Sexual and Gender Minority Youth (SGMY) and Online Interventions to Increase Help-seeking for Anxiety and/or Depression

University of Pittsburgh81 enrolled

Overview

the investigators will use 4 technology based tools (combinations of youtube videos, links to online resources, tiktok videos, and other media) in a study of 96 Sexual and Gender Minority Youth (SGMY) to determine the effectiveness of them in helping youth to seek out mental health help. Participants will be divided into 1 of 16 groups and will interact with other participants anonymously on Discord. Each group will have access to 1, 2, 3, or all 4 of the tools which are categorized by a specific subject (except for one group who will have no access to the tools in order to compare this outcome against those who use the tools). There will be a survey before starting the Discord portion which will last 4 weeks, and a survey afterwards.

Only one-third of adolescents access treatment for depression, and many fail to interact with clinic-based mental health resources. Sexual and gender minority youth (SGMY) are at greater risk for severe mental health disorders and suicidality but even less likely to access mental health services, even when access is available. Widespread factors - stigma, negative beliefs about treatment, lack of mental health knowledge - contribute to not seeking services. Mainstream mental health interventions fail to address unique factors to SGMY that inhibit help-seeking: double stigma (stigma around mental health as well as internalized homophobia and transphobia), concern about revealing SGM status, low family support, lack of access to SGM affirming mental health professionals. Despite being hard-to-reach, SGMY at risk for depression are quite active online. Yet SGMY-specific evidence-based online interventions are lacking and community interventions do not enhance mental health help-seeking. Targeted online interventions are needed to address unique factors which prevent help-seeking but are themselves usable and engaging. The current proposal will use a user-informed efficient approach to technology intervention design considering the heterogeneity and specific needs of SGMY. The investigators will use the Behavioral Intervention Technology Model to design and study several intervention principles (IPs), or theoretical concepts including intervention aims and behavioral strategies, to understand which mechanisms of action hold promise while being iterating design and potential modalities. The investigators will use human computer interaction (HCI) framework, Discover, Design/Build, and Test to develop and study several IPs. Specifically, will use HCI techniques to develop initial prototypes and seek iterative user feedback and evaluate 4 finalized low-fidelity prototypes using a factorial trial to understand each IP prototype's individual and combined feasibility, usability, acceptability, and change in help-seeking intention in an online sample of diverse (racially, ethnically, age, gender identity, sexual orientation) SGMY. This will inform the development of a high-fidelity intervention which may include different components for specific SGMY subgroups to be evaluated in a larger clinical trial. The PI, Dr. Radovic, is a physician researcher in adolescent medicine and has conducted years of research using stakeholder-informed methods and HCI techniques to inform intervention development. By working with experts in SGM health, stakeholder engagement, intervention design, qualitative analysis, HCI design, and BIT development and testing, the investigators have an exciting opportunity to bridge the gap for SGM adolescents with depression and suicidality to motivate and equip adolescents with the tools needed to access treatment. This proposal is responsive to NOT-MH-18-031 by conducting nimble iterative testing and NOT-MD-19-001 - testing stigma reduction interventions. Adolescents who are sexual and gender minority (or LGBTQ) have rising rates of depression, anxiety, and suicidality but are less likely to get mental health treatment than other adolescents due to stigma and low family support. These adolescents are quite active online. This study aims to understand what types of technology interventions are most promising for helping them to seek mental health help when indicated. Due to the exploratory nature of this clinical trial, we originally considered multiple secondary outcomes. As we proceeded with the study and obtained formative information from qualitative interviews to inform initial prototypes, we further clarified our conceptual model regarding our interests in the main outcome of mental health help-seeking and subsequent improvement in depression and anxiety symptoms. This help-seeking we hypothesized may be influenced by help-seeking intention, social support, internalized stigmatization of identity (internalized homophobia, internalized transphobia), confidentiality concerns, and expectations of rejection by mental healthcare providers. These measures therefore remained as secondary outcomes which we examined, and all others were moved to Other Pre-specified outcome measures. With regards to statistical analysis, due to limitations in sample size, and non-normality of data, we used non-parametric tests of statistical significance within the primary outcome of mental health help-seeking intention between each intervention compared to not that intervention and adjusted for multiple tests using false-discovery rate q-value calculated with the Yekutieli method in Stata.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

HEALTH_SERVICES_RESEARCH

Masking

SINGLE

Enrollment

Interventions

Intersectionality and IdentityBEHAVIORAL

Participants will use the computer application, Discord, a social media site that allows for sharing of content and interaction with other people in a variety of forms (video chat, direct messaging, and talking in group chat areas). We will be using the group chat function to set up discussion forums where there will be video and text resources focused on matters of intersectionality and identity. Participants will do at least one activity from three types each week for four weeks. The three activity types will have the participants engage with the content and then either discuss it in the forum ("Talk about it"), write a review about the content discussing why/why not they like it ("Rate it"), or Attempt to use the knowledge or skills to accomplish a task offline ("Try it").

