LGBTQ+ youth continue to report significant challenges to their wellbeing in schools (e.g., bullying, lack of representation in staff and curricula, and discrimination). The current study employed a large, diverse sample of LGBTQ+ youth to explore the types of support they reported receiving in schools. Participants completed a quantitative survey with a supplemental open-ended item leading to quantitative results conceptualized by nine themes. Quantitative findings illuminated that more than half of respondents reported that two or more teachers were supportive of their sexual orientation and gender identity, although youth of color and youth with gender-diverse identities reported lower likelihood of support. Themes included safety, lack of consistency, limited disclosure, programmatic silence, harmful legislation, transphobia, inclusion, representation, and youth recommendations. Triangulation of results suggest LGBTQ+ youth are receiving some school supports in response to their needs, but they have further recommendations for sustained efforts in positive directions (e.g., affiliate clubs, such as GSAs) and improvement in others (e.g., improved support during instances of bullying, agency in self-disclosure).

Intrusive thoughts (ITs) are common yet distressing experiences for many adolescents and young adults. Brief, accessible interventions that provide psychoeducation and coping strategies are needed, yet little is known about how youth perceive such interventions. The present study examined both qualitative and quantitative indicators of acceptability in adolescents and young adults with ITs who completed a digital single-session intervention (SSI). The study aimed to gather intervention feedback and determine whether symptom improvement and/or demographic factors predicted acceptability. We conducted a secondary analysis of a randomized controlled trial comparing our SSI to an information-only control group in individuals aged 13-25, focusing solely on acceptability factors of the SSI condition. Thematic analyses revealed that young people with ITs prefer interventions that normalize the experience of ITs, are emotionally validating, accessible and engaging, stimulate self-reflection, and contain evidence-based strategies. Importantly, those who reported qualitatively accepting the intervention were more likely to experience a reduction in hopelessness symptoms at post-intervention; however, acceptability was not associated with distress reduction. Of interest, those who identified as non-Caucasian were less likely to report they had a positive intervention experience compared to Caucasian individuals. Participants reported wanting more diverse examples of ITs to connect more with the psychoeducation, as well as more personalized examples for validation. These findings indicate acceptability factors and barriers that young adults with ITs experienced during a brief SSI. Future studies, employing more diverse examples of ITs, will be crucial for understanding further effects on acceptability and engagement.

Rural areas in the U.S. face continued inequities in infrastructure and investment, despite housing approximately 20% of the country’s population. Sourcewell, a service cooperative created by Minnesota as a local unit of government, developed the AscendRural program to de-risk technology adoption to improve rural well-being and health by sourcing and piloting innovative technologies alongside rural communities. In this mixed-methods evaluation, AscendRural partnered with Northwestern University researchers to evaluate (1): facilitators and barriers to the implementation of two technology solutions across five rural contexts, and (2) AscendRural’s impact as a facilitator of the pilot implementation. Survey data from technology companies and rural community partners before, during, and after the pilot period indicate high acceptability of AscendRural and their pilot model; however, aggregated trends in technology usage data suggest low uptake of technology solutions. Rapid qualitative analysis of de-identified interview transcripts identified key facilitators and barriers to implementation for technology and community stakeholders—as informed by the Capability, Opportunity, Motivation–Behavior Model (COM-B) and the Theoretical Domains Framework (TDF). We discuss theory-informed recommendations for future implementation efforts based on the ERIC taxonomy, to better serve rural communities within and beyond AscendRural.

Many studies have shown a robust connection between parent and child religiosity, but recent research has begun to examine what factors may strengthen or weaken this connection. Moreover, although parent religiosity generally has been associated with positive parenting behaviors, it also has been connected to the use of corporal punishment and authoritarian parenting style. Thus, other variables must exist that influence how parent and child religiosity interact with parenting style, such as regional differences (i.e., conservatism, population density, etc.). The current study expanded upon previous literature and frameworks by examining perceived maternal and paternal variables, extending the research to emerging adults, and examining different regions of the United States (i.e., Northeast, South, Midwest, West), as well as levels of conservatism and population An MTurk survey asked participants to report on their parents’ religiosity, parenting style, and conservatism, as well as their own religiosity and the region where they grew up. Structural equation modeling indicated that perceived parenting style moderated the relation between parent and child religiosity in emerging adulthood. Those interactions were further moderated by perceived parental conservatism as well as geographic and population density regions (i.e., 3-way interaction). Thus, geographic region, population density, and conservatism are all important components to understanding how perceived parental religiosity and parenting affect child religiosity in emerging adulthood.

