A unified protocol to address sexual minority women's minority stress, mental health and hazardous drinking

解决性少数群体女性压力、心理健康和危险饮酒问题的统一协议

• 批准号: 10363453
• 负责人: TONDA L HUGHES
• 金额: $ 79.49万
• 依托单位: YALE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-12 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10363453
• 关键词: Address; Affect; Affective; Alcohol consumption; Alcohol dependence; Alcohols; Anxiety; Awareness; Behavioral; Bisexual; Cardiovascular Diseases; Cities; Cognitive; Cognitive Therapy; Communities; Coping Behavior; Counseling; County; Demographic Factors; Discrimination; Ethnic Origin; Exposure to; Family; Foundations; Funding; Gender Identity; Health; Health Services; Heavy Drinking; Heterosexuals; Incentives; Individual; Intervention; Intervention Trial; Interview; Knowledge; Laws; Leadership; Lesbian; Lesbian Gay Bisexual Transgender Queer; Link; Liver diseases; Malignant Neoplasms; Mediating; Mental Depression; Mental Health; Meta-Analysis; Methods; Modality; Morbidity - disease rate; Motivation; National Institute on Alcohol Abuse and Alcoholism; Participant; Pathway interactions; Persons; Policies; Population; Populations at Risk; Preparation; Promoting Action on Research Implementation in Health Services framework; Protocols documentation; Provider; Psychotherapy; Race; Randomized Controlled Trials; Reaction; Reporting; Research; Risk; Role; Services; Sex Orientation; Sexual and Gender Minorities; Shame; Site; Stress and Coping; Structure; System; Testing; Therapeutic Intervention; Time; TimeLine; Training; United States National Institutes of Health; Waiting Lists; Woman; Women' s Health; World Health Organization; acceptability and feasibility; alcohol related problem; alcohol risk; alcohol use disorder; arm; assault; base; behavioral health; biological adaptation to stress; community center; community clinic; community setting; comorbid depression; comorbidity; coping; disparity reduction; drinking; efficacy testing; emotion dysregulation; empowered; expectation; experience; gender minority group; hazardous drinking; help-seeking behavior; high risk; high risk population; implementation facilitators; improved; internalized stigma; intervention delivery; laboratory experience; minority stress; minority stressor; mortality; peer; personalized medicine; pilot trial; primary outcome; psychosocial; queer; remote delivery; remote intervention; response; scale up; secondary outcome; sexual identity; sexual minority women; skills; social stigma; telehealth; treatment as usual; Address; Affect; Affective; Alcohol consumption; Alcohol dependence; Alcohols; Anxiety; Awareness; Behavioral; Bisexual; Cardiovascular Diseases; Cities; Cognitive; Cognitive Therapy; Communities; Coping Behavior; Counseling; County; Demographic Factors; Discrimination; Ethnic Origin; Exposure to; Family; Foundations; Funding; Gender Identity; Health; Health Services; Heavy Drinking; Heterosexuals; Incentives; Individual; Intervention; Intervention Trial; Interview; Knowledge; Laws; Leadership; Lesbian; Lesbian Gay Bisexual Transgender Queer; Link; Liver diseases; Malignant Neoplasms; Mediating; Mental Depression; Mental Health; Meta-Analysis; Methods; Modality; Morbidity - disease rate; Motivation; National Institute on Alcohol Abuse and Alcoholism; Participant; Pathway interactions; Persons; Policies; Population; Populations at Risk; Preparation; Promoting Action on Research Implementation in Health Services framework; Protocols documentation; Provider; Psychotherapy; Race; Randomized Controlled Trials; Reaction; Reporting; Research; Risk; Role; Services; Sex Orientation; Sexual and Gender Minorities; Shame; Site; Stress and Coping; Structure; System; Testing; Therapeutic Intervention; Time; TimeLine; Training; United States National Institutes of Health; Waiting Lists; Woman; Women' s Health; World Health Organization; acceptability and feasibility; alcohol related problem; alcohol risk; alcohol use disorder; arm; assault; base; behavioral health; biological adaptation to stress; community center; community clinic; community setting; comorbid depression; comorbidity; coping; disparity reduction; drinking; efficacy testing; emotion dysregulation; empowered; expectation; experience; gender minority group; hazardous drinking; help-seeking behavior; high risk; high risk population; implementation facilitators; improved; internalized stigma; intervention delivery; laboratory experience; minority stress; minority stressor; mortality; peer; personalized medicine; pilot trial; primary outcome; psychosocial; queer; remote delivery; remote intervention; response; scale up; secondary outcome; sexual identity; sexual minority women; skills; social stigma; telehealth; treatment as usual

