OBJECTIVE:This study examined whether death-related thoughts, passive suicidal ideation (SI), and active SI prospectively predict risk of alcohol use disorder (AUD) and cigarette use among sexual minority women (SMW), and whether these associations differ by exposure to single versus multiple forms of sexual violence. METHOD:Data came from a 24-year, five-wave U.S. longitudinal study of SMW's health, using Waves 3 (2010-2012; N = 726) and 4 (2017-2019; N = 525). Multivariable logistic regression models tested associations between Wave 3 sexual violence exposure (single type, multiple types, vs. none) and death-related thoughts, passive SI, and active SI. Additional models examined whether Wave 3 death-related thoughts and SI predicted Wave 4 AUD risk and cigarette use, adjusting for sociodemographic characteristics and Wave 3 alcohol and cigarette use. Moderation by sexual violence exposure was tested using interaction terms. RESULTS:Exposure to a single type of sexual violence was associated with death-related thoughts, whereas exposure to multiple types was associated with both death-related thoughts and active SI. Prospectively, death-related thoughts predicted AUD risk, and passive SI predicted cigarette use. Exploratory analyses suggested that the association between death-related thoughts and cigarette use was stronger among SMW without sexual violence histories than among those with exposure to multiple types of sexual violence. CONCLUSIONS:These findings highlight sexual violence as a determinant of death- and suicide-related cognitions and demonstrate that these cognitions prospectively shape substance use risk among SMW. Results underscore the importance of targeting upstream cognitive vulnerability processes in trauma-responsive prevention and intervention efforts.

Background:Sexual minority cisgender women, transgender men and women, and nonbinary or gender diverse (SMW/TGD) people experience disproportionately high rates of hazardous drinking and posttraumatic stress symptoms, due in part to elevated exposure to trauma, stigma-related stressors and related adaptations, and barriers to accessing affirming care. Existing integrated alcohol-trauma interventions have rarely been evaluated or culturally adapted for SMW/TGD people, underscoring the need for scalable, culturally responsive approaches for this population. This protocol describes development and pilot testing of Recovery through Inhibitory learning, Self-Efficacy promoting, problem-solving, and community building (RISE), a brief, culturally responsive telehealth intervention integrating selected Unified Protocol modules with exposure-based expressive writing for trauma-exposed SMW/TGD adults with hazardous drinking and at least subthreshold PTSD symptoms. Methods:Guided by the ADAPT-ITT framework, Aim 1 will adapt RISE using community- and provider-engaged methods with 20 SMW/TGD community members and 10 mental/behavioral health providers. Aim 2 will pilot RISE in a randomized trial comparing immediate treatment (n = 30) versus 6-week waitlist control (n = 30). RISE includes four adapted Unified Protocol sessions followed by five days of expressive writing about trauma, stigma, or other adverse experiences with clinician check-ins. Feasibility, acceptability, implementation indicators, and preliminary clinical outcomes will be assessed through self-report and clinician-administered measures. Conclusion:This study will generate preliminary data regarding feasibility, acceptability, and clinical promise of a brief, scalable intervention addressing hazardous drinking, posttraumatic stress, and stigma-related stressors and related adaptations among SMW/TGD populations. Findings will inform refinement of RISE and a future fully powered randomized controlled trial. Trial registration number:Registered on 15 October 2025 (ClinicalTrials.gov identifier: NCT07217795).