Objective. Leveraging data from a previously-conducted randomized trial, we examined whether Project RISE— a digital single-session intervention (SSI) focused on minority stress—was associated with equal improvements in levels of internalized stigma, identity pride, hopelessness, depression, and anxiety among White, sexual minority (SM), cisgender youth and racially and ethnically minoritized (REM), SM, and gender minority (GM) youth. We also tested whether higher levels of social support moderated outcomes.Methods. Participants randomly assigned to the intervention were included (n = 261 adolescents 13 to 16 years old; M age = 15; 51% REM youth; 68% transgender/gender-diverse). Two-way MANCOVAs were conducted to examine potential group differences outcomes across timepoints (i.e., post-intervention, two-week follow-up), between individuals holding multiple minoritized identities versus one. Moderation analyses were used to investigate whether social support moderated RISE outcomes. Results. Identifying with multiple minoritized identities was associated with higher levels of identity pride immediately post-intervention, and identifying as a GM was associated with slightly greater identity pride post-intervention. Youth who endorsed GM identities reported higher levels of hopelessness, depression, and anxiety at two-week follow-up, relative to cisgender youth. No other differences emerged.Conclusions. Youth with multiple minoritized identities, and especially those who identified as a GM, experienced significantly higher levels of identity pride following an online SSI targeting minority stress for LGBTQ+ teens. Results highlight the importance of applying an intersectional minority stress framework to online intervention design and considering social contexts (e.g., high versus low social support) when selecting treatments for youth with intersecting identities.

Intrusive thoughts are prevalent across the lifespan and can be particularly distressing during adolescence and young adulthood. Despite their high prevalence, many individuals lack access to effective strategies for managing these thoughts. Brief, accessible, and evidence-based interventions are needed to help individuals cope with intrusive thought-related distress. The present study aimed to pilot the effectiveness of a brief online Acceptance and Commitment Therapy (ACT)-based single-session intervention (SSI) that provided psychoeducation on intrusive thoughts and strategies for managing distress arising from negative appraisals in young adults. We recruited individuals aged 18-25 who reported that they experienced distressing thoughts in the last week. Distress associated with intrusive thoughts and hopelessness was measured at pre-intervention, post-intervention, and at two-week follow-up. Within-subject ANOVAs revealed significant reductions in intrusive thoughtrelated distress and hopelessness from pre- to post-intervention across all time points for both groups. The active SSI group had a significant reduction in distress compared to the active control group. There were no other significant interaction effects observed, either when considering hopelessness or at the follow-up time point. These preliminary findings highlight the importance of single-session interventions in helping youth understand and cope with intrusive thoughts. Future research should explore the relative contributions of different intervention components and the long-term effects on mental health outcomes.

The COVID-19 pandemic created social disruptions, leading to high levels of mental health problems for adolescents. Interpersonal stressors, such as lack of familial support, peer victimization, and discrimination, may have further exacerbated teen mental health issues. Yet, the psychological impact of interpersonal stressors and their interactive effects with high levels of loneliness remains unknown. In this pre-registered study, we used a diverse, nationwide sample of adolescents with elevated symptoms of depression ( n = 2,452, ages 13–16) to examine how familial support, peer victimization, and discrimination are concurrently associated with mental health outcomes. For teens with elevated depressive symptomology during the COVID-19 pandemic, lack of familial support, peer victimization, and discrimination were all significantly associated with depression, anxiety, hopelessness, and suicidal ideation. A significant moderation was also found with loneliness, such that for youth reporting high levels of loneliness, depression and anxiety symptoms remained high even despite familial support. Furthermore, for youth reporting high levels of loneliness, hopelessness remained high, regardless of their perceptions of peer victimization or daily discrimination. Interpersonal stressors, such as lack of familial support, had a large impact on youth mental health problems during COVID-19. However, despite interpersonal protective factors, high levels of loneliness were associated with depression, anxiety, and hopelessness, suggesting that loneliness should be a high-priority intervention target for youth, particularly during times of national disaster and disconnection.

