 2020, to February 15, 2021, included a systematic literature review and economic evaluation. The literature review analyzed published evidence on SOGICE among LGBTQ individuals of any age. The economic model evaluated the use of SOGICE vs no intervention, affirmative therapy vs no intervention, and affirmative therapy vs SOGICE to estimate the costs and adverse outcomes for each scenario and to assess the overall US economic burden of SOGICE. Published literature and public sources were used to estimate the number of LGBTQ youths exposed to SOGICE, the types of therapy received, and the associated adverse events (anxiety, severe psychological distress, depression, alcohol or substance abuse, suicide attempts, and fatalities).
Exposures:
SOGICE (licensed or religion-based practitioners) or affirmative therapy (licensed practitioners).
Main outcomes and measures:
Total incremental costs and quality-adjusted life-years (QALYs) vs no intervention and total economic burden of SOGICE.
Results:
Among 28 published studies, which included 190 695 LGBTQ individuals, 12% (range, 7%-23%) of youths experienced SOGICE, initiated at a mean age of 25 years (range, 5-58 years), with a mean (SD) duration of 26 (29) months. At least 2 types of SOGICE were administered to 43% of recipients. Relative to LGBTQ individuals who did not undergo SOGICE, recipients experienced serious psychological distress (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and attempted suicide (58% vs 39%). In the economic analysis, over a lifetime horizon with a 3% annual discount rate, the base-case model estimated additional $97 985 lifetime costs per individual, with SOGICE associated with 1.61 QALYs lost vs no intervention; affirmative therapy yielded cost savings of $40 329 with 0.93 QALYs gained vs no intervention. With an estimated 508 892 youths at risk for SOGICE in 2021, the total annual cost of SOGICE is estimated at $650.16 million (2021 US dollars), with associated harms totaling an economic burden of $9.23 billion.
Conclusions and relevance:
This economic evaluation study suggests that there is a high economic burden and high societal costs associated with SOGICE and identifies additional research questions regarding the roles of private and public funding in supporting this harmful practice.
Increasing prevalence and severity of undergraduate psychopathology alongside evidence linking spiritual well-being to the prevention of psychopathology has led to the development of campus-supported spiritual-mind-body (SMB) wellness interventions, which have yet to be formally tested in either open or controlled clinical trials. The primary aim of this open trial was to evaluate the feasibility and acceptability of an eight-session SMB wellness intervention, Awakened Awareness for Adolescents (AA-A), to support the developmental task of spiritual development and individuation. Undergraduates aged 18–24 (N = 77) from two sister universities participated in an open trial study. Clinical and spiritual well-being variables were assessed before and after delivery of the AA-A intervention. Paired samples t-tests were conducted to examine pre-to-post-intervention differences. Multiple regression models were conducted to estimate if post-intervention psychopathology symptoms were predicted by a change in spiritual well-being across the intervention. Analyses of student self-reported psychopathology indicated significant improvements in depression, anxiety, and post-traumatic stress symptoms as well as spiritual well-being variables from pre-to-post-intervention. Furthermore, improvements in spiritual well-being predicted improvements in depression, anxiety, and PTS. AA-A appears feasible and acceptable within a culturally, racially, and religiously diverse sample of college students in a secular university. Additionally, this study suggests that AA-A may initiate recovery from moderate forms of psychological distress by addressing pre-existing spiritual distress. SMB interventions may offer novel targeted prevention approaches by providing support for the developmental tasks of identity development and spiritual individuation within the college environment.
Gender and sexually diverse (GSD) students face unique challenges in schools due to the privileging of cisgender and heterosexist norms in these settings. In particular, GSD youth who belong to ethnically and racially minoritized groups face further challenges within school environments that disregard their cultural contexts and intersectional identities. It is important for school psychologists to ensure safe and high‐quality mental health, educational, and behavioral supports for these students. One possible avenue for building these types of supports is through school consultation. When school psychologists collaborate with other professionals in a culturally competent, participatory way, their work has the potential to bolster behavioral, academic, and mental health outcomes at the individual, group, and/or systems levels. Adapting Ingraham's multicultural school consultation model, this article proposes a multicultural, GSD affirming school consultation framework that also approaches the experiences of racially and ethnically minoritized individuals through the lenses of intersectionality and minority stress frameworks. Across its five domains, this adapted framework aims to give practitioners and researchers a conceptual foundation to support GSD students of minoritized ethnic and racial identities by considering interactions among consultants, consultees, and clients within their wider school contexts.
