A unified intervention for young gay and bisexual men's minority stress, mental health, and HIV risk

 描述（由申请人提供）：年轻的同性恋和双性恋男子（YGBM）不成比例地经历抑郁，焦虑和物质使用问题，是美国艾滋病毒感染的最高风险群体之一。事实上，少数民族的压力，精神病发病率，物质使用和艾滋病毒的风险相互助长，形成了一个协同威胁YGBM的健康。然而，没有任何干预措施解决少数民族的压力，心理健康和药物使用问题，或其对艾滋病毒风险的联合影响。最近发现的少数民族压力 这些途径为改善YGBM的心理健康和降低艾滋病毒风险提供了明确的目标。其中一些过程本质上是认知和情感的，如内化的同性恋恐惧症和拒绝图式，而另一些过程则以行为回避为特征，如性取向隐瞒，不自信和冲动。强有力的证据表明，YGBM的每一个共同发生的健康风险都植根于这些少数民族的压力途径。初步研究。ESTEEM（有效的技能，赋予有效的男人）是一个10个会话的技能建设干预，旨在通过解决潜在的认知，情感和行为途径，通过少数民族的压力损害健康，以减少YGBM的共同发生的健康风险。我们创建了ESTEEM（NIMH R34），通过采用统一的认知行为协议来促进抑郁/焦虑和高危YGBM中的少数压力应对。ESTEEM旨在使少数民族压力的不利影响正常化，减少内化的同性恋恐惧症和拒绝图式，并减少YGBM的不健康的回避倾向（例如，性行为中使用药物，不使用避孕套）。在一项初步的等待名单试验中，ESTEEM显著减少了YGBM的相关健康威胁谱，使其成为第一个同时改善YGBM心理健康、物质使用和性风险结果的循证干预措施。方法.确定（1）与社区心理健康治疗和艾滋病毒咨询和检测相比，ESTEEM的有效性，（2）ESTEEM是否通过其假设的认知，情感和行为少数压力过程发挥作用，以及（3）ESTEEM在改善心理健康和避免艾滋病毒感染方面的成本效益。我们在基线、3个月、6个月和12个月的主要结局是“保护性行为”，定义为在没有PrEP或已知HIV+主要伴侣的病毒载量检测不到的情况下无避孕套肛交。次要结果包括抑郁症，焦虑症，物质使用，性强迫症和PrEP摄取-自我们的R34试点以来获得FDA批准。针对不同问题部署独立干预措施是目前减少YGBM精神、行为和性健康问题的最昂贵方法。一个单一的干预，减少YGBM的抑郁症，焦虑，物质使用，和艾滋病毒的风险，通过减少这些问题的共同少数压力途径，是一个有效的，具有成本效益的替代目前孤立的方法，并持有很大的希望，减少性取向的健康差距年轻男子。

 DESCRIPTION (provided by applicant): Young gay and bisexual men (YGBM) disproportionately experience depression, anxiety, and substance use problems and are among the highest risk group for HIV infection in the U.S. Diverse methods locate the source of these health disparities in YGBM's exposure to minority stress. In fact, minority stress, psychiatric morbidity, substance use, and HIV risk fuel each other, forming a synergistic threat to YGBM's health. Yet no intervention addresses minority stress, mental health and substance use problems, or their joint impact on HIV risk in this population. Recently discovered minority stress pathways offer clear targets for improving YGBM's mental health and reducing HIV risk. Some of these processes are cognitive and affective in nature, such as internalized homophobia and rejection schemas, whereas others are characterized by behavioral avoidance, such as sexual orientation concealment, unassertiveness, and impulsivity. Strong evidence suggests that each of YGBM's co-occurring health risks is rooted in these minority stress pathways. Preliminary Studies. ESTEEM (Effective Skills to Empower Effective Men) is a 10-session skills-building intervention designed to reduce YGBM's co-occurring health risks by addressing the underlying cognitive, affective, and behavioral pathways through which minority stress impairs health. We created ESTEEM (NIMH R34), by adapting a unified cognitive-behavioral protocol to promote minority stress coping among depressed / anxious and at-risk YGBM. ESTEEM aims to normalize the adverse impact of minority stress, reduce internalized homophobia and rejection schemas, and decrease YGBM's unhealthy avoidance tendencies (e.g., substance use during sex, condom use non-assertion). In a preliminary waitlist trial, ESTEEM significantly reduced YGBM's spectrum of related health threats, making it the first evidence-based intervention to simultaneously improve mental health, substance use, and sexual risk outcomes in YGBM. Methods. To determine (1) the efficacy of ESTEEM compared to community mental health treatment and HIV counseling and testing, (2) whether ESTEEM works through its hypothesized cognitive, affective, and behavioral minority stress processes, and (3) ESTEEM's cost-effectiveness in terms of improved mental health and HIV infections averted. Our primary outcome at baseline, 3-, 6-, and 12-months is "protected sex," defined as condomless anal sex in the absence of PrEP or known undetectable viral load of HIV+ primary partners. Secondary outcomes include depression, anxiety, substance use, sexual compulsivity, and PrEP uptake-FDA-approved since our R34 pilot. Deploying stand-alone interventions for separate problems represents the current, but most costly, method of reducing YGBM's mental, behavioral, and sexual health problems. A single intervention that reduces YGBM's depression, anxiety, substance use, and HIV risk by reducing the common minority stress pathways across these problems represents an efficient, cost-effective alternative to currently isolated approaches, and holds great promise for reducing sexual orientation health disparities among young men.