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

针对年轻同性恋和双性恋男性的少数群体压力、心理健康和艾滋病毒风险的统一干预措施

基本信息

批准号：
9064338
负责人：
John Edward Pachankis
金额：
$ 82.71万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2016
资助国家：
美国
起止时间：
2016-02-15 至 2020-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/9064338
关键词：
Address Affect Affective Alcohol or Other Drugs use Anal Sex Anxiety Award Behavioral Bisexual Cognitive Cognitive Therapy Communities Counseling Data Depressed mood Development Economics Emotional Epidemic Evidence based intervention Exposure to FDA approved Future Gays HIV HIV Infections HIV risk Habits Health Health Personnel Heterosexuals Homophobia Impaired health Impulsivity Individual Intervention Interview Investments Joints Lesbian Gay Bisexual Transgender Mediating Mediation Mental Depression Mental Health Mental disorders Methods Minority Modeling Monitor Morbidity - disease rate National Institute of Mental Health Nature Outcome Pathway interactions Plant Roots Population Process Protocols documentation Psyche structure Public Health Resources Risk Risk Behaviors Safe Sex Self Efficacy Sex Orientation Sexual Health Source Stress Stress and Coping Testing Thinking Time Training Viral Load result anxious arm base behavioral health cognitive process condoms cost cost effective cost effectiveness efficacy testing emotion regulation empowered expectation experience health disparity high risk high risk men improved improved outcome male health men men who have sex with men mindfulness motivational enhancement therapy primary outcome public health relevance secondary outcome sex skills social social stigma theories therapy design uptake working men young man

项目摘要

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.

描述（由适用提供）：年轻的同性恋和双性恋男性（YGBM）不成比例地经历抑郁症，焦虑和药物使用问题，并且是美国各种方法中艾滋病毒感染的最高风险群体之一，可以在YGBM暴露于少数派压力中的这些健康差异的来源。实际上，少数群体压力，精神病发病率，药物使用和艾滋病毒风险互相燃料，从而形成了对YGBM健康的协同威胁。然而，没有干预能够解决少数群体的压力，心理健康和药物使用问题，或者它们对该人群中艾滋病毒风险的共同影响。最近发现的少数压力途径为改善YGBM的心理健康和降低HIV风险提供了明确的目标。其中一些过程本质上具有认知和情感性，例如内在的同性恋恐惧症和拒绝模式，而其他过程则具有避免行为的特征，例如性取向隐蔽，统一性和冲动性。有力的证据表明，YGBM的每种同时发生的健康风险都植根于这些少数族裔压力途径。初步研究。自尊（有效的有效男性能力的有效技能）是一种10条经验的技能建设干预措施，旨在通过解决少数群体压力损害健康的潜在认知，情感和行为途径，通过解决基本的认知，情感和行为途径，通过解决YGBM的同时发生健康风险。我们通过适应统一的认知行为方案来促进弱势 /焦虑和尊敬之间的少数族裔压力应对少数族裔压力，旨在使少数派压力的不利影响正常化，减少内在同性恋恐惧症和拒绝方案的不利影响，并减少YGBM的不健康的倾向（例如，在抑制性倾向）（例如，在抑制性倾向）（例如，在pentance contance pentance）中，我们创造了自尊（NIMH R34）。在一项初步候补列表试验中，自尊大大降低了YGBM相关健康威胁的范围，使其成为第一个基于证据的干预措施，以同时改善YGBM中的心理健康，药物使用和性风险结果。方法。（1）与社区心理健康治疗以及艾滋病毒咨询和测试相比，（2）尊敬的有效性，（2）尊敬是否通过其假设的认知，情感和行为少数群体压力过程来起作用，以及（3）（3）尊敬的成本效益，以改善的精神健康和艾滋病毒感染而避免。在基线，3，6和12个月的基线时，我们的主要结果是“受保护的性别”，在没有PREP或已知的HIV+主要伴侣的不可检测的病毒载量的情况下定义为无避孕套肛交。次要结果包括抑郁症，焦虑，药物使用，性强迫以及自R34飞行员以来批准的摄入量。部署独立问题的独立干预措施是减少YGBM的心理，行为和性健康问题的当前方法，但最昂贵的方法。通过减少这些问题的普通少数压力途径来减少YGBM的抑郁，焦虑，药物使用和HIV风险的单一干预措施代表了当前孤立方法的有效，具有成本效益的替代方案，并且对减少年轻男性的性取向健康分布有很大的希望。