Background: Adolescents in rural communities face significant geographic, cultural, and economic barriers to accessing mental health care, and depression treatments are often expensive, time-consuming, and inaccessible, leading many youth to drop out of treatment prematurely. Moreover, most evidence-based depression interventions fail to target relational difficulties, a fundamental, well-established depression risk factor in rural communities that increases susceptibility to depression and suicidal ideation. Method: This study had two aims: first, to iteratively co-design and tailor a single-session relationship competence intervention that was feasible, acceptable, and engaging for at-risk rural youth with elevated depressive symptoms using a human-centered design approach (n = 7; 85.7% Black; 57.1% Female); second, to test whether the resulting SSI improved relationship and communication knowledge, perceived change, and relationship learning, and reduced depressive symptoms at 3-month follow-up, using a randomized controlled trial (n = 440; 50.2% White; 31.4% Women). Results: Youth randomized to the SSI exhibited significantly lower depressive symptoms at follow-up than youth in the control condition, though both groups improved significantly overall. All participants reported similar gains in secondary outcomes (e.g., interpersonal skills) and rated the program as highly acceptable. Discussion: A relationship-focused SSI may offer a brief, scalable approach to improving depressive symptoms in rural adolescents over time by targeting relational difficulties as a modifiable risk factor. Recruitment challenges, including extensive exclusions for suspected fraudulent or bot-generated responses, limited the eligible rural sample size and constrain generalizability; future work should explore recruitment strategies embedded within trusted community settings.

The need for mental health services in Sub-Saharan Africa far exceeds the availability of support, creating long waitlists for the few services that are in place. To address this crisis, implementing evidence-based, single-session interventions for individuals seeking treatment may provide timely relief. StrongMinds—a mental health charity organization serving youth and adults in Uganda—piloted a Single-Session Consultation (SSC) service for new treatment-seekers with elevated depressive symptoms, as indicated by a score on a screener survey suggesting the presence of at least mild depression. To optimize its reach and fit with StrongMinds’ service delivery model, the SSC was delivered by trained lay providers in both individual and group-based formats. Within two months (September-October 2023), the SSC was delivered to 200 Ugandan adults with elevated depression symptoms (ages 16-86; 73% female) upon initial outreach for StrongMinds’ group psychotherapy services. SSC clients reported significant improvements in hopelessness and depression symptoms at 2-week (ds = -0.73, -1.12) and 1-month follow-ups (ds = -0.96, -1.44), while waiting for group psychotherapy. SSC clients reported high SSC satisfaction (M = 4.47/5), and intervention effects did not significantly differ by delivery format (i.e., individual vs. group format). Results suggest the SSC’s acceptability, feasibility, and utility as a low-intensity, scalable intervention for adolescents and adults in Uganda on waiting lists for longer-term psychotherapy.

PURPOSE:Lesbian, gay, bisexual, transgender, queer, intersex, asexual plus (LGBTQ+) youth face significant barriers to mental health care, ranging from a lack of access to therapists, months-long waitlists, and lack of insurance coverage to receiving incompetent care from non-affirming providers. The current study sought to understand the experiences of LGBTQ+ youth when accessing mental health care. METHODS:The current study utilized a fixed, embedded mixed methods design with 808 LGBTQ+ youth in the United States. Participants reported their experiences with mental health access and use, as well as provided qualitative responses about their experiences. RESULTS:In this sample, less than half of LGBTQ+ adolescents stated they were able to access mental health care when it was needed. Youth described experiencing unethical therapy practices by clinicians, cited their parents and practical concerns as barriers to accessing care, and concealing their identity from providers out of fear and mistrust. Youth also described feeling both validated and invalidated once they did receive care. Youth provided recommendations around LGBTQ+ competence, respect for youths' identities and autonomy, and making care as accessible as possible. DISCUSSION:Recommendations for caregivers, providers, organizations and programs, and policymakers are provided based on youth responses and previous literature. For example, guidelines were provided for parents on how to communicate with youth about mental health concerns, for therapists on how to improve cultural competency when working with LGBTQ+ youth, and for policymakers on how to improve access to affirming care through legislation and community engagement.

Most people with mental health needs cannot access treatment; among those who do, many access services only once. Accordingly, single-session interventions (SSIs) may help bridge the treatment gap. We conducted the first umbrella review synthesizing research on SSIs for mental health problems and service engagement in youth and adults. Our search yielded 24 systematic reviews of SSIs, which included 415 unique trials. Twenty reviews (83.33%) reported significant, positive effects of SSIs for one or more outcomes (anxiety, depression, externalizing problems, eating problems, substance use, treatment engagement or uptake). Across 12 reviews that meta-analytically examined SSIs' effectiveness relative to controls, SSIs showed a positive effect across outcomes and age groups (standardized mean difference = -0.25, I2 = 43.17%). Per AMSTAR 2 (A Measurement Tool to Assess Systematic Reviews), some methodological concerns emerged across reviews, such as low rates of preregistration. Overall, findings support the clinical utility of SSIs for certain psychological problems and populations. Implementation research is needed to integrate effective SSIs into systems of care.

