Depression, HIV, Minority Stress, Substance Abuse, Suicidality
Conditions
Keywords
Expressive Writing, Minority Stress, Lesbian Gay Bisexual
Brief summary
The purpose of this study is to test the feasibility of writing interventions specifically designed for lesbian, gay, and bisexual (LGB) emerging adults (ages 18-29) that are aimed at improving the outcomes: depression, suicidality, substance abuse and HIV risk behaviors.
Detailed description
This study is considered the third part (Phase 3) of a larger study where parts one and two were designed to utilize elicitation focus groups to develop effective intervention materials (Phase 1) and then refine the developed materials through structured interviews (Phase 2). Phase 3 will test feasibility and assess early signs of efficacy of writing interventions. To do this, participants will be randomized to one of three arms (one arm will serve as control). Those that choose to participate will be asked to complete outcome measures (depressive symptoms, suicidality, use of alcohol and illicit drugs, HIV risk behavior) and measures of proposed mediators (self-reported and biological stress, behavioral and emotional self-regulation) and moderators (e.g., social support, identity centrality) at baseline, post-intervention, and three-month follow-up. In addition, structured interviews with 15 intervention participants will be used to refine study procedures as the investigators scale up this intervention for a future randomized controlled trial (RCT).
Interventions
BEHAVIORALExpressive Writing (EW) Intervention
The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered.
BEHAVIORALSelf-Affirmation (SA) Intervention
The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences.
OTHERControl
Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies.
Sponsors
National Institute of Mental Health (NIMH)
Yale University
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
DOUBLE (Investigator, Outcomes Assessor)
Eligibility
Sex/Gender
ALL
Age
18 Years to 29 Years
Healthy volunteers
Yes
Inclusion criteria
* Self-identify as lesbian, gay, or bisexual * Live in Washington county, Tennessee (TN), or any of its 6 contiguous counties in northeastern TN * Have personal Internet access * Hair at least 2cm in length
Exclusion criteria
* Failure to meet inclusion criteria
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Change in Depression. | Baseline, Post Intervention (day 5), and 3 Months. | Depression will be measured using the Center for Epidemiological Studies -- Depression Scale (CESD). An overall depression score is computed as the sum of 20 items, with items 3, 11, 14, and 16 reversed. In cases with internally missing data (items not answered), the sums are computed after imputation of the missing values: # items on scale / # actually answered, multiplied by the sum obtained from the answered items. A range of 0-60, with higher scores indicating more depressive symptomatology during the past week. |
| Change in Psychological Distress. | Baseline, Post Intervention (day 5), and 3 Months. | Psychological Distress will be measured using the Brief Symptom Inventory (BSI). The BSI consists of 18 items scored 0-4. Items are averaged to yield a final score of 0-4. The higher the score, the greater the psychological distress. |
| Change in Anxiety. | Baseline, Post Intervention (day 5), and 3 Months. | Anxiety will be measured using the Beck Anxiety Inventory (BAI). The BAI total score is reported, which is the sum of all 21 items; with no subscales. The range of scores is 0-63, with higher scores indicating higher anxiety. |
| Change in Suicidality - Suicidal Ideation. | Baseline, Post Intervention (day 5), and 3 Months. | Suicidal ideation will be measured using the Suicidal Ideation Attributes Scale (SIDAS) . Total SIDAS scores are calculated as the sum of the five items, with controllability reverse scored (10=0, 9=1, …, 0=10). Total scores range from 0 to 50. |
| Change in Alcohol Use. | Baseline, Post Intervention, 3 Months | Alcohol use in participants will be assessed using the Alcohol Use Disorders Identification (AUDIT) instrument. The AUDIT consists of 10 items. Each of the questions has a set of responses to choose from, and each response has a score ranging from 0 to 4. All response scores should be added and recorded as Total. Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use, as well as possible alcohol dependence. (A cut-off score of 10 will provide greater specificity but at the expense of sensitivity.) The score range is 0-40. Higher scores indicate greater hazardous drinking. |
| Change in Drug Use. | Baseline, Post Intervention (day 5), and 3 Months. | The Short Inventory of Problems-Modified for Drug Use (SIP-DU) is a 15-item scale that asks respondents to rate each item on a dichotomous scale (No = 0, Yes = 1). Total score reported, which is the sum of all items; no subscales: Range 0-15, higher scores indicate greater problems with drug use. |
| Suicidal Intent | Baseline, Post Intervention (day 5), and 3 Months. | Suicidal intent will be assessed using a single item that asks: Within the last 3 months/past week, have you seriously considered attempting suicide? \[yes/no\] Number of participants who reported suicidal intent is reported. Originally titled Change in Suicidality - Suicidal Thoughts. |
| Attempted Suicide | Baseline, Post Intervention (day 5), and 3 Months. | Suicide attempts will be assessed using a single item that asks: Within the last past 3 months/past week, have you actually attempted suicide? \[yes/no\]. Reported are the number of participants who reported that they had attempted suicide. Original title: Change in Suicidality: Suicide Attempts. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Change in Impulsiveness- Attentional | Baseline, Post Intervention (day 5), and 3 Months. | Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The attentional scale has a range of 8-32, the greater the value, the greater the level of attentional impulsiveness. |
| Change in Impulsiveness- Motor | Baseline, Post Intervention (day 5), and 3 Months. | Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The motor scale has a range of 11-44, the greater the value, the greater the level of motor impulsiveness. |
| Change in Impulsiveness- Non-Planning | Baseline, Post Intervention (day 5), and 3 Months. | Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The non-planning scale has a range of 11-44, the greater the value, the greater the level of non-planning impulsiveness. |
| Change in Risk Taking | Baseline, Post Intervention (day 5), and 3 Months. | Risk taking impulse will be assessed using the Columbia Card Task. Participants are presented with 32 face-down cards. Some of these cards are gain cards (which add either +10 or +30 points to the participant's total score) and some of these cards are loss cards (which subtract either -250 or -750 points from the participant's total score). On each trial, the participant may turn over as many cards as desired until a loss card is encountered or the participant chooses to not turn over any more cards. As a participant turns over more cards, the probability of encountering a loss card increases. Therefore, turning over more cards constitutes greater risk taking. |
| Change in Minority Stress (Rejection) | Baseline, Post Intervention (day 5), and 3 Months. | To assess rejection as a form of minority stress, the Gay-Related Rejection Sensitivity Scale (GRRS) will be used.The Gay-related rejection sensitivity scale was adapted for this study to be gender-inclusive and has 12 items. Scale range 1-36, where higher scores indicate greater rejection sensitivity based on one's sexual orientation (worse outcome). |
