Building resilience: Co-designing an online rainbow wellbeing toolkit for public health systems to promote wellbeing and resilience in LGBTQ+ youth

尽管社会进步迅速，LGBTQ+青少年仍然经常遭受令人痛心的欺凌和受害。虐待和社会敌对环境反过来又对他们的心理健康产生负面影响（例如，他们更有可能抑郁，自残和企图自杀）以及他们的身体健康（例如，他们更有可能吸烟）。一个紧迫的公共卫生挑战是解决这些青少年在日常生活中所经历的社会暴力的不利影响。例如，阿莫斯和同事的论文来自英国全国代表性的纵向千禧年队列研究，近10，000名14奥尔兹的青少年报告说，性少数群体（例如LGB）青少年在过去12个月内受到口头和身体攻击的几率是异性恋同龄人的两倍。关于变性人和性别多样化青少年的经历报道较少，但研究一直记录了这些青少年不良健康和福祉结果的高发生率。2017年，英国政府对LGBT人群进行了一项调查，并收到了超过10万名LGBT人士的回复，他们报告了许多被歧视、欺凌和歧视的例子。这项调查现已被用于制定一项名为“男女同性恋、双性恋和变性者行动计划”的变革议程。该计划支持在学校、卫生服务和社区采取行动，使LGBT人群能够过上安全、幸福和健康的生活，而不必担心受到歧视。通常，由于学校的实际限制和对家庭的经济依赖，LGBT+青少年无法简单地离开有害的社会环境。许多人在地理上与聚集在大城市地区的LGBTQ+慈善机构或支持团体隔离，大多数人的父母都不是LGBTQ+。进一步加剧挑战的是，LGBTQ+青少年被认为是“出柜”更早，因此，他们往往还没有开发出更复杂的心理社会技能，LGBTQ+的人谁出来作为年轻的成年人拥有，这意味着他们的老年LGBTQ+同龄人可能更好地装备处理有害的社会环境。因此，迫切需要广泛提供有针对性的帮助，以帮助这些青少年发展最佳技能，使其茁壮成长。已采取战略来认识和改善有害的社会环境，如LGBTQ+组织在中学提供的反欺凌干预措施。然而，“反向护理法”表明，卫生系统的政策往往无意中限制了健康状况最差和处境最不利的人群的基于需求的护理。这包括LGBTQ+青少年，不是因为他们很难接触到，但像其他服务不足的人群，他们将很容易被忽视。虽然LGBTQ+青少年是一个“高风险”的人群，尽管性取向和性别重置是受保护的特点在平等法，很少有证据知情的干预措施已经为他们开发。最近两项关于心理社会治疗的系统性综述只发现了一种支持LGBTQ+青少年心理健康的单一测试在线工具，该工具由Lucassen在新西兰开发（即“Rainbow SPARX”）。应对策略，是基于证据的一般人群，但微调与LGBTQ+青少年铭记（例如，与战略，帮助他们管理LGBTQ+污名和歧视）提供了相当大的潜力。如果以参与的方式在线提供，并侧重于提高应对技能和建设复原力，情况尤其如此。

Despite rapid social progress LGBTQ+ adolescents often still experience distressing bullying and victimization. Mistreatment and socially hostile environments in turn negatively impact on their mental health (e.g. they are more likely to be depressed, self-harm and attempt suicide) as well as their physical health (e.g. they are more likely to smoke cigarettes). A pressing public health challenge is addressing the adverse effects of the social violence these adolescents experience on a day-to-day basis in the United Kingdom (UK). For example, Amos and colleagues' paper from the UK's nationally representative longitudinal Millennium Cohort Study of almost 10,000 14-year olds reported that sexual minority (e.g. LGB) adolescents had twice the odds of being verbally and physically assaulted in the past 12 months compared to their heterosexual peers. Less has been reported on the experiences of transgender and gender diverse adolescents, but studies have consistently documented a high prevalence of adverse health and wellbeing outcomes for these adolescents. In 2017 the UK Government conducted a survey of LGBT people and received responses from over 100,000 LGBT individuals who reported numerous examples of victimisation, bullying and discrimination. This survey has now been used to set an agenda for change, entitled the "LGBT Action Plan". This plan supports action in schools, health services and communities so that LGBT people can live safe, happy and healthy lives without fear of discrimination.Typically, LGBTQ+ adolescents cannot simply leave harmful social environments due to the practical constraints around their schooling and their economic dependence on their families. Many are geographically isolated away from the LGBTQ+ charities or support groups clustered in large urban areas and most will not have parents who are LGBTQ+. Further exacerbating the challenges is that LGBTQ+ adolescents are thought to be 'coming out' earlier and as a result they frequently have not yet developed the more sophisticated psycho-social skills that LGBTQ+ people who come out as young adults possess, which means their older LGBTQ+ peers may be better equipped to handle harmful social environments. Hence, there is an urgent need for widely accessible and targeted help to assist these adolescents to develop the best possible skills to thrive. Strategies have been employed to recognise and improve harmful social environments, such as anti-bullying interventions delivered by LGBTQ+ organisations in secondary schools. However, the 'Inverse Care Law' demonstrates that health systems' policies often inadvertently restrict needs-based care in populations with the poorest health and greatest levels of disadvantage. This includes LGBTQ+ adolescents, not because they are hard to reach, but like other under-served populations they will be easy to neglect.Although LGBTQ+ adolescents are a 'high risk' population, and despite sexual orientation and gender reassignment being protected characteristics in the Equality Act, few evidence-informed interventions have been developed for them. Two recent systematic reviews of psycho-social treatments identified only a single tested online tool to support the mental wellbeing of LGBTQ+ adolescents, which was developed in New Zealand by Lucassen (i.e. 'Rainbow SPARX'). Coping strategies that are evidence-based for the general population but are fine-tuned with LGBTQ+ adolescents in mind (e.g. with strategies that assist them to manage LGBTQ+ stigma and victimisation) proffers considerable potential. This is especially so if they are delivered online in an engaging manner and focus on enhancing coping skills and building resilience.