5 - (SYM 28) Minority Stress as a Mechanism in Change in Posttraumatic Stress Disorder Symptom Severity Among LGBQ+ Men

Individuals who identify as lesbian, gay, bisexual, transgender, queer, and other minoritized sexual and gender identifies (LGBTQ+) are at increased risk for trauma exposure and posttraumatic stress disorder (PTSD) compared with their heterosexual, cisgender counterparts. LGBTQ+ individuals also contend with chronic and often severe forms of discrimination and stigma, including bias-related sexual assault which is especially detrimental. Trauma treatment is critical for recovery for many individuals, yet few treatments specifically target concurrent minority stress concerns, which has been shown to be inextricably linked to PTSD sequelae and recovery for LGBTQ+ individuals. Treatment development and adaptation are critical to be inclusive of minority stress as treatment targets and to reduce psychiatric disparity among LGBTQ+ individuals. For this study, we conducted a randomized clinical trial comparing LGBTQ+-affirmative, peer-facilitated, trauma-focused Motivation Interviewing (Affirmative-MI) with peer-facilitated MI-as-usual (MI) for LGBTQ+ men with a history of sexual trauma (N = 356). We examined whether changes in minority stress explained changes in mental health symptoms across baseline, posttreatment, and 60- and 120-day follow-ups. Results from multilevel mediation models indicate that aspects of minority stress, including expectations for future experiences of discrimination and sexual orientation concealment, explained the association between Affirmative-MI and symptom severity, such that lower discrimination expectations and concealment was related to decreased symptom severity overtime. This study demonstrates promise of a brief, affirmative, and minority stress-inclusive intervention for sexual trauma-exposed LGBTQ+ men, but also insight into minority stress improvement as a mechanism of treatment efficacy.