Sexual and Gender Minority Youth (SGMY) and Online Interventions to Increase Help-seeking for Anxiety and/or Depression
- Conditions
- AnxietyDepressionSexual and Gender MinoritiesAdolescent Behavior
- Interventions
- Behavioral: ConfidentialityBehavioral: Intersectionality and IdentityBehavioral: Control Group - No InterventionsBehavioral: Educating Your CommunityBehavioral: How to find Affirming Caregivers
- Registration Number
- NCT06083987
- Lead Sponsor
- University of Pittsburgh
- Brief Summary
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.
- Detailed Description
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.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 96
Not provided
Not provided
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- FACTORIAL
- Arm && Interventions
Group Intervention Description Interventions 1 and 2 - Intersectionality and Identity/Confidentiality and Privacy Confidentiality Arm 3 will be given access to with the video and text content focused on intersectionality and confidentiality Interventions 1, 2, 3 and 4 - Intersectionality/Confidentiality/Educational Tools/Affirming Care Intersectionality and Identity Arm 6 will be given access to all 4 interventions, with the video and text content focused on intersectionality, confidentiality, education about identity, and determining if caregivers are affirming Control Group - No Interventions Control Group - No Interventions Arm 1 will have not be given any of the interventions and will be a control group. Intervention 1 - Intersectionality and Identity Intersectionality and Identity Arm 2 will be given access to intervention 1. It will have video and text content focused on identity and intersectionality. Interventions 1, 2, 3 and 4 - Intersectionality/Confidentiality/Educational Tools/Affirming Care Confidentiality Arm 6 will be given access to all 4 interventions, with the video and text content focused on intersectionality, confidentiality, education about identity, and determining if caregivers are affirming Interventions 1 and 3 - Intersectionality and Identity/Educational Tools Confidentiality Arm 7 will be given access to interventions 1 and 3, with the video and text content focused on intersectionality and education about identity Interventions 1 and 3 - Intersectionality and Identity/Educational Tools Educating Your Community Arm 7 will be given access to interventions 1 and 3, with the video and text content focused on intersectionality and education about identity Interventions 1, 3, and 4 - Intersectionality and Identity/Educational Tools/Finding Affirming Care How to find Affirming Caregivers Arm 8 will be given access to interventions 1, 3, and 4, with the video and text content focused on intersectionality, education about identity and determining if caregivers are affirming. Intervention 3 - Educational Tools Confidentiality Arm 14 will be given access to intervention 3. Video and text content will focus on education about identity Interventions 3 and 4 - Educational Tools/Finding Affirming Care Confidentiality Arm 15 will be given access to interventions 3 and 4. Video and text content will focus on educational tools about identity and determining if caregivers are affirming. Intervention 4 - Finding Affirming Care How to find Affirming Caregivers Arm 16 will be given access to intervention 4, with video and text content focusing on determining if caregivers are affirming. Interventions 1, 2, and 3 - Intersectionality/Confidentiality/Educational Tools Educating Your Community Arm 4 will be given access to with the video and text content focused on intersectionality, confidentiality, and education about identity Interventions 1, 2, and 4 - Intersectionality/Confidentiality/Finding Affirming Care How to find Affirming Caregivers Arm 5 will be given access to interventions 1, 2, and 4, with the video and text content focused on intersectionality, confidentiality, and determining if caregivers are affirming Interventions 1 and 4 - Intersectionality and Identity/Finding Affirming Care Intersectionality and Identity Arm 9 will be given access to interventions 1 and 4, with the video and text content focused on intersectionality and determining if caregivers are affirming. Intervention 2 - Confidentiality and Privacy Intersectionality and Identity Arm 10 will be given access to intervention 2, with the video and text content focused on confidentiality Intervention 2 - Confidentiality and Privacy Educating Your Community Arm 10 