Although stress due to racial and ethnic differences can negatively impact life satisfaction, there is a lack of focus on the differences between minority and nonminority older adults in how stress and coping skills impact life satisfaction. The objectives of this study are to explore (a) the differences between minority and nonminority older adults in their levels of life satisfaction, stress, and coping skills; and (b) the mediating effects of coping skills on the relationship between perceived stress and life satisfaction among both groups. Cross-sectional data from the Well Elderly 2 study ( N = 460) were utilized in bivariate and mediation analyses. Minority older adults reported higher levels of stress and prioritized different coping skills. Mediation was not supported for either group. These findings enable practitioners to focus on the coping skills more frequently identified by clients’ racial/ethnic grouping, as well as to target the primary stressors identified.
The authors discuss their work with a young adult client who identified as gender fluid. The client was a college student in a rural, mid-south town. The authors are two faculty members who worked with the client for a period of 2 years using a cotherapy supervision approach. The counseling approach was affirmative and person-centered. By keeping a focus on the exploration of gender foremost, the clinicians saw an abatement of other symptoms (depression, suicidality, self-harm, disordered eating, low self-confidence, emotion dysregulation, dissociation, and so on) and an improvement in wellness (relationships, emotion regulation, self-concept, assertiveness, appropriate boundary-setting, and so on) over time. The authors offer specific interventions such as collaborative letter writing and the creation of a transition roadmap. They also highlight the advantages and utility of a collaborative, person-centered, consent-based, affirmative approach to therapy with rural transgender and nonbinary clients with complex presenting concerns.
Abstract
Background: Lesbian, gay and bisexual (LGB) people may be at higher risk of mental
disorders than heterosexual people.
Method: We conducted a systematic review and meta-analysis of the prevalence of mental
disorder, substance misuse, suicide, suicidal ideation and deliberate self harm in LGB people.
We searched Medline, Embase, PsycInfo, Cinahl, the Cochrane Library Database, the Web of
Knowledge, the Applied Social Sciences Index and Abstracts, the International Bibliography
of the Social Sciences, Sociological Abstracts, the Campbell Collaboration and grey literature
databases for articles published January 1966 to April 2005. We also used Google and Google
Scholar and contacted authors where necessary. We searched all terms related to homosexual,
lesbian and bisexual people and all terms related to mental disorders, suicide, and deliberate
self harm. We included papers on population based studies which contained concurrent
heterosexual comparison groups and valid definition of sexual orientation and mental health
outcomes
Results: Of 13706 papers identified, 476 were initially selected and 28 (25 studies) met
inclusion criteria. Only one study met all our four quality criteria and seven met three of these
criteria. Data was extracted on 214,344 heterosexual and 11,971 non heterosexual people.
Meta-analyses revealed a two fold excess in suicide attempts in lesbian, gay and bisexual
people [pooled risk ratio for lifetime risk 2.47 (CI 1.87, 3.28)]. The risk for depression and
anxiety disorders (over a period of 12 months or a lifetime) on meta-analyses were at least 1.5
times higher in lesbian, gay and bisexual people (RR range 1.54-2.58) and alcohol and other
substance dependence over 12 months was also 1.5 times higher (RR range 1.51-4.00).
Results were similar in both sexes but meta analyses revealed that lesbian and bisexual women
were particularly at risk of substance dependence (alcohol 12 months: RR 4.00, CI 2.85, 5.61;
drug dependence: RR 3.50, CI 1.87, 6.53; any substance use disorder RR 3.42, CI 1.97-5.92),
while lifetime prevalence of suicide attempt was especially high in gay and bisexual men (RR
4.28, CI 2.32, 7.88).
Conclusions: LGB people are at higher risk of mental disorder, suicidal ideation, substance
misuse, and deliberate self harm than heterosexual people.
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 behavioural 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.
Lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth have the potential for considerable resilience. Positive media representations may mediate negative experiences and foster self-esteem, yet the relationship between resilience and both traditional offline and new online media remains underaddressed for this population. This grounded-theory exploration of media-based resilience-building activities by LGBTQ youth (n = 19) indicated four themes that media use enabled: coping through escapism; feeling stronger; fighting back; and finding and fostering community. Data are embedded to evidence thematic findings and incorporate participant voices. The importance of considering the media within contemporary LGBTQ youth's ecological framework to capture their resilience is considered.
There is considerable debate over whether adolescent sexual activity is maladaptive and associated with worse mental health outcomes versus a positive developmental milestone that is associated with better mental health outcomes. Although these perspectives are often pitted against one another, the current study employed a more integrative perspective: adolescent sexual activity may be maladaptive in certain contexts, but healthy in other contexts. We investigated whether family support and gender moderated the relation between sexual activity and mental health outcomes in a diverse sample of 519 lesbian, gay, and bisexual (LGB) youth. Specifically, we examined whether youth who engaged in more sexual activity would have fewer depressive symptoms in the context of a more supportive family environment, but more depressive symptoms in the context of a less supportive family environment and whether this effect was stronger for sexual minority girls. Consistent with the sexual health perspective, we found that among girls with more family support, those who engaged in more frequent same-sex sexual contact had lower levels of depressive symptoms. Unexpectedly, we found that among boys with more family support, those who engaged in more frequent same-sex sexual contact had higher levels of depressive symptoms. In contrast, girls and boys with less family support showed no relation between sexual activity and depressive symptoms. Overall, results suggest that context is critical when determining whether same-sex sexual contact among LGB youth should be considered maladaptive or beneficial.
When empirically supported treatments (ESTs) are effectively adapted for use with minority populations, they may be more efficacious. As such, there is a need to adapt existing ESTs for use with diverse sexual and gender minority youth (SGMY). The unique bias-based challenges faced by SGMY require the integration of affirmative practices into ESTs to effectively address the specific needs of this underserved group of youth. The primary purpose of the authors in this article is to present a clearly articulated stakeholder driven model for developing an affirmative adapted version of cognitive behavioral therapy (CBT) for use with diverse SGMY. The authors' approach to adaptation follows the "adapt and evaluate" framework for enhancing cultural congruence of interventions for minority groups. A community based participatory research approach, consistent with a stakeholder driven process, is utilized to develop the intervention from the ground up through the voices of the target community. Researchers conducted 3 focus groups with culturally diverse SGMY to explore salient aspects of youths' cultural and SGM identities in order to inform the intervention and ensure its applicability to a wide range of SGMY. Focus group data is analyzed and integrated into an existing group-based CBT intervention. The following themes emerge as critical to affirmative work with diverse SGMY: (1) the interplay between cultural norms, gender norms, sexual orientation, and gender identity; (2) the complex role of religious community within the lives of SGMY; and (3) consideration of extended family and cultural community as youth navigate their SGM identities.
This article describes an integrated model of service provision called a continuum of care (CoC), and illustrates the application of this approach to working with lesbian, gay, bisexual, transgender, and questioning (LGBTQ) youth through a case example. The CoC described in this article includes provision of individual and group counseling, case management, housing/family supports, socialization events, and prevention workshops, along with relevant outcomes. The relevance of a CoC model for LGBTQ youth due to the inclusion of community context and potential to empower service users is explored. Key recommendations for CoC models with LGBTQ youth include a focus on collaboration, provider education, and affirmative practice, and incorporating service user feedback.
Factors associated with the well-being of lesbian, gay, bisexual, transgender, queer, and questioning (LGBTQ) youth were qualitatively examined to better understand how these factors are experienced from the youths' perspectives. Largely recruited from LGBTQ youth groups, 68 youth participated in focus groups (n = 63) or individual interviews (n = 5). The sample included 50% male, 47% female, and 3% transgender participants. Researchers used a consensual methods approach to identify negative and positive factors across 8 domains. Negative factors were associated with families, schools, religious institutions, and community or neighborhood; positive factors were associated with the youth's own identity development, peer networks, and involvement in the LGBTQ community. These findings suggest a pervasiveness of negative experiences in multiple contexts, and the importance of fostering a positive LGBTQ identity and supportive peer/community networks. Efforts should work towards reducing and eliminating the prejudicial sentiments often present in the institutions and situations that LGBTQ youth encounter.