ConfidentialityBEHAVIORAL

Participants will use the computer application, Discord, a social media site that allows for sharing of content and interaction with other people in a variety of forms (video chat, direct messaging, and talking in group chat areas). We will be using the group chat function to set up discussion forums where there will be video and text resources focused on Confidentiality for caregivers. Participants will do at least one activity from three types each week for four weeks. The three activity types will have the participants engage with the content and then either discuss it in the forum ("Talk about it"), write a review about the content discussing why/why not they like it ("Rate it"), or Attempt to use the knowledge or skills to accomplish a task offline ("Try it").

Educating Your CommunityBEHAVIORAL

Participants will use the computer application, Discord, a social media site that allows for sharing of content and interaction with other people in a variety of forms (video chat, direct messaging, and talking in group chat areas). We will be using the group chat function to set up discussion forums where there will be video and text resources focused on matters of the education of family and friends about identity. Participants will do at least one activity from three types each week for four weeks. The three activity types will have the participants engage with the content and then either discuss it in the forum ("Talk about it"), write a review about the content discussing why/why not they like it ("Rate it"), or Attempt to use the knowledge or skills to accomplish a task offline ("Try it").

How to find Affirming CaregiversBEHAVIORAL

Participants will use the computer application, Discord, a social media site that allows for sharing of content and interaction with other people in a variety of forms (video chat, direct messaging, and talking in group chat areas). We will be using the group chat function to set up discussion forums where there will be video and text resources focused on matters of finding affirming caregivers. Participants will do at least one activity from three types each week for four weeks. The three activity types will have the participants engage with the content and then either discuss it in the forum ("Talk about it"), write a review about the content discussing why/why not they like it ("Rate it"), or Attempt to use the knowledge or skills to accomplish a task offline ("Try it").

Control Group - No InterventionsBEHAVIORAL

Control Group - Will be given no interventions

Eligibility

Sex: ALLMin age: 14 YearsMax age: 19 YearsHealthy volunteers:

Medical Language ↔ Plain English

List the inclusion criteria: have access to a smartphone; have finished 6th grade; have access to and intellectual and physical ability to use the internet; fit demographic criteria (SGMY); and have symptoms of depression and/or anxiety that are mild or more severe (PHQ-8 and/or GAD-7 = 5 or above) We will routinely monitor the sample to attempt to reach the following proportions: 50% ages 14-16 and 50% ages 17-19 50% identify as sexual minority but cisgender and 50% identify as not cisgender at least 40% identify as a racial or ethnic minority If any of the proportions are reached (e.g. if 60% of recruited sample identify as not belonging to a racial or ethnic minority we will change screen settings to exclude those who are not List the exclusion criteria: no access to smart phone or internet, did not complete the 6th grade, not able to use internet, depression and anxiety are less than mild (PHQ-8 and GAD-7 scores \<5); presently are in ongoing psychotherapy (i.e. have attended or plan to attend more than 1 session). If they have been in therapy within the past 3 months

Locations (1)

Virtual Social Media Based Recruitment

Pittsburgh, Pennsylvania, United States

Outcomes

Primary Outcomes

Feasibility - IP Use Proportion

Average proportions of IP components completed out of IP components available per individual participant (IP component defined as opportunity offered to interact with the intervention - some individuals will have more opportunities offered than others due to factorial randomization)

Time frame: Over one month

Feasibility - IP Use Days

Average Proportion of days IP is used per individual (number of days session accessed over total offered which is 28 days)

Time frame: Over one month

Feasibility - IP Use Time

Average length of time IP is used (length of session)

Time frame: Over one month

Usability

System Usability Scale, min: 0, Max: 100, higher scores mean better usability

Time frame: 1 month

Acceptability of the Intervention Principle

Open-ended questions about whether the Discord server and the tools used were: helpful; whether it was affirming of SGM status; if timing and amount of content were appropriate, if privacy and confidentiality were maintained, and if they had any negative consequences of participation (e.g. parent questioning them )

