Effectiveness of an online single-session minority stress intervention: No evidence for variation by structural stigma, internalized stigma, or social support

In the United States, the experience of minority stress among LGBTQ+ youth varies across regions with high and low levels of stigma (e.g., laws, policies, and cultural norms that limit the lives of individuals with stigmatized identities). Some evidence suggests that stigma can undermine response to individual-level psychosocial interventions among youth, creating the need to identify factors that may buffer against minority stressors’ effects in high-stigma contexts. Social support may be one such factor. Therefore, among LGBTQ+ youth who received a digital, single-session intervention (SSI) focused on minority stress, we investigated whether structural and internalized stigma and social support predicted intervention response, independently or interactively. Specifically, we predicted that LGBTQ+ youth in environments characterized by high stigma would report weaker SSI responses. Further, we predicted that LGBTQ+ youth who perceived higher social support would report stronger SSI responses. We also tested structural stigma and social support as moderators. Using data from a previously-completed randomized evaluation, we analyzed data from 244 LGBTQ+ adolescents, aged 13 to 16 years, across 181 counties in 46 U.S. states, who engaged with the SSI. We created a factor representing structural stigma using confirmatory factor analysis at the county level. No evidence emerged for structural stigma or social support as a moderator of intervention effects on internalized stigma, identity pride, or mental health-related outcomes, either at post-intervention or at 2-week follow up. Results speak to the potentially broad utility of the SSI tested in this trial for LGBTQ+ youth with limited access to mental health support. • Advancing our understanding of LGBTQ+ youth mental health is essential. • LGBTQ+ youth experienced similar intervention effects across levels of structural stigma. • Intervention effects remained consistent regardless of perceived social support. • Novel use of county-level structural stigma index to assess intervention impact. • The intervention demonstrated consistent effects even in high-stigma environments.