Mindfulness for all? Differences in engagement and treatment outcomes for sexual minority people during a mindfulness app clinical trial

Background: Sexual minority individuals experience higher rates of mental health problems, but often have unmet service needs due to stigma, discrimination, and socioeconomic burdens. Online mental health interventions are cost-efficient and can minimize stigma, with some studies suggesting better treatment outcomes in sexual minorities compared to heterosexual individuals. While mindfulness-based apps have demonstrated efficacy in improving mental health in the general population, less is known about the engagement and response of sexual minority, compared to heterosexual, individuals. Objectives: Using data from a non-randomized clinical trial of a mindfulness app (AmDTx), this secondary analysis aims to examine whether sexual minority status predicts app engagement and treatment outcomes. We hypothesize that sexual minority individuals (vs. heterosexual) will adopt and engage with the app to a greater degree and report improved treatment outcomes over time. Methods: Treatment-seeking adults (N=183) received access to AmDTx and reported treatment outcomes at 2, 4, 8, and 12 weeks. Linear regression and multilevel models will evaluate sexual minority status as a predictor of adoption (attempted meditation); attrition (time spent in study); and app engagement (total meditation hours, number of activities completed); and as a moderator of treatment outcomes (functional disability, depression, anxiety, stress) over time. Covariates will include sex and gender. Future Applications: Sexual minority individuals experience poorer mental health and face greater difficulties accessing mental health care compared to their heterosexual counterparts. Identifying whether mindfulness apps hold a potential advantage in improving mental health in sexual minority populations can facilitate treatment access and outcomes in underserved populations.