Multiethnic lesbian and bisexual adolescent females (MLBAF) are
vulnerable to health and mental health risks, such as depression,
suicide, self-harm, family and school concerns, and stress resulting
from a “triple jeopardy” of marginalization, yet these risks remain
virtually unstudied. Based on minority stress theory, this pilot
study found that for a sample of MLBAF (n = 116), the odds of
self-reported poor mental health were more than five times higher
for each unit increase in stress and almost seven times higher for
sexual abuse. The presence of youth substance abuse academic
problems and younger age made a significant contribution to poor
self-reported mental health while high self-efficacy scores resulted in
significantly fewer mental health concerns. Implications for practice
are discussed.
Background:
A community-based occupational therapy program aims to provide client-centered and occupation-based interventions to at-risk youth.
Objective:
This pilot study explores how at-risk youth experiencing psychosocial and environmental barriers to occupation respond to client-centered and occupation-based occupational therapy in the community.
Method:
One-on-one semi-structured interviews were conducted with five youth participants receiving individual therapy interventions through a community-based occupational therapy program. The transcript data were analyzed qualitatively.
Results:
Three themes emerged: (i) client-centered and occupation-based OT interventions, (ii) the youths' increased self-advocacy, and (iii) the enhancement of youths' perception of their future.
Conclusion and significance:
The youth in this study described OT interventions exemplifying client-centered and occupation-based therapy, a non-prescriptive approach that validates the individual and may prove especially effective in serving the at-risk youth population.
School settings are often fraught with risks for sexual minority youth, yet the presence of targeted and supportive services within educational contexts is surprisingly rare. This article (a) describes the development of Affirmative Supportive Safe and Empowering Talk (ASSET), a gay-affirmative, school-based group counseling intervention created specifically to promote the resiliency of multiethnic sexual minority youth; (b) suggests group themes and approaches; and (c) discusses critical considerations for implementation. ASSET may be considered a promising intervention that provides opportunities to bridge the unique gaps in service for this vulnerable population.
Little information is available to cognitive-behavioral therapists about how to integrate HIV prevention into standard cognitive behavioral (CBT) treatments among gay and bisexual men, especially for those gay and bisexual men who are at risk for contracting HIV due to their social anxiety. The purpose of the present paper is to assist cognitive behavioral therapists who are treating HIV-negative gay and bisexual men who have high social anxiety. This paper provides an overview of the extant research on social anxiety and its effects on sexual risk behaviors and how to integrate these two types of problems into a coherent treatment plan for gay and bisexual men. The treatment described here uses the framework of CBT for social anxiety (e.g., Hope, Heimberg, & Turk, 2010) and adapts it to include substance use management in interpersonal situations and to reduce sexual risk behavior. The application of empirically supported therapy techniques to reduce both social anxiety and HIV risk behavior for gay and bisexual men is illustrated using three case examples. The present treatment is potentially appropriate for HIV-negative gay and bisexual men who present with social anxiety and who wish to remain HIV-negative by decreasing their sexual risk behavior.
Objectives:
We examined a syndemic of psychosocial health issues among young men who have sex with men (MSM), with men and women (MSMW), and with women (MSW). We examined hypothesized drivers of syndemic production and effects on suicide attempts.
Methods:
Using a pooled data set of 2005 and 2007 Youth Risk Behavior Surveys from 11 jurisdictions, we used structural equation modeling to model a latent syndemic factor of depression symptoms, substance use, risky sex, and intimate partner violence. Multigroup models examined relations between victimization and bullying experiences, syndemic health issues, and serious suicide attempts.
Results:
We found experiences of victimization to increase syndemic burden among all male youths, especially MSMW and MSM compared with MSW (variance explained = 44%, 38%, and 10%, respectively). The syndemic factor was shown to increase the odds of reporting a serious suicide attempt, particularly for MSM (odds ratio [OR] = 5.75; 95% confidence interval [CI] = 1.36, 24.39; P < .001) and MSMW (OR = 5.08; 95% CI = 2.14, 12.28; P < .001) compared with MSW (OR = 3.47; 95% CI = 2.50, 4.83; P < .001).