will be given access to intervention 2, with the video and text content focused on confidentiality Interventions 2, 3 and 4 - Confidentiality and Privacy/Educational Tools/Finding Affirming Care How to find Affirming Caregivers Arm 12 will be given access to interventions 2, 3, and 4. Video and text content will focus on confidentiality, education about identity, and determine if caregivers are affirming. Interventions 1, 3, and 4 - Intersectionality and Identity/Educational Tools/Finding Affirming Care Educating Your Community Arm 8 will be given access to interventions 1, 3, and 4, with the video and text content focused on intersectionality, education about identity and determining if caregivers are affirming. Interventions 2 and 3 - Confidentiality and Privacy/Educational Tools Confidentiality Arm 11 will be given access to interventions 2, and 3. Video and text content will focus on confidentiality and education about identity. Interventions 2, 3 and 4 - Confidentiality and Privacy/Educational Tools/Finding Affirming Care Educating Your Community Arm 12 will be given access to interventions 2, 3, and 4. Video and text content will focus on confidentiality, education about identity, and determine if caregivers are affirming. Intervention 3 - Educational Tools How to find Affirming Caregivers Arm 14 will be given access to intervention 3. Video and text content will focus on education about identity Interventions 1 and 4 - Intersectionality and Identity/Finding Affirming Care How to find Affirming Caregivers Arm 9 will be given access to interventions 1 and 4, with the video and text content focused on intersectionality and determining if caregivers are affirming. Interventions 3 and 4 - Educational Tools/Finding Affirming Care Intersectionality and Identity Arm 15 will be given access to interventions 3 and 4. Video and text content will focus on educational tools about identity and determining if caregivers are affirming. Interventions 2 and 3 - Confidentiality and Privacy/Educational Tools Intersectionality and Identity Arm 11 will be given access to interventions 2, and 3. Video and text content will focus on confidentiality and education about identity. Interventions 2 and 3 - Confidentiality and Privacy/Educational Tools Educating Your Community Arm 11 will be given access to interventions 2, and 3. Video and text content will focus on confidentiality and education about identity. Interventions 2, 3 and 4 - Confidentiality and Privacy/Educational Tools/Finding Affirming Care Confidentiality Arm 12 will be given access to interventions 2, 3, and 4. Video and text content will focus on confidentiality, education about identity, and determine if caregivers are affirming. Interventions 3 and 4 - Educational Tools/Finding Affirming Care How to find Affirming Caregivers Arm 15 will be given access to interventions 3 and 4. Video and text content will focus on educational tools about identity and determining if caregivers are affirming. Interventions 2 and 4 - Confidentiality and Privacy/Finding Affirming Care Intersectionality and Identity Arm 13 will be given access to interventions 1, 3, and 4. Video and text content will focus on confidentiality and determining if caregivers are affirming. Interventions 2 and 4 - Confidentiality and Privacy/Finding Affirming Care Educating Your Community Arm 13 will be given access to interventions 1, 3, and 4. Video and text content will focus on confidentiality and determining if caregivers are affirming. Interventions 2 and 4 - Confidentiality and Privacy/Finding Affirming Care How to find Affirming Caregivers Arm 13 will be given access to interventions 1, 3, and 4. Video and text content will focus on confidentiality and determining if caregivers are affirming. Intervention 3 - Educational Tools Educating Your Community Arm 14 will be given access to intervention 3. Video and text content will focus on education about identity Intervention 4 - Finding Affirming Care Intersectionality and Identity Arm 16 will be given access to intervention 4, with video and text content focusing on determining if caregivers are affirming. Intervention 4 - Finding Affirming Care Educating Your Community Arm 16 will be given access to intervention 4, with video and text content focusing on determining if caregivers are affirming. Intervention 4 - Finding Affirming Care Confidentiality Arm 16 will be given access to intervention 4, with video and text content focusing on determining if caregivers are affirming.
