Sexual and gender minority youth experience serious mental health risks, yet are not impacted by typically efficacious interventions: secondary mental health outcomes from randomized controlled trial (ATN 149).

In 30 seconds

This randomized controlled trial assessed secondary mental health outcomes of three HIV-prevention intervention components—automated text messaging, online peer support, and strengths-based coaching—in 895 sexual and gender minority youth aged 16–24 years recruited in Los Angeles and New Orleans. Over 24 months, participants generally reported mild anxiety and depression symptoms, while youth classified as high risk had greater baseline symptoms and mental health service use. Symptoms and service use declined over time across groups, but interventions did not significantly reduce symptoms or stabilize service use. Coaching was associated with more mental health specialist service use among low-risk than high-risk youth.

Key findings

• At baseline, 38% of participants were classified as high risk; this group had greater anxiety and depression symptoms and mental health service use.
• Anxiety and depression symptoms and mental health service use declined over time across intervention groups.
• Interventions did not significantly reduce symptoms or stabilize mental health service use.
• The two coaching arms were associated with more mental health specialist service use among low-risk than high-risk youth.

Why it matters

The findings highlight that a substantial proportion of sexual and gender minority youth had a history of serious mental health events, even though recent symptoms were generally mild. Integrating mental health support into HIV-prevention programs may be relevant, but these results do not show that the tested intervention strategies improved symptoms or maintained service use.

What to keep in mind

Mental health outcomes were secondary outcomes of interventions primarily targeting HIV risk reduction; the abstract reports no significant symptom benefit.