Results Summary

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.

Final Research Report

This project's final research report is expected to be available by May 2024.

Peer-Review Summary

Peer review of PCORI-funded research helps make sure the report presents complete, balanced, and useful information about the research. It also assesses how the project addressed PCORI’s Methodology Standards. During peer review, experts read a draft report of the research and provide comments about the report. These experts may include a scientist focused on the research topic, a specialist in research methods, a patient or caregiver, and a healthcare professional. These reviewers cannot have conflicts of interest with the study.

The peer reviewers point out where the draft report may need revision. For example, they may suggest ways to improve descriptions of the conduct of the study or to clarify the connection between results and conclusions. Sometimes, awardees revise their draft reports twice or more to address all of the reviewers’ comments. 

Peer reviewers commented and the researchers made changes or provided responses. Those comments and responses included the following:

  • The reviewers agreed that this is an important study with an impressive sample size in a population that experiences significant health disparities. However, they suggested changes to enhance the clarity of the report. These included an updated definition for sexual and gender minority (SGM) to encompass transgender and non-binary people, and a clarification in the results section of the report regarding the gender identity of participants who did not identify as male. In response to these recommendations, the researchers revised the SGM definition to include transgender and non-binary people throughout the report. They also updated information related to the gender of the participants to include the count and percent of cisgender men and those on the transmasculine spectrum. 
  • The reviewers highlighted that the researchers selected covariates for their regression model based on p-values but suggested alternative methods like pre-specification or using standardized mean differences. They also questioned the appropriateness of testing baseline covariates in a randomized trial. The researchers responded that they identified only the Sexual Orientation Concealment score as a significant baseline covariate (p = 0.04) but did not include this as a covariate because they used a threshold of p < 0.01 for identifying covariates to account for multiple comparisons. The researchers also clarified that they analyzed the interaction terms of demographic variables for all participants and any variables that had a significant correlation with the outcomes as moderators. 
  • The reviewers pointed out an inconsistency regarding the inclusion of dissociation as a moderator in the analysis, as it was mentioned in the section “Changes to the Original Study Protocol” but not detailed in methods or results sections. The researchers updated the protocol changes section to reflect that dissociation, initially planned as moderator, was reclassified as a secondary outcome. This change was due to its lack of statistical significance in moderator analyses. Consequently, results related to dissociation are only reported in the section detailing secondary outcomes. Finally, the reviewers expressed concerns about categorization of racial minorities into “non-white” race and treatment of major depression comorbidity as a covariate in the study. The researchers removed non-white race and major depression comorbidity from the report, as these were not analyzed.
  • The reviewers asked how the length of time from prior episode of sexual trauma might impact the result of the study as time was not listed as covariate in the report. The researchers clarified that they did not assess this variable in the study.
  • The reviewers asked for a description of the inclusion criteria for peer leaders and if trans male peers were not participating in the study due to challenges with recruitment. In the methods section, the researchers described the selection criteria for peer leaders, noting the absence of stringent parameters for identifying individuals who could serve as credible and effective peer leaders. The researchers also explained that the peers were referred from the community partners, and no trans men were referred.
  • The reviewers suggested that the report should include a clearer description or a directed acyclic diagram of the causal model, particularly focusing on the mediators being tested. They deemed the current explanation as too broad. The researchers replied that their mediator analysis was exploratory. They initially identified secondary outcomes linked to primary outcomes using linear mixed models. Those were individually tested as mediators of the relationship between treatment assignment and depression. Out of these, five significant mediators, such as psychosocial functioning, structural stigma, expectations of discrimination, sexual orientation concealment and self-reliance (all Conformity to Masculine Norms) were identified and subsequently included in a multiple mediator model to ascertain which mediator had the most substantial impact on overall depression scores.

Conflict of Interest Disclosures

Project Information

Joan M. Cook, PhD
Yale University
$1,390,341
Peer Online Motivational Interviewing for Sexual and Gender Minority Male Survivors

Key Dates

November 2018
March 2023
2018
2023

Study Registration Information

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Last updated: March 14, 2024