Conclusions:
Interventions addressing multiple psychosocial health outcomes should be developed and tested to better meet the needs of young MSM and MSMW.
Sexual minority youth (SMY) face multiple challenges as a result of their marginalized sexual and/or gender identities, yet evidence informed programs for the population are absent from the literature. This study describes the pilot research efforts of affirmative supportive safe and empowering talk (ASSET), the first LGBTQ affirmative school-based group counseling intervention created specifically to promote resiliency. In a pilot uncontrolled trial, multiethnic SMY (n = 263) completed measures of self-esteem, social connectedness, and proactive coping at baseline and following completion of the ASSET intervention. Post-intervention analysis using general linear modeling suggests that self-esteem and proactive coping increased significantly across all subgroups, while social connectedness remained constant. ASSET holds promise to enhance the resiliency of SMY in school-based practice settings. Further research should address the effect of ASSET participation on measures of risk and resiliency, and compare outcomes across multiple group interventions.
Sexual minority youth (SMY) are at high risk for negative mental health outcomes such as depression, anxiety, substance abuse, and suicidality. However, there has been a disconnect between clinical social work practice and research with SMY, resulting in a lack of rigorous research that demonstrates the use of effective interventions. While cognitive behavioral therapy (CBT) has long been established as a best practice option for the general adolescent population suffering from mental health problems, knowledge about the use of CBT with SMY lags far behind. Thus, the purpose of this article is to present a clearly defined adaptation of CBT for SMY that integrates gay affirmative practices for youth (e.g., coming out, stigma and discrimination, the role of social support and community). Specifically, the authors: (a) discuss the impact of minority stress on SMY; (b) highlight the specific components of CBT that represent a good fit for SMY and also address the criticisms of using such an approach; (c) consider the importance of using gay affirmative practices with SMY; and (d) offer recommendations for incorporating gay affirmative practices into traditional CBT models to better meet the needs of SMY.
This article (1) describes the development of a strengths-based case management (SBCM) model for multiethnic sexual minority youths; (2) provides a profile of participant risks and strengths; and (3) discusses critical considerations for implementation with this population. Participants (N = 162) reported complex risks such as family rejection as well as personal strengths. SBCM is a promising intervention that provides opportunities to bridge the unique gaps in service for this vulnerable population. Strategies to incorporate strengths into program assessments and address issues such as family engagement and service delivery challenges are offered.
Research suggests that lesbian, gay, and bisexual (LGB) youths are at increased risk for both victimization and internalizing mental health problems, but limited research has studied their association or factors that increase resilience. The sample in this study included 425 LGBs between the ages of 16 and 24 years. The majority had disclosed their sexual orientation to family or friends (98%), and 97% had someone in their lives who was accepting of their orientation. Racial/ethnic minority and female participants in general reported lower levels of disclosure and acceptance. Most participants reported some form of sexual orientation-related victimization (94%). Victimization was associated with psychological distress, but a compensatory model indicated that in the context of this victimization both peer and family support had significant promotive effects. A test of a protective model found social support did not ameliorate negative effects of victimization. The positive effects of family support decreased with age. Peer and family support were particularly important, but they did not significantly dampen the negative effects of victimization. Findings suggest that mental health professionals working with LGB youths should address social support and that public health approaches are needed to reduce levels of victimization.
Sexual minority youth report higher rates of depression and suicidality than do heterosexual youth. Little is known, however, about whether these disparities continue as youth transition into young adulthood. The primary goals of this study were to describe and compare trajectories of adolescent depressive symptoms and suicidality among sexual minority and heterosexual youth, examine differences in depressive symptoms and suicidality trajectories across sexual orientation subgroups, and determine whether there are gender differences in these longitudinal disparities. Four waves of data from the National Longitudinal Study of Adolescent Health were analyzed using latent curve modeling (N = 12,379; 53 % female). Results showed that the rates of depressive symptoms and suicidality in early adolescence were higher among sexual minority youth than among heterosexual youth, and that these disparities persisted over time as participants transitioned into young adulthood. Consistent with previous cross-sectional studies, the observed longitudinal disparities were largest for females and for bisexually-identified youth. Sexual minority youth may benefit from childhood and early adolescent prevention and intervention programs.
