Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment
BackgroundLesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequent...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
JMIR Publications
2023-04-01
|
| Series: | JMIR Formative Research |
| Online Access: | https://formative.jmir.org/2023/1/e45796 |
| _version_ | 1797734165552037888 |
|---|---|
| author | Katie R Berry Kate Gliske Clare Schmidt Ley David Elliette Cray Michael Killian Caroline Fenkel |
| author_facet | Katie R Berry Kate Gliske Clare Schmidt Ley David Elliette Cray Michael Killian Caroline Fenkel |
| author_sort | Katie R Berry |
| collection | DOAJ |
| description |
BackgroundLesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population.
ObjectiveThis program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming.
MethodsData were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum.
ResultsLGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge.
ConclusionsThis program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically. |
| first_indexed | 2024-03-12T12:39:20Z |
| format | Article |
| id | doaj.art-63dd3d2726df423792b141396b09d491 |
| institution | Directory Open Access Journal |
| issn | 2561-326X |
| language | English |
| last_indexed | 2024-03-12T12:39:20Z |
| publishDate | 2023-04-01 |
| publisher | JMIR Publications |
| record_format | Article |
| series | JMIR Formative Research |
| spelling | doaj.art-63dd3d2726df423792b141396b09d4912023-08-28T23:56:24ZengJMIR PublicationsJMIR Formative Research2561-326X2023-04-017e4579610.2196/45796Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following TreatmentKatie R Berryhttps://orcid.org/0000-0001-8340-3259Kate Gliskehttps://orcid.org/0000-0001-6109-3624Clare Schmidthttps://orcid.org/0000-0002-4493-5591Ley David Elliette Crayhttps://orcid.org/0000-0002-6480-4409Michael Killianhttps://orcid.org/0000-0002-2287-9007Caroline Fenkelhttps://orcid.org/0000-0003-0601-9020 BackgroundLesbian, gay, bisexual, transgender, queer, intersex, asexual, and other minoritized gender and sexual identities (LGBTQIA+) youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. In addition, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers because of stigmatization, which may prevent continuation of care, yet there is a lack of mental health treatment and outcome research addressing these disparities. However, there is some indication that LGBTQIA+ individuals feel more comfortable with web-based formats, indicating that telehealth services may be beneficial for this population. ObjectiveThis program evaluation explored the effectiveness of a remote intensive outpatient program with a curriculum tailored specifically to LGBTQIA+ youth with high-acuity depression, anxiety, and suicidality. This study sought to understand baseline acuity differences between LGBTQIA+ and non-LGBTQIA+ youth and young adult patients and to determine if there were differences in clinically significant improvement by subtypes within the LGBTQIA+ population following participation in LGBTQIA+-specific programming. MethodsData were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-injury (NSSI) in 878 patients who attended at least six sessions of a remote intensive outpatient program for youth and young adults. Of these 878 clients, 551 (62.8%) were identified as having at least one LGBTQIA+ identity; they participated in an LGBTQIA+-adapted program of the general curriculum. ResultsLGBTQIA+ patients had more clinically severe intake for depression, NSSI, and suicidal ideation. Nonbinary clients had greater NSSI within the LGBTQIA+ sample at intake than their binary counterparts, and transgender clients had significantly higher depressive scores at intake than their nontransgender counterparts. LGBTQIA+ patients demonstrated improvements in all outcomes from intake to discharge. The Patient Health Questionnaire for Adolescents depression scores improved from 18.15 at intake to 10.83 at discharge, representing a 41.5% reduction in depressive symptoms. Overall, 50.5% (149/295) of the LGBTQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge, 72.1% (160/222) who endorsed active suicidal ideation at intake no longer reported it at discharge, and 55.1% (109/198) of patients who met the criteria for clinical NSSI no longer met the criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical NSSI at discharge. ConclusionsThis program evaluation found substantial differences in rates of depression, NSSI, and suicidal ideation between LGBTQIA+ clients compared with their non-LGBTQIA+ counterparts. In addition, this evaluation showed a considerable decrease in symptoms when clients attended LGBTQIA+-affirming care. The findings provide support for the role of LGBTQIA+-specific programming to meet the elevated mental health needs of these youth and that more research is needed to understand barriers that may negatively affect transgender clients, specifically.https://formative.jmir.org/2023/1/e45796 |
| spellingShingle | Katie R Berry Kate Gliske Clare Schmidt Ley David Elliette Cray Michael Killian Caroline Fenkel Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment JMIR Formative Research |
| title | Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment |
| title_full | Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment |
| title_fullStr | Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment |
| title_full_unstemmed | Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment |
| title_short | Lesbian, Gay, Bisexual, Transgender, Queer, Intersex, Asexual, and Other Minoritized Gender and Sexual Identities–Adapted Telehealth Intensive Outpatient Program for Youth and Young Adults: Subgroup Analysis of Acuity and Improvement Following Treatment |
| title_sort | lesbian gay bisexual transgender queer intersex asexual and other minoritized gender and sexual identities adapted telehealth intensive outpatient program for youth and young adults subgroup analysis of acuity and improvement following treatment |
| url | https://formative.jmir.org/2023/1/e45796 |
| work_keys_str_mv | AT katierberry lesbiangaybisexualtransgenderqueerintersexasexualandotherminoritizedgenderandsexualidentitiesadaptedtelehealthintensiveoutpatientprogramforyouthandyoungadultssubgroupanalysisofacuityandimprovementfollowingtreatment AT kategliske lesbiangaybisexualtransgenderqueerintersexasexualandotherminoritizedgenderandsexualidentitiesadaptedtelehealthintensiveoutpatientprogramforyouthandyoungadultssubgroupanalysisofacuityandimprovementfollowingtreatment AT clareschmidt lesbiangaybisexualtransgenderqueerintersexasexualandotherminoritizedgenderandsexualidentitiesadaptedtelehealthintensiveoutpatientprogramforyouthandyoungadultssubgroupanalysisofacuityandimprovementfollowingtreatment AT leydavidelliettecray lesbiangaybisexualtransgenderqueerintersexasexualandotherminoritizedgenderandsexualidentitiesadaptedtelehealthintensiveoutpatientprogramforyouthandyoungadultssubgroupanalysisofacuityandimprovementfollowingtreatment AT michaelkillian lesbiangaybisexualtransgenderqueerintersexasexualandotherminoritizedgenderandsexualidentitiesadaptedtelehealthintensiveoutpatientprogramforyouthandyoungadultssubgroupanalysisofacuityandimprovementfollowingtreatment AT carolinefenkel lesbiangaybisexualtransgenderqueerintersexasexualandotherminoritizedgenderandsexualidentitiesadaptedtelehealthintensiveoutpatientprogramforyouthandyoungadultssubgroupanalysisofacuityandimprovementfollowingtreatment |