Objective High rates of depression and PTSD contribute to sexual risk, particularly in men who have sex with men (MSM) who have experienced childhood sexual abuse. The comorbidity between depression and PTSD and mechanisms by which they contribute to sexual risk in MSM remain unclear. This study sought to demonstrate the feasibility and utility of a novel network approach to (1) characterize symptom interconnections between depression and PTSD in MSM, (2) identify specific symptoms related to sexual risk behavior, and (3) compare symptom networks across groups at different levels of risk. Method Cross-sectional baseline data were collected from 296 HIV-negative urban MSM as part of a multi-site randomized intervention trial. Symptoms of depression and PTSD were self-reported along with sexual risk behavior. Analyses were performed in R using regularized partial correlation network modeling. Results Network analyses revealed complex associations between depression and PTSD symptoms and in relation to sexual risk behavior. While symptoms clustered within their respective disorders, depression and PTSD were connected at key symptom nodes (e.g., sleep, concentration). Specific symptoms (e.g., avoiding thoughts and feelings) were linked to sexual risk behavior. Network comparisons across risk groups suggested avoidant processes could be more readily activated in higher-risk individuals, whereas hyperarousal symptoms may be more salient for lower-risk individuals. Conclusions This study is one of the earliest network analyses of depression and PTSD, and first to extend this inquiry to health behavior. Symptom-level investigations may clarify mechanisms underlying psychological comorbidity and behavioral risk in MSM and refine targets for intervention/prevention.

BackgroundIndividuals identifying as a sexual minority report engaging in nonsuicidal self-injury (NSSI) at substantially higher rates compared to their heterosexual peers. Given that NSSI is a known risk factor for suicide, it is important to understand the processes unique to being a sexual minority that increases risk for NSSI so that adequate prevention efforts can be established. The current study integrated Minority Stress Theory and the Interpersonal Theory of Suicide to test a model of NSSI and suicide risk.MethodsA total of 137 college students who identified as a sexual minority completed an anonymous on-line study assessing NSSI, suicidal thoughts/behaviors, and constructs of the minority stress and interpersonal theories. Two linear regressions using bootstrapping analyses were conducted to test our hypotheses.ResultsMinority stress was directly associated with NSSI and via perceived burdensomeness, explaining 27 % of the variance. NSSI was associated with increased risk for suicide thoughts/behaviors directly, and through acquired capability, explaining 45 % of the variance.ConclusionsThese findings provide evidence that unique stressors individuals face as a result of their sexual minority status increases risk for self-harm by influencing cognitive and emotional processes such as burdensomeness and acquired capability. Implications for prevention, intervention, and future research are briefly discussed.

Childhood sexual abuse (CSA) is associated with post-traumatic stress disorder (PTSD), which can be associated with condomless sex among men who have sex with men (MSM). However, the impact of moderating factors on the relationship between PTSD symptom severity and condomless sex is poorly understood. We examined whether PTSD symptom severity was associated with condomless sex among MSM with CSA histories, and whether substance dependence, self-esteem, and distress tolerance moderated that relationship (n = 288). Notably, no direct relationship between PTSD symptom severity and condomless sex was found. Adjusted models indicated that condomless sex was differentially impacted by PTSD symptom severity among those without substance dependence (ΔR2 = 0.03, p = 0.034) and, counterintuitively, those with high self-esteem (ΔR2 = 0.07, p = 0.005). PTSD symptom severity was associated with condomless sex across levels of distress tolerance. Findings indicate that substance use, self-esteem, and distress tolerance should be targeted in high-risk MSM with CSA even if they do not have PTSD.

Objective: Brief alcohol interventions (BAIs) have historically centered on young adults attending 4-year predominantly white institutions. The purpose of this scoping review is to determine BAIs evaluated among young adults with one or more marginalized/understudied racial, ethnic, sexual, gender, and military/ Veteran identities and/or who are embedded in an understudied context based on houselessness, attending a 2-year institution, or not attending college. A secondary objective is to explore definitions of the constructs young adult and brief to inform subsequent systematic reviews. Method: Sources had to be published in English between January 1, 1999 and December 31, 2019 and report the evaluation of an intervention ≤5 hr long, delivered over ≤4 weeks, among participants aged 18-30 years (or 16-30 in college contexts) within a specified marginalized/understudied subpopulation/context wherein alcohol use and/or consequences were a primary outcome. Systematic searches were conducted in APA PsycNet, the EBSCO Psychology and Behavioral Sciences Collection, PubMed, Sociological Abstracts, and Web of Science. Screening was independently performed by two coders who also extracted data. Results: Of 4,825 identified records, 158 provided data; 86 described interventions fitting our definition of brief; of these, only 21 met criteria based on our definition of young adult, with nine meeting full inclusion criteria based on young adult subpopulation. Conclusions: Findings signify a need for additional research evaluating BAIs among young adult subpopulations and highlight the importance of carefully defining and reporting participant characteristics. Increased attention to sociocultural considerations and strengths relevant to the diverse contexts and intersecting identities of young adults may strengthen extant BAIs and equitably mitigate alcohol-related harm. Public Health Significance StatementThis scoping review highlights a need for more research assessing how well brief alcohol interventions work across young adults in various contexts and with one or more marginalized or understudied identities. The results suggest that attention to key definitions (e.g., What is meant by brief? How might the age range for young adult vary depending on social roles and settings?) and subpopulation-specific factors (e.g., experiences of discrimination, cultural sources of resilience) may lead to improved future research efforts in this area.