Time frame: 1 month

Help-Seeking Intention From Counselor or Therapist - TAU vs Not TAU

single help-seeking intention ruler-based question (i.e. 'I intend to seek help from a counselor or therapist for my mental health problems' scale 1-7, a higher number signifying a higher intent to seek help

Time frame: 1 month

Help-Seeking Intention From Counselor or Therapist - Intervention 1 vs. Not 1

Time frame: 1 month

Help-Seeking Intention From Counselor or Therapist - Intervention 2 vs. Not 2

Time frame: 1 month

Help-Seeking Intention From Counselor or Therapist - Intervention 3 vs. Non-3

Time frame: 1 month

Help-Seeking Intention From Counselor or Therapist - Intervention 4 vs. Not 4

Time frame: 1 month

Secondary Outcomes

Social Support - TAU vs Not TAU

The Medical Outcome Study Social Support Scale measures types of social support. Per item, options range from 1 to 5 with higher levels are associated with greater support. We will use the emotional/informational subscale from this report and instead of transforming to 0-100 like the original, we will use the untransformed mean score of the items which can range 1 to 5.

Time frame: 1 month

Social Support - Intervention 1 vs. Not 1

Time frame: 1 month

Social Support - Intervention 2 vs. Not 2

Time frame: 1 month

Social Support - Intervention 3 vs. Not 3

Time frame: 1 month

Social Support - Intervention 4 vs. Not 4

Data from ClinicalTrials.gov

This platform is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare professional.

Internalized Homophobia - TAU vs Not TAU

Sexual Minority Adolescent Stress Inventory Internalized homonegativity subscale for the past 30 days. min: 0, max: 7. Higher score indicates greater internalized homophobia

Time frame: 1 month

Internalized Homophobia - Intervention 1 vs Not 1

Sexual Minority Adolescent Stress Inventory Internalized homonegativity subscale. - asked about past 30 days min: 0, max: 7. Higher score indicates greater internalized homophobia

Time frame: 1 month

Internalized Homophobia - Intervention 2 vs Not 2

Sexual Minority Adolescent Stress Inventory Internalized homonegativity subscale. - asked about past 30 days min: 0, max: 7. Higher score indicates greater internalized homophobia

Time frame: 1 month

Internalized Homophobia - Intervention 3 vs Not 3

Sexual Minority Adolescent Stress Inventory Internalized homonegativity subscale. - asked about past 30 days min: 0, max: 7. Higher score indicates greater internalized homophobia

Time frame: 1 month

Internalized Homophobia - Intervention 4 vs Not 4

Sexual Minority Adolescent Stress Inventory Internalized homonegativity subscale. - asked about past 30 days min: 0, max: 7. Higher score indicates greater internalized homophobia

Time frame: 1 month

Internalized Transphobia - TAU vs Not TAU

Gender Minority Stress and Resilience Measure. min: 0, max: 40. Higher score indicates greater internalized transphobia

Time frame: 1 month

Internalized Transphobia - Intervention 1 vs Not 1

Gender Minority Stress and Resilience Measure. min: 0, max: 40. Higher score indicates greater internalized transphobia

Time frame: 1 month

Internalized Transphobia - Intervention 2 vs Not 2

Gender Minority Stress and Resilience Measure. min: 0, max: 40. Higher score indicates greater internalized transphobia

Time frame: 1 month

Internalized Transphobia - Intervention 3 vs Not 3

Gender Minority Stress and Resilience Measure. min: 0, max: 40. Higher score indicates greater internalized transphobia

Time frame: 1 month

Internalized Transphobia - Intervention 4 vs Not 4

Gender Minority Stress and Resilience Measure. min: 0, max: 40. Higher score indicates greater internalized transphobia

Time frame: 1 month

Expectance of Rejection Due to SGM Status TAU vs Not TAU

Single-item yes/no and open ended question - asked about past 30 days

Time frame: 1 month

Expectance of Rejection Due to SGM Status Intervention 1 vs Not 1

Single-item yes/no and open ended question - asked about past 30 days

Time frame: 1 month

Expectance of Rejection Due to SGM Status Intervention 2 vs Not 2

Single-item yes/no and open ended question - asked about past 30 days

Time frame: 1 month

Expectance of Rejection Due to SGM Status Intervention 3 vs Not 3

Single-item yes/no and open ended question - asked about past 30 days

Time frame: 1 month

Expectance of Rejection Due to SGM Status Intervention 4 vs Not 4

Single-item yes/no and open ended question - asked about past 30 days

Time frame: 1 month

Confidentiality Concerns TAU vs Not TAU