This week we will be discussing a systematic review article published in May 2020 in the Journal of LGBT Youth. The article, titled “Psychotherapeutic Interventions for LGBTQ+ youth: a systematic review” was written by authors Bochicchio, Reeder, Ivanoff, Pope, and Stefancic.
Why did they do it?
It is well documented that suicide is one of the top causes of death for adolescents worldwide. Further, researchers have demonstrated that the LGBTQ+ community is at particularly high risk of engaging in suicidal and/or self-injurious behavior. Regarding the youth population, as stated by the authors of this review, compared to heterosexual and cisgender youth, LGBTQ+ youth are four to six times more likely to carry out a suicide attempt that requires medical treatment. Additionally, they often experience heightened rates of other mental health concerns (e.g., depression, anxiety, substance abuse).
Amidst evidence that LGBTQ+ youth are at elevated risk for experiencing mental health problems, there is scarce information regarding best psychotherapeutic practices with LGBTQ+ youth. As such, the authors of this systematic review aimed to identify psychotherapeutic interventions used to address mental health and substance use problems among LGBTQ+ youth, as well as identify and investigate if and how these interventions were adapted to incorporate a more affirmative approach.
How did they do it?
The authors followed the Preferred Reporting Items for Systematic Reviews (PRISMA) framework to carry out their systematic review, with their literature search including peer-reviewed articles published within the past 20 years. Overall, 10 studies met full inclusion criteria for the review, and all participants in the included studies identified as part of the LGBTQ+ community and presented with various mental health concerns. Among included studies, authors discuss CBT and non-CBT based interventions, affirmative support and safe empowering talk (ASSET), community reinforcement approach (CRA), and online drug abuse prevention interventions.
What did they find?
Overall, the authors of this systematic review concluded that research examining treatment among LGBTQ+ youth, and particularly transgendered youth is severely lacking. The authors did, however, find that in terms of clinical intervention, both CBT and non-CBT based interventions appear promising for the treatment of mental health among LGBTQ+ youth. In studies included in this review, there were significant decreases in both anxiety and depression symptoms from baseline to post-intervention. Intervention adaptations for LGBTQ+ youth included both surface level adaptations (e.g., altering “observable” intervention characteristics to enhance compatibility with the community) and deep adaptations (e.g., contextualizing individual experience within population specific stressors).
The authors also identified significant limitations in the quality and design of many of the studies included in this review. According to the authors, all but two of the studies lacked randomization and a comparison group, thus making it nearly impossible to determine whether or not the adapted interventions were superior to “normal” treatment protocols. Another limitation included the lack of studies evaluating suicidal behavior, despite the well-known elevated rate of suicidal behavior among LGBTQ+ youth.
What does it all mean (our take)?
We thank the authors for this critically important systematic review. The apparent shortage of research evaluating how to best treat mental health difficulties experienced by LGBTQ+ youth is a highly important finding here, and demonstrates that while the field acknowledges this is an important domain, more resources should be allocated toward further research. Individualized treatment is what practitioners strive for, and we look forward to continuing to read more articles like these, that are paving the way to ensure that anyone who needs mental healthcare receives the highest quality and most effective care available.