| Change in Parental Attitudes | Baseline, Post Intervention (day 5), and 3 Months. | The participant's perception of their parent's attitudes towards their sexual orientation are assessed using the Parental Attitudes Toward Child's Sexual Orientation. This tool has 4 items- 2 that deal with mother/parent 1/closest female guardian, 2 that deal with father/parent 2/closest male guardian. The second item for each parent asks about their attitude towards the respondent's sexual orientation on a scale from 1 (completely tolerant and accepting) to 7 (completely hostile and rejecting). Scores for maternal and paternal attitude should be averaged for each participant. The score has a range from 1-7, where higher scores indicate greater rejection from parents (worse outcome). |
| Change in Outness | Baseline, Post Intervention (day 5), and 3 Months. | Participants openness about one's sexual orientation will be assessed using the Outness Inventory (OI). A respondent is asked to rate how open they are with various people in society (from family to strangers) on an 11 item questionnaire. The scale for responding is 0-7- where 7 indicates that a person is completely open with their sexual orientation status. The scale score is obtained by averaging the 11 items for a score range of 0-7, where higher scores indicate more openness about respondents' sexual orientation in different domains of their lives/different people. 0 indicates that an item does not apply/ there is no such group of people/person in the respondents' life. A score of 7 would indicate that one is completely open or out with respect to sexual orientation. |
| Self Injury. | Baseline, Post Intervention (day 5), and 3 Months. | Self injury behaviors will be assessed with the item that asks: How many times in the past 3 months/past week have you engaged in self-harm behavior (e.g., cutting, biting, burning, hitting self) with the intent of harming, but not killing, yourself? Reported are the frequency of self-harm behaviors/self-injury reported by participants. Original title: Change in Self Injury. |
| Change in Discrimination - 9 Items (Part 1) | Baseline, Post Intervention (day 5), and 3 Months. | Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 1. Part 1 is a 9 item inventory where respondents rate statements on a scale of 1-6. The scale has a summed total score ranging from 9-54, higher scores indicate higher discrimination. The higher the score, the greater the feeling that one is discriminated against for one's sexual orientation. |
| Change in Discrimination - Item 1 (Part 2) | Baseline, Post Intervention (day 5), and 3 Months. | Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 1: Overall, how much has discrimination based on your sexual orientation interfered with you having a full and productive life? |
| Change in Discrimination - Item 2 (Part 2) | Baseline, Post Intervention (day 5), and 3 Months. | Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 2: Overall, how much harder has your life been because of discrimination based on your sexual orientation? |
| Change in Victimization | Baseline, Post Intervention (day 5), and 3 Months. | Feelings of victimization are captured using the LGBT Victimization Experiences measure. This questionnaire consists of 10 items. The LGBT victimization scale is rated on a 0 Never to 3 3+ times scale with a total score range 0-30. The total score reflects the amount of victimization one has experienced due to being known or thought to be LGBTQ. Higher scores indicate more negative experiences. |
| Change in Religious Affiliation | Baseline, Post Intervention (day 5), and 3 Months. | Tolerance of one's sexual orientation through the lense of one's practiced religion is measured using a single question. Respondents use a 1-7 scale to rate the question How tolerant is your religion toward your sexual orientation?- where 7 indicates total rejection and hostility. |
| Change in Religious Strain | Baseline, Post Intervention (day 5), and 3 Months. | Religious Strain Scale total score obtained by reverse scoring items 1-7 and then summing across the 20 items (range 0-60), higher scores indicate greater religious strain. |
| Change in Internalized Homophobia | Baseline, Post Intervention (day 5), and 3 Months. | Internalized homophobia in participants will be assessed using the Internalized Homophobia Scale (IHS). The IHS score is obtained by averaging the scores across the 9 items (rather than summing). Range is 1-4, with higher scores indicating higher internalized stigma related to one's sexual orientation. |
| Rumination | Baseline, Post Intervention (day 5), and 3 Months. | Rumination will be assessed using the Ruminative Response Scale - Brooding Subscale (RRS). This scale is modified from the original measure where only items 5, 10, 13, 15 and 16 are used. Each item is scored by respondents on a scale of 1 to 4. To get the overall score, the 5 items are summed; total scores range from 5-20, with higher scores indicating greater brooding and rumination (related to depression) in an individual. |
| Perceived Support | Baseline, Post Intervention (day 5), and 3 Months. | Perceived social support is measured using the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a 12 item instrument that uses a scale 1-7 to rate each item. The scoring is done by taking the average of the items- therefore a score of 7 indicates the highest level of perceived social support. |
| Hopelessness | Baseline, Post Intervention, 3 Months | Hopelessness will be measured using the Beck Hopelessness Scale (BHS). The BHS is a 20-item dichotomous scale (No = 0, Yes = 1). Items 1, 3, 5, 6, 8, 10, 13, 15 and 19 are reverse-scored. The total score is out of 20, where 20 would be the highest score and considered a negative indicator of hopelessness. |
| Lesbian, Gay, Bisexual (LGB) Identity | Baseline, Post Intervention (day 5), and 3 Months. | LGB identity will be measured using the 'LGB Identity Centrality' instrument.The measure consists of 4 items that are rated on a scale of 1-7. The summed scores have a range of 4-28 and the higher score would indicate a stong agreement (positive) with the centrality of one's LGB identity. |
| Change in Cortisol | 1 and 4 months post baseline. | Participants will provide 50-100 hair strands (at least 2 cm in length) to be used to determine levels of stress based on the cortisol levels found in the analyses of the hair provided. |
| Change in Stress | Baseline, Post Intervention (day 5), and 3 Months. | Stress will be assessed using the Perceived Stress Scale (PSS). Participants were asked to respond to the 14-item version. Participants respond to each item on a 0-4 scale and scores are obtained by reversing responses to the 7 positively stated items (items 4,5,6,7,9,10, & 13), and then summing across all scale items. Range = 0-56. Higher scores indicating higher perceived stress. |
| Change in Impulsiveness Total Score | Baseline, Post Intervention (day 5), and 3 Months. | Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score where the range is 30-120. The highest score indicates the greatest the level of impulsiveness. |
Countries
United States
Participant flow
Recruitment details
Participants were specifically recruited through tailored advertising on geo-targeted websites; bulletin boards and listservs of local colleges; in-person announcement and flyers at local businesses, community events, and the gay-straight alliances of area schools. Participants completed a brief online survey to confirm eligibility.
Pre-assignment details
Participants completed a brief online survey to confirm eligibility, defined as: age 18 -29; identifying as sexual minority; currently living in one of the eligible counties; and having daily personal Internet access. Participants emailed a photo of an identification card(e.g. a driver's license), as proof of age. 108 people were randomized.
Participants by arm
| Arm | Count |
|---|---|
| Control Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days.
