Behavioral Health Interventions for LGBTQ+ Youth: A Systematic Review

Study Aims: LGBTQ+-identified individuals are at elevated risk for suicidal attempts and ideation, self-harm, substance use, and mental illness; this risk is magnified amongst LGBTQ+ adolescents (Liu and Mustanski, 2012; Marshal et al., 2008). Evidence-based behavioral interventions use skill acquisition and generalization as treatment for these mental health concerns, albeit there is limited existing research examining the effectiveness of these interventions specifically among LGBTQ+ adolescents. Thus, it is critical to synthesize extant literature assessing the efficacy of such interventions within this population.

Methods: This systematic review examines behavioral interventions for LGBTQ+ adolescents with mental illness and substance use. Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) method, a screening process was used to assess eligibility for inclusion (Moher et al., 2009).

Results:  Researchers consulted three electronic databases (Embase, PsycInfo, and Web of Science), yielding 621 results. Six additional references were identified through reference lists. During screening, 613 studies were excluded due to irrelevance. Fourteen articles were assessed via full text review. Three additional exclusions did not assess behavioral health outcomes in LGBTQ+ adolescents or were not delivered by a mental health professional. Eleven studies, ranging from a 3-session drug use prevention program to a 10-session school-counseling program, met inclusion criteria. Studies were evaluated for methodological quality and treatment outcomes. Outcomes included decreased suicidal behaviors, depressive symptoms, substance use, and social isolation. Significant design and methodological limitations were present across most included studies; five studies presented case reports and only one study used a randomized controlled trial design. Treatment models were evaluated to determine if they were implemented in standardized form, or if they were adapted for the specific needs of LGBTQ+ youth (e.g. minority stress).

Conclusion: The review suggests limited and preliminary evidence supporting the use of interventions to reduce mental health problems specifically in LGBTQ+ adolescents. Given the methodological limitations of the studies, it is not yet possible to determine the effectiveness of specific adaptations addressing minority stress. More rigorous research is required to determine if interventions including minority stress of LGBTQ+ adolescents are more effective than standard treatment models. Despite the increased risk of suicide in the LGBTQ+ community, only two of the reviewed studies assessed changes in suicidal behavior. It is essential that future research examines the efficacy of interventions on mental health and self-harm within this demographic.