1
|
Schaechter T, Flowers SN, Weiss M, Becker-Haimes EM, Sanchez AL. Culturally Adapted Interventions for Anxiety and Trauma-Related Disorders in Marginalized Youth: A Systematic Review. Child Psychiatry Hum Dev 2025:10.1007/s10578-025-01833-3. [PMID: 40397328 DOI: 10.1007/s10578-025-01833-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/24/2025] [Indexed: 05/22/2025]
Abstract
Treatment inequities persist among marginalized youth who experience anxiety and trauma-related disorders. Culturally adapted interventions show potential for improving outcomes for marginalized youth. However, it is unclear the extent to which they improve engagement and can be successfully implemented in practice settings. This systematic review characterizes adaptations to anxiety treatments and their effectiveness for treatment engagement, clinical, and implementation outcomes. Twelve articles met inclusion criteria. Adaptations most frequently altered treatment procedures, language, or content, and least frequently altered treatment approach or goals based on cultural conceptualizations of mental health. Most adaptations targeted racially or ethnically minoritized youth and did not target intersectionality. Adapted treatments were overall effective in reducing anxious distress, yet rigorous study designs were lacking. Engagement outcomes for adapted treatments were inconsistent, and implementation outcomes (e.g., feasibility, acceptability, fidelity) were rarely assessed. The current literature is promising yet inconclusive about the benefits of adapted treatments over standard protocols.
Collapse
Affiliation(s)
- Temma Schaechter
- Department of Education and Human Services, Lehigh University, Bethlehem, PA, USA.
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA.
| | - Sasha N Flowers
- Psychology Department, George Mason University, Fairfax, VA, USA
| | - Michal Weiss
- School of Global Public Health, New York University, New York, NY, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily M Becker-Haimes
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
- Hall Mercer Community Mental Health, University of Pennsylvania Health System, Philadelphia, PA, USA
| | - Amanda L Sanchez
- Psychology Department, George Mason University, Fairfax, VA, USA
- Department of Psychiatry, University of Pennsylvania, Philadelphia, PA, USA
| |
Collapse
|
2
|
Earnshaw VA, Mousavi M, Qiu X, Fox AB. Mental Illness and Substance Use Disorder Stigma: Mapping Pathways Between Structures and Individuals to Accelerate Research and Intervention. Annu Rev Clin Psychol 2025; 21:85-111. [PMID: 39805034 DOI: 10.1146/annurev-clinpsy-081423-023228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2025]
Abstract
Researchers, interventionists, and clinicians are increasingly recognizing the importance of structural stigma in elevating the risk of mental illnesses (MIs) and substance use disorders (SUDs) and in undermining MI/SUD treatment and recovery. Yet, the pathways through which structural stigma influences MI/SUD-related outcomes remain unclear. In this review, we aim to address this gap by summarizing scholarship on structural MI/SUD stigma and identifying pathways whereby structural stigma affects MI/SUD-related outcomes. We introduce a conceptual framework that describes how structural-level stigma mechanisms influence the MI/SUD treatment cascade via (a) interpersonal- and individual-level stigma mechanisms and (b) mediating processes among people with MI/SUD (i.e., access to resources, psychological responses, behavioral responses, social isolation). We consider intersections between MI/SUD stigma and stigma based on race/ethnicity, gender identity, and sexual orientation. Finally, we discuss the implications of this review for future research, interventions, and clinical practice.
Collapse
Affiliation(s)
- Valerie A Earnshaw
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA;
| | - Mohammad Mousavi
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA;
| | - Xueli Qiu
- Department of Human Development and Family Sciences, University of Delaware, Newark, Delaware, USA;
| | - Annie B Fox
- School of Healthcare Leadership, MGH Institute of Health Professions, Boston, Massachusetts, USA
| |
Collapse
|
3
|
Pachankis JE, Clark KA. The Mental Health of Sexual Minority Individuals: Five Explanatory Theories and Their Implications for Intervention and Future Research. Annu Rev Clin Psychol 2025; 21:1-31. [PMID: 39621422 DOI: 10.1146/annurev-clinpsy-081423-022014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/08/2025]
Abstract
Research on the disparity in common mental health problems borne by sexual minority individuals has entered a stage of increasing theoretical complexity. Indeed, such a substantial disparity is likely not determined by a singular cause and therefore warrants diverse etiological perspectives tested with increasingly rigorous methodologies. The research landscape is made even more complex by the constant and rapid shift in the ways in which sexual minority people understand and characterize their own identities and experiences. This review introduces readers to this complexity by summarizing the historical legacy of research on the sexual orientation disparity in mental health, describing five contemporary theoretical explanations for this disparity and their supporting evidence, and suggesting theoretically informed interventions for reducing this disparity. Last, we offer an agenda for future research to accurately model the complexity of the pathways and solutions to the disproportionately poorer mental health of sexual minority populations.
Collapse
Affiliation(s)
- John E Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA;
| | - Kirsty A Clark
- Department of Medicine, Health, and Society, Vanderbilt University, Nashville, Tennessee, USA
| |
Collapse
|
4
|
Bränström R, Pachankis JE. Sexual Orientation Differences in Age of First Treatment for a Mental Health Diagnosis: A Population-Based Study of Childhood and Adolescence. J Am Acad Child Adolesc Psychiatry 2025; 64:602-611. [PMID: 39098721 DOI: 10.1016/j.jaac.2024.07.916] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 06/26/2024] [Accepted: 07/26/2024] [Indexed: 08/06/2024]
Abstract
OBJECTIVE The aim of the current study was to identify the age at which sexual orientation disparity in mental health diagnoses can be first identified, as well as gender and sexual identity subgroup differences in such treatment, in a population-based sample. METHOD Young people aged 16 to 25 (N = 10,406) participating in the probability-based Swedish National Public Health Survey in 2018 were included. This sample was linked to physician-assessed mental health care treatment history data starting when all participants were 8 years old using national health care registries. RESULTS Participants reporting a sexual minority identity in adolescence and young adulthood were more than 3 times as likely to have been treated for an internalizing disorder diagnosis (eg, depression, anxiety) and more than twice as likely to have been treated for a neurodevelopmental disorder diagnosis during childhood than participants reporting a heterosexual identity. Sexual minority participants overall and women in particular were more likely to have been treated for an internalizing disorder diagnosis at an early age compared with heterosexual participants, with this disparity starting at age 13. The sexual orientation disparity in likelihood of treatment for a neurodevelopmental disorder diagnosis was particularly elevated among bisexual/pansexual women with this disparity starting in early/middle adolescence. CONCLUSION This population-based study linked to physician-assessed mental health diagnoses during childhood and adolescence identifies the age at which sexual orientation differences in treatment for common mental disorders emerge. The early emergence of this disparity suggests a potential benefit of interventions that facilitate social belonging for all youth. PLAIN LANGUAGE SUMMARY In this study, the authors explored the link between self-reported sexual orientation with physician-assessed mental health diagnoses and treatment history during childhood and adolescence. Using data from 10,406 participants in the Swedish National Public Health Survey, the authors found that those reporting a sexual minority identity in young adulthood were more than 3 times as likely to have been treated for depression and/or anxiety with this disparity starting at age 13. Sexual orientation disparity was particularly elevated among bi-/pansexual women, who have been previously treated for a neurodevelopmental disorder, with this disparity starting in early/mid adolescence. This study represents the first use of a population-based sample to identify the age at which sexual orientation differences in common mental disorders emerge. The early emergence of these disparities suggests a potential benefit of interventions that facilitate social belonging for all youth.