Control: Participants randomly assigned to the control condition will be asked to write about what they have done since waking up that morning for 20 minutes across 3 consecutive days. This control matches the time and activity of the EW and SA arms and has been implemented across dozens of EW and SA studies. | 36 |
| Expressive Writing (EW) Expressive Writing (EW) prompts individuals to write about personally stressful events, potentially enabling cognitive processing of unresolved, psychological and physiological stressors.
Expressive Writing (EW) Intervention: The EW intervention will utilize the procedures piloted earlier with gay and bisexual male college students in urban and rural regions of the US. In this condition, participants will be instructed to write for 20 minutes across three consecutive days in a free-form manner about the most stressful or traumatic LGB-related event that they have encountered. | 36 |
| Self-Affirmation (SA) Self-Affirmation (SA) interventions prompt individuals to write advice to a (hypothetical) similarly stigmatized person regarding how best to cope with stigma-related stress. By affirming one's own stigmatized identity through the process of helping another similarly stigmatized person.
Self-Affirmation (SA) Intervention: The SA intervention will ask participants to read a brief description, over the course of 3 consecutive days, of a (hypothetical) LGB youth who is facing minority stress. Each day's description will contain a different LGB youth facing a different stigma-related stressor derived from Phase 1 and 2 interviews. Participants will then be asked to write a letter for 20 minutes to advise the LGB youth how best to cope with minority stress drawing on their personal experiences. | 36 |
| Total | 108 |
Withdrawals & dropouts
| Period | Reason | FG000 | FG001 | FG002 |
|---|---|---|---|---|
| Overall Study | Lost to Follow-up | 7 | 4 | 10 |
| Overall Study | Withdrawal by Subject | 2 | 0 | 0 |
Baseline characteristics
| Characteristic | Expressive Writing (EW) | Total | Control | Self-Affirmation (SA) |
|---|---|---|---|---|
| Age, Continuous | 23.47 years STANDARD_DEVIATION 2.88 | 23.68 years STANDARD_DEVIATION 3.11 | 24.14 years STANDARD_DEVIATION 3.24 | 23.42 years STANDARD_DEVIATION 3.25 |
| Education Level College Degree | 17 Participants | 50 Participants | 18 Participants | 15 Participants |
| Education Level Less than College | 19 Participants | 58 Participants | 18 Participants | 21 Participants |
| Employment Status Full-time | 13 Participants | 41 Participants | 14 Participants | 14 Participants |
| Employment Status Part-time | 13 Participants | 46 Participants | 21 Participants | 12 Participants |
| Employment Status Student | 5 Participants | 11 Participants | 0 Participants | 6 Participants |
| Employment Status Unemployed | 5 Participants | 10 Participants | 1 Participants | 4 Participants |
| Ethnicity (NIH/OMB) Hispanic or Latino | 0 Participants | 2 Participants | 1 Participants | 1 Participants |
| Ethnicity (NIH/OMB) Not Hispanic or Latino | 36 Participants | 106 Participants | 35 Participants | 35 Participants |
| Ethnicity (NIH/OMB) Unknown or Not Reported | 0 Participants | 0 Participants | 0 Participants | 0 Participants |
| Family Class Background Lower Middle Class | 4 Participants | 17 Participants | 8 Participants | 5 Participants |
| Family Class Background Middle Class | 11 Participants | 32 Participants | 10 Participants | 11 Participants |
| Family Class Background Poor | 7 Participants | 16 Participants | 3 Participants | 6 Participants |
| Family Class Background Upper Middle Class | 3 Participants | 7 Participants | 3 Participants | 1 Participants |
| Family Class Background Working Class | 11 Participants | 36 Participants | 12 Participants | 13 Participants |
| Personal Income Less than $10,000 | 17 Participants | 41 Participants | 11 Participants | 13 Participants |
| Personal Income More than $10,000 | 19 Participants | 67 Participants | 25 Participants | 23 Participants |
| Race/Ethnicity, Customized American Indian /Alaskan Native | 2 Participants | 2 Participants | 0 Participants | 0 Participants |
| Race/Ethnicity, Customized Asian | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Black/African American | 4 Participants | 10 Participants | 2 Participants | 4 Participants |
| Race/Ethnicity, Customized Native Hawaiian/Pacific Islander | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized Other | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Race/Ethnicity, Customized White | 33 Participants | 100 Participants | 33 Participants | 34 Participants |
| Region of Enrollment United States | 36 participants | 108 participants | 36 participants | 36 participants |
| Relationship Status In a Relationship | 26 Participants | 73 Participants | 25 Participants | 22 Participants |
| Relationship Status Single | 10 Participants | 35 Participants | 11 Participants | 14 Participants |
| Sex: Female, Male Female | 26 Participants | 77 Participants | 25 Participants | 26 Participants |
| Sex: Female, Male Male | 10 Participants | 31 Participants | 11 Participants | 10 Participants |
| Sex/Gender, Customized Gender Non-Conforming/Binary | 3 Participants | 10 Participants | 3 Participants | 4 Participants |
| Sex/Gender, Customized Gender Queer | 2 Participants | 10 Participants | 4 Participants | 4 Participants |
| Sex/Gender, Customized Man | 12 Participants | 31 Participants | 10 Participants | 9 Participants |
| Sex/Gender, Customized Other | 2 Participants | 5 Participants | 2 Participants | 1 Participants |
| Sex/Gender, Customized Transgender Man | 3 Participants | 7 Participants | 1 Participants | 3 Participants |
| Sex/Gender, Customized Transgender Woman | 0 Participants | 1 Participants | 1 Participants | 0 Participants |
| Sex/Gender, Customized Two-spirit | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
| Sex/Gender, Customized Woman | 21 Participants | 60 Participants | 20 Participants | 19 Participants |
| Sexual Orientation Asexual | 1 Participants | 2 Participants | 0 Participants | 1 Participants |
| Sexual Orientation Bisexual | 9 Participants | 30 Participants | 13 Participants | 8 Participants |
| Sexual Orientation Gay | 9 Participants | 26 Participants | 8 Participants | 9 Participants |
| Sexual Orientation Lesbian | 9 Participants | 30 Participants | 12 Participants | 9 Participants |
| Sexual Orientation Other | 2 Participants | 4 Participants | 0 Participants | 2 Participants |
| Sexual Orientation Pansexual | 6 Participants | 15 Participants | 3 Participants | 6 Participants |
| Sexual Orientation Questioning | 0 Participants | 1 Participants | 0 Participants | 1 Participants |
Adverse events
| Event type | EG000 affected / at risk | EG001 affected / at risk | EG002 affected / at risk |
|---|---|---|---|
| deaths Total, all-cause mortality | 0 / 36 | 0 / 36 | 0 / 36 |
| other Total, other adverse events | 0 / 36 | 0 / 36 | 0 / 36 |
| serious Total, serious adverse events | 0 / 36 | 0 / 36 | 0 / 36 |
Outcome results
Primary
Attempted Suicide
Suicide attempts will be assessed using a single item that asks: Within the last past 3 months/past week, have you actually attempted suicide? \[yes/no\]. Reported are the number of participants who reported that they had attempted suicide. Original title: Change in Suicidality: Suicide Attempts.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Control | Attempted Suicide | 3 Months | 0 Participants |
| Control | Attempted Suicide | Post-Intervention | 0 Participants |
| Control | Attempted Suicide | Baseline | 1 Participants |
| Expressive Writing (EW) | Attempted Suicide | Post-Intervention | 0 Participants |
| Expressive Writing (EW) | Attempted Suicide | 3 Months | 0 Participants |
| Expressive Writing (EW) | Attempted Suicide | Baseline | 0 Participants |
| Self-Affirmation (SA) | Attempted Suicide | 3 Months | 0 Participants |
| Self-Affirmation (SA) | Attempted Suicide | Baseline | 1 Participants |
| Self-Affirmation (SA) | Attempted Suicide | Post-Intervention | 0 Participants |
Primary
Change in Alcohol Use.
