3 - (SYM 104) Investigating Engagement in a Digital Mental Health Intervention for LGBTQ+ Adolescents

Digital Mental Health (DMH) programs are increasingly recognized as scalable opportunities for providing support to marginalized youth, who are at increased risk for poor mental health and limited access to support. However, many DMH programs report high dropout rates. As a result, researchers designing DMH programs for marginalized youth must consider how to balance clinical intensity with minimal user burden. In this study, we examine engagement patterns in a DMH program for LGBTQ+ adolescents to inform future intervention design. Methods. Adolescents were recruited through Instagram to participate in a Randomized Control Trial. Inclusion criteria included endorsing LGBTQ+ identity, English fluency, and age between 13-16. A total of 262 participants (M age = 15.05, SD age = 0.98) were randomly assigned to the intervention. Participants completed questionnaires on hopelessness and self-hate at pre-intervention and immediately post-intervention. Results. A total of 228 individuals started the intervention and 194 finished, indicating a low dropout rate of 14.9%. Dropout did not differ by race, gender identity, sexual orientation, or age. The total number of clicks a user made in the intervention (range: 1-644, M = 157.9, SD = 91.77) and the total time spent on the intervention (range: 6.9 - 3139.7 seconds, M = 756.66, SD = 527.16) did not moderate changes in hopelessness or self-hate. The highest rate of dropout occurred on the first page that asked for an interactive response (26.47% of users who dropped out did so on this page). On a page where participants were directed to write their “fullest name” including the multiple identities they hold, a greater number of page clicks was associated with a greater reduction in self-hate from baseline to immediately-post intervention (β = -0.006, p = 0.04), but not a greater reduction in hopelessness. Discussion. DMH interventions are increasingly designed to target the mental health needs of minoritized youth. Engagement in interventions through interactive elements is often considered crucial to improve outcomes. However, our results did not show evidence that greater engagement in the intervention as a whole led to greater reductions in hopelessness or self-hate. At the same time, greater engagement on an intervention page focused on self-identity did lead to greater reductions in self-hate. Our results suggest that researchers consider interactivity carefully; the quality and intentionality of interactive elements in a DMH program may be more important than the quantity.