项目 ESTEEM 方案：一项 LGBTQ 肯定治疗对年轻成年性少数男性心理健康和性健康的随机对照试验。

Project ESTEEM protocol: a randomized controlled trial of an LGBTQ-affirmative treatment for young adult sexual minority men's mental and sexual health.

机构信息

Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, USA.

Department of Biostatistics, Yale School of Public Health, New Haven, USA.

出版信息

BMC Public Health. 2019 Aug 9;19(1):1086. doi: 10.1186/s12889-019-7346-4.

DOI:10.1186/s12889-019-7346-4

PMID:31399071

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC6688287/

Abstract

BACKGROUND

Young gay and bisexual men disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in young gay and bisexual men's exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to young gay and bisexual men's health. Yet no known intervention addresses minority stress to improve mental health, substance use problems, or their joint impact on HIV risk in this population. This paper describes the design of a study to test the efficacy of such an intervention, called ESTEEM (Effective Skills to Empower Effective Men), a 10-session skills-building intervention designed to reduce young gay and bisexual men's co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health.

METHODS

This study, funded by the National Institute of Mental Health, is a three-arm randomized controlled trial to examine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing and (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes. Our primary outcome, measured 8 months after baseline, is condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake, also measured 8 months after baseline.

DISCUSSION

Delivering specific stand-alone treatments for specific mental, behavioral, and sexual health problems represents the current state of evidence-based practice. However, dissemination and implementation of this one treatment-one problem approach has not been ideal. A single intervention that reduces young gay and bisexual men's depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems would represent an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men.

TRIAL REGISTRATION

Registered October 10, 2016 to ClinicalTrials.gov Identifier: NCT02929069 .

摘要

背景

在美国，年轻的男同性恋和双性恋者中抑郁、焦虑和物质使用问题的比例过高，他们是感染艾滋病毒风险最高的群体之一。各种方法都将这些健康差异的根源定位在年轻男同性恋和双性恋者所经历的少数群体压力上。事实上，少数群体压力、精神疾病发病率、物质使用和艾滋病毒风险相互助长，对年轻男同性恋和双性恋者的健康构成协同威胁。然而，目前还没有已知的干预措施可以解决少数群体压力问题，以改善心理健康、物质使用问题或减少它们对该人群中艾滋病毒风险的共同影响。本文介绍了一项研究的设计，该研究旨在测试一种名为 ESTEEM（增强有效男性的有效技能）的干预措施的效果，这是一种 10 节技能建设干预措施，旨在通过解决少数群体压力损害健康的潜在认知、情感和行为途径，减少年轻男同性恋和双性恋者同时存在的健康风险。

方法

这项由美国国家心理健康研究所资助的研究是一项三臂随机对照试验，旨在检验（1）ESTEEM 与社区心理健康治疗和艾滋病毒咨询和检测相比的效果，以及（2）ESTEEM 是否通过其假设的认知、情感和行为少数群体压力过程发挥作用。我们的主要结局指标是在基线后 8 个月测量的无保护肛交行为，即在没有 PrEP 或已知 HIV+ 主要性伴侣不可检测病毒载量的情况下。次要结局指标包括抑郁、焦虑、物质使用、性强迫和 PrEP 使用率，也在基线后 8 个月测量。

讨论

为特定的心理、行为和性健康问题提供特定的独立治疗是目前循证实践的状态。然而，这种单一治疗-单一问题方法的推广和实施并不理想。一种单一的干预措施，如果通过减少这些问题中常见的少数群体压力途径，降低年轻男同性恋和双性恋者的抑郁、焦虑、物质使用和艾滋病毒风险，将代表一种高效、具有成本效益的替代方案，这对于减少年轻男性中性取向健康差异具有很大的潜力。