Intervention Development for Social Stress, Mental Health, and HIV Risk Among MSM

描述(申请人提供)：男同性恋者、双性恋者和其他男男性行为者(MSM)是美国受艾滋病毒影响最严重的人群，也是美国仅有的几个新感染人数持续上升的风险群体之一。男男性接触者还经历着极不成比例的精神健康障碍的风险，特别是抑郁和焦虑。许多研究表明，这种心理健康差距是由MSM经历的与他们的性取向有关的早期和持续的应激源造成的，称为少数民族应激。尽管少数族裔压力与焦虑和抑郁密切相关，少数族裔压力和相关的心理健康问题协同推动艾滋病毒危险行为，但现有的艾滋病毒预防干预措施没有针对少数族裔压力，以减少MSM的艾滋病毒危险行为。该项目旨在开发一种理论驱动的干预措施，通过瞄准将少数群体应激与艾滋病毒危险行为联系起来的基本心理社会机制，减少少数群体应激对健康的耗尽影响。这些机制包括不适应情绪调节、消极思维方式、低自我效能感、回避和冲动，这些正是现有认知-行为、人工干预的目标--统一议定书 情绪障碍的跨诊断治疗(UPTTED)UPTTED通过动机访谈、交互感知和情景暴露、认知重组、正念和自我监控练习来改变这些机制，所有这些都基于认知行为原则以及压力的发展和情感神经科学模型。这项拟议的研究将调整UPTTED，以支持高危MSM适应少数族裔压力的应对，缓解相关的抑郁和焦虑，并减少艾滋病毒风险行为。调整后的UPTTED预计将提高对少数群体压力的不良影响的认识；在面临少数群体压力时促进客观的自我图式；并加强个人管理少数群体压力及相关焦虑和抑郁的技能和自我效能，以降低感染艾滋病毒的风险。在过去3个月内经历过少数族裔压力、心理健康问题和艾滋病毒风险行为的MSM(n=30)和社区卫生专家(n=30)将提供建议，以适应现有的干预手册，包括与文化相关的插曲、例子和练习，以适应少数族裔压力和管理艾滋病毒风险。适应性干预的可行性、可接受性和初步效果将 然后在MSM(n=60)的随机等待名单对照试验中进行测试，这些MSM报告最近有少数民族压力、抑郁和焦虑以及艾滋病毒危险行为的经历。主要结果将是艾滋病毒危险行为。次要结果将是中介因素的减少，包括抑郁、焦虑和概念模型的机制。该项目创新性地试图测试第一个针对少数族裔压力的心理和性健康后果的理论驱动的干预措施的初步效果，并通过瞄准有力地驱动这些同时存在的健康威胁的潜在机制来实现这一点。 公共卫生相关性：男同性恋者、双性恋者和其他男男性行为者(MSM)是美国最大的艾滋病毒感染者群体，也是美国仅有的几个新艾滋病毒感染率正在上升的风险群体之一。通过解决MSM中艾滋病毒风险的基本来源，包括少数民族压力和相关的心理健康困难，该项目开发的干预措施可以减少MSM中的艾滋病毒危险行为，从而减少艾滋病毒的传播。

DESCRIPTION (provided by applicant): Gay, bisexual, and other men who have sex with men (MSM) are the population most severely affected by HIV in the U.S. and one of the only risk groups in the U.S. for which new infections continue to rise. MSM also experience a vastly disproportionate risk of mental health disorders, especially depression and anxiety. Numerous studies have shown that this mental health disparity arises from the early and ongoing stressors, known as minority stress, that MSM experience related to their sexual orientation. Despite the fact that minority stress is strongly related to anxiety and depression, and that minority stress and related mental health problems synergistically propel HIV risk behaviors, no existing HIV prevention intervention targets minority stress in order to reduce MSM's HIV risk behavior. This project aims to develop a theoretically-driven intervention that reduces the health-depleting effects of minority stress through targeting the basic psychosocial mechanisms linking minority stress to HIV risk behavior. These mechanisms include maladaptive emotion regulation, negative thinking styles, low self-efficacy, avoidance, and impulsivity, which are the very targets of an existing cognitive-behavioral, manualized intervention--the Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders (UPTTED). The UPTTED changes these mechanisms using motivational interviewing, interoceptive and situational exposure, cognitive restructuring, mindfulness, and self-monitoring exercises, all grounded in cognitive-behavioral principles and developmental and affective neuroscience models of stress. The proposed study will adapt the UPTTED to support high-risk MSM's adaptive coping with minority stress, alleviate associated depression and anxiety, and reduce HIV risk behavior. The adapted UPTTED is expected to increase awareness of the unhealthy impact of minority stress; facilitate objective self-schemas in the face of minority stress; and strengthen one's skills and self-efficacy for managing minority stress and associated anxiety and depression to reduce risk for acquiring HIV. MSM who have experienced minority stress, mental health problems, and HIV risk behavior in the previous 3 months (n = 30) and community health experts (n = 30) will provide suggestions for adaptations to the existing intervention manual, including culturally relevant vignettes, examples, and exercises for adaptively responding to minority stress and managing HIV risk. The feasibility, acceptability, and preliminary efficacy of the adapted intervention will then be tested in a randomized waitlist controlled trial with MSM (n = 60) who report recent experiences with minority stress, depression and anxiety, and HIV risk behavior. The primary outcome will be HIV risk behavior. Secondary outcomes will be reductions in mediators including depression, anxiety, and the mechanisms of the conceptual model. This project innovatively seeks to test the preliminary efficacy of the first theoretically-driven intervention targeting the mental and sexual health consequences of minority stress and does so by targeting the underlying mechanisms that powerfully drive these simultaneous health threats. PUBLIC HEALTH RELEVANCE: Gay, bisexual, and other men who have sex with men (MSM) represent the largest group of individuals infected with HIV in the U.S. and one of the only risk groups in the U.S. for which new HIV infection rates are increasing. By addressing fundamental sources of HIV risk among MSM, including minority stress and associated mental health difficulties, the intervention developed in this project can reduce HIV risk behavior among MSM and therefore the spread of HIV.