(PS9-100) Differential Mood Outcomes in Outpatient DBT: Examining Depression and Anxiety Symptom Trajectories Among Sexual and Gender Minority Adults

Background:  

Sexual and Gender Minority (SGM) individuals are disproportionately affected by depression and anxiety, potentially due to unique stressors outlined in the Minority Stress Model, such as stigma, discrimination, and reduced social support, contributing to elevated rates of affective disorders. The extent to which SGM-specific stressors impact DBT treatment outcomes remains unclear and gaps remain in understanding potential differences in the rate or magnitude of improvement in affective symptoms. This study examines whether mood outcomes differ in outpatient DBT for adults identifying as SGM compared to non-SGM.

The first hypothesis (H1) predicted that, at baseline, SGM clients would report significantly higher levels of depression and anxiety symptoms, as measured by the PHQ-9 and GAD-7, compared to non-SGM clients. The second hypothesis (H2) posited that the rate of improvement in depression and anxiety symptoms during treatment would not differ significantly between SGM and non-SGM clients.

Methods:  

255 participants were drawn from a population of adult DBT patients at an outpatient private practice, of which 38.8% (N=99) identified as SGM and 61.2% (N=156) non-SGM. The average age of participants was 31.2 years old. The PHQ-9 and GAD-7 were completed prior to treatment and between 2 and 12 months after treatment began.

Results:

A mixed linear effects model indicated that, at baseline, SGM clients had significantly greater mood symptom severity than non-SGM clients, as evidenced by higher scores on both the PHQ-9 (β = 2.1, SE = 0.75, p < .001) and GAD-7 (β = 1.44, SE = 0.62, p < .001). These results support the hypothesis (H1) that SGM individuals experience elevated baseline depression and anxiety symptoms compared to their non-SGM counterparts.

There were significant improvements month over month in both the PHQ-9 (β =-0.11, SE = 0.03, p < .001) and GAD-7 (β =-0.11, SE = 0.03 , p < .001). Additionally, a significant interaction was found between time in treatment and SGM status for the PHQ-9 (β =-0.11, SE = 0.05, p < .05), indicating that while all patients improved significantly over time, SGM clients exhibited a faster rate of improvement in depression symptoms compared to non-SGM clients. However, no significant interaction was found for the GAD-7 (β = -0.08, SE = 0.04, p > .05), suggesting that the rate of anxiety symptom improvement did not differ significantly between groups. These findings suggest that while SGM patients enter treatment with more severe depression symptoms, they may experience greater relative benefit from outpatient DBT treatment.

Conclusion:

Findings extend prior research on the mental health disparities faced by SGM populations and the efficacy of DBT in treating mood symptoms. The elevated baseline depression and anxiety symptoms observed among SGM clients align with the Minority Stress Model, underscoring the impact of unique stressors such as stigma and discrimination. The faster rate of improvement in depression symptoms among SGM clients also aligns with this model, suggesting that they may be particularly responsive to affirming and effective mental health interventions once they receive adequate support.