Sexual minority women, transgender people, and nonbinary (SMW/TNB) people experience disproportionately high rates of traumatic stressors (e.g., child abuse, sexual violence), which are associated with adverse trauma-related mental health outcomes, such as dissociation. SMW/TNB people also experience ongoing stressors related to their minoritized sexual and/or gender identities (e.g., discrimination). Dissociation has been associated with minority stressors in studies primarily using single-time point, cross-sectional approaches. Reliance on single-time point approaches may obscure how minority stressors and trauma-related outcomes, like dissociation, covary within individuals and unfold over time. We conducted a secondary analysis of data from a 14-day daily diary study with trauma-exposed SMW/TNB participants (N = 57) to examine whether variations in daily minority stressors were associated with same-day fluctuations in dissociation. Results indicated minority stressors and dissociation significantly covaried over the 14-day study period. Multilevel models showed that participants' reports of higher-than-average daily minority stressors were associated with same-day reports of higher-than-average dissociative symptoms, B = 0.24, 95% CI [0.07, 0.41], p = .007. Participants also reported small decreases in dissociation levels over the study period, B = -0.05, 95% CI [-0.08, -0.02], p = .004. The findings highlight the importance of considering the health impacts of consistent state elevations in dissociation associated with minority stressors for SMW/TNB people. Future time-varying approaches should investigate temporal sequencing of minority stressors and dissociation, assess whether minority stressors relate to dissociation independent of trauma exposure, and explore whether trauma exposure characteristics (e.g., identity-relatedness of trauma) moderate this association.

OBJECTIVE:This study examined heterogeneity in the prevalence estimates of mental health, alcohol, and drug use outcomes across cisgender heterosexual subgroups and sexual and gender minority subgroups using a national probability sample. METHOD:We conducted a secondary data analysis with the U.S. Transgender Population Health Survey (n = 1,436). We calculated prevalence estimates of serious psychological distress, suicidal ideation and attempts, elevated posttraumatic stress disorder symptoms, hazardous alcohol use, hazardous drug use, and co-occurring outcomes across subgroups using cutoffs from common screening measures (e.g., three-item Alcohol Use Disorder Identification Test). We then assessed disparities between sexual and gender minority subgroups and cisgender heterosexual men and women across outcomes and co-occurring outcomes. RESULTS:Suicidality was significantly higher across all sexual and gender minority subgroups compared with cisgender heterosexual subgroups. Cisgender sexual minority women, transgender sexual minority men and women, and nonbinary sexual minority people-subgroups with both oppressed sexual and gender identities who likely experience both sexual- and gender-based forms of oppression (e.g., homophobia, transphobia, sexism)-were significantly more likely than cisgender heterosexual subgroups to report most outcomes, including serious psychological distress, elevated posttraumatic stress disorder symptoms, and hazardous drug use. Nonbinary sexual minority people and cisgender sexual minority women consistently exhibited the largest disparities compared with cisgender heterosexual subgroups across most outcomes and co-occurring outcomes. CONCLUSIONS:Findings highlight the importance of disaggregating across sexual and gender identity in probability samples to understand heterogeneity in prevalence estimates of mental health, alcohol, and drug use outcomes and identify subgroups in need of targeted health equity efforts. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Recent calls have been made to decolonize White-dominated, Western narratives around concealment (e.g., that disclosure should be prioritized) and instead to examine psychosocial factors associated with concealment. Existing literature lacks exploration into daily variations of sexual or gender identity concealment (hereafter, "concealment") among sexual and gender minority people, especially sexual minority women (SMW) and transgender and gender-diverse (TGD) individuals who have experienced trauma. Additionally, there is little research delving into individual characteristics, such as trait-based avoidance coping, and specific contexts, including daily minority stressors and threat appraisal, prompting trauma-exposed SMW and TGD people to conceal their identities. Addressing these gaps, we aimed to develop and test an innovative model that advances stress and coping frameworks by integrating minority stress and social safety theories. We used data from a 14-day intensive longitudinal study among 57 trauma-exposed SMW and TGD people. Minority stressors and threat appraisal were associated with concealment at both the within- and between-person levels, respectively. Trait-based general avoidance coping predicted identity concealment and moderated the link between daily minority stressors and concealment. Daily minority stressors were associated with greater concealment only among those who reported lower avoidance coping. Concealment may operate as an experiential avoidance behavior among those who habitually cope by using avoidance and as a goal-directed coping response among trauma-exposed SMW and TGD people who face acute minority stressors and report less avoidance coping. Counseling psychologists exploring the function of concealment with trauma-exposed SMW and TGD people should attend to stigma exposure, threat appraisal, and avoidance coping. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

