Comparing Two Ways to Help Sexual and Gender Minority Men Who Have Been Sexually Abused Reduce Depression and Increase Mental Health Treatment Engagement

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What was the research about?

Sexual and gender minority, or SGM, men include those who identify as gay, bisexual, trans, nonbinary, genderqueer, or intersex. SGM men experience higher rates of sexual abuse than other men. These experiences can lead to depression; substance use; suicide; or posttraumatic stress disorder, or PTSD.

In this study, the research team compared two online programs for SGM men who have been sexually abused and have depression:

• Motivational interviewing (MI). SGM men received six weekly, 90-minute online video sessions. During these sessions, two trained peers talked about types of stress in daily life, trauma and behavior change, personal values and strengths, building self-confidence, and planning for positive life changes. Peers supported behavior change and using mental health treatment.
• MI plus affirmative care. Along with the MI program, during sessions with peers, SGM men received information about myths and facts regarding sexual abuse of boys and men, sexual abuse of SGM individuals, and men seeking mental health treatment. Peers talked about how to change unhelpful patterns of thinking.

What were the results?

Right after the programs ended and two and four months later, the two programs didn’t differ in improving:

• Depressive symptoms
• Use of mental health treatment
• PTSD symptoms
• Quality of life
• Suicidal thoughts

These health outcomes improved for patients in both programs.

Among patients with severe depression, patients who received MI plus affirmative care had fewer depression symptoms than patients who received MI.

Who was in the study?

The study included 356 SGM men in the United States and Canada who had been sexually abused. Of these, 85 percent were White, 15 percent were Hispanic, and 9 percent were Black. Also, 66 percent identified as gay; 22 percent as bisexual; 2 percent as men who have sex with men; and 11 percent as pansexual, asexual, or another sexual attraction. The average age was 35; 83 percent identified as cisgender and 17 percent identified on the transmasculine spectrum.

What did the research team do?

The research team recruited SGM men online through social media websites. The team assigned men by chance to one of the two programs. Men completed surveys about health outcomes at the start of the study, after the programs ended, and two and four months later.

SGM men who have been sexually abused and advocacy groups helped design the study.

What were the limits of the study?

The SGM men who volunteered to take part in the study may have been more comfortable sharing their sexual abuse or assault experiences. Results may differ for men who aren’t as comfortable sharing these experiences.

Future research could look at the effect MI programs have on other people who have experienced abuse.

How can people use the results?

Clinics can use these results when considering ways to help SGM men who have been sexually abused.

Objective

To compare the effectiveness of motivational interviewing (MI) versus MI plus trauma-informed affirmative care in reducing depression and increasing mental health treatment engagement for sexual and gender minority (SGM) men who have been sexually abused

Study Design

This randomized controlled trial compared the effectiveness of MI versus MI plus trauma-informed affirmative care in improving depression and mental health treatment engagement for SGM men who have been sexually abused.

Researchers randomly assigned participants to one of two programs:

• MI. Participants received six weekly, 90-minute videoconference group sessions with two trained peers with lived experience of sexual abuse or assault. Session topics included life stressors, trauma-related behavioral change, building self-efficacy, and readiness to change and planning for positive life changes. Peers helped participants identify reasons for behavioral change and encouraged them to engage with formal mental health services.
• MI plus trauma-informed, affirmative care. Along with the MI program, during sessions with peers, participants received information about myths and facts regarding sexual abuse of boys and men, sexual abuse of SGM individuals, and men seeking mental health treatment. Peers provided psychoeducation and helped participants reframe unhelpful thoughts.

The study included 356 SGM men who had been sexually abused. Among participants, 85% were White, 15% were Hispanic, and 9% were Black. Also, 66% identified as gay; 22% identified as bisexual; 2% identified as men who have sex with men; and 11% identified as pansexual, asexual, or another sexual orientation. The average age was 35; 83% identified as cisgender, and 17% identified on the transmasculine spectrum.

Researchers recruited participants online through social media platforms. Participants volunteered to be included in the study. Participants completed online surveys about study outcomes at baseline, immediately after completing the program, and two and four months later.

SGM men who have experienced sexual trauma and representatives of community-based organizations helped design the study.

Results

Immediately after the programs, and two and four months later, the two programs did not differ significantly in:

• Reducing depression symptoms, posttraumatic stress disorder (PTSD) symptoms, suicidality, or dissociative experiences
• Increasing mental health treatment engagement
• Improving psychosocial functioning

Participants in both programs had improvements in all primary and secondary outcomes (all p<0.001).

Among participants with severe depression, compared with participants who received MI, patients who received MI plus trauma-informed affirmative care had fewer depression symptoms after completing the program (p=0.006) and two months afterward (p=0.01).

Limitations

Because participants volunteered to be in the study, they may have felt more comfortable disclosing their personal information. Results may have differed among individuals who were not as comfortable disclosing their sexual orientation or sexual trauma history.

Conclusions and Relevance

In this study, neither program was more effective in reducing depression symptoms and increasing mental health treatment engagement; both programs improved these outcomes for SGM men who have been sexually abused.

Future Research Needs

Future research could examine the effects of MI programs on other populations that have experienced sexual abuse or assault.