Accepted for/Published in: JMIR Formative Research
Date Submitted: Oct 1, 2024
Date Accepted: Apr 24, 2025
Impact of Online Mental Health Resources During COVID-19 on LGBTQ+ Adults and Compared to Heterosexual Adults: Exploratory Analyses of Pre-Post Survey Data
ABSTRACT
Background:
Lesbian, gay, bisexual, transgender, queer and/or questioning (LGBTQ+) individuals faced greater mental health challenges during COVID-19 than binary gender heterosexual (non-LGBTQ+) adults. The T4W/Juntos website for free wellbeing resources, developed during COVID-19 with partner input, included LGBTQ-focused resources. A pilot evaluation for adults (18+ years old) found engagement in and use of website 4-6 weeks before follow-up associated with reduced (post-pre) depression. Results for LGBTQ+ were not reported.
Objective:
To describe baseline depression, anxiety, and website engagement for LGBTQ+ compared with non-LGBTQ+ adults and post-pre change in depression and anxiety (primary).
Methods:
Community partners invited providers, clients, and partners to visit website and complete online surveys (September 20, 2021-April 4, 2022) and at 4-6–week follow-up (October 22, 2021-May 17, 2022). LGBTQ+ were compared to non-LGBTQ+ in demographics, website use, and depression/anxiety. Sensitivity analyses adjusted for nonresponse (inverse probability weighting/IPW). Regression analyses identified key predictors for significant reduction (post-pre) in depression (PHQ-2) and anxiety (GAD-2).
Results:
Of 315 adults completing baseline and 193 follow-up, 64 (20.3%) and 37 (19.2%) were LGBTQ+, respectively. At baseline, more LGBTQ+ compared to non-LGBTQ+ had more moderate or greater anxiety or depression (GAD-2/PHQ-2≥3) (60.3% versus 24.8%, χ21 =28.65, P<.001) and more COVID-19 stressors (8.1(SD 4.4) versus 6.5(SD 4.0), t298=2.8, P=.003). Prior to follow-up, LGBTQ+ compared to non-LGBTQ+ had similar website use and any recommending website to others (P >.05) LGBTQ+ compared to non-LGBTQ+ had more reduction (post-pre) in mean GAD-2, -0.8 (SD 2.0) versus 0.0 (SD 1.2), t177=-3.08, P=0.002) and mean PHQ-2 (-0.7 (SD 1.7) versus -0.1 (SD 1.4), t180=-2.16, P=.03). For LGBTQ+, predictors of post-pre decline (adjusting for nonresponse) in mean GAD-2 included visiting website/using resources 4-6 weeks prior (β = -1.95 (-3.20, -0.70), P=0.003); for decline in mean PHQ-2, visiting website/using resources was a borderline significant predictor adjusting for nonresponse (β = -.94 (-2.00, 0.013), P=.09). For non-LGBTQ+, visiting website was not a significant predictor of post-pre decline in mean PHQ-2 or GAD-2 (each P>.05).
Conclusions:
LGBTQ+ reported higher baseline depression, anxiety, and COVID stressors than non-LGBTQ adults, consistent with prior findings demonstrating unequal impacts on marginalized groups. Among LGBTQ+ adults but not non-LGBTQ+, higher website use was associated with reduction in anxiety over time. Findings suggest online resources tailored to LGBTQ+ may promote wellbeing for LGBTQ+ adults impacted by social stressors/pandemics. Clinical Trial: Not applicable.
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