Heightened stress reactivity, particularly heightened blood pressure (BP) reactivity, during emerging adulthood predicts future adverse cardiovascular health. Coping skill interventions for young adults may buffer against stress reactivity. This study tested the stress-buffering effects of a group-based 40-min compassion skills microintervention compared to a time-matched cognitive behavior therapy (CBT) skills control group. The compassion intervention included psychoeducation about compassion and a guided practice focused on cultivating compassion for a close other and for the self. The CBT skills group included psychoeducation about thoughts, feelings, and behaviors and a guided worksheet activity focused on practicing cognitive reappraisal strategies. Young adults (n = 50) were cluster randomized to the compassion or CBT skills group. Participants attended a lab visit, completed their assigned intervention, and underwent the group-based Trier Social Stress Test (TSST-G). Systolic and diastolic BP, heart rate, self-reported stress, and behavioral responses were assessed. Compared to cognitive reappraisal, participants in the compassion microintervention exhibited lower diastolic BP reactivity, less BP hyperreactivity (i.e., responses ≥20 and ≥15 mmHg for systolic and diastolic BP, respectively) and fewer observable stress behaviors to the TSST-G. Compassion skills are a promising area of research for stress management and cardiovascular health prevention among young adults.

LGBTQ-affirmative cognitive-behavioral therapy (CBT) is an evidence-based treatment for reducing transdiagnostic mental and behavioral health concerns among LGBTQ individuals. Preserving the effects of this intervention as it is translated into practice can maximize public health benefits. This study systematically identifies and evaluates implementation strategies for LGBTQ-affirmative CBT. First, we identified and operationalized implementation strategies used across five trials of LGBTQ-affirmative CBT using the Pragmatic Implementation Reporting Tool. Second, we evaluated the relative importance of these strategies via a quantitative assessment (N = 31 unique trial implementers). Survey responses were analyzed descriptively within each trial. Across all trials, we organized strategies as (1) high priority, (2) moderate priority, and (3) optional (if resources are available) for implementing LGBTQ-affirmative CBT. Within each trial, we identified 20 or more implementation strategies that were used, many of which overlapped across trials. We identified nine high priority strategies (e.g., working with clients to engage them in LGBTQ-affirmative CBT), nine moderate priority strategies (e.g., conducting ongoing training in LGBTQ-affirmative CBT), and nine optional/resource dependent strategies (e.g., showing visual indicators of LGBTQ affirmation within the physical spaces where LGBTQ-affirmative CBT is delivered). LGBTQ-affirmative CBT is a complex intervention requiring a package of implementation strategies. Our findings provide guidance for implementers in settings with different levels of resources regarding the highest priority strategies that may be needed to preserve the effectiveness of LGBTQ-affirmative CBT as it is translated into real-world settings.

BACKGROUND AND PURPOSE:This study aimed to develop and test a novel model integrating social-learning and self-medication frameworks by examining the association between self-efficacy to resist alcohol and other drug (AOD) use and daily AOD use and unhealthy drinking risk among trauma-exposed sexual minority women (SMW) and transgender and gender-diverse (TGD) people. We examined whether minority stressors moderated these associations. METHODS:Data were from 57 trauma-exposed SMW and TGD people who participated in a 14-day daily diary study. Multilevel binary logistic models and ordinal logistic models were employed to examine associations between self-efficacy to resist AOD use and daily AOD use and unhealthy drinking risk at within- and between-person levels. We assessed same- and cross-level interactions between daily self-efficacy to resist AOD use and minority stressors in predicting AOD use and unhealthy drinking risk within the same 24-hour period (i.e., standardized as 6 pm to 6 pm; hereafter referred to as "same-day"). RESULTS:Self-efficacy to resist AOD use was associated with lower AOD use and unhealthy drinking risk. Minority stressors were associated with daily AOD use. Among those who experienced higher (vs. lower) average sexual minority stressors over the 2-week daily diary period, higher-than-usual self-efficacy to resist AOD use was less protective in decreasing risk of same-day unhealthy drinking. CONCLUSIONS:Interventions aiming to mitigate AOD use and unhealthy drinking risk by bolstering self-efficacy to resist AOD use should consider the impact of recent cumulative exposure to sexual minority stressors in this population. Further, policy efforts are needed to reduce perpetuation of stigma.

