Optimizing Technology Interventions for Help-Seeking for Depression and Suicidality in Sexual and Gender Minority Youth

优化技术干预措施，帮助性和性别少数青年寻求抑郁和自杀倾向

• 批准号: 10301242
• 负责人: Ana Radovic-Stakic
• 金额: $ 23.14万
• 依托单位: UNIVERSITY OF PITTSBURGH AT PITTSBURGH
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-10 至 2023-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10301242
• 关键词: Address; Adolescent; Adolescent Medicine; Affect; Age; Analysis of Variance; Anxiety; Attention; Attitude; Behavior Therapy; Behavioral; Belief; Cause of Death; Clinic; Clinical Trials; Code; Depression and Suicide; Development; Diagnosis; Discrimination; Electronic Mail; Environment; Evidence based treatment; Feedback; Fright; Future; Gender Identity; Goals; Health; Health Personnel; Health Professional; Health Resources; Health Services Accessibility; Health Technology; Healthcare; Heterogeneity; Homophobia; Individual; Intention; Internet; Intervention; Intervention Studies; Interview; Knowledge; Lead; Lesbian Gay Bisexual Transgender Queer; Literature; Mainstreaming; Maps; Marketing; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Modality; Modeling; Morbidity - disease rate; Outcome; Paper; Physicians; Population; Preventive; Primary Health Care; Randomized Controlled Trials; Reading; Research; Research Personnel; Risk; Route; Sampling; Schools; Services; Sex Orientation; Sexual and Gender Minorities; Sexual and Gender Minority Youth; Social support; Subgroup; Suicide; Techniques; Technology; Testing; Text Messaging; Work; Youth; age group; anxiety symptoms; anxiety treatment; base; behavior change; care seeking; child depression; community based research; community intervention; computer human interaction; depressive symptoms; design; digital health; evidence base; experience; family support; follow-up; health knowledge; help-seeking behavior; improved; multiphase optimization strategy; online intervention; preference; prevent; primary care setting; prototype; racial and ethnic; recruit; routine screening; sexual health intervention; social; social media; social stigma; successful intervention; support network; systematic review; theories; therapy design; therapy development; tool; transphobia; uptake; usability; web-based intervention

A. Abstract Only one-third of adolescents access treatment for depression, and many fail to interact with clinic-based men- tal health resources. Sexual and gender minority youth (SGMY) are at greater risk for severe mental health disorders and suicidality but even less likely to access mental health services, even when access is available. Widespread factors – stigma, negative beliefs about treatment, lack of mental health knowledge - contribute to not seeking services. Mainstream mental health interventions fail to address unique factors to SGMY that in- hibit help-seeking: double stigma (stigma around mental health as well as internalized homophobia and tran- sphobia), concern about revealing SGM status, low family support, lack of access to SGM affirming mental health professionals. Despite being hard-to-reach, SGMY at risk for depression are quite active online. Yet SGMY-specific evidence-based online interventions are lacking and community interventions do not enhance mental health help-seeking. Targeted online interventions are needed to address unique factors which prevent help-seeking but are themselves usable and engaging. The current proposal will use a user-informed efficient approach to technology intervention design considering the heterogeneity and specific needs of SGMY. We will use the Behavioral Intervention Technology Model to design and study several intervention principles (IPs), or theoretical concepts including intervention aims and behavioral strategies, to understand which mechanisms of action hold promise while being iterating design and potential modalities. We will use human computer interac- tion (HCI) framework, Discover, Design/Build, and Test to develop and study several IPs. Specifically we will (1a) conduct an internet-based qualitative study in SGMY to explore current use of online tools, perspectives on intervention targets (e.g. negative attitudes like stigma, social support, knowledge), and preferences for IP components and delivery modalities, (1b) use HCI techniques to develop initial prototypes and seek iterative user feedback and (2) evaluate 4 finalized low-fidelity prototypes using a factorial trial to understand each IP prototype’s individual and combined feasibility, usability, acceptability, and change in help-seeking intention in an online sample of diverse (racially, ethnically, age, gender identity, sexual orientation) SGMY. This will inform the development of a high-fidelity intervention which may include different components for specific SGMY sub- groups to be evaluated in a larger clinical trial. The PI, Dr. Radovic, is a physician researcher in adolescent medicine and has conducted years of research using stakeholder-informed methods and HCI techniques to inform intervention development. By working with experts in SGM health, stakeholder engagement, interven- tion design, qualitative analysis, HCI design, and BIT development and testing, we have an exciting opportunity to bridge the gap for SGM adolescents with depression and suicidality to motivate them to and equip them with the tools they need to access treatment. This proposal is responsive to NOT-MH-18-031 by conducting nimble iterative testing and NOT-MD-19-001 - testing stigma reduction interventions.

A.摘要 只有三分之一的青少年接受抑郁症治疗，许多人无法与诊所的男性互动- 谈论卫生资源。性和性别少数青年（SGMY）面临更大的严重心理健康风险 精神障碍和自杀倾向，但更不可能获得精神卫生服务，即使可以获得。 广泛的因素-耻辱，对治疗的消极信念，缺乏心理健康知识-有助于 不寻求服务。主流的心理健康干预措施未能解决SGMY的独特因素， 寻求帮助：双重耻辱（围绕心理健康的耻辱以及内化的同性恋恐惧症和跨性别歧视） 抑郁症），担心透露SGM状态，家庭支持低，缺乏SGM确认心理 卫生专业人员。尽管很难接触到，但有抑郁风险的SGMY在网上相当活跃。然而 缺乏针对SGMY的循证在线干预措施，社区干预措施也没有加强 心理健康求助需要有针对性的在线干预措施，以解决防止 求助，但他们自己是有用的和参与。目前的建议将使用一个用户知情的高效 考虑SGMY的异质性和具体需求的技术干预设计方法。我们将 使用行为干预技术模型设计和研究几个干预原则（IP），或 理论概念，包括干预目标和行为策略，以了解哪些机制， 在迭代设计和潜在模式的同时，行动保持承诺。我们将使用人机交互- 的基础架构，发现，设计/构建和测试，以开发和研究几个IP。具体来说，我们将 (1a)在SGMY进行基于互联网的定性研究，以探索当前使用的在线工具，观点 关于干预目标（例如，污名化、社会支持、知识等消极态度）和对知识产权的偏好 组件和交付模式，（1b）使用HCI技术开发初始原型，并寻求迭代 用户反馈和（2）使用析因试验评估4个最终的低保真原型，以了解每个IP 原型的个体和组合的可行性、可用性、可接受性，以及在 一个在线样本的不同（种族，民族，年龄，性别认同，性取向）SGMY。这将通知 开发高保真干预，其中可能包括特定SGMY子系统的不同组件， 在更大的临床试验中进行评估。PI，Radovic博士，是一名青少年医学研究员， 医学，并进行了多年的研究，使用知情的方法和人机交互技术， 制定知情干预措施。通过与SGM健康专家合作，利益相关者参与， 任务设计、定性分析、HCI设计以及BIT开发和测试，我们有一个令人兴奋的机会 为有抑郁和自杀倾向的SGM青少年弥合差距，激励他们并为他们提供 他们获得治疗所需的工具。本建议书通过灵活执行 迭代测试和NOT-MD-19-001测试减少耻辱干预。