AFFIRM Online: Utilising an Affirmative Cognitive–Behavioural Digital Intervention to Improve Mental Health, Access, and Engagement among LGBTQA+ Youth and Young Adults

Abstract

Digital mental health interventions may enable access to care for LGBTQA+ youth and young adults that face significant threats to their wellbeing. This study describes the preliminary efficacy of AFFIRM Online, an eight-session manualised affirmative cognitive behavioural group intervention delivered synchronously. Participants (Mage = 21.17; SD = 4.52) had a range of sexual (e.g., queer, lesbian, pansexual) and gender (e.g., non-binary, transgender, cisgender woman) identities. Compared to a waitlist control (n = 50), AFFIRM Online participants (n = 46) experienced significantly reduced depression (b = −5.30, p = 0.005, d = 0.60) and improved appraisal of stress as a challenge (b = 0.51, p = 0.005, d = 0.60) and having the resources to meet those challenges (b = 0.27, p = 0.059, d = 0.39) as well active coping (b = 0.36, p = 0.012, d = 0.54), emotional support (b = 0.38, p = 0.017, d = 0.51), instrumental support (b = 0.58, p < 0.001, d = 0.77), positive framing (b = 0.34, p = 0.046, d = 0.42), and planning (b = 0.41, p = 0.024, d = 0.49). Participants reported high acceptability. This study highlights the potential of digital interventions to impact LGBTQA+ youth mental health and explores the feasibility of digital mental health to support access and engagement of youth with a range of identities and needs (e.g., pandemic, lack of transportation, rural locations). Findings have implications for the design and delivery of digital interventions for marginalised youth and young adults.

Virtual care during the pandemic: Multi-family group sessions for Hong Kong Chinese families of adolescents with intellectual disabilities

“…Recent literature has demonstrated the use of online interventions for engaging adolescents with diverse psychosocial needs shows promise (e.g. Craig et al, 2021 ; Sansom-Daly et al, 2019 ). Despite mobile phones and other devices often being restricted in the lives of adolescents with intellectual disabilities ( Callus et al, 2019 ), the active participation of these adolescents in the group process described here may suggest the feasibility and acceptability of the use of a videoconferencing-based group intervention for Chinese adolescents with intellectual disabilities in Hong Kong.…”

Promoting Resilience and Well-being Through Co-design (The PRIDE Project): Protocol for the Development and Preliminary Evaluation of a Prototype Resilience-Based Intervention for Sexual and Gender Minority Youth

“…The focus of our work, and the limited earlier intervention research focused on SGMY in this field, has been directed at an individual level. For instance, Rainbow SPARX [ 21 ] and AFFIRM Online [ 26 ] have sought to reduce symptomatology, such as depressive symptoms, among individual SGMY. However, there are wider systemic issues that require attention in the United Kingdom and elsewhere, because SGMY are forced to live in a challenging heteropatriarchal society.…”

“…For instance, during the IDENTIFY to POSITION stages of the project, SGMY may highlight a preference for a reduced focus on managing symptoms of depression, which has been a key outcome or focus of digital interventions for SGMY to date (eg, for Rainbow SPARX [ 21 ], TODAY! [ 23 ], and AFFIRM Online [ 26 ]). Instead, SGMY may recommend, for example, that behavioral strategies to better handle peer bullying be a major focus of the toolkit.…”

“…This intervention was co-designed together with SGMY [ 24 ] and evaluated in a mixed methods open trial [ 21 , 25 ]. Most recently, a further intervention for SGMY has been delivered digitally for young people (aged 14-29 years) in Canada, also within a research context [ 26 ]. The intervention AFFIRM Online consists of 8 sessions facilitated by an SGM clinician and is provided on the web in a synchronous manner [ 26 ].…”

“…Most recently, a further intervention for SGMY has been delivered digitally for young people (aged 14-29 years) in Canada, also within a research context [ 26 ]. The intervention AFFIRM Online consists of 8 sessions facilitated by an SGM clinician and is provided on the web in a synchronous manner [ 26 ]. Arguably, requiring SGM clinician facilitation limits the intervention’s ability to potentially support large numbers of SGMY.…”