目的:LGBTQ肯定认知行为疗法(CBT)解决少数民族压力,以改善性少数群体的心理和行为健康。这种治疗方法从未在像中国这样的高污名环境中使用在线递送进行过测试。
方法:中国年轻的性少数男性(n=120;年龄16-30岁;HIV阴性;报告抑郁和/或焦虑症状以及过去90天的HIV传播风险行为),随机接受10次文化适应的异步LGBTQ肯定基于互联网的CBT(ICBT)或仅每周评估。主要结果包括HIV传播风险行为(即过去30天无公寓肛交)。次要结果包括HIV社会认知机制(例如,安全套使用自我效能),心理健康(例如,抑郁症),和行为健康(例如,酒精使用),以及少数民族压力(例如,验收问题),和普遍的(例如,情绪调节)在基线和4和8个月随访时的机制。适度分析检查了治疗功效与基线污名经历和疗程完成的关系。
结果:与仅评估相比,LGBTQ肯定ICBT并没有在HIV传播风险行为或社会认知机制方面产生更大的减少。然而,LGBTQ肯定ICBT在4个月和8个月的随访中,抑郁(d=-0.50,d=-0.63)和焦虑(d=-0.51,d=-0.49)得到了更大的改善,分别;8个月随访时的酒精使用(d=-0.40);和某些少数群体压力(例如,内化的污名)和普遍(即,情绪失调)与仅评估相比的机制。LGBTQ肯定ICBT对于降低内在化污名较低的参与者的HIV传播风险行为更有效(d=0.42)。更多的会议完成预示着自杀和沉思的减少。
结论:LGBTQ肯定ICBT对中国年轻性少数男性有初步疗效。研究结果可以在肯定支持有限的情况下为年轻的性少数群体男性提供未来的干预措施。
OBJECTIVE: LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals\' mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery.
METHODS: Chinese young sexual minority men (n = 120; ages 16-30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion.
RESULTS: Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d = -0.50, d = -0.63) and anxiety (d = -0.51, d = -0.49) at 4- and 8-month follow-up, respectively; alcohol use (d = -0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d = 0.42). Greater session completion predicted greater reductions in suicidality and rumination.
CONCLUSIONS: LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.