PROJECT SUMMARY Background. Sexual minority women (SMW) represent one of the highest-risk groups for hazardous drinking (HD) and comorbid mental health problems (e.g., depression, anxiety) because of their exposure to minority stressors (i.e., stigma-related burdens) and associated stress reactions, like drinking to cope. Research has identified cognitive (e.g., expectations of rejection), affective (e.g., shame), and behavioral (e.g., avoidant coping) pathways through which minority stress places SMW at disproportionate risk of HD and comorbid depression/anxiety. Yet no interventions address these pathways. In fact, no HD intervention has ever been tested for efficacy with SMW. Preliminary Studies. With deep stakeholder input and NIH (R01MH109413- 02S1) and foundation (Lesbian Health Fund) support, we created EQuIP (Empowering Queer Identities in Psychotherapy). EQuIP is a 10-session cognitive-behavioral intervention focused on improving SMW’s minority stress reactions by raising awareness of the harms of minority stress, building self-affirming cognitive styles, and reducing avoidant coping. In a waitlist-controlled pilot trial (n=60), EQuIP showed strong promise for reducing HD and depression/anxiety by building adaptive responses to minority stress, making it the first intervention with preliminary efficacy for improving this population’s co-occurring behavioral and mental health challenges. Methods. We now seek to test EQuIP’s efficacy and identify facilitators of scale-up of this promising intervention. Aim 1: In a 2-arm randomized controlled trial (RCT) with SMW who experience HD and comorbid depression and/or anxiety, we will test the efficacy of EQuIP (n=225) against treatment-as-usual (i.e., supportive counseling) (n=225). Our primary outcome is proportion of heavy drinking days (≥4 drinks) on 30- day timeline followback. Secondary outcomes include reduction in WHO alcohol risk level and depression and anxiety. Because remote intervention delivery has quickly become normative, both EQuIP and treatment-as- usual will be delivered via telehealth (Zoom). In fact, our second pilot of EQuIP found strong feasibility and acceptability of telehealth delivery. Aim 2: Assessments at baseline, 4, 8, and 12 months will determine if reductions in EQuIP’s intended psychosocial mechanisms (e.g., internalized stigma, rejection sensitivity, emotion dysregulation) mediate heavy drinking reductions. To advance personalized medicine, we will also examine whether EQuIP is differentially efficacious across key demographic factors and stigma moderators. Aim 3: To prepare for implementation in frontline settings, we will conduct semi-structured interviews with directors (n=20), providers (n=20), and service users (n=20) from a network of 250 US LGBTQ community clinics. Applying the i-PARIHS framework will help identify facilitators that can support EQuIP implementation at these centers. Summary. As the first trial of an intervention for SMW’s HD and co-occurring mental health, this study responds to NIAAA’s call for trials of “interventions that address AUDs and related problems and that are appropriate to the needs of sexual and gender minority populations.”

项目摘要 背景。性少数妇女（SMW）是危险饮酒的最高风险群体之一 （HD）和合并的心理健康问题（例如抑郁症，动画），因为它们暴露于少数群体 压力源（即柱头相关的伯良）和相关的应力反应，例如饮酒。研究有 确定的认知（例如，对拒绝的期望），情感（例如，羞耻）和行为（例如，回避者） 应对）少数群体压力使SMW处于高清和合并症的风险不成比例的途径 抑郁/焦虑。然而，没有干预措施解决这些途径。实际上，从来没有高清干预 通过SMW测试了效率。初步研究。具有深度利益相关者的输入和NIH（R01MH109413-- 02S1）和基金会（女同性恋卫生基金）支持，我们创建了设备（授权酷儿身份 心理治疗）。设备是10条经验的认知行为干预措施，重点是改善SMW的少数 通过提高对少数派压力的危害的认识，建立自我表达的认知风格来做出压力反应， 并减少回避应对。在候补名单控制的试验试验（n = 60）中，设备表现出强烈的希望 通过建立对少数派压力的自适应反应来减少高清和抑郁/焦虑，使其成为第一个 以初步效率进行干预，以改善该人群的同时发生行为和心理健康 挑战。方法。我们现在寻求测试设备的效率并确定规模的促进者 有希望的干预。目标1：在与SMW的2臂随机对照试验（RCT）中，经验高清和 合并的抑郁症和/或焦虑，我们将测试设备效率（n = 225），以应对治疗态度（即 支持咨询）（n = 225）。我们的主要结果是30-的大量饮酒日（≥4饮料）的比例 一天时间表后卫。次要结果包括降低谁酒精风险水平和抑郁症以及 焦虑。因为远程干预措施迅速变得正常，所以设备和治疗都可以作为 - 通常将通过远程医疗（Zoom）交付。实际上，我们的第二架设备飞行员发现了强大的可行性和 远程医疗交付的可接受性。 AIM 2：基线，4、8和12个月的评估将确定是否是否 设备预期的社会心理机制的降低（例如，内在的污名，拒绝敏感性， 情绪失调）介导了大量饮酒。为了进步个性化医学，我们也将 检查设备在关键的人口统计学因素和污名主持人之间是否有效地有效。 目标3：为在一线设置中实施做准备，我们将与 董事（n = 20），提供商（n = 20）和服务用户（n = 20）来自250 US LGBTQ社区的网络 诊所。应用I-Parihs框架将有助于确定可以支持配备实施的促进者 在这些中心。概括。作为SMW高清和共同出现心理健康的干预措施的第一次试验， 这项研究回应了NIAAA的呼吁，要求对“解决AUD和相关问题的干预措施，以及 适合性别和性别少数群体的需求。”