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A unified protocol to address sexual minority women's minority stress, mental health and hazardous drinking

解决性少数群体女性压力、心理健康和危险饮酒问题的统一协议

基本信息

批准号：
10363453
负责人：
TONDA L HUGHES
金额：
$ 79.49万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2022
资助国家：
美国
起止时间：
2022-09-12 至 2027-08-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10363453
关键词：
Address Affect Affective Alcohol consumption Alcohol dependence Alcohols Anxiety Awareness Behavioral Bisexual Cardiovascular Diseases Cities Cognitive Cognitive Therapy Communities Coping Behavior Counseling County Demographic Factors Discrimination Ethnic Origin Exposure to Family Foundations Funding Gender Identity Health Health Services Heavy Drinking Heterosexuals Incentives Individual Intervention Intervention Trial Interview Knowledge Laws Leadership Lesbian Lesbian Gay Bisexual Transgender Queer Link Liver diseases Malignant Neoplasms Mediating Mental Depression Mental Health Meta-Analysis Methods Modality Morbidity - disease rate Motivation National Institute on Alcohol Abuse and Alcoholism Participant Pathway interactions Persons Policies Population Populations at Risk Preparation Promoting Action on Research Implementation in Health Services framework Protocols documentation Provider Psychotherapy Race Randomized Controlled Trials Reaction Reporting Research Risk Role Services Sex Orientation Sexual and Gender Minorities Shame Site Stress and Coping Structure System Testing Therapeutic Intervention Time TimeLine Training United States National Institutes of Health Waiting Lists Woman Women&apos s Health World Health Organization acceptability and feasibility alcohol related problem alcohol risk alcohol use disorder arm assault base behavioral health biological adaptation to stress community center community clinic community setting comorbid depression comorbidity coping disparity reduction drinking efficacy testing emotion dysregulation empowered expectation experience gender minority group hazardous drinking help-seeking behavior high risk high risk population implementation facilitators improved internalized stigma intervention delivery laboratory experience minority stress minority stressor mortality peer personalized medicine pilot trial primary outcome psychosocial queer remote delivery remote intervention response scale up secondary outcome sexual identity sexual minority women skills social stigma telehealth treatment as usual

项目摘要

PROJECT SUMMARY Background. Sexual minority women (SMW) represent one of the highest-risk groups for hazardous drinking (HD) and comorbid mental health problems (e.g., depression, anxiety) because of their exposure to minority stressors (i.e., stigma-related burdens) and associated stress reactions, like drinking to cope. Research has identified cognitive (e.g., expectations of rejection), affective (e.g., shame), and behavioral (e.g., avoidant coping) pathways through which minority stress places SMW at disproportionate risk of HD and comorbid depression/anxiety. Yet no interventions address these pathways. In fact, no HD intervention has ever been tested for efficacy with SMW. Preliminary Studies. With deep stakeholder input and NIH (R01MH109413- 02S1) and foundation (Lesbian Health Fund) support, we created EQuIP (Empowering Queer Identities in Psychotherapy). EQuIP is a 10-session cognitive-behavioral intervention focused on improving SMW’s minority stress reactions by raising awareness of the harms of minority stress, building self-affirming cognitive styles, and reducing avoidant coping. In a waitlist-controlled pilot trial (n=60), EQuIP showed strong promise for reducing HD and depression/anxiety by building adaptive responses to minority stress, making it the first intervention with preliminary efficacy for improving this population’s co-occurring behavioral and mental health challenges. Methods. We now seek to test EQuIP’s efficacy and identify facilitators of scale-up of this promising intervention. Aim 1: In a 2-arm randomized controlled trial (RCT) with SMW who experience HD and comorbid depression and/or anxiety, we will test the efficacy of EQuIP (n=225) against treatment-as-usual (i.e., supportive counseling) (n=225). Our primary outcome is proportion of heavy drinking days (≥4 drinks) on 30- day timeline followback. Secondary outcomes include reduction in WHO alcohol risk level and depression and anxiety. Because remote intervention delivery has quickly become normative, both EQuIP and treatment-as- usual will be delivered via telehealth (Zoom). In fact, our second pilot of EQuIP found strong feasibility and acceptability of telehealth delivery. Aim 2: Assessments at baseline, 4, 8, and 12 months will determine if reductions in EQuIP’s intended psychosocial mechanisms (e.g., internalized stigma, rejection sensitivity, emotion dysregulation) mediate heavy drinking reductions. To advance personalized medicine, we will also examine whether EQuIP is differentially efficacious across key demographic factors and stigma moderators. Aim 3: To prepare for implementation in frontline settings, we will conduct semi-structured interviews with directors (n=20), providers (n=20), and service users (n=20) from a network of 250 US LGBTQ community clinics. Applying the i-PARIHS framework will help identify facilitators that can support EQuIP implementation at these centers. Summary. As the first trial of an intervention for SMW’s HD and co-occurring mental health, this study responds to NIAAA’s call for trials of “interventions that address AUDs and related problems and that are appropriate to the needs of sexual and gender minority populations.”

项目总结