Alcohol use in participants will be assessed using the Alcohol Use Disorders Identification (AUDIT) instrument. The AUDIT consists of 10 items. Each of the questions has a set of responses to choose from, and each response has a score ranging from 0 to 4. All response scores should be added and recorded as Total. Total scores of 8 or more are recommended as indicators of hazardous and harmful alcohol use, as well as possible alcohol dependence. (A cut-off score of 10 will provide greater specificity but at the expense of sensitivity.) The score range is 0-40. Higher scores indicate greater hazardous drinking.
Time frame: Baseline, Post Intervention, 3 Months
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Alcohol Use. | 3 Months | 5.26 units on a scale | Standard Deviation 4.62 |
| Control | Change in Alcohol Use. | Baseline | 5.08 units on a scale | Standard Deviation 3.77 |
| Control | Change in Alcohol Use. | Post-Intervention | 4.67 units on a scale | Standard Deviation 4 |
| Expressive Writing (EW) | Change in Alcohol Use. | 3 Months | 2.91 units on a scale | Standard Deviation 3.76 |
| Expressive Writing (EW) | Change in Alcohol Use. | Baseline | 4.25 units on a scale | Standard Deviation 4.29 |
| Expressive Writing (EW) | Change in Alcohol Use. | Post-Intervention | 3.70 units on a scale | Standard Deviation 4.33 |
| Self-Affirmation (SA) | Change in Alcohol Use. | 3 Months | 5.58 units on a scale | Standard Deviation 5.98 |
| Self-Affirmation (SA) | Change in Alcohol Use. | Baseline | 5.97 units on a scale | Standard Deviation 6 |
| Self-Affirmation (SA) | Change in Alcohol Use. | Post-Intervention | 3.73 units on a scale | Standard Deviation 4.35 |
Comparison: The primary comparison was between EW and control to test the interaction between treatment and time.p-value: 0.195% CI: [-2.8, 0.24]Mixed Models Analysis
Primary
Change in Anxiety.
Anxiety will be measured using the Beck Anxiety Inventory (BAI). The BAI total score is reported, which is the sum of all 21 items; with no subscales. The range of scores is 0-63, with higher scores indicating higher anxiety.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Anxiety. | Post-Intervention | 14.73 units on a scale | Standard Deviation 13.43 |
| Control | Change in Anxiety. | Baseline | 21.72 units on a scale | Standard Deviation 14.14 |
| Control | Change in Anxiety. | 3 Months | 18.26 units on a scale | Standard Deviation 13.19 |
| Expressive Writing (EW) | Change in Anxiety. | Post-Intervention | 13.54 units on a scale | Standard Deviation 10.91 |
| Expressive Writing (EW) | Change in Anxiety. | 3 Months | 13.03 units on a scale | Standard Deviation 10.55 |
| Expressive Writing (EW) | Change in Anxiety. | Baseline | 20.28 units on a scale | Standard Deviation 12.29 |
| Self-Affirmation (SA) | Change in Anxiety. | Baseline | 26.94 units on a scale | Standard Deviation 13.91 |
| Self-Affirmation (SA) | Change in Anxiety. | 3 Months | 19.73 units on a scale | Standard Deviation 10.78 |
| Self-Affirmation (SA) | Change in Anxiety. | Post-Intervention | 19.47 units on a scale | Standard Deviation 13.16 |
Comparison: The primary comparison was between EW and control to test the interaction between treatment and time.p-value: 0.0795% CI: [-8.55, 0.47]Mixed Models Analysis
Primary
Change in Depression.
Depression will be measured using the Center for Epidemiological Studies -- Depression Scale (CESD). An overall depression score is computed as the sum of 20 items, with items 3, 11, 14, and 16 reversed. In cases with internally missing data (items not answered), the sums are computed after imputation of the missing values: # items on scale / # actually answered, multiplied by the sum obtained from the answered items. A range of 0-60, with higher scores indicating more depressive symptomatology during the past week.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Depression. | 3 Months | 23.44 units on a scale | Standard Deviation 13.09 |
| Control | Change in Depression. | Baseline | 24.75 units on a scale | Standard Deviation 11.83 |
| Control | Change in Depression. | Post-Intervention | 21.03 units on a scale | Standard Deviation 11.79 |
| Expressive Writing (EW) | Change in Depression. | Baseline | 25.17 units on a scale | Standard Deviation 12.07 |
| Expressive Writing (EW) | Change in Depression. | Post-Intervention | 17.42 units on a scale | Standard Deviation 11.46 |
| Expressive Writing (EW) | Change in Depression. | 3 Months | 18.45 units on a scale | Standard Deviation 10.97 |
| Self-Affirmation (SA) | Change in Depression. | Post-Intervention | 21.73 units on a scale | Standard Deviation 13.45 |
| Self-Affirmation (SA) | Change in Depression. | Baseline | 29.06 units on a scale | Standard Deviation 13.41 |
| Self-Affirmation (SA) | Change in Depression. | 3 Months | 22.92 units on a scale | Standard Deviation 14.61 |
Comparison: The primary comparison was between EW and control to test the interaction between treatment and time.p-value: <0.0195% CI: [-11.03, -1.64]Mixed Models Analysis
Primary
Change in Drug Use.
