School of Social Policy, University of Birmingham, Birmingham B15 2TT, UK.
School of Health and Social Care, University of Essex, Colchester CO4 3SQ, UK.
Int J Environ Res Public Health. 2023 Feb 28;20(5):4274. doi: 10.3390/ijerph20054274.
Globally, research indicates that LGBTQ+ young people have elevated rates of poor mental health in comparison with their cisgender heterosexual peers. The school environment is a major risk factor and is consistently associated with negative mental health outcomes for LGBTQ+ young people. The aim of this UK study was to develop a programme theory that explained how, why, for whom, and in what context school-based interventions prevent or reduce mental health problems in LGBTQ+ young people, through participation with key stakeholders. Online realist interviews were conducted in the UK with (1) LGBTQ+ young people aged between 13-18 years attending secondary schools ( = 10); (2) intervention practitioners ( = 9); and (3) school staff ( = 3). A realist retroductive data analysis strategy was employed to identify causal pathways across different interventions that improved mental health outcomes. The programme theory we produced explains how school-based interventions that directly tackle dominant cisgender and heterosexual norms can improve LGBTQ+ pupils' mental health. We found that context factors such as a 'whole-school approach' and 'collaborative leadership' were crucial to the delivery of successful interventions. Our theory posits three causal pathways that might improve mental health: (1) interventions that promote LGBTQ+ visibility and facilitate usualising, school belonging, and recognition; (2) interventions for talking and support that develop safety and coping; and (3) interventions that address institutional school culture (staff training and inclusion polices) that foster school belonging, empowerment, recognition, and safety. Our theoretical model suggests that providing a school environment that affirms and usualises LGBTQ+ identities and promotes school safety and belonging can improve mental health outcomes for LGBTQ+ pupils.
在全球范围内，研究表明，与顺性别异性恋同龄人相比，LGBTQ+ 年轻人的心理健康状况较差。学校环境是一个主要的风险因素，并且一直与 LGBTQ+ 年轻人的负面心理健康结果相关。本项英国研究旨在制定一个方案理论，通过与主要利益相关者合作，解释学校为基础的干预措施如何、为何、针对谁以及在何种情况下可以预防或减少 LGBTQ+ 年轻人的心理健康问题。在英国，通过在线真实主义访谈，对以下三类人员进行了研究：(1) 13-18 岁就读于中学的 LGBTQ+年轻人（= 10 人）；(2) 干预从业者（= 9 人）；(3) 学校工作人员（= 3 人）。采用真实主义回溯数据分析策略，确定了不同干预措施改善心理健康结果的因果途径。我们提出的方案理论解释了直接针对主流顺性别和异性恋规范的学校干预措施如何改善 LGBTQ+ 学生的心理健康。我们发现，诸如“全校方法”和“协作领导”等背景因素对于成功实施干预措施至关重要。我们的理论提出了三个可能改善心理健康的因果途径：(1) 促进 LGBTQ+可见性并促进常规化、学校归属感和认同的干预措施；(2) 用于谈话和支持的干预措施，以培养安全性和应对能力；(3) 解决机构学校文化（员工培训和包容政策）的干预措施，以促进学校归属感、赋权、认同和安全。我们的理论模型表明，提供一个肯定和常规化 LGBTQ+身份并促进学校安全和归属感的学校环境可以改善 LGBTQ+学生的心理健康结果。
