LGBTQ + Affirmative CBT: a hierarchical linear model of longitudinal outcomes and mechanisms of change

Background: Sexual and gender diverse adolescents and young adults (SGDAYA) experience mental health disparities, yet few empirical investigations into the long-term impact of affirmative treatments on their well-being exist.

Methods: This study explored the longitudinal effects of a brief affirmative cognitive-behavioral therapy (CBT) group intervention (AFFIRM) on the depression and anxiety of SGDAYA (N = 202), as well as how pre-treatment and mid-intervention change mechanisms contributed to their improved mental health. Participants' age ranged from 14 to 29 years old at baseline (M = 22.12, SD = 4.60). Data were collected at four time points (pre-test, post-test, 6 months, 1 year) and analyzed using hierarchical linear models.

Results: Participants reported significant improvements in anxiety and depression from baseline to 1-year follow-up as well as increased engagement coping, social support, hope, and improved stress appraisal. SGDAYA, who appraised stress as a threat and had less ability to envision a hopeful future (hope pathway) at baseline, reported greater improvements in depression and anxiety; additionally, those who used more disengagement coping strategies prior to AFFIRM reported more reduction in depression. Participants with the most significant long-term improvement in depression reported (a) greater increases in their resources to deal with stress, (b) more uptake of engagement coping, and (c) improved hope pathway.

Conclusions: This study suggests that an affirmative cognitive-behavioural group intervention designed for SGDAYA can have a long-term impact on their depression and anxiety and highlights the important role of engagement coping, social support, hope and cognitive appraisals on youth mental health.

Engaging and strengthening youth through international community-based research: Implementation and evaluation of an International Youth Advisory Board

Youth advisory boards are ubiquitous in community-based research, yet there is limited description of their development or direct benefits to participants within international research contexts. This convergent mixed-method study describes and evaluates the design and implementation of a bilingual International Youth Advisory Board (IYAB) of 10 sexual and gender diverse youth (SGDY) aged 15–21 from Canada, the USA, and Mexico. During a 1-year term, youth participated in six virtual meetings, each incorporating an affirming group check in activity, bespoke youth-development workshop requested by participants (e.g., maintaining healthy relationships, managing conflict), and a feedback session to review draft study materials (e.g., recruitment flyers, surveys, and infographics). Participants completed brief quantitative measures at pre- and posttest and reported increased hope, self-esteem, sense of SGD community, self-advocacy skills, access to supportive adults, groupwork skills, and research competence. Qualitative data collected during a focus group in the final meeting were analyzed using inductive content analysis, producing five content categories of growth, diversity, action, connection, and reciprocity. Integrating these findings, three recommendations for implementing an IYAB are described: (1) support youth development and impact, (2) integrate diverse perspectives, and (3) design a transparent feedback loop. Implications for community psychology and community-based participatory research are discussed.