JMIR Publications

ABSTRACT

Background:

LGBTQIA+ youth have disproportionately high levels of depression, self-harm, and suicidal thoughts and behaviors. Additionally, LGBTQIA+ youth frequently report lower levels of satisfaction or comfort with their health care providers due to stigmatization that may prevent continuation of care. Yet there is a lack of mental health treatment and outcome research that addresses these disparities. However there is some indication that LGBTQIA+ individuals feel more comfortable in online formats indicating that telehealth services may be beneficial for this population.

Objective:

This program evaluation explored the effectiveness of one remote intensive outpatient program (IOP) with a curriculum tailored specifically to LGBTQIA+ youth with high acuity depression, anxiety, and suicidality. This evaluation sought to answer: 1) Are LGBTQIA+ youth and young adult patients more clinically severe at intake and discharge relative to non-LGTBQIA+ patients? 2) Are LGBTQIA+ youth and young adult patients experiencing clinically significant change from intake to discharge in LGBTQIA+ specific programming? and 3) Are there subgroup differences in change within the LGBTQIA+ population?

Methods:

Data were collected from intake and discharge outcome surveys measuring depression, suicidality, and nonsuicidal self-harm (NSSI) for 880 patients who attended at least 6 sessions of a remote IOP for youth and young adults. 575 clients identified as having at least one LGBTQIA+ identity; they participated in a LGBTQIA+ adapted program of the general curriculum.

Results:

LGBTQIA+ patients were more clinically severe at intake in 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 compared to their non-transgender counterparts. LGBTQIA+ patients demonstrated improvement on all outcomes from intake to discharge. PHQ-A depression scores improved from 18.15 at intake to 10.83 at discharge and 41.49% of clients reported a reduction in depressive symptoms. 50.5% of LGTBQIA+ youth who endorsed passive suicidal ideation at intake no longer reported it at discharge; 72.1% who endorsed active suicidal ideation at intake no longer reported It at discharge, and 55.1% of patients who met criteria for clinical NSSI no longer met criteria at discharge. In the subgroup analysis, transgender patients were still 2 times more likely to report clinical nonsuicidal self-injury at discharge.

Conclusions:

This program evaluation found significant differences in rates of depression, NSSI and suicidal ideation between LGBTQIA+ clients compared to their non-LGBTQIA+ counterparts. Additionally, this evaluation showed a significant decrease in symptoms when clients attended LGBTQIA+ affirming care. 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.