Peer online motivational interviewing and affirmative care for sexual and gender minority men who are survivors of sexual trauma: A randomized clinical trial

A randomized clinical trial was conducted comparing the effectiveness of motivational interviewing (MI) versus MI with trauma-informed affirmative care (AC; i.e., MI+AC) to reduce adverse psychiatric symptoms and facilitate entry into formal mental health services for sexual and gender minority (SGM) men who experienced sexual trauma. The sample consisted of SGM men who were survivors of sexual trauma (N = 354, M_age = 35 years, range: 18-75 years, 41.8% racial/ethnic minority), screened positive for depression, and were not actively engaged in mental health treatment. Participants were randomly assigned to one of two conditions (MI or MI+AC), each consisting of six online group sessions delivered by trained peers with lived experience of sexual trauma. Trained peers delivered both versions of MI as intended, with high fidelity and competence (independently rated), and assessments occurred at baseline, posttreatment, and 2- and 4-month follow-ups. SGM men in both conditions reported decreases in depression and increases in mental health service utilization, but there were no between-group differences in these outcomes over time. However, the results demonstrated superior efficacy of MI+AC regarding reducing posttraumatic stress disorder symptoms, B = -1.13, ΔR² = .001, p = .039, and barriers to health care seeking compared to MI, B = -2.00, ΔR² = .002, p = .009. These data support the value of enhanced AC that centers trauma and minority stress in treatment.