Collapse
Affiliation(s)
| | - John E Pachankis
- Yale School of Public Health and the Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
5
|
Price MA, Mulkern PJ, Condon M, Rakhilin M, Johansen K, Lyon AR, Saldana L, Pachankis J, Woodward SA, Roeder KM, Moran LR, Jerskey BA. Leveraging Community Engagement and Human-Centered Design to Develop Multilevel Implementation Strategies to Enhance Adoption of a Health Equity Intervention. RESEARCH SQUARE 2025:rs.3.rs-5702080. [PMID: 40195981 PMCID: PMC11974998 DOI: 10.21203/rs.3.rs-5702080/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2025]
Abstract
Background Health equity intervention implementation (which promotes positive health outcomes for populations experiencing disproportionately worse health) is often impeded by health-equity-specific barriers like provider bias; few studies demonstrate how to overcome these barriers through implementation strategies. An urgent health equity problem in the U.S. is the mental health of transgender youth. To address this, we developed Gender-Affirming Psychotherapy (GAP), a health equity intervention comprising best-practice mental health care for transgender youth. This paper details the identification of implementation determinants and the development of targeted strategies to promote provider adoption of GAP. Methods This study represents part of a larger study of mental health provider adoption of GAP. Here we describe the first 2 stages of the 3-stage community-engaged and human-centered design process - Discover, Design/Build, and Test - to identify implementation determinants of adoption and develop implementation strategies with transgender youth, their parents, and mental health providers. This process involved collecting data via focus groups, design meetings, usability testing, and champion meetings. Data were analyzed using rapid and conventional content analysis. Qualitative coding of implementation determinants was guided by the Health Equity Implementation Framework, and implementation strategy coding was facilitated by the ERIC Implementation Strategy Compilation. Results We identified 15 determinants of GAP adoption, and all were specific to the transgender population (e.g., inclusive record system, anti-transgender attitudes). Seventeen implementation strategies were recommended and 12 were developed, collectively addressing all identified determinants. Most strategies were packaged into an online self-paced mental health provider training (implementation intervention) with 6 training tools. Additional inner setting strategies were designed to support training uptake (e.g., mandate training) and GAP adoption (e.g., change record system). Conclusions Community-engaged and human-centered design methods can identify health equity intervention implementation determinants and develop targeted strategies. We highlight five generalizable takeaways for health equity implementation scientists: (1) implementer bias may be a key barrier, (2) experience with the health equity population may be an important facilitator, (3) stakeholder stories may be an effective training tool, (4) inner setting-level implementation strategies may be necessary, and (5) teaching implementers how to build implementation strategies can overcome resource-constraints. Trial registration: NCT05626231.
Collapse
|
6
|
Pachankis J, Chiaramonte D, Scheer JR, Ankrum H, Eisenstadt B, Hobbs R, Baldwin H, Kidd JD, Witkiewitz K, Esserman DA, Plourde K, Drabble L, Hughes T. Randomised controlled trial of LGBTQ-affirmative cognitive-behavioural therapy for sexual minority women's minority stress, mental health and hazardous drinking: Project EQuIP protocol. BMJ Open 2025; 15:e086738. [PMID: 40032395 PMCID: PMC11877267 DOI: 10.1136/bmjopen-2024-086738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Accepted: 01/22/2025] [Indexed: 03/05/2025] Open
Abstract
INTRODUCTION Sexual minority women represent one of the highest-risk groups for hazardous drinking and comorbid mental health problems (eg, depression, anxiety). Research has identified cognitive (eg, expectations of rejection), affective (eg, emotion dysregulation) and behavioural (eg, avoidant coping) pathways through which minority stress (eg, stigma) places sexual minority women at disproportionate risk of hazardous drinking and comorbid depression/anxiety; yet no evidence-based interventions have been tested to address these pathways in this population. This article describes the design of Project EQuIP (Empowering Queer Identities in Psychotherapy), a randomised controlled trial of a transdiagnostic lesbian, gay, bisexual, transgender, queer (LGBTQ)-affirmative cognitive-behavioural therapy intervention (CBT) designed to improve minority stress coping and reduce sexual minority women's hazardous drinking and mental health comorbidities. METHODS AND ANALYSIS This two-arm randomised controlled trial, funded by the National Institute on Alcohol Abuse and Alcoholism, has two objectives: (1) test the efficacy of 10 sessions of LGBTQ-affirmative CBT compared with 10 sessions of supportive counselling for sexual minority women in the community (anticipated n=450) who report hazardous alcohol use and meet criteria for a Diagnostic and Statistical Manual of Mental Disorders - 5 diagnosis of a depression or anxiety disorder and (2) examine psychosocial mechanisms and demographic factors as potential mediators and moderators, respectively, of the treatment-outcome relationship. This study's primary outcome is change in the proportion of heavy drinking days. Secondary outcomes are changes in depressive and anxious symptoms. ETHICS AND DISSEMINATION The Yale University Human Subjects Committee reviewed and approved the research protocol. Results of this study will be disseminated to researchers and practitioners through peer-review publications and conference presentations, and directly to study participants. TRIAL REGISTRATION NUMBER Registered on 17 August 2022 (ClinicalTrials.gov identifier: NCT05509166).
Collapse
Affiliation(s)
- John Pachankis
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Danielle Chiaramonte
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | | | - Hadley Ankrum
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Benjamin Eisenstadt
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Rebekah Hobbs
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Hunter Baldwin
- Department of Social and Behavioral Sciences, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Jeremy D Kidd
- Columbia University Irving Medical Center, New York, New York, USA
| | | | - Denise Ann Esserman
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Kendra Plourde
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | | | - Tonda Hughes
- Columbia University School of Nursing, New York, New York, USA
| |
Collapse
|
7
|
Dunn IBJMD, Power E, Casey LJ, Wootton BM. Cognitive behavioural therapy for internalizing symptoms in LGBTQ+ people: a preliminary meta-analysis. Cogn Behav Ther 2025; 54:246-275. [PMID: 39625808 DOI: 10.1080/16506073.2024.2434021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2024] [Accepted: 11/15/2024] [Indexed: 01/29/2025]
Abstract
Internalizing disorders are common in lesbian, gay, bisexual, transgender, queer, questioning, and otherwise non-heterosexual or non-cisgender (LGBTQ+) people. Few studies have evaluated the efficacy of cognitive behavior therapy (CBT), a well-established treatment for internalizing disorders, in LGBTQ+ people. The current study quantitatively synthesized outcomes from existing trials of CBT for internalizing disorders in LGBTQ+ people. Seven databases were searched, identifying 14 relevant studies with a total of 414 participants. A medium within-group effect size was found for depressive symptoms from pre-treatment to post-treatment (k = 14; g = 0.60; 95% CI: 0.44-0.76; I2 = 71.59) and pre-treatment to 2-6-month follow-up (k = 7; g = 0.63; 95% CI: 0.40-0.86; I2 = 71.59). For anxiety and related disorder symptoms, a medium within-group effect size was found from both pre-treatment to post-treatment (k = 10; g = 0.73; 95% CI: 0.47-0.99; I2 = 71.59) and to 3-9-month follow-up (k = 5; g = 0.70; 95% CI: 0.54-0.87; I2 = 36.04). Exploratory analyses indicated small between-group effects at post-treatment between intervention and control groups. Effect sizes were comparable to those in the general population, indicating preliminary support for treating internalizing disorders in LGBTQ+ people with CBT.