The Short Inventory of Problems-Modified for Drug Use (SIP-DU) is a 15-item scale that asks respondents to rate each item on a dichotomous scale (No = 0, Yes = 1). Total score reported, which is the sum of all items; no subscales: Range 0-15, higher scores indicate greater problems with drug use.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Drug Use. | Post-Intervention | 0.36 units on a scale | Standard Deviation 1.03 |
| Control | Change in Drug Use. | Baseline | 0.39 units on a scale | Standard Deviation 0.99 |
| Control | Change in Drug Use. | 3 Months | 0.33 units on a scale | Standard Deviation 0.83 |
| Expressive Writing (EW) | Change in Drug Use. | Post-Intervention | 0.67 units on a scale | Standard Deviation 2.53 |
| Expressive Writing (EW) | Change in Drug Use. | Baseline | 0.31 units on a scale | Standard Deviation 0.98 |
| Expressive Writing (EW) | Change in Drug Use. | 3 Months | 0.84 units on a scale | Standard Deviation 2.89 |
| Self-Affirmation (SA) | Change in Drug Use. | Baseline | 1.47 units on a scale | Standard Deviation 2.99 |
| Self-Affirmation (SA) | Change in Drug Use. | 3 Months | 1.58 units on a scale | Standard Deviation 3.56 |
| Self-Affirmation (SA) | Change in Drug Use. | Post-Intervention | 0.57 units on a scale | Standard Deviation 1.7 |
Comparison: The primary comparison was between EW and control to test the interaction between treatment and time.p-value: 0.7695% CI: [-1.19, 1.57]Mixed Models Analysis
Primary
Change in Psychological Distress.
Psychological Distress will be measured using the Brief Symptom Inventory (BSI). The BSI consists of 18 items scored 0-4. Items are averaged to yield a final score of 0-4. The higher the score, the greater the psychological distress.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Psychological Distress. | Baseline | 2.31 units on a scale | Standard Deviation 0.85 |
| Control | Change in Psychological Distress. | Post-Intervention | 1.84 units on a scale | Standard Deviation 0.77 |
| Control | Change in Psychological Distress. | 3 Months | 2.14 units on a scale | Standard Deviation 0.92 |
| Expressive Writing (EW) | Change in Psychological Distress. | 3 Months | 1.77 units on a scale | Standard Deviation 0.65 |
| Expressive Writing (EW) | Change in Psychological Distress. | Baseline | 2.22 units on a scale | Standard Deviation 0.73 |
| Expressive Writing (EW) | Change in Psychological Distress. | Post-Intervention | 1.82 units on a scale | Standard Deviation 0.67 |
| Self-Affirmation (SA) | Change in Psychological Distress. | 3 Months | 2.35 units on a scale | Standard Deviation 0.8 |
| Self-Affirmation (SA) | Change in Psychological Distress. | Baseline | 2.63 units on a scale | Standard Deviation 0.86 |
| Self-Affirmation (SA) | Change in Psychological Distress. | Post-Intervention | 2.08 units on a scale | Standard Deviation 0.86 |
Comparison: The primary comparison was between EW and control to test the interaction between treatment and time.p-value: 0.0395% CI: [-0.62, -0.03]Mixed Models Analysis
Primary
Change in Suicidality - Suicidal Ideation.
Suicidal ideation will be measured using the Suicidal Ideation Attributes Scale (SIDAS) . Total SIDAS scores are calculated as the sum of the five items, with controllability reverse scored (10=0, 9=1, …, 0=10). Total scores range from 0 to 50.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Suicidality - Suicidal Ideation. | Baseline | 6.05 units on a scale | Standard Deviation 9.81 |
| Control | Change in Suicidality - Suicidal Ideation. | 3 Months | 4.63 units on a scale | Standard Deviation 8.19 |
| Control | Change in Suicidality - Suicidal Ideation. | Post-Intervention | 2.36 units on a scale | Standard Deviation 4.08 |
| Expressive Writing (EW) | Change in Suicidality - Suicidal Ideation. | Baseline | 4.19 units on a scale | Standard Deviation 6.92 |
| Expressive Writing (EW) | Change in Suicidality - Suicidal Ideation. | Post-Intervention | 1.21 units on a scale | Standard Deviation 3.57 |
| Expressive Writing (EW) | Change in Suicidality - Suicidal Ideation. | 3 Months | 3.87 units on a scale | Standard Deviation 7.4 |
| Self-Affirmation (SA) | Change in Suicidality - Suicidal Ideation. | Baseline | 9.42 units on a scale | Standard Deviation 11.21 |
| Self-Affirmation (SA) | Change in Suicidality - Suicidal Ideation. | 3 Months | 5.31 units on a scale | Standard Deviation 7.54 |
| Self-Affirmation (SA) | Change in Suicidality - Suicidal Ideation. | Post-Intervention | 2.70 units on a scale | Standard Deviation 6.24 |
Comparison: The primary comparison was between EW and control to test the interaction between treatment and time.p-value: 0.7395% CI: [-6.48, 8.77]Mixed Models Analysis
Primary
Suicidal Intent
Suicidal intent will be assessed using a single item that asks: Within the last 3 months/past week, have you seriously considered attempting suicide? \[yes/no\] Number of participants who reported suicidal intent is reported. Originally titled Change in Suicidality - Suicidal Thoughts.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (COUNT_OF_PARTICIPANTS) |
|---|---|---|---|
| Control | Suicidal Intent | Post-Intervention | 0 Participants |
| Control | Suicidal Intent | Baseline | 4 Participants |
| Control | Suicidal Intent | 3 Months | 3 Participants |
| Expressive Writing (EW) | Suicidal Intent | Post-Intervention | 0 Participants |
| Expressive Writing (EW) | Suicidal Intent | Baseline | 4 Participants |
| Expressive Writing (EW) | Suicidal Intent | 3 Months | 1 Participants |
| Self-Affirmation (SA) | Suicidal Intent | Baseline | 9 Participants |
| Self-Affirmation (SA) | Suicidal Intent | 3 Months | 2 Participants |
| Self-Affirmation (SA) | Suicidal Intent | Post-Intervention | 1 Participants |
Secondary
Change in Cortisol
Participants will provide 50-100 hair strands (at least 2 cm in length) to be used to determine levels of stress based on the cortisol levels found in the analyses of the hair provided.