In the United States, the experience of minority stress among LGBTQ+ youth varies across regions with high and low levels of stigma (e.g., laws, policies and cultural norms that limit the lives of individuals with stigmatized identities). Some evidence suggests that stigma can undermine response to individual-level psychosocial interventions among youth, creating a need to identify factors that may buffer against minority stressors’ effects in high-stigma contexts. Social support may be one such factor. Therefore, among LGBTQ+ youth who received a digital, single-session intervention (SSI) focused on minority stress, we investigated whether structural and internalized stigma and social support predicted intervention response, independently or interactively. Specifically, we predicted that LGBTQ+ youth in environments characterized by high stigma would report weaker SSI responses. Further, we predicted that LGBTQ+ youth who perceived higher social support would report stronger SSI responses. We also tested structural stigma and social support as moderators. Using data from a previously-completed randomized evaluation, we analyzed data from 244 LGBTQ+ adolescents, aged 13 to 16 years, across 181 counties in 46 U.S. states, who engaged with the SSI. We created a factor representing structural stigma using confirmatory factor analysis at the county level. No evidence emerged for structural stigma or social support as a moderator of intervention effects on internalized stigma, identity pride, or mental health-related outcomes, either at post-intervention or at two-week follow up. Results speak to the potentially broad utility of the SSI tested in this trial for LGBTQ+ youth with limited access to mental health support.

Healthcare workers (HCWs) and trainees face deleterious mental health difficulties resulting from demanding work responsibilities and in the shadow of the COVID-19 pandemic. Yet, few mental health resources exist that are tailored to the unique needs of HCWs. To provide confidential, private, and accessible mental health support to HCWs at Stony Brook Medicine we adapted and disseminated three evidence-based, digital, self-guided single-session interventions (SSIs). Through focus groups, interviews, and surveys, we collected HCW testimonials and feedback for adapting each SSI. Using an open-access, internet-based platform (i.e., Single Session Support Center website), we piloted each adapted SSI to investigate their individual and combined effects on hopelessness, agency, and subjective distress. Usage patterns were analyzed to assess engagement, effect sizes were calculated to determine SSI effectiveness, and acceptability was measured to determine real-world applicability. HCWs who completed a SSI (n = 91) reported significant improvements in agency and hopelessness, although differential effects emerged between SSIs. Acceptability results were high, across all three SSIs, indicating satisfaction with the self-guided program. Findings suggest digital, self-guided SSIs may be accessible, acceptable, and effective for providing HCWs with mental health support at any time, and from any location connected to the internet.

Two-spirit, lesbian, gay, bisexual, transgender, queer, intersex, asexual plus (2SLGBTQIA+) youth face significant barriers to mental health care, ranging from a lack of access to therapists (e.g., months-long waitlists, lack of insurance coverage, etc.) to receiving incompetent care from non-affirming providers. To better understand the experiences of youth when accessing mental health care, the current study utilized a fixed, embedded mixed methods design with 808 2SLGBTQIA+ youth in the United States. In this sample, less than half of 2SLGBTQIA+ adolescents stated they were able to access mental health care when it was needed. Youth described experiencing unethical therapy practices by clinicians, cited their parents and practical concerns as barriers to accessing care, and concealing their identity from providers out of fear and mistrust. Youth also described feeling both validated and invalidated once they do receive care. Recommendations for caregivers, providers, organizations and programs, and policymakers are provided based on youth responses.

In this study we aimed to examine behavioral determinants influencing parents’ willingness to recommend digital mental health interventions (DMHIs) to their youth, guided by the Capability, Opportunity, Motivation–Behavior (COM-B) model. Methods: We conducted semi-structured interviews with 22 parents of adolescents aged 13-19 years with mental health concerns. Interviews were thematically analyzed using a hybrid inductive-deductive approach. Results: Findings mapped onto COM-B domains. Capability barriers included low awareness, uncertainty about SSIs, and difficulty navigating digital tools. Opportunity facilitators involved embedding SSIs in trusted settings and receiving endorsements from credible sources, though views on peer recommendations were mixed. Motivation was shaped by alignment with parental values (e.g., safety, communication) and emotional responses such as fear or skepticism related to DMHIs and privacy. Conclusion: Results from this study highlight the need for dissemination strategies that directly address parental concerns and priorities, including culturally relevant messaging, tailored framing, and delivery through familiar and trusted community settings.