Collapse
Affiliation(s)
- Isaac B J M D Dunn
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Emma Power
- Department of Speech Pathology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Liam J Casey
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| | - Bethany M Wootton
- Discipline of Clinical Psychology, Graduate School of Health, University of Technology, Sydney, NSW, Australia
| |
Collapse
|
8
|
O'Brien C, Waite EE, Denning DM, Haliczer LA, Dixon-Gordon KL. Exploring the Role of Self-Defective Beliefs in the Relation Between Sexual Orientation and Nonsuicidal Self-Injury in Young Women. Suicide Life Threat Behav 2025; 55:e13158. [PMID: 39927841 DOI: 10.1111/sltb.13158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 01/08/2024] [Accepted: 12/04/2024] [Indexed: 02/11/2025]
Abstract
INTRODUCTION People who identify as sexual minorities (SM) report higher rates of nonsuicidal self-injury (NSSI) than heterosexual individuals. One explanatory factor that may be important in this relation is self-defective beliefs. The present study examined the role of self-defective beliefs in the link between sexual orientation and NSSI. METHOD Participants were college-aged women (n = 145) with (n = 84) and without (n = 61) recent, recurrent NSSI, completed measures of NSSI and self-defective beliefs. Participants were recruited from a large college and surrounding area in the northeastern U.S. RESULTS suggest that SM participants were more likely to report a history of NSSI, frequent and versatile NSSI, and greater self-defective beliefs compared to heterosexual participants, but not more likely to report medically severe NSSI. Results from cross-sectional mediation analyses revealed that self-defective beliefs mediated the relation between SM identity and lifetime NSSI history and partially mediated the relations for NSSI medical severity and versatility, but not NSSI frequency. CONCLUSIONS Taken together, our findings suggest that self-defective beliefs are a salient cognitive concern associated with indicators of NSSI severity in college-aged SM women. Additional research is needed to determine whether these findings replicate in SM men, transgender, and gender diverse populations.
Collapse
Affiliation(s)
- Connor O'Brien
- Department of Psychological and Brain Science, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Elinor E Waite
- Department of Psychological and Brain Science, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Dominic M Denning
- Department of Psychological and Brain Science, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Lauren A Haliczer
- Department of Psychological and Brain Science, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| | - Katherine L Dixon-Gordon
- Department of Psychological and Brain Science, University of Massachusetts Amherst, Amherst, Massachusetts, USA
| |
Collapse
|
9
|
Owens C, Montemayor BN. Sexualized drug use factors among rural sexual minority men. J Rural Health 2025; 41:e12917. [PMID: 39780355 PMCID: PMC11711912 DOI: 10.1111/jrh.12917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2024] [Revised: 12/04/2024] [Accepted: 12/20/2024] [Indexed: 01/11/2025]
Abstract
PURPOSE Although rural sexual minority men (SMM) use substances immediately before/during sex (i.e., sexualized drug use), the factors contributing to this behavior are unknown. We examined the factors associated with past year sexualized drug use among rural SMM. METHODS Rural SMM in the Southern region of the United States (N = 345) completed an online cross-sectional survey from February to March 23, 2024. Participants answered questions about their sexualized drug use behaviors, sexual behaviors, minority stressors, and demographics. We conducted a hierarchical logistic regression to estimate the adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for factors associated with past year sexualized drug use. FINDINGS Over three-quarters of participants (79.7%) used substances immediately before/during sex in the past year. Sexualized drug use was associated with exposure to sexual minority stressors, polysubstance use, sexually transmitted infection testing, having oral sex, receiving drugs from a man in exchange for sex, and older age. CONCLUSION Sexualized drug use is prevalent among rural SMM, and sexual minority stressors and past year sexual risk and substance misuse behaviors were contributing factors. Rural primary care clinics, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) service organizations, and outpatient and inpatient substance use organizations should implement integrative sexual and substance use screening, counseling, and referral services for their rural clients.
Collapse
Affiliation(s)
- Christopher Owens
- Department of Health Behavior, School of Public HealthTexas A&M UniversityCollege StationTexasUSA
| | - Benjamin N. Montemayor
- Department of Health Behavior, School of Public HealthTexas A&M UniversityCollege StationTexasUSA
| |
Collapse
|
10
|
Holly LE. Cultural and Social Aspects of Anxiety Disorders. Psychiatr Clin North Am 2024; 47:775-785. [PMID: 39505453 DOI: 10.1016/j.psc.2024.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2024]
Abstract
Understanding the cultural and social aspects of anxiety disorders is necessary to ensure the design and implementation of effective, evidence-based methods for diagnosis, prevention, and treatment among diverse populations, particularly those who are minoritized, marginalized, and traditionally underserved. This article describes variations in anxiety disorder prevalence and the association between sociocultural characteristics and stressors known to increase risk for anxiety. The ways sociocultural context impacts anxiety phenomenology and expression is explored. Then, the literature examining differential help-seeking and service utilization among diverse populations is reviewed followed by a summary of culturally responsive, evidence-based practices for anxiety disorders.
Collapse
Affiliation(s)
- Lindsay E Holly
- Department of Psychology, Marquette University, Cramer Hall, 604 North 16th Street, Milwaukee, WI 53233, USA.
| |
Collapse
|
11
|
Burger J, Pachankis JE. State of the Science: LGBTQ-Affirmative Psychotherapy. Behav Ther 2024; 55:1318-1334. [PMID: 39443068 DOI: 10.1016/j.beth.2024.02.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 02/27/2024] [Accepted: 02/29/2024] [Indexed: 10/25/2024]
Abstract
Sexual and gender minority (SGM) individuals experience significantly higher levels of depression, anxiety, and behavioral comorbidities (i.e., substance use, suicide) compared to heterosexual and cisgender individuals. LGBTQ-affirmative psychotherapy aims to ameliorate the adverse psychosocial processes, ultimately caused by stigma, that underlie this disparity. Over the past two decades, the mental health field has introduced professional guidelines and treatment protocols for LGBTQ-affirmative psychotherapy, and established their efficacy across distinct SGM populations, delivery modalities, and settings. This state of the science review outlines the history, current evidence, and future directions of LGBTQ-affirmative psychotherapy. It provides an historical account of clinically relevant research for SGM populations and outlines the factors that moved the field from pathologizing perspectives to affirmative approaches. It then discusses the current evidence for LGBTQ-affirmative psychotherapy, as well as studies identifying treatment moderators, including race/ethnicity and stigma exposure, as well as potential treatment mechanisms, including hypervigilance, shame, negative self-schemas, unassertiveness, and emotion dysregulation. SGM individuals can only benefit from LGBTQ-affirmative psychotherapy if protocols are widely available and used by therapists. To this end, the article presents current findings on implementation and dissemination, such as therapist training, and different treatment delivery modalities. Finally, the article outlines an agenda for future research to advance the field of LGBTQ-affirmative psychotherapy, including identifying treatment mechanisms, successfully implementing and disseminating treatment protocols, determining which contexts and client characteristics warrant adaptations to current protocols, and understanding how LGBTQ-affirmative psychotherapy can interact with structural and systemic conditions to exert the strongest possible impact on SGM mental health.
