Advance-CTR

Advance RI-CTR Mentored Research Award (2024)

“A Novel Civic Engagement Intervention to Improve Mental Health Outcomes Among LGBTQ+ Adults”

Among LGBTQ+ adults (lesbian, gay, bisexual, transgender, queer plus adults aged 18+), depression and anxiety have been increasing at an alarming rate since the COVID-19 pandemic. Compared to cisgender and heterosexual populations, LGBTQ+ adults are 2.5 times more likely to experience depression and anxiety, with rates as high as 50-60% among younger LGBTQ+ adults. Depression and anxiety are a significant cause of morbidity in the United States, and further place LGBTQ+ individuals at an increased risk for substance use problems, overdose, and suicide.4–7 Importantly, the LGBTQ+ community experiences significant discrimination and disempowerment, which results in heightened mental health burden. This year alone, over 500 legislative bills have been introduced across the country that directly target LGBTQ+ individuals (e.g., restricting education related to sexual and gender identity). Current psychological interventions have shown promise in reducing mental health burden among LGBTQ+ adults. 

However, they emphasize managing internal responses to stress (e.g., cognitions, emotions) and interpersonal skills (e.g., assertiveness training) rather than the structural determinants of minority stress themselves (e.g., discriminatory policies). This is problematic, given the large body of evidence demonstrating how structural factors greatly impact the health of LGBTQ+ individuals. Interventions that address minority stress from a structural lens are needed to reduce the high burden of depression and anxiety among LGBTQ+ adults.

Civic engagement (e.g., volunteering, community outreach) offers a novel approach to improving mental health among LGBTQ+ adults. Civic engagement interventions foster increased social connectedness and empowerment to facilitate systems-level change and address structural determinants of health. By increasing social connectedness and empowerment, a civic engagement intervention has potential to improve mental health outcomes at the individual level while also increasing engagement in mitigating the very structures that drive health inequities. Previous evidence has demonstrated effectiveness of civic engagement interventions for reducing cardiovascular disease risk among Black women, functional disability among aging adults, and HIV risk for sexual minority youth and formerly incarcerated adults. Multiple other cross-sectional and longitudinal studies demonstrate meaningful mental health benefits among those from marginalized communities who participate in civic engagement. 

However, no evidence-based civic engagement interventions currently exist to improve mental health among LGBTQ+ adults. This approach makes intuitive sense for the LGBTQ+ community and would leverage critical consciousness, the theory that individuals from systematically marginalized backgrounds become empowered by learning to critically analyze their social conditions and acting to change them.

The proposed study will undertake formative development of a novel civic engagement intervention (CIVIx), followed by an open trial to determine feasibility and acceptability of CIVIx. The long-term goal of this study is to improve mental health outcomes within the LGBTQ+ community, through two aims:

• Aim 1: Conduct in-depth qualitative interviews (N=20) with LGBTQ+ adults to explore how civic engagement can address minority stressors and improve mental health. The study team will conduct semi-structured interviews with purposive sampling of 10 cisgender and 10 transgender/gender diverse (TGD) LGBTQ+ adults with depression and/or anxiety. This formative phase will focus on understanding how minority stressors impact mental health, civic activity in response to stressors, and specific content and structure LGBTQ+ adults would like to see as part of a civic engagement-based intervention for mental health.

• Aim 2: Develop and evaluate a novel civic engagement-based intervention (CIVIx) in an open trial of LGBTQ+ adults with depression and/or anxiety (N=30). The team will develop and evaluate a culturally-tailored civic engagement intervention in an open trial of 30 LGBTQ+ adults with depression and/or anxiety (33% TGD). Based on prior civic engagement interventions, CIVIx will preliminarily consist of 5-6, 90-minute group sessions over three months with a one-month follow-up. Session topics will likely include: reflecting on how structural barriers impact health, building coping skills and empowerment to mitigate structural barriers, and completing a “civic empowerment project” in collaboration with a local community-based organization.

This study will address critical gaps in mental healthcare within the LGBTQ+ community by 1) connecting individuals to community, and 2) empowering individuals to critically analyze and mitigate structural factors inhibiting mental wellness. Study data will inform a larger scale, NIH R34 randomized controlled trial. Dr. Fenn's experiences adapting and delivering evidence-based treatments for patients living with mood and anxiety disorders have provided her with an excellent bridge to conduct community-engaged, culturally-sensitive intervention development among LGBTQ+ adults. 

This Advance RI-CTR Mentored Research Award will facilitate critical training, time, and resources to prepare Dr. Fenn for a career in developing and evaluating culturally-tailored interventions among marginalized populations such as LGBTQ+ adults. Advance RI-CTR’s resources, combined with a highly-successful mentorship team (Drs. Philip A. Chan, Ethan Moitra & Amy Nunn), will allow a promising clinical investigator to achieve successful training and independence.