114. Optimizing Online Tools to Support Sexual and Gender Minority Youth with Depressive or Anxiety Symptoms: Qualitative Study

Sexual and gender minority youth (SGMY) are at higher risk for depression and anxiety than non-SGMY, but have less access to mental health services. We sought to explore perspectives of a non-clinical sample of SGMY on the design of the prototype components for online mental health help-seeking interventions. Adolescents ages 14-19 were recruited through social media advertising. They were eligible if they had at least mild depressive or anxiety symptoms (PHQ-8 and/or GAD-7 = 5 or above) and identified as SGM. A waiver of parental consent was obtained to ensure the protection of a vulnerable population. Participants were invited to a 60-minute interview over HIPAA-compliant online platform. Interviews explored SGMY current use of online resources or support groups, perspectives on proposed intervention targets, such as negative attitudes like stigma (i.e. mental health, internalized homophobia, transphobia), social support, knowledge, attitudes influencing therapy seeking, and preferences for intervention components and delivery modalities. Interviews were audio-recorded, transcribed, and coded. A template thematic analysis approach was used to analyze data. Ten interviews were completed. Participants' interest for resources included those related to medical/social transition, information on SGM identities, and information related to finding therapy or other healthcare that is vetted by their peers. SGMY preferred the use of digital storytelling like video diaries/blogs which discuss experiences faced by other SGMY. Participants preferred, regardless of the delivery modality, for SGMY to be the content creators. Youth reported significant stigma across the intersection of mental health and SGM identity including across age, "I've even had remarks like, 'Oh, shut up, everyone in your generation has anxiety.'" (Participant 18), and cultural groups, "I feel like getting through to at least people, like older people of color, parents, because they grew up thinking that it was bad. So then you're going to grow up thinking it's bad, but when you're actually going through it, it just puts a big wall in between you and getting help." (Participant 47). Participants expressed strong interest in interventions that include communication with others in the SGM community, "I feel like this could be helpful, especially if it's other queer people or queer youth talking about their experiences. I think I watch a lot of these videos on YouTube anyway, and I feel like if other people could upload their own videos and stories, that would also [be helpful]." (Participant 135) Participants also expressed significant interest in the presence of a knowledgeable professional to assist in implementation of the intervention. Content of digital interventions developed for SGMY mental health need to incorporate of the multiplicative nature of stigma across different groups of SGMY. Interventions should include comprehensive educational resources, peer support especially through sharing peer experiences, and oversight by a professional moderator.