Discussion
ideation, anxiety, depression, prejudice, ideations, help-seeking behaviors
RECRUITMENT, CORONAVIRUS DISEASE 2019, HOLIDAY
This randomized controlled trial aimed to examine the efficacy of a digital online-based multicomponent intervention promoting help-seeking in LGBTQ+ young adults with mental health problems. Compared to the control condition, participants who received the intervention showed improvements in general help-seeking intentions for both emotional problems and suicidal ideations. The significant differences at the primary time points (1-month follow-up) prove that the intervention program of the current study is effective. The mean differences between groups of help-seeking intention between baseline and 1-month follow-up were 0.17 for emotional problems and 0.19 for suicidal ideation. Compared with other similar studies [There is no cut-off value of the current scales used to assess the intentions of help-seeking [Aside from the improvements mentioned above, the intervention did not significantly promote participants’ professional help-seeking attitude and reduce participants’ help-seeking stigma. One potential explanation of these findings could be that the intricate connection between professional help-seeking attitude and help-seeking stigma has formulated a vicious cycle, blocking the intervention effect. Previous research indicated that help-seeking from LGBTQ+ individuals to professionals was deemed undesirable by the LGBTQ+ community in China due to the common idea embedded in the community culture that “help from each other (peer support)” could be more helpful compared to taking the risk of facing invalidation, discrimination, and prejudice to meet non-affirmative professionals, contributing to negative professional help-seeking attitudes and less motivation to seek help when in need [We also found the scores of primary outcomes of participants in the control condition increased over time. One possible explanation is that participants in the control condition have the placebo effect. That is, participants think they have accepted effective intervention, so they gave an increased score, which was also the effect of single-blinding. In addition, for the protection of participants at risk of suicide, we added a directory including 3 kinds of safety resources at the end of both brochures received by participants in the control condition and intervention condition. The increase in the help-seeking score of participants in the control condition may be due to this directory. With the purpose of avoiding the interference of these confounding factors, the current study was designed as a randomized controlled trial to verify the effectiveness of the intervention contents. Therefore, the impact of the directory on help-seeking was balanced between participants in 2 conditions.Based on the structured discussion outline of the intervention condition (One of the strengths of the current study was the willingness of participants to trust the researchers and disclose personal information such as educational background and family income. The potential reason for this is that, at the informed consent stage before the research, the researchers introduced the confidential content in the informed consent to the participants in detail, which also promoted the participants’ trust in the researcher so that they were willing to authentically answer their personal information. Considering the effectiveness of the primary outcomes in the current study and the high completion rate of participants, we believe that the digital online-based multicomponent intervention (including psychoeducational videos, online facilitator-led group discussions, and informative electronic help-seeking brochures) could also be applied to other general populations, so as to effectively promote help-seeking for mental health.There were several other strengths from an implementation standpoint that needed to be addressed. First, the present intervention was conducted with high fidelity and completed with low dropout rates. Three group facilitators have received fidelity training on delivering this evidence-based intervention pre-intervention and passed the fidelity assessment examining adherence to study protocol, quality of delivery, and participant responsiveness with high fidelity ratings. Second, under the benefits of high fidelity, the completion rate was extremely high (95%), which was much higher compared to the average completion rate (80%) for most randomized controlled trials, suggesting that not only did we precisely and accurately implement intervention procedures as planned but also the high level of urgency of such interventions for the LGBTQ+ population [The primary limitation is that this study did not effectively promote participants’ actual help-seeking behaviors. The potential explanation could be the inference of the particular time period chosen to conduct both the present study and its post-intervention follow-ups. Chinese New Year (i.e., the Chinese Spring Festival) has always been the most celebrated national holiday in China, during which families, friends, and relatives reunite with each other. However, due to lower levels of both personal privacy and security arising from large family gatherings, it could also be the least possible occasion in which LGBTQ+ young adults would risk revealing their identities for help-seeking, subsequently blocking their actual help-seeking behaviors. Together with the impact of the pandemic (i.e., Coronavirus Disease 2019), even if they intended to seek help, significantly reduced availability and accessibility of resources was a difficulty they must overcome. The second limitation of this study was that the present study was limited to 3-month follow-ups, which might not be long enough for drastic mindset and behavioral changes in help-seeking to occur. Future studies should extend the follow-up time. The third limitation was that half of the participants of the current sample were transgender, nonbinary, genderqueer, or questioning population. This is because the promotion of online recruitment advertising of this study has been promoted by many LGBTQ+ community organizers. Online posters have been released through social media platforms, such as WeChat or QQ groups, which are popular in the Chinese LGBTQ+ community. Since our study received recognition from community organizers in the LGBTQ+ community, especially organizers from the transgender community, transgender young adults who usually could not be reached via posters and online research participation campaigns expressed their interest in participating in our study, explaining why there were more transgender participants in our study.The present study strives to examine the efficacy of the digital online-based multicomponent intervention aiming to promote help-seeking in LGBTQ+ young adults. The intervention was found to be an effective integrated model for enhancing LGBTQ+ young adults’ general help-seeking intentions and promoting their depression and anxiety literacy. Although the clinical significance of the present study’s findings warrants future research, the results of the present study add to an emerging breadth of evidence indicating that a brief, digital, online-based, and multicomponent intervention holds great potential in downscaling currently existing mental health barriers faced by the LGBTQ+ population.