Treating Depression in LGBTQ+ Adolescents and Young Adults Using Remote Intensive Outpatient Programming (IOP)

Background & Purpose: Youth from LGBTQ+ communities face barriers to mental health treatment, including a shortage of programs available to this population and a lack of identity-sensitive programming among those that are. One approach, Intensive Outpatient Programming (IOP), has been found to be an effective model for youth seeking treatment but it is limited to those with the ability to travel to clinical settings several days per week, which has implications for programs’ ability to address the unique needs of individuals from marginalized populations, given that treatment groups by necessity reflect the majority of the population in a particular geographic location. The purpose of the quality improvement effort presented here was to test the effectiveness of an alternative delivery method of IOP model, remote IOP, to reduce depression in youth. The effort was guided by the following questions: 1) is remote IOP effective in reducing depression among youth and 2) do treatment effects differ by groups defined by gender or sexual orientation?

Methods: A longitudinal evaluation of changes in depression between intake and discharge was conducted using data collected as part of on-going quality improvement efforts of a remote IOP program serving youth across 14 states. Repeated-measures t-tests and Analysis of Variance (ANOVA) were used to evaluate changes in Patient Health Questionnaire Modified for Adolescents (PHQ-A) scores among clients who attended a minimum of 18 program hours between June 2021 and January 2022. Threats to validity of findings due to history effects and spontaneous remission were also tested.

Results: A total of 238 cases were included in analyses, of which 63% entered treatment with moderate to severe depression. Clients ranged in age from 11 to 25, with an average age of 16 years. Overall, 67% of the sample identified as members of an LGBTQ+ community and almost a quarter (23%) of the sample were outside of the male/female binary. Significant decreases equating to a medium effect size were seen in depression scores between intake and discharge. No significant differences were found in gain scores between subgroups defined by gender or sexual orientation. Results suggest that changes could not be explained solely by history effects or spontaneous remission.

Conclusion & Implications: Findings suggest that remote IOP may be an effective alternative to place-based IOP treatment and an effective model for youth from marginalized gender and sexual orientation communities. The opportunity to work outside of the limitations of place and local demographics allows clinicians to create specialized treatment groups sensitive to identity-specific needs and, given the disproportionately high percentage of clients who identified as a member of an LGBTQ+ community, suggests providing a safer space to self-disclose than those based in local facilities. This remote IOP model as delivered here may help move the field forward in advancing social justice by offering more opportunities and safer spaces for youth from LGBTQ+ communities to receive identity-sensitive treatment and in doing so address the disparities that lead to poorer outcomes and greater treatment barriers experienced by LGBTQ+ youth compared to their cis-gender, heterosexual peers.