Objective Sexual minority women (SMW) and transgender and/or nonbinary (TNB) people report more adverse health outcomes (e.g., depression, anxiety, posttraumatic stress, substance use) relative to heterosexual, cisgender people, often due to the additional stress burden from experiencing stigma. Physiological and emotional stress reactivity are mechanisms through which high cumulative stress contributes to adverse health outcomes. The randomized controlled trial (RCT) described in this study protocol examines whether a single-session compassion microintervention may attenuate physiological and emotional stress reactivity to the minority stress Trier Social Stress Test (MS-TSST) among SMW/TNB people. This study will also examine whether the compassion microintervention reduces depression, anxiety, posttraumatic stress symptoms, and substance use from baseline to one-month follow-up, and assess microintervention acceptability. Methods This protocol describes a two-arm parallel RCT. Participants are recruited online and at in-person events (e.g., Pride events). Participants complete baseline measures online (e.g., demographics, anxiety symptoms) and then complete an in-person lab visit that includes the compassion microintervention (or no training control). Immediately after the intervention period, participants complete the MS-TSST. Measures of physiological (i.e., blood pressure, cortisol) and emotional (i.e., negative affect, state anxiety) reactivity are collected throughout the lab visit. Participants also complete a one-month follow-up survey. Participants randomized to the microintervention are invited to complete a semi-structured virtual interview about their experiences to assess acceptability. Conclusion Findings from this study could provide initial evidence that compassion microinterventions show promise in addressing stigma-related stress reactivity among SMW/TNB people.ClinicalTrials.gov registration: NCT05949060

Background: Sexual minority women (SMW) and transgender and/or nonbinary (TNB) individuals report an elevated prevalence of posttraumatic stress disorder (PTSD) symptoms and negative alcohol-related outcomes compared to heterosexual women and cisgender people. SMW and TNB individuals also face barriers to utilizing treatment, which can result in delayed or missed appointments. Accessible, feasible, and effective treatment approaches, such as web-based expressive writing (EW) treatments, are needed to address PTSD and negative alcohol-related outcomes in these populations. Method: We describe the design of a mixed-method pilot randomized controlled trial which will compare an EW treatment adapted for SMW and TNB people (stigma-adapted EW) and trauma (i.e., non-adapted) EW with an active (neutral-event) control to determine acceptability and feasibility of a future fully powered randomized controlled trial. The sample will include 150 trauma-exposed SMW and TNB individuals from across the United States who will be randomly assigned to stigma-adapted EW (n = 50), trauma EW (n = 50), or control (n = 50). Participants will be assessed before treatment, one-week after the first writing session, and three-months after the first writing session. This paper identifies steps for evaluating the acceptability and feasibility of the proposed study and determining changes in outcomes resulting from adapted and non-adapted EW treatments to inform refinements. This paper also highlights our strategy for testing theory-driven mediators and moderators of treatment outcomes. Conclusions: This mixed-method pilot trial will inform the first fully powered, self-administered, brief web-based treatment to reduce PTSD symptom severity and negative alcohol-related outcomes among trauma-exposed SMW and TNB individuals.