Collapse
|
12
|
Jonathan GK, Armstrong C, Miyares P, Williams J, Wilhelm S. Advancing Psychosocial Treatment for Body Dysmorphic Disorder: A State-of-the-Science Review. Behav Ther 2024; 55:1249-1288. [PMID: 39443065 DOI: 10.1016/j.beth.2024.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 04/02/2024] [Accepted: 04/02/2024] [Indexed: 10/25/2024]
Abstract
Body dysmorphic disorder (BDD) is an underrecognized, challenging illness with severe comorbidities, demanding urgent advancements in treatment strategies. This state-of-the-science review describes current research on existing BDD treatments, beginning with a detailed discussion of cognitive-behavioral therapy (CBT), the primary psychosocial intervention for BDD, and its foundational theories. We emphasize the significant progress in the field, including the efficacy of face-to-face CBT, the promising outcomes of digital interventions for broadening access to care, and emerging treatments that warrant further exploration. The review also addresses the critical gap of targeted interventions for youth, considering the diseases' typical onset during adolescence. Our review also sheds light on the significant gap in research dedicated to testing these treatments in underserved communities, stressing the importance of including these populations in research and culturally informed and adapted, if necessary, care. The review concludes with recommendations for future directions, outlining areas for ongoing treatment development and research to expand the scope and efficacy of interventions for BDD.
Collapse
|
13
|
Yi M, Li X, Chiaramonte D, Sun S, Pan S, Soulliard Z, Eisenstadt BE, Ljótsson B, Hagaman A, Pachankis J. Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China. Behav Res Ther 2024; 181:104605. [PMID: 39029333 PMCID: PMC11371497 DOI: 10.1016/j.brat.2024.104605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 05/09/2024] [Accepted: 07/12/2024] [Indexed: 07/21/2024]
Abstract
OBJECTIVE LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals' mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery. METHOD Chinese young sexual minority men (n = 120; ages 16-30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion. RESULTS Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d = -0.50, d = -0.63) and anxiety (d = -0.51, d = -0.49) at 4- and 8-month follow-up, respectively; alcohol use (d = -0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d = 0.42). Greater session completion predicted greater reductions in suicidality and rumination. CONCLUSIONS LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.
Collapse
Affiliation(s)
- Mengyao Yi
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China.
| | | | - Shufang Sun
- Brown University School of Public Health, Providence, RI, USA
| | - Si Pan
- The Second Xiangya Hospital, Central South University, Changsha, Hunan Province, China
| | | | | | | | - Ashley Hagaman
- Yale School of Public Health, Yale University, New Haven, CT, USA
| | - John Pachankis
- Yale School of Public Health, Yale University, New Haven, CT, USA.
| |
Collapse
|
14
|
Esposito EC, Ellerkamp H, Eisenberg AM, Handley ED, Glenn CR. Suicide Ideation Among Transgender and Gender Diverse Adolescents: The Role of Parental Invalidation of Adolescents' Gender Identity. Res Child Adolesc Psychopathol 2024; 52:1329-1342. [PMID: 38767739 DOI: 10.1007/s10802-024-01203-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2024] [Indexed: 05/22/2024]
Abstract
Transgender and gender diverse (TGD) youth experience chronic and acute stress associated with their gender identity contributing to their increased risk of suicide and suicide ideation (SI) compared to non-TGD peers. This study examined how invalidating and accepting gender-related experiences with a parent impact SI severity among TGD adolescents cross-sectionally and longitudinally, within-person. Participants were 15 TGD adolescents with past month SI recruited across community and clinical settings. Adolescents completed a baseline assessment of validated interviews and self-report measures on parental invalidation and SI severity. Over a 14-day follow-up period, adolescents reported instances of parental gender invalidation and acceptance, relative stress of those experiences, and SI severity multiple times/day via ecological momentary assessment (EMA). Bivariate associations of parental invalidation and acceptance with SI were examined at baseline, while multilevel models examined the relationship within-person over follow-up. Cross-sectionally, greater perceived invalidation and non-affirmation by their parents was associated with more severe SI. Over the follow up, instances of perceived parental invalidation were associated with passive SI within-person. Findings partially support the minority stress theory and social safety perspective by showing that perceived gender-invalidation from parents affects SI in TGD adolescents, both cross-sectionally and longitudinally. Further research is needed to identify specific emotional and cognitive factors, such as perceived stress, that contribute to the risk of SI among TGD youth and inform the development of targeted interventions for this vulnerable population.
Collapse
Affiliation(s)
- Erika C Esposito
- Department of Psychology, Mt. Hope Family Center, University of Rochester, 355 Meliora Hall, Box 270266, Rochester, NY, 14627, USA.
| | - Hannah Ellerkamp
- Northwell Health Physician Partners LGBTQ Transgender Program, Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, NY, Hempstead, USA
| | - Alana M Eisenberg
- Department of Psychology, Mt. Hope Family Center, University of Rochester, 355 Meliora Hall, Box 270266, Rochester, NY, 14627, USA
| | - Elizabeth D Handley
- Department of Psychology, Mt. Hope Family Center, University of Rochester, 355 Meliora Hall, Box 270266, Rochester, NY, 14627, USA
| | - Catherine R Glenn
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
- Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA
| |
Collapse
|
15
|
Jennings TL, Sprankle E. Therapist Multicultural Orientation: Client Perceptions of Cultural Humility, LGB Identity, and the Working Alliance. JOURNAL OF HOMOSEXUALITY 2024; 71:2200-2216. [PMID: 37405404 DOI: 10.1080/00918369.2023.2229473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/06/2023]
Abstract
Little attention has been given to how therapist cultural humility may benefit lesbian, gay, and bisexual (LGB) clients. Thus, the current study examined whether therapist cultural humility predicted stronger client-therapist working alliances in a sample of 333 LGB individuals. LGB identity centrality (IC; the extent to which a person's LGB identity is central to their overall identity) and LGB identity affirmation (IA; the extent to which an LGB person associates their sexual orientation with positive thoughts or feelings) were considered as moderators. Therapist cultural humility predicted stronger working alliances between LGB clients and their therapist; however, this association was not moderated by IC or IA. The present results suggest that LGB clients who rated their therapists as culturally humble toward their sexual orientation also reported stronger working alliances with their therapist, regardless of IC or IA. Lastly, exploratory analyses revealed that lower therapist cultural humility ratings were associated with greater sexual orientation acceptance concerns, internalized homonegativity, difficulties coming out, and sexual orientation concealment. The clinical implications of these findings are discussed. Future research should consider the benefits of therapist cultural humility for other gender and sexually diverse persons.