- Primary Outcome Measures
Name Time Method Feasibility - IP use proportion Over one month Proportion of IP components completed
Usability 1 month System Usability Scale, min: 0, Max: 100, higher scores mean better usability
Acceptability of the intervention Principle 1 month Open-ended questions about whether IP was 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 )
Feasibility - IP use days Over one month Proportion of days IP is used (number of sessions over total offered)
Feasibility - IP use time Over one month Average length of time IP is used (length of session)
Help-Seeking Intention from Counselor or Therapist 1 month 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
- Secondary Outcome Measures
Name Time Method Social Isolation 1 month 4-item version of revised UCLA Loneliness Scale. min: 4, max: 16. Higher score means greater levels of loneliness
Help-Seeking Intention from Multiple Sources 1 month The General Help Seeking Questionnaire (Rickwood, 2005) asks the likelihood of seeking help from a potential individual for a personal or emotional problem. A higher score per individual indicates a higher likelihood and intention to seek help from this source.
Social Support 1 month The Medical Outcome Study Social Support Scale (Sherbourne, 1991) measures types of social support. This subscale ranges from 0-100, with higher levels associated with greater support. We will use the emotional/informational subscale from this report.
Depression 1 month Patient Health Questionnaire-8 measures depression severity with a score ranging from 0 to 24, a higher score indicating greater severity.
Depression and Anxiety Knowledge 1 month The Depression and Anxiety literacy questionnaires (Gulliver 2012) measures knowledge about depression and anxiety diagnosis and treatment. The total score ranges from 0-22, with a higher score indicating greater knowledge of depression. We will use a brief version of this scale.
Expectance of rejection due to SGM status 1 month Single-item yes/no and open ended question
12 Item Short Form Survay from the RAND Medical Outcomes Study (SF-12) 1 month SF-12 (Jenkinson 1997).
SF-12 survey generates two summary scores: a physical component score (pcs-12) and a mental component score (mcs-12). These scores are calculated using an algorithm that weighs the responses according to their contribution to the physical or mental health dimensions. The scores are then standardized to have a mean of 50 and a standard deviation of 10 in the general population. Higher scores indicate better health status and lower scores worse health status.
PCS-12 raw scores min is -3.37 and max is 69.68.
MCS-12 raw scores min is -10.64 and max is 73.18Anxiety 1 month Generalized Anxiety Disorders 7-item Questionnaire measures extent of anxiety symptoms. The total score ranges from 0 to 21 with a higher score indicating greater severity.
Antidepressant Outcome Expectations 1 month The Antidepressant Meanings Scale (Cohane, 2008) measures an individual's level of negative attitudes toward taking an antidepressant medication if prescribed. It is a continuous measure and the total score ranges from 0 to 24, with a higher score indicating more negative attitudes.
Receipt of any mental health treatment in past 4 weeks 1 month Actual Help Seeking Questionnaire (Rickwood 2005) which does not involve scoring; list of whether help-seeking was sought from different individuals for mental health concerns
Perceived Need for Treatment 1 month Open-ended question about whether adolescent thinks they need any mental health service
Beliefs about therapy 1 month Barriers to Adolescents Seeking Help Scale-Brief Version (Wilson 2005/Kuhl 1997) measures perceptions about seeking treatment from a mental health provider. The total score ranges from 1 to 11, a higher score indicated greater barriers.
Internalized Homophobia 1 month Sexual Minority Adolescent Stress Inventory Internalized homonegativity subscale. min: 0, max: 7. Higher score indicates greater internalized homophobia
Mental Health Stigma, Personal and Perceived 1 month The Depression Stigma Scale (Griffiths 2004) measures stigmatizing attitudes toward depression treatment. It is a continuous measure and the total score ranges from 0-36. There are two subscales: the personal stigma subscale which totals 0-18 and the perceived stigma subscale which totals 0-18. These two are summed for the total stigma score. A higher score indicates a worse outcome.
Confidentiality Concerns 1 month Confidentiality item from BASH-B scale, min: 1, max: 6, higher score means individual agrees that a therapist would not maintain confidentiality
Internalized Transphobia 1 month Gender Minority Stress and Resilience Measure. min: 0, max: 40. Higher score indicates greater internalized transphobia
Trial Locations
- Locations (1)
Virtual Social Media Based Recruitment
🇺🇸Pittsburgh, Pennsylvania, United States