Posttraumatic stress disorder (PTSD) is more prevalent among sexual minority women (SMW) than among heterosexual women. PTSD risk varies among SMW, but no meta-analysis has clarified sexual identity-related disparities in probable PTSD among women or SMW's heterogeneity in PTSD risk. SMW are also at pro-nounced risk of comorbid PTSD and hazardous drinking (HD). However, the difference in comorbid PTSD/HD between SMW and heterosexual women is understudied. This meta-analysis aimed to provide a comprehensive understanding of differences between SMW and heterosexual women and among SMW across demographic characteristics. Peer-reviewed publications that were written in English and reported quantitative data on PTSD specific to SMW were included. Eligible publications (n = 45) were identified through a systematic search of 11 electronic databases, supplemented by a search of reference lists of relevant papers. We found that probable PTSD, PTSD symptom severity, and probable comorbid PTSD/HD are highly prevalent among SMW, with SMW of color, transgender and gender diverse people, and bi+ women (e.g., bisexual, pansexual, queer) being at greatest risk. These results emphasize the need to improve accurate assessment of trauma-related sequelae among SMW and to develop, disseminate, and implement culturally sensitive treatments to reduce PTSD and comorbid PTSD/HD among at-risk SMW.

Objective: LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses the adverse impacts of minority stress. However, this treatment has rarely been tested in randomized controlled trials with LGBTQ youth and never using an asynchronous online platform for broad reach. This study examined the feasibility, acceptability, preliminary efficacy, and multi-level stigma moderators of LGBTQ-affirmative internet-based CBT (ICBT).Method: Participants were 120 LGBTQ youth (ages 16-25; 37.5% transgender or non-binary; 75.8% assigned female at birth; 49.2% non-Latino White) living across 38 U.S. states and reporting depression and/or anxiety symptoms. Participants were randomized to receive 10 sessions of LGBTQ-affirmative ICBT or only complete 10 weekly assessments of mental and behavioral health and minority stress; all completed measures of psychological distress, depression, anxiety, suicidal thoughts, alcohol use, and HIV-transmission-risk behavior at baseline and 4 and 8 months post-baseline; 20 LGBTQ-affirmative ICBT participants completed a qualitative interview regarding intervention acceptability.Results: Participants randomized to LGBTQ-affirmative ICBT completed, on average, 6.08 (SD = 3.80) sessions. Participants reported that LGBTQ-affirmative ICBT was helpful and engaging and provided suggestions for enhancing engagement. Although most outcomes decreased over time, between-group comparisons were small and non-significant. LGBTQ-affirmative ICBT was more efficacious in reducing psychological distress than assessment-only for participants in counties high in anti-LGBTQ bias (b = -1.73, p = 0.001, 95% CI [-2.75, -0.70]). Session dosage also significantly predicted reduced depression and anxiety symptoms.Conclusions: LGBTQ-affirmative ICBT represents a feasible and acceptable treatment. Future research can identify more efficacious approaches and modalities for engaging LGBTQ youth, especially those living under stigmatizing conditions, who might benefit most.