Time frame: 1 and 4 months post baseline.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Cortisol | 4 Months | 10.37 pg/mg | Standard Deviation 10.18 |
| Control | Change in Cortisol | 1 Month | 10.12 pg/mg | Standard Deviation 12.2 |
| Expressive Writing (EW) | Change in Cortisol | 1 Month | 8.28 pg/mg | Standard Deviation 10.96 |
| Expressive Writing (EW) | Change in Cortisol | 4 Months | 6.18 pg/mg | Standard Deviation 5.49 |
| Self-Affirmation (SA) | Change in Cortisol | 1 Month | 10.91 pg/mg | Standard Deviation 15.85 |
| Self-Affirmation (SA) | Change in Cortisol | 4 Months | 12.21 pg/mg | Standard Deviation 28.72 |
Secondary
Change in Discrimination - 9 Items (Part 1)
Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 1. Part 1 is a 9 item inventory where respondents rate statements on a scale of 1-6. The scale has a summed total score ranging from 9-54, higher scores indicate higher discrimination. The higher the score, the greater the feeling that one is discriminated against for one's sexual orientation.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Discrimination - 9 Items (Part 1) | Post Intervention | 18.61 units on a scale | Standard Deviation 9.47 |
| Control | Change in Discrimination - 9 Items (Part 1) | Baseline | 19.75 units on a scale | Standard Deviation 10.63 |
| Control | Change in Discrimination - 9 Items (Part 1) | 3 Months | 17.81 units on a scale | Standard Deviation 9.22 |
| Expressive Writing (EW) | Change in Discrimination - 9 Items (Part 1) | Post Intervention | 17.88 units on a scale | Standard Deviation 7.27 |
| Expressive Writing (EW) | Change in Discrimination - 9 Items (Part 1) | Baseline | 19.22 units on a scale | Standard Deviation 7.26 |
| Expressive Writing (EW) | Change in Discrimination - 9 Items (Part 1) | 3 Months | 16.87 units on a scale | Standard Deviation 7.49 |
| Self-Affirmation (SA) | Change in Discrimination - 9 Items (Part 1) | Baseline | 21.14 units on a scale | Standard Deviation 8.72 |
| Self-Affirmation (SA) | Change in Discrimination - 9 Items (Part 1) | 3 Months | 17.81 units on a scale | Standard Deviation 8.64 |
| Self-Affirmation (SA) | Change in Discrimination - 9 Items (Part 1) | Post Intervention | 20.47 units on a scale | Standard Deviation 9.42 |
Secondary
Change in Discrimination - Item 1 (Part 2)
Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 1: Overall, how much has discrimination based on your sexual orientation interfered with you having a full and productive life?
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Discrimination - Item 1 (Part 2) | 3 Months | 0.74 units on a scale | Standard Deviation 0.81 |
| Control | Change in Discrimination - Item 1 (Part 2) | Post Intervention | 0.67 units on a scale | Standard Deviation 0.66 |
| Control | Change in Discrimination - Item 1 (Part 2) | Baseline | 0.78 units on a scale | Standard Deviation 0.76 |
| Expressive Writing (EW) | Change in Discrimination - Item 1 (Part 2) | 3 Months | 0.87 units on a scale | Standard Deviation 0.72 |
| Expressive Writing (EW) | Change in Discrimination - Item 1 (Part 2) | Baseline | 0.89 units on a scale | Standard Deviation 0.82 |
| Expressive Writing (EW) | Change in Discrimination - Item 1 (Part 2) | Post Intervention | 1.00 units on a scale | Standard Deviation 0.79 |
| Self-Affirmation (SA) | Change in Discrimination - Item 1 (Part 2) | Post Intervention | 0.97 units on a scale | Standard Deviation 0.89 |
| Self-Affirmation (SA) | Change in Discrimination - Item 1 (Part 2) | Baseline | 1.19 units on a scale | Standard Deviation 0.98 |
| Self-Affirmation (SA) | Change in Discrimination - Item 1 (Part 2) | 3 Months | 0.73 units on a scale | Standard Deviation 0.87 |
Secondary
Change in Discrimination - Item 2 (Part 2)
Everyday discrimination experienced by participants will be measured using the Everyday Discrimination - Sexual Orientation (EDSO) Part 2. Part 2 is a 2 item inventory where respondents rate statements on a scale of 0-3. The lower the score, the less the feeling that one is discriminated against overall for one's sexual orientation. Item 2: Overall, how much harder has your life been because of discrimination based on your sexual orientation?
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Discrimination - Item 2 (Part 2) | Baseline | 1.03 units on a scale | Standard Deviation 0.81 |
| Control | Change in Discrimination - Item 2 (Part 2) | Post Intervention | 1.00 units on a scale | Standard Deviation 0.79 |
| Control | Change in Discrimination - Item 2 (Part 2) | 3 Months | 0.85 units on a scale | Standard Deviation 0.72 |
| Expressive Writing (EW) | Change in Discrimination - Item 2 (Part 2) | Post Intervention | 1.24 units on a scale | Standard Deviation 0.87 |
| Expressive Writing (EW) | Change in Discrimination - Item 2 (Part 2) | 3 Months | 1.06 units on a scale | Standard Deviation 0.73 |
| Expressive Writing (EW) | Change in Discrimination - Item 2 (Part 2) | Baseline | 1.42 units on a scale | Standard Deviation 0.87 |
| Self-Affirmation (SA) | Change in Discrimination - Item 2 (Part 2) | Post Intervention | 1.30 units on a scale | Standard Deviation 1.02 |
| Self-Affirmation (SA) | Change in Discrimination - Item 2 (Part 2) | 3 Months | 1.15 units on a scale | Standard Deviation 0.97 |
| Self-Affirmation (SA) | Change in Discrimination - Item 2 (Part 2) | Baseline | 1.53 units on a scale | Standard Deviation 0.91 |
Secondary
Change in Impulsiveness- Attentional
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The attentional scale has a range of 8-32, the greater the value, the greater the level of attentional impulsiveness.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Impulsiveness- Attentional | Baseline | 16.36 units on a scale | Standard Deviation 4.98 |
| Control | Change in Impulsiveness- Attentional | 3 Months | 15.43 units on a scale | Standard Deviation 4.33 |
| Control | Change in Impulsiveness- Attentional | Post-Intervention | 15.79 units on a scale | Standard Deviation 4.69 |
| Expressive Writing (EW) | Change in Impulsiveness- Attentional | 3 Months | 15.75 units on a scale | Standard Deviation 4.19 |
| Expressive Writing (EW) | Change in Impulsiveness- Attentional | Baseline | 16.44 units on a scale | Standard Deviation 4.59 |
| Expressive Writing (EW) | Change in Impulsiveness- Attentional | Post-Intervention | 15.64 units on a scale | Standard Deviation 4.62 |
| Self-Affirmation (SA) | Change in Impulsiveness- Attentional | Post-Intervention | 16.70 units on a scale | Standard Deviation 4.19 |
