1 - (SYM 17) Structural Stigma and Single-session Intervention Efficacy Among Sexual Minority Adolescents: Emphasizing Emotions in High-stigma Contexts

Background: Structural stigma—i.e., social policies, cultural attitudes, and other societal-level conditions that restrict the rights and opportunities of the stigmatized—represents a fundamental cause of mental health inequity among sexual minority (vs. heterosexual) youth (Hatzenbuehler, 2017). Likewise, structural stigma has been found to undermine mental health intervention efficacy among stigmatized groups (e.g., Black youth; Price et al., 2022)—perhaps in part because these treatments do not address psychosocial mechanisms susceptible to chronic stigmatization, including emotion-related processes (Hollinsaid et al., 2023). We therefore considered whether sexual minority adolescents living in US states with higher (vs. lower) levels of structural stigma responded more favorably to a brief emotion-focused intervention relative to two other interventions.

Methods: We examined structural stigma—objectively measured at the state level—as a moderator of single-session intervention (SSI) efficacy among 1,954 sexual minority (e.g., lesbian, gay, bisexual) adolescents (ages 13–16) from 50 states (Schleider et al., 2022). Specifically, we compared the effects of an SSI encouraging emotion identification and expression to the effects of SSIs emphasizing behavioral activation and growth mindset on depression, anxiety, and COVID-related trauma outcomes among sexual minority adolescents in more (vs. less) stigmatizing environments.

Results: Structural stigma moderated SSI efficacy for depression and for COVID-related trauma outcomes at 3-month follow-up, such that the emotion-focused SSI outperformed two active SSIs among sexual minority adolescents in higher- (vs. lower-) stigma states. SSIs were similarly effective in addressing anxiety across stigma contexts.

Conclusions: Results indicate that an SSI encouraging emotion identification and expression—even without directly teaching therapy skills—was either more or equally effective to two active SSIs among sexual minority adolescents in states with higher (vs. lower) levels of structural stigma. Whereas prior research demonstrates that psychological interventions are generally less effective among stigmatized youth in more stigmatizing environments (Price et al., 2022), our findings suggest that emotion-related experiences—which are often suppressed by sexual minorities in high-stigma settings (Hollinsaid et al., 2023)—may represent a valuable intervention target for sexual minority adolescents chronically exposed to structural stigma.