Objective: Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existing interventions. Method: Participants were young human immunodeficiency virus (HIV)-negative SMM (N = 254; ages = 18-35; 67.2% racial/ethnic minority) experiencing a depression, anxiety, and/or stress-/trauma-related disorder and past-90-day HIV transmission risk behavior. After completing HIV testing and counseling, participants were randomized to receive 10-session ESTEEM (n = 100); 10-session community-based lesbian, gay, bisexual, and queer/questioning (LGBQ)-affirmative counseling (n = 102); or only HIV testing and counseling (n = 52). Results: For the primary outcome of any HIV transmission risk behavior at 8 months, ESTEEM was not significantly associated with greater reduction compared to HIV testing and counseling (risk ratio [RR] = 0.89, p = .52). Supportive analyses of the frequency of HIV transmission risk behavior at 8 months showed a nonsignificant difference between ESTEEM compared to HIV testing and counseling (RR = 0.69) and LGBQ-affirmative counseling (RR = 0.62). For secondary outcomes (e.g., depression, anxiety, substance use, suicidality, number of mental health diagnoses) at 8 months, ESTEEM had a larger effect size than the two comparison conditions, but these comparisons did not reach statistical significance when adjusting for the false discovery rate. Observed effect sizes for condition comparisons were smaller than the effect sizes used to power the study. In exploratory analyses, ESTEEM showed promise for reducing comorbidity. Conclusions: Because the control conditions were associated with stronger effects than anticipated, and given the heterogeneous nature of transdiagnostic outcomes, the study possessed insufficient power to statistically detect the consistently small-to-moderate benefit of ESTEEM compared to the two control conditions. What is the public health significance of this article? As long as young sexual minority men (SMM) face minority stress, identity-affirming and effective psychological interventions are needed to address the impact that this stress has on their mental and sexual health. This study found evidence that an lesbian, gay, bisexual, and queer/questioning (LGBQ)-affirmative, minority-stress-focused, transdiagnostic cognitive-behavioral therapy (CBT) intervention called ESTEEM was associated with reductions across numerous mental and sexual health outcomes among young SMM experiencing co-occurring mental and sexual health concerns, though not significantly greater reductions than the two existing interventions to which ESTEEM was compared.

A limited number of studies have examined mechanisms undergirding interventions that mitigate mental health problems or health-risk behaviors that disproportionately burden sexual minorities. A recent trial of expressive writing and self-affirmation writing found that these brief interventions had salubrious effects on mental health and health-risk behaviors; the present research examines the putative mechanisms underlying these effects. Sexual minority emerging adults (N = 108) completed a brief online expressive writing, self-affirmation writing, or neutral control writing intervention and, at baseline and 3-month follow-up, completed measures of mental health, health-risk behaviors, stress, and self-regulation. Expressive writing yielded improvements in mental health and these effects were mediated by reductions in perceived stress. Self-affirmation caused improvements in health-risk behaviors, though neither stress nor self-regulation mediated these effects. This finding provides preliminary novel evidence regarding a mechanism underlying a widely used psychological intervention with documented mental health benefits for sexual minorities and other populations disproportionately affected by stress. Public Significance Statement This study found that writing about difficult or painful sexual identity-related experiences reduced perceived stress which, in turn, improved mental health among LGBTQ+ young adults in a high-stigma, low-resource context. This finding may be helpful to psychologists, practitioners, policymakers, and funders who aim to design and disseminate programs capable of addressing mental health inequities among sexual minority and other stress-exposed communities.

Social anhedonia, a tendency toward experiencing social stimuli as less positive or pleasurable, is associated with maladaptive personality traits, poor interpersonal functioning, and psychopathology, and is typically elevated in males compared with females. However, the correlates of social anhedonia in youth have not been well defined. In this study, 275 young adolescents from a community sample completed measures of social anhedonia, personality, interpersonal functioning, and symptoms; mothers also completed personality and symptom measures. Social anhedonia was associated with low positive emotionality and, to a lesser extent, high disinhibition and negative emotionality. Social anhedonia was also correlated with several markers of poor interpersonal functioning and a wide range of internalizing and externalizing symptoms. Interactions between sex variables indicated that associations were particularly strong in males. Overall, findings suggest that social anhedonia is an important construct to explore in early adolescence, with meaningful associations with psychosocial functioning, especially among males.