Introduction: Despite the promise of SSIs in reducing mental health difficulties, SSIs remain rarely integrated into routine healthcare settings. One set of factors that can preclude or facilitate the implementation of novel service models is provider attitudes, which have not been systematically studied in the SSI context. Accordingly, the objectives of this paper are to: (1) discuss the importance of provider attitudes as a potential barrier or facilitator to the deployment of SSIs in routine healthcare systems; (2) provide evidence on providers’ initial attitudes toward SSIs; and (3) outline recommendations to address attitudes towards SSIs in future implementation efforts. Method: A total of 466 providers rated their attitudes towards SSIs before and immediately after a brief training. The aims and data analytic plan were pre-registered on OSF (https://osf.io/zgvmw/). Results: The average minimum number of sessions providers believed as necessary to yield clinically-significant symptom reductions declined from 11.02 (SD = 23.14) to 4.44 (SD = 9.78) from pre-to-post training. Participants perceived the SSI to be useful (Mpre = 3.92, Mpost = 4.12) at both pre-and-post training. Expectancies of the SSI’s acceptability (Mpre = 3.45, Mpost = 3.76) and effectiveness (Mpre = 2.99, Mpost = 3.59) grew more positive post-training. Perceptions around the SSC’s limitations did not meet the cut- off (Mpre = 3.07, Mpost = 3.10) at both time points. Conclusion. Provider attitudes represent a targetable implementation facilitator to promote the uptake and sustainment of SSIs in routine healthcare settings.

Structural stigma has been shown to have negative consequences on LGBTQ+ youth's mental health. Most research has focused on stigma at the national or state level, limiting understanding of how local institutions and environments influence mental health. In the current study, we sought to examine the association of multiple layers of structural stigma (e.g., at the county and state levels) on depression and anxiety severity, substance use, and mental healthcare access, for LGBTQ+ youth in the United States. Thus, we recruited 609 LGBTQ+ youth (Mage = 15.6, SDage = 1.17; 71.9% White) to complete survey measures about their mental health and access to care. Further, we extracted 2023 data from Project Implicit and the Human Rights Campaign to create factors of structural stigma at the county and state levels. Consistent with existing literature, our results demonstrate that structural stigma, particularly when examined at the county level (as opposed to the state level), may exert significant impacts on mental health outcomes such as depression, anxiety, and substance use severity for LGBTQ+ youth.

PurposeThis study aims to examine the unique lived experiences of international graduate students in light of COVID-19 and the recent sociopolitical climate in the USA (e.g. Black Lives Matter movement, protests against anti-Asian hate crimes and gun violence).Design/methodology/approachThe authors used an exploratory qualitative design embedded within a constructivist/interpretivist paradigm. A total of 31 international health service psychology graduate students completed an online survey, 17 of whom participated in a 60-min one-on-one semi-structured interview.FindingsParticipants reported facing a range of difficulties (e.g. travel ban/inability to spend time with family, visa-related concerns, racism, decreased support) during the global pandemic and the recent sociopolitical climate in the USA. A total of 48 themes were identified and organized into six domains: COVID-19-related stress and worry, experiences of racism/discrimination, coping mechanisms, support received, recommendations for programs and higher learning institutions and advice for other international graduate students.Originality/valueThe recent sociopolitical climate in the US exacerbated some of the preexisting inequities for international graduate students due to their international student status and the global pandemic. Although few in number, students also spoke about some positive changes as a result of these major historical and political events. Implications for graduate education, clinical practice and policymaking are discussed.

Most people with mental health needs cannot access treatment; among those who do, many access services only once. Accordingly, single-session interventions (SSIs) may help bridge the treatment gap. We conducted the first umbrella review synthesizing research on SSIs for mental health problems and service engagement in youth and adults. Our search yielded 24 systematic reviews of SSIs including 415 unique trials. Twenty reviews (83.33%) reported significant, positive effects of SSIs for >1 outcomes (anxiety; depression; externalizing problems; eating problems; substance use; treatment engagement or uptake). Across 12 reviews that meta-analytically examined SSIs’ effectiveness relative to controls, SSIs showed a positive effect across outcomes and age groups, SMD=-0.25, I2 = 43.17%. Per AMSTAR-2, some methodological concerns emerged across reviews, such low rates of pre-registration. Overall, findings support the clinical utility of SSIs for certain psychological problems and populations. Implementation research is needed to integrate effective SSIs into systems of care.