Preexposure prophylaxis (PrEP) and postexposure prophylaxis (PEP) has been shown to be effective in preventing transmission of human immunodeficiency virus (HIV). A dose-response relationship between adherence and HIV transmission is illustrated in the current PrEP literature, and adherence interventions for PrEP may be useful, although currently few effective programs have been developed and tested. There is a paucity of randomized controlled trials testing PEP adherence interventions, and further research is needed. We conclude by proposing the importance of tailoring adherence counseling to address psychosocial factors and mental health stressors that may negatively affect adherence.

Objective Sexual and gender minority (SGM) adults often report a disproportionately high rate of suicidal ideation compared to their heterosexual and cisgender counterparts. The current study aimed to understand the relationship between discrimination for one's sexual orientation or gender identity and suicidal ideation. We hypothesized that discrimination would be associated with suicidal ideation at one's worst point through the indirect effects of hopelessness regarding thwarted belongingness and perceived burdensomeness. Method A sample of 178 SGM adults (M age = 30.34, range 18–69; 76% white) completed an online questionnaire assessing minority‐specific stressors and suicide‐related thoughts and behaviors. Results A mediation model with bootstrapping indicated that greater discrimination was associated with more frequent suicidal ideation at one's worst point through the indirect effect of hopelessness regarding thwarted belongingness. Conclusions The current study provides evidence that the pathway between discrimination and worst point suicidal ideation may be partially explained by the perception that one will never belong. These findings support the utility of an understudied Interpersonal Theory of Suicide hypothesis for research among SGM adults.

Objective A commonly held belief about physical attractiveness is that attractive individuals are psychologically healthier than less attractive individuals (i.e., the “beauty is good” stereotype). To date, the data on this stereotype and its relationship with depression is limited, with a paucity of literature comparing subjective and objective appearance evaluations and depressive symptoms. Additionally, there is no known research on this relationship among sexual minorities (i.e., gay and bisexual individuals), a highly vulnerable population. The primary aims of the study were to assess the prediction of depression symptoms by subjective and objective appearance evaluation, and secondary aims were to assess the interaction of subjective and objective appearance with sexual orientation. Method Participants were 4,882 American emerging adults (M age =22 years; 2,253 males, 2,629 females) taken from a U.S. nationally representative dataset (Add Health). Results Increased negative subjective appearance evaluation was associated with elevated rates of depressive symptoms (B = −.27, p < .001), while objective appearance evaluation was not significantly related to depressive symptoms. Sexual orientation significantly moderated the relationship between subjective appearance and depression (B = .19, p = .009), with a stronger positive association between negative appearance evaluation and depressive symptoms noted among sexual minority vs. heterosexual participants. Limitations Limitations include cross-sectional design and self-report nature of questionnaires. Conclusions Findings suggest that the ‘beauty is good’ stereotype may not be valid in regard to depressive symptoms, and that subjective appearance evaluation is a robust predictor of depression, particularly for sexual minority individuals.

Objective: Transgender and gender-nonconforming (TGNC) emerging adults (EAs) are a vulnerable population at risk for negative mental health and alcohol use outcomes often attributed to unique experiences of discrimination and transphobia, including in colleges/universities through institutionalized transphobia. There are no extant psychosocial interventions that focus on the experiences of EA TGNC undergraduate students. Method: The current study utilized a Community-Based Participatory Research framework and exploratory qualitative approach to better understand the unique experiences of this population (N = 16). Data are presented from an inductive thematic analysis of focus groups and interview transcripts that highlight TGNC experiences of gender-based stressors and substance use and provide feedback on a brief psychosocial intervention to prevent high-risk alcohol use among TGNC. Results: Main themes were TGNC-specific experiences (e.g., pronoun misuse, invalidating interactions with faculty and staff), coping with gender-based discrimination and stressors (e.g., use of alcohol and other drugs), and resources and programs (e.g., lack of TGNC representation in leadership roles). Notable subthemes included the impact of intersecting gender, race, and class divisions, medical and mental health-care concerns, and qualities of interventions perceived as effective versus ineffective. Conclusions: This is one of the first studies to gather information related to the desires of EA TGNC undergraduate students on addressing high-risk alcohol use. Data provide considerations for developing psychosocial interventions to address negative mental health outcomes and risks associated with alcohol and other drug use among EA TGNC undergraduate students, such as creating safe interventions and utilizing a strengths-based approach to teaching coping skills.