Interventions to Reduce Mental Health Problems, Drug Use, and Violence Exposure in Sexual and Gender Minority Youth

The psychosocial challenges faced by sexual and gender minority youth (SGMY) are numerous and well-studied. But what about the effectiveness of interventions to reduce these challenges that can include mental health issues, violence victimization or substance use? Coulter et al. (10.1542/peds.2018-3367) conducted a systematic review being released this week in our journal looking at over a decade of studies and were only able to find 9 published interventions addressing mental health, 2 for substance use, and 1 for reducing violence victimization.  All appear to improve mental health of SGMY youth, two reduced substance use, and one victimization. Some worked at a state policy level, others with families, and yet others involved medical interventions involving gender-affirming hormones and/or puberty blockers.   

With the rising prevalence of SGMY patients in our practices and the psychosocial disparities that exist in this population compared to cisgender heterosexual youth, it is disappointing that only 12 studies could be identified in this review. Why is this, and what can we as pediatricians do to help these children and teens even if the published successful intervention studies are not as robust as we would like them to be?  We asked adolescent and health policy specialists Drs. Nadia Dowshen and Carol Ford from the Children’s Hospital of Philadelphia to share their thoughts about this review in an accompanying commentary (10.1542/peds.2019-2133).  Drs. Dowshen and Ford discuss the difficulties in doing high quality research in this important population of patients so they might achieve better health equity. They also remind us of the important role we, along with schools, communities, and even social media can play to help support and advocate for SGMY and families so they feel accepted and supported and less apt to develop the problems discussed in the Coulter study.