Peer Support Interventions for Sexual and Gender Minority Youth with Behavioral Health Needs: A Scoping Review

Background: Sexual and gender minority youth (SGMY) in the general adolescent population have 2-4 times the risk of suicidality and self-harm compared to their heterosexual, cisgender peers. SGMY also experience barriers to engagement with treatment that supports their health and well-being, including discriminatory and traumatizing interactions with healthcare and social service providers. Research on the importance of peer support for SGMY social, emotional, and behavioral health is well documented. Supportive peers are a consistent protective factor for SGMY mental health. However, peer provider and peer support models of intervention to enhance mental health treatment engagement and continuity of care are less well studied. In this scoping review, we reviewed research that focused on a specific peer support program, intervention, or platform where one or more peers, meaning individuals with shared lived experience as the target population, delivered or co-delivered peer support in person or in a virtual setting. The central research questions for this scoping review are: (1) How is peer support defined and operationalized in peer support programs, interventions, or platforms for SGMY with behavioral health needs, and (2) What are the impacts of these programs, interventions, or platforms on SGMY engagement and behavioral health?

Methods: Scoping review study methods following the framework recommended by Colquhoun et al. (2014) involve 6 stages: (1) identifying the research question; (2) identifying relevant studies; (3) study selection; (4) charting the data; (5) collating, summarizing, and reporting results; and (6) consultation with key stakeholders. Searches were conducted in PsycInfo (EBSCO), PubMed, Medline (Ovid), CINAHL (Ebsco), Social Sciences Citation Index, SCOPUS, and LGBTQ+ Source, tailoring terms for each database and including both
controlled vocabulary terms and keywords. 535 studies were imported for screening and 154 duplicates were removed. After title and abstract review, 323 studies were removed and 54 studies were read in full. Of those, 11 studies were included in the final review.

Results: Findings show variation in peer support definitions and modalities across formal and informal program platforms from highly structured intervention development to community-generated peer support. There is promising evidence for peer support to increase treatment engagement, and the acceptability and usability of peer support interventions for SGMY populations. Areas for continued attention include better definitional work on peer support for this population, including types of support specific to the contextual needs of SGMY. We identified an emerging typology of peer support critical for SGMY with behavioral health needs: community knowledge, navigational capacity, affective capacity, and sociopolitical development.

Conclusion and Implications: Peer support, informal and formal, is especially salient to SGMY due to the long history of seeking and building supportive relationships outside of hetero/cis normative norms of family and relationships. As mental health treatment needs continue to grow for SGMY, the need for peer support interventions increases. Peer support interventions are aligned with the values of community-generated holistic mental healthcare for SGM populations, and have the potential to change treatment engagement and behavioral health outcomes for this minoritized population.