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苦的欺凌和受害。虐待和社会敌对环境反过来对他们的精神健康（例如，他们更有可能抑郁、自残和企图自杀）以及身体健康（例如，他们更有可能吸烟）产生负面影响。在联合王国（联合王国），一项紧迫的公共卫生挑战是解决这些青少年每天遭受的社会暴力的不利影响。例如，Amos和同事的论文来自英国全国代表性的千禧年纵向队列研究，该研究对近10,000名14岁的青少年进行了研究，报告称，在过去的12个月里，性少数群体（如LGB）青少年遭受言语和身体攻击的几率是异性恋同龄人的两倍。关于跨性别和性别多样化青少年的经历的报道较少，但研究一致证明，这些青少年的不良健康和福祉结果非常普遍。2017年，英国政府对LGBT人群进行了一项调查，收到了超过10万名LGBT人士的反馈，他们报告了许多受害、欺凌和歧视的例子。这项调查现在被用来制定一个名为“LGBT行动计划”的变革议程。该计划支持在学校、保健服务和社区采取行动，使同性恋、双性恋和变性者能够安全、幸福和健康地生活，而不必担心受到歧视。通常情况下，LGBTQ+青少年不能简单地离开有害的社会环境，因为他们在学校的实际限制和他们对家庭的经济依赖。许多人在地理上与LGBTQ+慈善机构或大城市地区聚集的支持团体隔绝，而且大多数人的父母都不是LGBTQ+。进一步加剧挑战的是，LGBTQ+青少年被认为更早“出柜”，结果他们往往还没有发展出LGBTQ+年轻人所拥有的更复杂的心理社会技能，这意味着他们年长的LGBTQ+同龄人可能更有能力应对有害的社会环境。因此，迫切需要提供广泛可及和有针对性的帮助，以帮助这些青少年发展尽可能好的技能，从而茁壮成长。已经采用了一些策略来识别和改善有害的社会环境，例如LGBTQ+组织在中学提供的反欺凌干预措施。然而，“反保健法”表明，卫生系统的政策往往在不经意间限制了健康状况最差和处境最不利的人群的基于需求的保健。这包括LGBTQ+青少年，不是因为他们很难接触到，而是像其他服务不足的人群一样，他们很容易被忽视。尽管LGBTQ+青少年是一个“高风险”人群，尽管性取向和性别重置在《平等法案》中受到保护，但针对他们的循证干预措施却很少。最近两篇关于心理社会治疗的系统综述发现，只有一种经过测试的在线工具可以支持LGBTQ+青少年的心理健康，该工具是由新西兰的Lucassen(即。“彩虹SPARX”)。针对一般人群的以证据为基础的应对策略，同时考虑到LGBTQ+青少年（例如，帮助他们管理LGBTQ+耻辱和受害的策略），提供了相当大的潜力。如果这些课程以吸引人的方式在线授课，并侧重于提高应对技能和建立韧性，则尤其如此。

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.