Collapse
Affiliation(s)
- Todd L Jennings
- Department of Psychology, Minnesota State University, Mankato, Minnesota, USA
| | - Eric Sprankle
- Department of Psychology, Minnesota State University, Mankato, Minnesota, USA
| |
Collapse
|
16
|
Brown TA, Klimek-Johnson P, Siegel JA, Convertino AD, Douglas VJ, Pachankis J, Blashill AJ. Promoting Resilience to Improve Disordered Eating (PRIDE): A case series of an eating disorder treatment for sexual minority individuals. Int J Eat Disord 2024; 57:648-660. [PMID: 38279188 DOI: 10.1002/eat.24150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/16/2024] [Accepted: 01/16/2024] [Indexed: 01/28/2024]
Abstract
OBJECTIVE Despite the increased risk for eating disorders (EDs) among sexual minority (SM) individuals, no ED treatments exist specifically for this population. SM stress and appearance-based pressures may initiate and/or maintain ED symptoms in SM individuals; thus, incorporating strategies to reduce SM stressors into existing treatments may help address SM individuals' increased ED risk. This mixed-methods study evaluated the feasibility, acceptability, and preliminary efficacy of Promoting Resilience to Improve Disordered Eating (PRIDE)-a novel ED treatment for SM individuals. METHODS N = 14 SM individuals with an ED diagnosis received 14 weekly sessions integrating Enhanced Cognitive Behavioral Therapy for EDs (CBT-E) with techniques and principles of SM-affirmative CBT developed to address SM stressors. Participants completed qualitative interviews and assessments of ED symptoms and SM stress reactions at baseline (pretreatment), posttreatment, and 1-month follow-up. RESULTS Supporting feasibility, 12 of the 14 (85.7%) enrolled participants completed treatment, and qualitative and quantitative data supported PRIDE's acceptability (quantitative rating = 3.73/4). By 1-month follow-up, 75% of the sample was fully remitted from an ED diagnosis. Preliminary efficacy results suggested large and significant improvements in ED symptoms, clinical impairment, and body dissatisfaction, significant medium-large improvements in internalized stigma and nonsignificant small-medium effects of sexual orientation concealment. DISCUSSION Initial results support the feasibility, acceptability, and initial efficacy of PRIDE, an ED treatment developed to address SM stressors. Future research should evaluate PRIDE in a larger sample, compare it to an active control condition, and explore whether reductions in SM stress reactions explain reductions in ED symptoms. PUBLIC SIGNIFICANCE This study evaluated a treatment for SM individuals with EDs that integrated empirically supported ED treatment with SM-affirmative treatment in a case series. Results support that this treatment was well-accepted by participants and was associated with improvements in ED symptoms and minority stress outcomes.
Collapse
Affiliation(s)
- Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Patrycja Klimek-Johnson
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Jaclyn A Siegel
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - Alexandra D Convertino
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
| | - Valerie J Douglas
- Department of Psychology, San Diego State University, San Diego, California, USA
| | - John Pachankis
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut, USA
| | - Aaron J Blashill
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California San Diego, San Diego, California, USA
- Department of Psychology, San Diego State University, San Diego, California, USA
| |
Collapse
|
17
|
Charak R, Cano-Gonzalez I, Ronzon-Tirado R, Schmitz RM, Tabler J, Karsberg S, Flores A, Ford JD. LGBTQ+ identity-related abuse during childhood and associations with depression and suicide behavior: Role of adulthood cisheterosexism and expressive suppression. CHILD ABUSE & NEGLECT 2023; 145:106433. [PMID: 37660426 DOI: 10.1016/j.chiabu.2023.106433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/28/2023] [Accepted: 08/24/2023] [Indexed: 09/05/2023]
Abstract
BACKGROUND Exposure to minority stressors specific to LGBTQ+ individuals, such as heterosexism and cissexism (or cisheterosexism) is not covered under the traditional adverse childhood experiences framework. This is important because childhood identity-related abuse by a parent/caregiver can lead to mental health challenges in later life through the adoption of maladaptive coping mechanisms. OBJECTIVE The present study aimed to examine the role of cisheterosexism and expressive suppression as serial mediators in the associations between identity-related abuse and depressive symptoms and suicide behavior. PARTICIPANTS AND SETTING Participants included 563 LGBTQ+ identifying adults between 18 and 64 years (M = 30.02, SD = 9.05) from different regions of Spain and were recruited through social media (e.g., Twitter, Facebook, and Instagram). METHOD A serial mediation model was conducted with cisheterosexism and expressive suppression as the mediators in the associations between LGBTQ+ identity-related childhood abuse and depressive symptoms and suicide behavior. RESULTS Findings indicated a positive indirect effect of identity-related abuse on depressive symptoms through cumulative cisheterosexism (B = 0.628, p < .01), and via cumulative cisheterosexism and suppression (B = 0.146, p < .05). No significant indirect effect was found for identity-related abuse on depressive symptoms via suppression (B = 0.086). An indirect effect was found for identity-related abuse on suicide behavior via cumulative cisheterosexism (B = 0.250, p < .01). CONCLUSIONS Findings reveal that LGBTQ+ identity-related cisheterosexist experiences perpetrated by parents or caregivers are associated with harmful, long-term impacts on symptoms of depression and suicide behavior via experiences of cisheterosexism and expressive suppression.
Collapse
Affiliation(s)
- Ruby Charak
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX, USA.
| | - Ines Cano-Gonzalez
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX, USA
| | | | - Rachel M Schmitz
- Department of Sociology, Oklahoma State University, Stillwater, OK, USA
| | - Jennifer Tabler
- Department of Criminal Justice and Sociology, University of Wyoming, Laraime, USA
| | - Sidsel Karsberg
- Department of Psychology and Behavioural Sciences, Aarhus University, Aarhus, Denmark
| | - Ayleen Flores
- Department of Psychological Science, The University of Texas Rio Grande Valley, Edinburg, TX, USA
| | - Julian D Ford
- Department of Psychiatry, University of Connecticut Health Center, Farmington, CT, USA
| |
Collapse
|
18
|
Fowler JA, Buckley L, Muir M, Viskovich S, Paradisis C, Zanganeh P, Dean JA. Digital mental health interventions: A narrative review of what is important from the perspective of LGBTQIA+ people. J Clin Psychol 2023; 79:2685-2713. [PMID: 37528773 DOI: 10.1002/jclp.23571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 06/19/2023] [Accepted: 07/15/2023] [Indexed: 08/03/2023]
Abstract
OBJECTIVES Digital mental health interventions are a promising therapeutic modality to provide psychological support to LGBTQIA+ (lesbian, gay, bisexual, trans, Queer, intersex, asexual, plus other gender, sexual, and romantic minority identities) people. The aim of this narrative review is to explore how the LGBTQIA+ community has been engaged in the design of digital mental health interventions, how content has been tailored to the LGBTQIA+ community, and features identified as important by LGBTQIA+ participants. METHODS A total of 33 studies were included in this review from a larger yield of 1933 identified from systematic searches of five databases (PsycINFO, PubMed, Scopus, CINAHAL, and Medline). Data were analyzed narratively and using content analysis. RESULTS Only half of the studies reported engaging the LGBTQIA+ community in intervention designs. Interventions have been tailored in a variety of ways to support LGBTQIA+ individuals-such as through affirming imagery, recruitment through LGBTQIA+ networks, and designing content to focus specifically on LGBTQIA+ issues. A range of features were identified as important for participants, namely how content was tailored to LGBTQIA+ experiences, providing connection to community, and links to other relevant LGBTQIA+ resources. While not a primary aim, results also showed that a wide range of digital modalities can significantly improve a range of mental health problems. CONCLUSION Digital interventions are an acceptable and effective form of therapeutic intervention, but future research needs to focus on meaningful engagement of community members to inform design and implementation.
Collapse
Affiliation(s)
- James A Fowler
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Lisa Buckley
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Miranda Muir
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Shelley Viskovich
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Chris Paradisis
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Parnian Zanganeh
- Faculty of Health and Behavioral Sciences, School of Psychology, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith A Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Poche Centre for Indigenous Health, The University of Queensland, Brisbane, Queensland, Australia
| |
Collapse
|
19
|
Scheer JR, Behari K, Schwarz AA, Cascalheira CJ, Helminen EC, Pirog SA, Jaipuriyar V, Sullivan TP, Batchelder AW, Jackson SD. Expressive writing treatments to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed sexual minority women and transgender/nonbinary people: Study protocol for a mixed-method pilot trial. Contemp Clin Trials Commun 2023; 35:101197. [PMID: 37671246 PMCID: PMC10475481 DOI: 10.1016/j.conctc.2023.101197] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 07/21/2023] [Accepted: 08/18/2023] [Indexed: 09/07/2023] Open
Abstract
Background Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.