This article describes the planning and implementation of a mixed-method community needs assessment with the intent of creating a system of care for gay, lesbian, bisexual, transgender, and questioning (GLBTQ) youths in an urban area. Flowing from qualitative to quantitative research strategies, this needs assessment utilized key informant interviews, focus groups, and survey research in a countywide initiative. Rather than outline each set of findings, this article provides a brief description of the four phases of research activities and the action steps that were completed during each phase. Community context for the needs assessment is described in detail and a final system of care is proposed. Notable barriers and challenges associated with the community needs assessment are also articulated.
This study examined how lesbian, gay, and bisexual (LGB) adolescents reporting clinically significant depressive and suicidal symptoms understand the causes of their psychological distress. The role of the quality of the adolescent-parent relationship as a risk or protective factor was explored. Ten qualitative interviews were analyzed using the Consensual Qualitative Research method. Results showed that adolescents viewed family rejection of sexual orientation, extra-familial LGB related victimization, and non-LGB related negative family life events as the most common causes of their psychological distress. Most of the adolescents also reported experiencing support from at least one family member, and half reported experiencing significant extra-familial (e.g., peers, school counselor) support. Almost all of the adolescents reported wishing that their relationships with their parents were closer and characterized by more acceptance, as well as a willingness to participate in family therapy to improve their relationships with their parents. Clinical implications are discussed.
This lead article of the special issue discusses conceptual and methodological considerations in studying sexual minority issues, particularly in research conducted by counseling psychologists (including the work represented in this special issue). First, the overarching challenge of conceptualizing and defining sexual minority populations is described. Second, the importance and value of scholarship about sexual minority issues are highlighted. Third, challenges in sexual minority research are outlined, using the articles in this special issue for illustrative purposes, and suggestions are offered for consideration in future research. Finally, the article concludes with a discussion of the ways in which counseling psychologists are uniquely positioned to advance knowledge, practice, and social justice through research on sexual minority issues.
This meta-analysis examines the relationship between active coping and psychosocial health among youth. Results from 40 studies
of coping with interpersonal stress were synthesized using a random-effects model. Four areas of psychosocial functioning
were examined: externalizing and internalizing behavior problems, social competence, and academic performance. The magnitude
of the relationship between active coping and psychosocial functioning was small, with correlations ranging from 0.02 for
internalizing behavior to 0.12 for academic performance. Mean effects were moderated by stressor controllability: youth who
used active coping in response to controllable stressors had fewer externalizing problems and higher social competence, as
compared to those who used active coping in response to uncontrollable stressors. Implications for primary prevention programs
and directions for future research on child and adolescent coping are discussed.
Men who have sex with men (MSM) show high rates of HIV infection, and higher rates of depression than non-MSM. We examined
the association between depression and sexual risk among “high risk” MSM. Evidence has been mixed regarding the link between
depression and risky sex, although researchers have rarely considered the role of psychosocial vulnerabilities such as self-efficacy
for sexual safety or “escape” coping styles. In a national sample (N=1,540) of HIV-positive and HIV-negative MSM who reported unprotected sex and drug use with sex partners, we found evidence
that depression is related to HIV transmission risk. Self-efficacy for sexual safety and cognitive escape mediated the link
between depression and risk behavior, suggesting that psychosocial vulnerability plays an important role in the association
of depression with sexual risk. These findings may help us construct more accurate theories regarding depression and sexual
behavior, and may inform the design of sexual safety interventions.
KeywordsDepression–Sexual risk–MSM–Cognitive escape–Self-efficacy
Lesbian, gay, bisexual, and transgender (LGBT) youth are at risk for engaging in negative health behaviors and for experiencing at-school victimization. Specific benefits of attending a high school with a gay-straight alliance (GSA), including lower levels of suicidality, have been published; however, it is unclear whether GSAs are related to lower levels of problematic substance use, depressive symptoms, and psychological distress. Using a sample of 145 LGBT youth recruited from college and university organizations for LGBT students, we examined whether attending a high school with a GSA was related to more positive school experiences and mental health outcomes for LGBT youth. The results indicate that youth who attended a high school with a GSA report significantly more favorable outcomes related to school experiences, alcohol use, and psychological distress. The implications of the findings are discussed as they relate to school psychologists. Important limitations of this study are reviewed.
