Department of Family and Community Health, University of Pennsylvania, Philadelphia, PA, United States.
Hopelab, San Francisco, CA, United States.
J Med Internet Res. 2022 Aug 1;24(8):e39094. doi: 10.2196/39094.
Efficacious mental health interventions for sexual and gender minority youth have had limited reach, given their delivery as time-intensive, in-person sessions. Internet-based interventions may facilitate reach to sexual and gender minority youth; however, there is little research examining their efficacy.
This study aims to describe the results of a pilot randomized controlled trial of imi, a web application designed to improve mental health by supporting lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity affirmation, coping self-efficacy, and coping skill practice.
Sexual and gender minority youth (N=270) aged 13 to 19 (mean 16.5, SD 1.5) years and living in the United States were recruited through Instagram advertisements. Approximately 78% (210/270) of the sample identified as racial or ethnic minorities. Participants were randomized in a 1:1 fashion to the full imi intervention web application (treatment; 135/270, 50%) or a resource page-only version of the imi site (control; 135/270, 50%). The imi application covered four topical areas: gender identity; lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority identity; stress and coping; and internalized homophobia and transphobia. Participants explored these areas by engaging with informational resources, exercises, and peer stories at a self-guided pace. Both arms were assessed via web-based surveys at baseline and 4-week follow-up for intervention satisfaction, stress appraisals (ie, challenge, threat, and resource), coping skills (ie, instrumental support, positive reframing, and planning), and mental health symptoms among other outcomes. Main intent-to-treat analyses compared the arms at week 4, controlling for baseline values on each outcome.
Survey retention was 90.4% (244/270) at week 4. Participants in the treatment arm reported greater satisfaction with the intervention than participants in the control arm (t=-2.98; P=.003). The treatment arm showed significantly greater improvement in challenge appraisals (ie, belief in one's coping abilities) than the control (Cohen d=0.26; P=.008). There were no differences between the arms for threat (d=0.10; P=.37) or resource (d=0.15; P=.14) appraisals. The treatment arm showed greater increases in coping skills than the control arm (instrumental support: d=0.24, P=.005; positive reframing: d=0.27, P=.02; planning: d=0.26, P=.02). Mental health symptoms improved across both the treatment and control arms; however, there were no differences between arms. Within the treatment arm, higher engagement with imi (≥5 sessions, >10 minutes, or >10 pages) predicted greater improvement in stress appraisals (all P values <.05).
The results provide initial evidence that asynchronous psychosocial interventions delivered via a web application to sexual and gender minority youth can support their ability to cope with minority stress. Further research is needed to examine the long-term effects of the imi application.
ClinicalTrials.gov NCT05061966; https://clinicaltrials.gov/ct2/show/NCT05061966.
有效的心理健康干预措施对性少数群体和性别少数群体青年的影响有限，因为这些干预措施需要密集的面对面服务。基于互联网的干预措施可能有助于接触性少数群体和性别少数群体青年；然而，关于其效果的研究很少。
本研究旨在描述 imi 的试点随机对照试验结果，imi 是一款旨在通过支持女同性恋、男同性恋、双性恋、跨性别、酷儿和其他性少数群体和性别少数群体认同、应对自我效能感和应对技能实践来改善心理健康的网络应用程序。
招募了年龄在 13 至 19 岁（平均 16.5，SD 1.5）之间、居住在美国的性少数群体和性别少数群体青年（N=270），通过 Instagram 广告进行招募。大约 78%（210/270）的样本被认定为种族或少数民族。参与者以 1:1 的比例随机分配到完整的 imi 干预网络应用程序（治疗组；135/270，50%）或 imi 网站的仅资源页面版本（对照组；135/270，50%）。imi 应用程序涵盖了四个主题领域：性别认同；女同性恋、男同性恋、双性恋、跨性别、酷儿和其他性少数群体和性别少数群体认同；压力和应对；以及内化的恐同症和跨性别恐惧症。参与者通过以自我指导的速度参与信息资源、练习和同伴故事来探索这些领域。在基线和 4 周随访时，通过基于网络的调查评估干预满意度、压力评估（即挑战、威胁和资源）、应对技能（即工具支持、积极重新评估和规划）以及心理健康症状等其他结果。主要意向治疗分析比较了第 4 周时的手臂，控制了每个结果的基线值。
第 4 周的调查保留率为 90.4%（244/270）。与对照组相比，治疗组的参与者对干预的满意度更高（t=-2.98；P=.003）。治疗组在挑战评估（即对自己应对能力的信念）方面的改善明显大于对照组（Cohen d=0.26；P=.008）。治疗组和对照组在威胁评估（d=0.10；P=.37）或资源评估（d=0.15；P=.14）方面没有差异。治疗组的应对技能比对照组有更大的提高（工具支持：d=0.24，P=.005；积极重新评估：d=0.27，P=.02；规划：d=0.26，P=.02）。治疗组和对照组的心理健康症状都有所改善；然而，两组之间没有差异。在治疗组中，更高的 imi 参与度（≥5 次会话、≥10 分钟或≥10 页）预测压力评估的改善更大（所有 P 值均<.05）。
结果初步表明，通过网络应用程序向性少数群体和性别少数群体青年提供异步心理社会干预措施，可以支持他们应对少数群体压力的能力。需要进一步研究来检验 imi 应用程序的长期效果。
ClinicalTrials.gov NCT05061966；https://clinicaltrials.gov/ct2/show/NCT05061966。