Collapse
Affiliation(s)
- Jillian R. Scheer
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Kriti Behari
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Aubriana A. Schwarz
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Cory J. Cascalheira
- Department of Counseling and Educational Psychology, New Mexico State University, Las Cruces, NM, 88003, USA
- VA Puget Sound Health Care System, Seattle, WA, 98108, USA
| | - Emily C. Helminen
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Sophia A. Pirog
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Virinca Jaipuriyar
- Department of Psychology, Syracuse University, Syracuse, NY, 414 Huntington Hall, Syracuse, NY, 13244, USA
| | - Tami P. Sullivan
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, 06501, USA
| | - Abigail W. Batchelder
- Harvard Medical School, Harvard University, Boston, MA, 02114, USA
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA
- The Fenway Institute, Fenway Health, Boston, MA, 02115, USA
| | - Skyler D. Jackson
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT, 06501, USA
| |
Collapse
|
20
|
Shen J, Rubin A, Cohen K, Hart E, Sung J, McDanal R, Roulston C, Sotomayor I, Fox K, Schleider J. Randomized evaluation of an online single-session intervention for minority stress in LGBTQ+ adolescents. Internet Interv 2023; 33:100633. [PMID: 37635950 PMCID: PMC10457524 DOI: 10.1016/j.invent.2023.100633] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 05/26/2023] [Accepted: 06/06/2023] [Indexed: 08/29/2023] Open
Abstract
Background LGBTQ+ youth face myriad adverse health outcomes due to minority stress, creating a need for accessible, mechanism-targeted interventions to mitigate these minority stress-related risk factors. We tested the effectiveness and acceptability of Project RISE, an online single-session intervention designed to ameliorate internalized stigma and improve other outcomes among LGBTQ+ youth. We hypothesized that youth assigned to RISE (versus a control) would report significantly reduced internalized stigma and increased identity pride at post-intervention and at two-week follow-up and would find RISE acceptable. Methods We recruited adolescents nationally through Instagram advertisements in May 2022 (N = 538; M age = 15.06, SD age = 0.97). Participants were randomly assigned to RISE or an information-only control and completed questionnaires pre-intervention, immediately post-intervention, and two weeks post-intervention. Inclusion criteria included endorsing: (1) LGBTQ+ identity, (2) age 13-16, (3) English fluency (4) Internet access, and (5) subjective negative impact of LGBTQ+ stigma. Results Relative to participants in the control condition, participants who completed RISE reported significant decreases in internalized stigma (d = -0.49) and increases in identity pride (d = 0.25) from pre- to immediately post-intervention, along with decreased internalized stigma (d = -0.26) from baseline to two-week follow-up. Participants rated both RISE and the information-only control as highly, equivalently acceptable. Conclusions RISE appears to be an acceptable and useful online SSI for LGBTQ+ adolescents, with potential to reduce internalized stigma in both the short- and longer-term. Future directions include evaluating effects of Project RISE over longer follow-ups and in conjunction with other mental health supports.
Collapse
Affiliation(s)
- J. Shen
- Department of Psychology, Stony Brook University, United States of America
| | - A. Rubin
- Department of Psychology, University of Denver, United States of America
| | - K. Cohen
- Department of Psychology, Stony Brook University, United States of America
| | - E.A. Hart
- Department of Psychology, University of Denver, United States of America
| | - J. Sung
- Department of Psychology, Stony Brook University, United States of America
| | - R. McDanal
- Department of Psychology, Stony Brook University, United States of America
| | - C. Roulston
- Department of Psychology, Stony Brook University, United States of America
| | - I. Sotomayor
- Department of Psychology, Stony Brook University, United States of America
| | - K.R. Fox
- Department of Psychology, University of Denver, United States of America
| | - J.L. Schleider
- Department of Psychology, Stony Brook University, United States of America
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, United States of America
| |
Collapse
|
21
|
Keefe JR, Louka C, Moreno A, Spellun J, Zonana J, Milrod BL. Open Trial of Trauma-Focused Psychodynamic Psychotherapy for Posttraumatic Stress Disorder Among LGBTQ Individuals. Am J Psychother 2023; 76:115-123. [PMID: 37203147 DOI: 10.1176/appi.psychotherapy.20220037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/20/2023]
Abstract
OBJECTIVE Lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals report higher rates of exposure to traumatic events and posttraumatic stress disorder (PTSD) compared with heterosexual and cisgender individuals. No treatment outcomes research has focused on PTSD in the LGBTQ population. Trauma-focused psychodynamic psychotherapy (TFPP) is a brief, manualized, attachment- and affect-focused psychotherapy for PTSD. TFPP explicitly incorporates broad identity-related and societal factors into its conceptualization of trauma and its consequences, which may be especially helpful for LGBTQ patients with minority stress who seek affirmative care. METHODS Fourteen LGBTQ patients with PTSD, assessed with the Clinician-Administered PTSD Scale for DSM-5 (CAPS-5), received 24 sessions of twice-weekly (12 weeks) TFPP via teletherapy provided by supervised early-career therapists inexperienced in the modality. Sessions were videotaped to monitor therapists' treatment adherence. Patients were assessed at baseline, week 5, termination (week 12), and 3 months posttreatment for PTSD symptoms (assessed with the CAPS-5) and secondary outcomes. RESULTS TFPP was well tolerated by patients, with 12 (86%) completing the intervention. CAPS-5-measured PTSD symptoms, including dissociation, significantly improved during treatment (mean decrease=-21.8, d=-1.98), and treatment gains were maintained at follow-up. Most patients experienced PTSD clinical response (N=10, 71%) or diagnostic remission (N=7, 50%). Patients generally experienced significant, concomitant improvements in complex PTSD symptoms, general anxiety, depression, and psychosocial functioning. Adherence to the intervention among therapists was high, with 93% of rated sessions meeting adherence standards. CONCLUSIONS TFPP shows promise in the treatment of PTSD among sexual and gender minority patients seeking LGBTQ-affirmative PTSD care.
Collapse
Affiliation(s)
- John R Keefe
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Charalambia Louka
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Andrew Moreno
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Jessica Spellun
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Jess Zonana
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| | - Barbara L Milrod
- Department of Psychiatry and Behavioral Sciences, Albert Einstein College of Medicine, New York City (Keefe, Milrod); Department of Psychiatry, Weill Cornell Medical College, New York City (Keefe, Moreno, Spellun, Zonana, Milrod); Department of Psychiatry, New York-Presbyterian/Weill Cornell Medical Center, New York City (Louka); Silver Hill Hospital, New Canaan, Connecticut (Zonana)
| |
Collapse
|
22
|
Scheer JR, Clark KA, McConocha E, Wang K, Pachankis JE. Toward Cognitive-Behavioral Therapy for Sexual Minority Women: Voices From Stakeholders and Community Members. COGNITIVE AND BEHAVIORAL PRACTICE 2023; 30:471-494. [PMID: 37547128 PMCID: PMC10403251 DOI: 10.1016/j.cbpra.2022.02.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
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.
