A systematic review of evidence-based cognitive and/or behavioural interventions targeting mental health in LGBTQ+ populations

Background: Despite a minority stress-related higher risk to develop mental health difficulties, and problematic access to and treatment from healthcare providers, research into mental health support for LGBTQ+ (individuals who identify as lesbian, gay, bisexual, transgender, queer, or with any other non-heterosexual and/or non-cisgender identity) individuals is limited. The aims of this systematic review were to explore evidence-based cognitive and/or behavioural interventions and adaptations targeting mental health in LGBTQ+ populations, before providing recommendations for future clinical and research directions. Methods: Six databases were searched in February-March 2022 and risk of bias evaluated using the Cochrane RoB 2/ROBINS-I tools. A narrative synthesis following the PICOS (Population, Intervention, Comparison, Outcomes and Study designs) framework and the review questions was used to examine the results. Results: Sixteen studies met inclusion criteria, including various interventions and adaptations, as well as mental health difficulties, and other emotion- and minority stress-related processes/constructs. Risk of bias was judged as high, and critical/serious, respectively, in all studies. Outcomes included improvements in symptoms of depression (most statistically/clinically significant effects and large effect sizes, particularly in the randomised controlled trails – RCTs), and anxiety, emotion regulation, and internalised homophobia in the pre-post studies. Conclusion: Cognitive and/or behavioural interventions and adaptations for LGBTQ+ populations feature a range of therapeutic modalities and levels of adaptation, with largely positive effects, in the context of limited and heterogenous literature and risk of bias concerns, as well as limitations related to publication bias and inclusion criteria of the current work. Suggestions for future clinical and research directions include a focus on generic therapeutic competencies and metacompetencies, and affirmative, potentially more holistic approaches, as well as more consistency in methodology, more focus on underserved LGBTQ+ populations and intersectionality, and more detailed investigations into mechanisms of change.