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

A、摘要 只有三分之一的青少年接受抑郁症治疗，许多人无法与临床男性进行互动。 总计卫生资源。性少数和性别少数青少年 (SGMY) 面临严重心理健康问题的风险更大 精神疾病和自杀倾向，甚至更不可能获得精神卫生服务，即使可以获得精神卫生服务。 广泛的因素——耻辱、对治疗的消极信念、缺乏心理健康知识——导致 不寻求服务。主流心理健康干预措施未能解决 SGMY 的独特因素： 抑制寻求帮助：双重耻辱（围绕心理健康的耻辱以及内在的同性恋恐惧症和跨性别歧视） 恐惧症）、担心透露 SGM 状况、家庭支持度低、无法获得 SGM 肯定精神 卫生专业人员。尽管很难联系到，但有抑郁症风险的SGMY在网上却相当活跃。然而 SGMY 特定的基于证据的在线干预措施缺乏，社区干预措施没有增强 心理健康寻求帮助。需要有针对性的在线干预措施来解决阻碍的独特因素 寻求帮助，但本身可用且有吸引力。当前的提案将使用用户知情的高效方法 考虑SGMY的异质性和特定需求的技术干预设计方法。我们会 使用行为干预技术模型来设计和研究若干干预原则 (IP)，或者 包括干预目标和行为策略在内的理论概念，以了解干预的机制 行动在迭代设计和潜在模式的同时充满希望。我们将使用人机交互 化（HCI）框架、发现、设计/构建和测试，以开发和研究多个 IP。具体我们将 (1a) 在 SGMY 中进行基于互联网的定性研究，以探索在线工具的当前使用情况、观点 干预目标（例如耻辱、社会支持、知识等负面态度）和知识产权偏好 组件和交付方式，(1b) 使用 HCI 技术开发初始原型并寻求迭代 用户反馈并 (2) 使用阶乘试验评估 4 个最终的低保真原型，以了解每个 IP 原型的单独和组合的可行性、可用性、可接受性以及寻求帮助意图的变化 多样化（种族、民族、年龄、性别认同、性取向）SGMY 的在线样本。这将告知 制定高保真干预措施，其中可能包括针对特定 SGMY 子项目的不同组成部分 组在更大规模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 医学并使用利益相关者知情的方法和人机交互技术进行了多年的研究 为干预措施的制定提供信息。通过与 SGM 健康、利益相关者参与、干预方面的专家合作， 化设计、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 弥合SGM青少年抑郁症和自杀倾向的差距，激励他们并装备他们 他们获得治疗所需的工具。该提案通过灵活实施来响应 NOT-MH-18-031 迭代测试和 NOT-MD-19-001 - 测试减少耻辱干预措施。

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.