Collapse
|
23
|
Kirakosian N, Stanton AM, McKetchnie SM, King D, Dolotina B, O'Cleirigh C, Grasso C, Potter J, Mayer KH, Batchelder AW. Suicidal Ideation Disparities Among Transgender and Gender Diverse Compared to Cisgender Community Health Patients. J Gen Intern Med 2023; 38:1357-1365. [PMID: 36650322 PMCID: PMC9844943 DOI: 10.1007/s11606-022-07996-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 12/23/2022] [Indexed: 01/18/2023]
Abstract
BACKGROUND Transgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences. OBJECTIVE To examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals. DESIGN Data were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation. PARTICIPANTS 29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018. MAIN MEASURES Demographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ2[5, n=25,959]=906.454, p<0.001). CONCLUSIONS TGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.
Collapse
Affiliation(s)
- Norik Kirakosian
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Amelia M Stanton
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Samantha M McKetchnie
- School of Social Work, Boston College, Newton, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - Dana King
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Brett Dolotina
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Conall O'Cleirigh
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Chris Grasso
- The Fenway Institute, Fenway Health, Boston, MA, USA
| | - Jennifer Potter
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Abigail W Batchelder
- The Fenway Institute, Fenway Health, Boston, MA, USA.
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA.
- Harvard Medical School, Boston, MA, USA.
| |
Collapse
|
24
|
Scheer JR, Lawlace M, Cascalheira CJ, Newcomb ME, Whitton SW. Help-Seeking for Severe Intimate Partner Violence Among Sexual and Gender Minority Adolescents and Young Adults Assigned Female at birth: A Latent Class Analysis. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:6723-6750. [PMID: 36472356 PMCID: PMC10050117 DOI: 10.1177/08862605221137711] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
Sexual and gender minority adolescents and young adults assigned female at birth (SGM-AFAB) report high rates of intimate partner violence (IPV) victimization. Despite adverse health outcomes of IPV, many survivors, particularly SGM-AFAB, do not seek help. This study (1) examined the proportion of SGM-AFAB who reported severe IPV victimization who sought help; (2) elucidated patterns of help-seeking facilitators and barriers; and (3) identified associations between sociodemographic characteristics, IPV victimization types, and minority stressors and latent classes of help-seeking facilitators and barriers. Participants included 193 SGM-AFAB (Mage = 20.6, SD = 3.4; 65.8% non-monosexual; 73.1% cisgender; 72.5% racial/ethnic minority; 16.6% annual household income $20,000 or less). Most participants who experienced severe IPV did not seek help (62.2%). Having a person or provider who was aware of the participant's abusive relationship was the most common reason for seeking help (50; 68.5%). Minimizing IPV was the most common reason for not seeking help (103; 87.3%). Fewer than 5% of SGM-AFAB who experienced severe IPV and who did not seek help reported SGM-specific help-seeking barriers, including not wanting to contribute to negative perceptions of the LGBTQ community, not disclosing their SGM status, and perceiving a lack of tailored services. Help-seeking facilitators and barriers varied by sociodemographic characteristics. Three classes of help-seeking facilitators and two classes of help-seeking barriers emerged. SGM-AFAB subgroups based on sexual and gender identity, recent coercive control, and identity as IPV victims differed in latent classes. This study's findings confirm SGM-AFAB IPV survivors' low likelihood of seeking help. Our results also underscore the importance of continuing to bolster SGM-AFAB survivors' access to trauma-informed, culturally sensitive, and affirming support. Further, multilevel prevention and intervention efforts are needed to reduce minimization of abuse and anticipatory judgment and blame among SGM-AFAB who hold multiple marginalized identities, experience coercive control, and identify as IPV victims.
Collapse
|
25
|
Rathod S, Phiri P, de Visser R, Moore S, Au-Yeung K, Collier O, Gu J, Bartl G, Greenwood K. Applying the cultural adaption framework to the Early Youth Engagement (EYE-2) approach to early intervention in psychosis. BRITISH JOURNAL OF CLINICAL PSYCHOLOGY 2023. [PMID: 37096744 DOI: 10.1111/bjc.12423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 03/10/2023] [Accepted: 03/12/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVES Disengagement from Early Intervention in Psychosis (EIP) services is pronounced in individuals from racially minoritized or diverse ethnic backgrounds, lesbian, gay, bisexual, transgender, and queer or questioning individuals, and individuals from some religious or spiritual backgrounds. The Early Youth Engagement in first episode psychosis study (EYE-2) is a cluster randomized controlled trial that tests a new engagement intervention. The current study aimed to (i) explore perspectives of service users from diverse backgrounds in relation to spirituality, ethnicity, culture and sexuality on engagement and the EYE-2 approach and (ii) use an evidence-based adaptation framework to incorporate their needs and perspectives into the EYE-2 resources and training. METHODS This qualitative study used semi-structured interviews to explore service users' experiences and perspectives on EYE-2 approaches and resources. The study was conducted within EIP teams across three inner-city sites in England chosen to reflect diverse urban populations. Topic guides covered participant's identity, perceptions of EYE-2 resources, and experience of using mental health services. Transcribed interviews underwent thematic analysis. RESULTS In this study, 21 service users aged 18 to 35 (M = 25.4; SD = 5.5) participated in semi-structured interviews. Seven key themes were identified across the four domains of the cultural adaptation framework: Differing cognitions and beliefs; multiple facets of culture; language as a barrier to engagement; stigma and discrimination; adaptations to EYE-2 resources; trust in therapeutic alliance; and individual differences in therapeutic preferences. CONCLUSIONS The emergent themes highlighted a need to cater to various aspects of cultural diversity when developing EIP materials and services.
Collapse
Affiliation(s)
- Shanaya Rathod
- Tom Rudd Unit, Research Department, Southern Health NHS Foundation Trust, Moorgreen Hospital, Southampton, UK
| | - Peter Phiri
- Tom Rudd Unit, Research Department, Southern Health NHS Foundation Trust, Moorgreen Hospital, Southampton, UK
| | - Richard de Visser
- School of Psychology, University of Sussex, Brighton, UK
- Department of Primary Care & Public Health, Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - Sophie Moore
- Tom Rudd Unit, Research Department, Southern Health NHS Foundation Trust, Moorgreen Hospital, Southampton, UK
| | - Karmen Au-Yeung
- Research and Development, Psychology Department, Greater Manchester Mental Health NHS Foundation Trust, Manchester, UK
| | - Olivia Collier
- Maudsley Psychology Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - Jenny Gu
- School of Psychology, University of Sussex, Brighton, UK
| | - Gergely Bartl
- School of Psychology, University of Sussex, Brighton, UK
| | - Kathryn Greenwood
- School of Psychology, University of Sussex, Brighton, UK
- Research and Development, Sussex Partnership NHS Foundation Trust, Sussex Education Centre, Hove, UK
| |
Collapse
|
26
|
Shepherd BF, Maki JL, Zelaya DG, Warner Ş, Wilson A, Brochu PM. Development and Validation of the Gay-Specific Intraminority Stigma Inventory (G-SISI): Initial Evidence Underpinned by Intraminority Stress Theory. Eur J Investig Health Psychol Educ 2023; 13:170-186. [PMID: 36661763 PMCID: PMC9858161 DOI: 10.3390/ejihpe13010013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/15/2023] Open
Abstract
There is currently a lack of measures testing intraminority stress within gay men. Therefore, the current study sought to develop and psychometrically test the Gay-Specific Intraminority Stigma Inventory (G-SISI). Based on a content review of the literature and a panel of experts, a pool of items assessing gay men's perceived exposure to a range of discriminatory attitudes from other gay men was generated. Utilizing a randomly split sample of 1723 gay men between the ages of 19 and 79 years, an exploratory factor analysis was first performed (n = 861). The remaining unexamined data were then used to conduct a confirmatory factor analysis (n = 862). The results support a six-factor model: (1) Age Stigma, (2) Socioeconomic Stigma, (3) Gay Non-Conformity Stigma, (4) Racial Stigma, (5) Gender Expression Stigma, and (6) Body Stigma. Cronbach's alpha for the total scale was 0.90 and for the subscales ranged from 0.60 to 0.85. Sociodemographic factors and measures of community involvement were differentially associated with the G-SISI subscales, providing evidence of construct validity. The findings demonstrate initial support for the dimensionality and validity of the G-SISI, which targets modifiable factors (e.g., identity-based stigma) that may increase stress and reduce community coping resources among gay men with diverse identities.