| Self-Affirmation (SA) | Change in Impulsiveness- Attentional | 3 Months | 16.69 units on a scale | Standard Deviation 5.53 |
| Self-Affirmation (SA) | Change in Impulsiveness- Attentional | Baseline | 16.33 units on a scale | Standard Deviation 4.11 |
Secondary
Change in Impulsiveness- Motor
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The motor scale has a range of 11-44, the greater the value, the greater the level of motor impulsiveness.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Impulsiveness- Motor | 3 Months | 21.96 units on a scale | Standard Deviation 5.17 |
| Control | Change in Impulsiveness- Motor | Baseline | 20.78 units on a scale | Standard Deviation 4.33 |
| Control | Change in Impulsiveness- Motor | Post-Intervention | 15.71 units on a scale | Standard Deviation 5.01 |
| Expressive Writing (EW) | Change in Impulsiveness- Motor | 3 Months | 21.23 units on a scale | Standard Deviation 4.18 |
| Expressive Writing (EW) | Change in Impulsiveness- Motor | Baseline | 20.78 units on a scale | Standard Deviation 4 |
| Expressive Writing (EW) | Change in Impulsiveness- Motor | Post-Intervention | 20.52 units on a scale | Standard Deviation 3.94 |
| Self-Affirmation (SA) | Change in Impulsiveness- Motor | 3 Months | 20.27 units on a scale | Standard Deviation 3.11 |
| Self-Affirmation (SA) | Change in Impulsiveness- Motor | Post-Intervention | 21.23 units on a scale | Standard Deviation 4.16 |
| Self-Affirmation (SA) | Change in Impulsiveness- Motor | Baseline | 21.39 units on a scale | Standard Deviation 4.14 |
Secondary
Change in Impulsiveness- Non-Planning
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS-11). The BIS-11 is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score, as well as three factors: attentional (6, 5, 9, 11, 20, 24, 26, 28; motor (2, 3, 4, 16, 17, 19, 21, 22, 23, 25, 30); non-planning (1, 7, 8, 10, 12, 13, 14, 15, 18, 27, 29). The non-planning scale has a range of 11-44, the greater the value, the greater the level of non-planning impulsiveness.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Impulsiveness- Non-Planning | Baseline | 17.00 units on a scale | Standard Deviation 5.2 |
| Control | Change in Impulsiveness- Non-Planning | Post-Intervention | 15.71 units on a scale | Standard Deviation 5.01 |
| Control | Change in Impulsiveness- Non-Planning | 3 Months | 16.00 units on a scale | Standard Deviation 4.74 |
| Expressive Writing (EW) | Change in Impulsiveness- Non-Planning | 3 Months | 17.16 units on a scale | Standard Deviation 6.06 |
| Expressive Writing (EW) | Change in Impulsiveness- Non-Planning | Baseline | 16.80 units on a scale | Standard Deviation 5.59 |
| Expressive Writing (EW) | Change in Impulsiveness- Non-Planning | Post-Intervention | 16.61 units on a scale | Standard Deviation 6.58 |
| Self-Affirmation (SA) | Change in Impulsiveness- Non-Planning | 3 Months | 16.62 units on a scale | Standard Deviation 4.98 |
| Self-Affirmation (SA) | Change in Impulsiveness- Non-Planning | Post-Intervention | 16.13 units on a scale | Standard Deviation 5.31 |
| Self-Affirmation (SA) | Change in Impulsiveness- Non-Planning | Baseline | 16.58 units on a scale | Standard Deviation 5.18 |
Secondary
Change in Impulsiveness Total Score
Impulsiveness will be assessed using the Barratt Impulsiveness Scale (BIS). The BIS is a 30 item questionnaire that uses a 1-4 rating scale per item. The 30-item self-report questionnaire, can yield a total score where the range is 30-120. The highest score indicates the greatest the level of impulsiveness.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Impulsiveness Total Score | Post-Intervention | 52.35 units on a scale | Standard Deviation 10.5 |
| Control | Change in Impulsiveness Total Score | Baseline | 53.75 units on a scale | Standard Deviation 11.92 |
| Control | Change in Impulsiveness Total Score | 3 Months | 53.39 units on a scale | Standard Deviation 11.38 |
| Expressive Writing (EW) | Change in Impulsiveness Total Score | Post-Intervention | 52.76 units on a scale | Standard Deviation 12.34 |
| Expressive Writing (EW) | Change in Impulsiveness Total Score | 3 Months | 54.14 units on a scale | Standard Deviation 11.43 |
| Expressive Writing (EW) | Change in Impulsiveness Total Score | Baseline | 51.03 units on a scale | Standard Deviation 11.31 |
| Self-Affirmation (SA) | Change in Impulsiveness Total Score | Baseline | 54.31 units on a scale | Standard Deviation 4.11 |
| Self-Affirmation (SA) | Change in Impulsiveness Total Score | 3 Months | 53.58 units on a scale | Standard Deviation 9.37 |
| Self-Affirmation (SA) | Change in Impulsiveness Total Score | Post-Intervention | 54.06 units on a scale | Standard Deviation 11.36 |
Secondary
Change in Internalized Homophobia
Internalized homophobia in participants will be assessed using the Internalized Homophobia Scale (IHS). The IHS score is obtained by averaging the scores across the 9 items (rather than summing). Range is 1-4, with higher scores indicating higher internalized stigma related to one's sexual orientation.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Internalized Homophobia | Baseline | 1.42 units on a scale | Standard Deviation 0.57 |
| Control | Change in Internalized Homophobia | 3 Months | 1.29 units on a scale | Standard Deviation 0.63 |
| Control | Change in Internalized Homophobia | Post-Intervention | 1.27 units on a scale | Standard Deviation 0.64 |
| Expressive Writing (EW) | Change in Internalized Homophobia | 3 Months | 1.39 units on a scale | Standard Deviation 0.57 |
| Expressive Writing (EW) | Change in Internalized Homophobia | Baseline | 1.38 units on a scale | Standard Deviation 0.5 |
| Expressive Writing (EW) | Change in Internalized Homophobia | Post-Intervention | 1.27 units on a scale | Standard Deviation 0.53 |
| Self-Affirmation (SA) | Change in Internalized Homophobia | Baseline | 1.58 units on a scale | Standard Deviation 0.65 |
| Self-Affirmation (SA) | Change in Internalized Homophobia | 3 Months | 1.52 units on a scale | Standard Deviation 0.58 |
| Self-Affirmation (SA) | Change in Internalized Homophobia | Post-Intervention | 1.56 units on a scale | Standard Deviation 0.58 |
Secondary
Change in Minority Stress (Rejection)
To assess rejection as a form of minority stress, the Gay-Related Rejection Sensitivity Scale (GRRS) will be used.The Gay-related rejection sensitivity scale was adapted for this study to be gender-inclusive and has 12 items. Scale range 1-36, where higher scores indicate greater rejection sensitivity based on one's sexual orientation (worse outcome).
