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Sexual and gender minority youth (SGMY) experience persistent mental health disparities yet few research-based solutions exist. AFFIRM, an affirmative cognitive behavioral therapy (CBT) group intervention, was designed by social workers to improve intersectional SGMY’s mental health by mobilizing their coping skills despite ongoing minority stress. As part of a community- based clinical trial, AFFIRM’s efficacy was previously supported with pre-test and immediate post-test data and a comparison group. This study builds on those results to explore: (a) the longitudinal impact of AFFIRM on SGMY’s depression and anxiety; (b) pre-intervention factors that affect treatment effects; and (c) key intervention constructs that contribute to SGMY mental health.
Methods
Community-based snowball sampling leveraged social media and organizational referral. Data was collected from AFFIRM participants (n=145) at four time points: pre-test, post-test, 6-month follow up, and 1-year follow up. Participants attended developmentally appropriate groups with ages ranging from 13 to 29 years old (M=22.01, SD=4.72). Non-mutually exclusive diverse social identities were represented with the most frequent gender identities as transgender (26.2%) and nonbinary (19.3%); sexual orientations as gay (27.6%) and queer (20.0%) as well as White (55%), Asian (23.4%) and Black (20.0%). Participants also completed measures that included: (a) outcome variables (i.e., depression and anxiety), (b) intervention factors (i.e., coping, hope, and stress appraisal), and (c) demographics. Data was analyzed using multilevel linear modeling.
Results
AFFIRM participants experienced significant reductions in depression (b=-0.89, p=.012) and anxiety (b=-0.11, p=.003) from pre-test to 1-year follow up. Minor differences were found between the key constructs. Participants reported greater decreases in depression if they had fewer resources to deal with stress (b=1.31, p=.034), less hope (b=1.13, p=.010), and higher levels of disengagement coping (b=-2.11, p=.018) before the intervention. SGMY who appraised stress as threat (b=-0.25, p=.009), reported lower engagement coping (b=0.30, p=.042) and hope (b=0.14, p=.006) showed more improvement in anxiety. Participants showed more sustained improvement in depression one year after AFFIRM if they had more increase in the resources to deal with stress (b=-1.65, p=.010), reported more uptake of engagement coping (b=-3.80, p=.008), and developed more hope (b=-0.94, p=.040). Longitudinal reductions in anxiety were supported by significant increases in engagement coping (b=-0.33, p=.036).
Conclusions and Implications
Given the complexity of mental health within SGMY, the findings positively support the behavioral health benefits of social work science while demonstrating the impact of AFFIRM for SGMY. The study also demonstrates that AFFIRM was particularly useful for SGMY that encountered multiple stressors with limited coping skills. Results also indicate that the key intervention constructs that facilitated resilience (i.e., stress appraisal, coping, and hope) are critical to the development of transdiagnostic interventions for this population and to the long-term mental health benefits of AFFIRM. Ongoing methods to integrate these results into research that addresses mental health inequities will be discussed through the framework of social justice-focused practice.