Collapse
Affiliation(s)
- Benjamin F. Shepherd
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Justin L. Maki
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - David G. Zelaya
- School of Public Health, Brown University, Providence, RI 02903, USA
- Department of Psychiatry, Harvard Medical School, Boston, MA 02215, USA
| | - Şeniz Warner
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Adriana Wilson
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| | - Paula M. Brochu
- Department of Clinical and School Psychology, Nova Southeastern University, Fort Lauderdale, FL 33314, USA
| |
Collapse
|
27
|
Shepherd BF, Kelly LM, Brochu PM, Wolff JC, Swenson LP. An examination of theory-based suicidal ideation risk factors in college students with multiple marginalized identities. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2023; 93:107-119. [PMID: 36913274 PMCID: PMC10015593 DOI: 10.1037/ort0000666] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Social marginalization increases the risk of suicidal ideation (SI) among individuals with diverse identities, yet research examining the effects of marginalization has focused on one identity. Emerging adulthood is a critical period of identity development and the age group with the highest rates of SI. Considering the challenges of living in potentially heterosexist, cissexist, racist, and sizeist environments, we tested whether possessing multiple marginalized identities was associated with severity of SI through factors proposed in the interpersonal-psychological theory (IPT) and the three-step theory (3ST) of suicide and if mediation paths were moderated by sex. A sample of 265 college students completed a cross-sectional online survey assessing SI and constructs related to IPT and 3ST. The number of marginalized identities was generated by adding minoritized sexual orientation, race/ethnicity other than non-Hispanic White, body mass index >25 kg/m2, sexual attraction to same sex but identified as heterosexual, and gender-fluid identity. In IPT multiple mediation analyses, possessing more marginalized identities was associated with SI severity through burdensomeness and hopelessness, but not belonging. Indirect paths through burdensomeness and belonging were moderated by sex. For 3ST, possessing more marginalized identities was associated with SI severity through hopelessness and psychological pain, but not social connection or meaning in life. Future research should consider intersecting social identities and test mechanisms by which multiply marginalized college students develop resilience to SI risk factors, such as support within their marginalized groups, to inform suicide assessment and intervention efforts on college campuses. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
Collapse
Affiliation(s)
| | - Lourah M. Kelly
- School of Medicine, University of Connecticut
- Department of Psychology, Suffolk University
| | - Paula M. Brochu
- Department of Clinical and School Psychology, Nova Southeastern University
| | - Jennifer C. Wolff
- Warren Alpert Medical School of Brown University
- Rhode Island Hospital
| | | |
Collapse
|
28
|
Feinstein BA, Katz BW, Benjamin I, Macaulay T, Dyar C, Morgan E. The Roles of Discrimination and Aging Concerns in the Mental Health of Sexual Minority Older Adults. LGBT Health 2022; 10:324-330. [DOI: 10.1089/lgbt.2022.0113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Brian A. Feinstein
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Benjamin W. Katz
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Isabel Benjamin
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Taylor Macaulay
- Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, Illinois, USA
| | - Christina Dyar
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
| | - Ethan Morgan
- College of Nursing, The Ohio State University, Columbus, Ohio, USA
- Infectious Diseases Institute, and The Ohio State University, Columbus, Ohio, USA
- College of Public Health, The Ohio State University, Columbus, Ohio, USA
| |
Collapse
|
29
|
Price MA, Hollinsaid NL. Future Directions in Mental Health Treatment with Stigmatized Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2022; 51:810-825. [PMID: 36007234 PMCID: PMC9835015 DOI: 10.1080/15374416.2022.2109652] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
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.
Collapse
Affiliation(s)
- Maggi A. Price
- School of Social Work, Boston College, Boston, MA
- Department of Psychology, Harvard University, Cambridge, MA
| | | |
Collapse
|
30
|
Jennings TL, Gleason N, Kraus SW. Assessment of compulsive sexual behavior disorder among lesbian, gay, bisexual, transgender, and queer clients •. J Behav Addict 2022; 11:216-221. [PMID: 35895457 PMCID: PMC9295217 DOI: 10.1556/2006.2022.00028] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 03/28/2022] [Accepted: 04/15/2022] [Indexed: 11/19/2022] Open
Abstract
Numerous debates surround the recent inclusion of compulsive sexual behavior disorder (CSBD) in the International Classification of Diseases (11th ed.), such as the appropriate classification of this construct and what symptom criteria best capture this syndrome. Although controversy surrounding CSBD abounds, there is general agreement that researchers should examine this syndrome in diverse groups, such as lesbian, gay, bisexual, and transgender populations. However, there have been few investigations into how diverse sociocultural contexts may influence the assessment and treatment of CSBD. Therefore, we propose several differential diagnosis considerations when working with sexual and gender diverse clients to avoid CSBD misdiagnosis.
Collapse
Affiliation(s)
- Todd L. Jennings
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| | - Neil Gleason
- Department of Psychology, University of Washington, Seattle, WA, USA
| | - Shane W. Kraus
- Department of Psychology, University of Nevada, Las Vegas, NV, USA
| |
Collapse
|
31
|
Sexual Communication Among Sexual and Gender/Sex Diverse Folks: An Overview of What We Know and Suggestions for Where to Go. CURRENT SEXUAL HEALTH REPORTS 2022. [DOI: 10.1007/s11930-022-00328-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
|
32
|
Puccinelli M, Seay J, Otto A, Garcia S, Crane TE, Benzo RM, Solle N, Mustanski B, Merchant N, Safren SA, Penedo FJ. An adapted cognitive behavioral stress and self-management (CBSM) intervention for sexual minority men living with HIV and cancer using the SmartManage eHealth platform: Study design and protocol. (Preprint). JMIR Res Protoc 2022; 11:e37822. [PMID: 35849435 PMCID: PMC9345025 DOI: 10.2196/37822] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/11/2022] [Accepted: 05/17/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions International Registered Report Identifier (IRRID)
Collapse
Affiliation(s)
- Marc Puccinelli
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Julia Seay
- Naval Health Research Center, San Diego, CA, United States
| | - Amy Otto
- Department of Public Health Sciences, University of Miami, Miami, FL, United States
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Sofia Garcia
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Tracy E Crane
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
| | - Roberto M Benzo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Natasha Solle
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
| | - Brian Mustanski
- Feinberg School of Medicine, Northwestern University, chicago, IL, United States
| | - Nipun Merchant
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
| | - Steven A Safren
- Department of Psychology, University of Miami, Miami, FL, United States
| | - Frank J Penedo
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL, United States
- Department of Medicine, University of Miami, Miami, FL, United States
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| |
Collapse
|