OBJECTIVE To remedy the notable gap in evidence-based treatments for sexual minority women, this study tested the efficacy of a minority-stress-focused cognitive-behavioral treatment intended to improve this population's mental and behavioral health. METHOD The intervention, EQuIP (Empowering Queer Identities in Psychotherapy), was adapted from a transdiagnostic cognitive-behavioral treatment as also recently adapted for sexual minority men. Sexual minority women at risk of mental and behavioral health problems (n = 19) and expert providers with this population (n = 12) shaped the treatment's development, including by supporting its primary focus on universal and minority-stress-focused processes underlying this population's disproportionately poor mental and behavioral health. The resulting treatment was then delivered to young adult sexual minority women (n = 60; M age = 25.58; 41.67% racial/ethnic minority; 43.33% transgender/nonbinary) experiencing depression/anxiety and past 90-day heavy alcohol use. RESULTS Compared to waitlist (n = 30), participants randomized to immediately receive EQuIP (n = 30) experienced significantly reduced depression and anxiety (d = 0.85, 0.86, respectively); effects for alcohol use problems were smaller (d = 0.29) and marginally significant. In pre- to post-intervention pooled analyses, effect sizes for minority stress processes (mean d = .25) and universal risk factors (mean d = .48), through which the treatment was expected to work, were small and moderate, respectively, and in the expected direction. CONCLUSIONS This study provides initial support for a minority-stress-focused transdiagnostic cognitive-behavioral treatment for sexual minority women. These first results can launch exploration of other mechanisms and modalities through which to equip this population with evidence-based support. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

OBJECTIVETo identify scalable interventions for improving sexual minority mental health and health-risk behavior, this study tested the efficacy of two self-guided online writing interventions-expressive writing and self-affirmation. To reach sexual minority young adults living in high-stigma, low-resource settings, we developed and tested these interventions in Appalachian Tennessee.METHODIn consultation with sexual minority young adults (n = 10) and stakeholders (n = 10) living in Appalachian Tennessee, we adapted these two writing interventions that we then delivered to 108 local sexual minority young adults (Mage = 23.68, SD = 3.11). Participants, representing diverse sexual and gender identities and socioeconomic backgrounds, were randomly assigned to participate in a 3-session expressive writing intervention, self-affirmation intervention, or neutral control. Participants completed mental health and health-risk behavior measures at baseline, postintervention, and 3-month follow-up.RESULTSCompared to the neutral control, expressive writing exerted 3-month improvements in depressive symptoms (d = 0.48) and general psychological distress (d = 0.36) whereas self-affirmation exerted improvement in suicidal ideation (d = 0.62) and drug abuse (d = 0.59). Participants who were exposed to greater contextual minority stressors common in rural regions (i.e., discrimination and victimization) experienced significantly greater 3-month reductions in depression from expressive writing and self-affirmation compared to control. Those who experienced greater discrimination also experienced significantly greater 3-month reductions in suicidality from self-affirmation compared to control.CONCLUSIONBrief writing interventions exert significant impact on the mental health of young adult sexual minorities, especially those exposed to minority stress. Future research can consider strategies for population-level implementation, especially in high-stigma, low-resource settings. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Sexual violence exposure represents a serious public health issue among female youth given its association with female youths' engagement in health-risk behaviours. Sexual minority female youth are particularly vulnerable to sexual violence exposure, alcohol use, suicidality, and sexual-risk behaviour. Using the population-based 2017 Youth Risk Behaviour Survey, we examined sexual violence as a mediator of sexual orientation disparities in health-risk behaviours among female youth. This study included 7,532 female students in grades 9 through 12 across the US. Participants identified their sexual orientation as heterosexual (73.5%); bisexual (12.2%); and, gay or lesbian (2.2%). Compared to heterosexual female youth, sexual violence exposure, alcohol use, binge drinking, and multiple sex partners were more common among bisexual female youth. The elevated risk of suicidality was most notable among gay or lesbian female youth relative to heterosexual female youth and bisexual female youth relative to heterosexual female youth. Mediation analyses showed that sexual violence exposure partially explained the sexual orientation disparity in these co-occurring health-risk behaviours between bisexual female youth and heterosexual female youth. Our findings highlight the need for clinical attention to be paid to assessing and treating the health effects of sexual violence, especially among bisexual female youth.