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Minority Stress (Rejection) | 3 Months | 12.17 units on a scale | Standard Deviation 8.16 |
| Control | Change in Minority Stress (Rejection) | Baseline | 14.47 units on a scale | Standard Deviation 7.35 |
| Control | Change in Minority Stress (Rejection) | Post-Intervention | 12.92 units on a scale | Standard Deviation 8.23 |
| Expressive Writing (EW) | Change in Minority Stress (Rejection) | Post-Intervention | 10.95 units on a scale | Standard Deviation 6.51 |
| Expressive Writing (EW) | Change in Minority Stress (Rejection) | 3 Months | 9.31 units on a scale | Standard Deviation 7.6 |
| Expressive Writing (EW) | Change in Minority Stress (Rejection) | Baseline | 12.33 units on a scale | Standard Deviation 6.11 |
| Self-Affirmation (SA) | Change in Minority Stress (Rejection) | 3 Months | 12.33 units on a scale | Standard Deviation 5.65 |
| Self-Affirmation (SA) | Change in Minority Stress (Rejection) | Baseline | 14.94 units on a scale | Standard Deviation 7.43 |
| Self-Affirmation (SA) | Change in Minority Stress (Rejection) | Post-Intervention | 12.99 units on a scale | Standard Deviation 6.41 |
Secondary
Change in Outness
Participants openness about one's sexual orientation will be assessed using the Outness Inventory (OI). A respondent is asked to rate how open they are with various people in society (from family to strangers) on an 11 item questionnaire. The scale for responding is 0-7- where 7 indicates that a person is completely open with their sexual orientation status. The scale score is obtained by averaging the 11 items for a score range of 0-7, where higher scores indicate more openness about respondents' sexual orientation in different domains of their lives/different people. 0 indicates that an item does not apply/ there is no such group of people/person in the respondents' life. A score of 7 would indicate that one is completely open or out with respect to sexual orientation.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Outness | Post-Intervention | 4.55 units on a scale | Standard Deviation 1.66 |
| Control | Change in Outness | Baseline | 4.46 units on a scale | Standard Deviation 1.56 |
| Control | Change in Outness | 3 Months | 4.95 units on a scale | Standard Deviation 1.49 |
| Expressive Writing (EW) | Change in Outness | 3 Months | 5.16 units on a scale | Standard Deviation 1.49 |
| Expressive Writing (EW) | Change in Outness | Post-Intervention | 5.13 units on a scale | Standard Deviation 1.39 |
| Expressive Writing (EW) | Change in Outness | Baseline | 5.32 units on a scale | Standard Deviation 1.43 |
| Self-Affirmation (SA) | Change in Outness | Baseline | 5.05 units on a scale | Standard Deviation 1.4 |
| Self-Affirmation (SA) | Change in Outness | Post-Intervention | 4.94 units on a scale | Standard Deviation 1.21 |
| Self-Affirmation (SA) | Change in Outness | 3 Months | 5.01 units on a scale | Standard Deviation 1.33 |
Secondary
Change in Parental Attitudes
The participant's perception of their parent's attitudes towards their sexual orientation are assessed using the Parental Attitudes Toward Child's Sexual Orientation. This tool has 4 items- 2 that deal with mother/parent 1/closest female guardian, 2 that deal with father/parent 2/closest male guardian. The second item for each parent asks about their attitude towards the respondent's sexual orientation on a scale from 1 (completely tolerant and accepting) to 7 (completely hostile and rejecting). Scores for maternal and paternal attitude should be averaged for each participant. The score has a range from 1-7, where higher scores indicate greater rejection from parents (worse outcome).
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzes as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Parental Attitudes | Baseline | 2.85 units on a scale | Standard Deviation 1.5 |
| Control | Change in Parental Attitudes | 3 Months | 2.75 units on a scale | Standard Deviation 1.46 |
| Control | Change in Parental Attitudes | Post-Intervention | 2.71 units on a scale | Standard Deviation 1.21 |
| Expressive Writing (EW) | Change in Parental Attitudes | Post-Intervention | 2.60 units on a scale | Standard Deviation 1.47 |
| Expressive Writing (EW) | Change in Parental Attitudes | Baseline | 2.59 units on a scale | Standard Deviation 1.52 |
| Expressive Writing (EW) | Change in Parental Attitudes | 3 Months | 2.63 units on a scale | Standard Deviation 1.36 |
| Self-Affirmation (SA) | Change in Parental Attitudes | 3 Months | 2.68 units on a scale | Standard Deviation 1.48 |
| Self-Affirmation (SA) | Change in Parental Attitudes | Baseline | 2.61 units on a scale | Standard Deviation 1.46 |
| Self-Affirmation (SA) | Change in Parental Attitudes | Post-Intervention | 2.36 units on a scale | Standard Deviation 1.28 |
Secondary
Change in Religious Affiliation
Tolerance of one's sexual orientation through the lense of one's practiced religion is measured using a single question. Respondents use a 1-7 scale to rate the question How tolerant is your religion toward your sexual orientation?- where 7 indicates total rejection and hostility.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Religious Affiliation | 3 Months | 2.20 units on a scale | Standard Deviation 1.47 |
| Control | Change in Religious Affiliation | Post Intervention | 2.78 units on a scale | Standard Deviation 1.57 |
| Control | Change in Religious Affiliation | Baseline | 2.70 units on a scale | Standard Deviation 1.86 |
| Expressive Writing (EW) | Change in Religious Affiliation | 3 Months | 2.56 units on a scale | Standard Deviation 1.5 |
| Expressive Writing (EW) | Change in Religious Affiliation | Baseline | 3.05 units on a scale | Standard Deviation 1.84 |
| Expressive Writing (EW) | Change in Religious Affiliation | Post Intervention | 2.79 units on a scale | Standard Deviation 1.65 |
| Self-Affirmation (SA) | Change in Religious Affiliation | Post Intervention | 2.71 units on a scale | Standard Deviation 1.94 |
| Self-Affirmation (SA) | Change in Religious Affiliation | Baseline | 2.78 units on a scale | Standard Deviation 2.06 |
| Self-Affirmation (SA) | Change in Religious Affiliation | 3 Months | 3.13 units on a scale | Standard Deviation 1.96 |
Secondary
Change in Religious Strain
Religious Strain Scale total score obtained by reverse scoring items 1-7 and then summing across the 20 items (range 0-60), higher scores indicate greater religious strain.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Religious Strain | Post Intervention | 27.52 units on a scale | Standard Deviation 9.52 |
| Control | Change in Religious Strain | Baseline | 29.08 units on a scale | Standard Deviation 8.92 |
| Control | Change in Religious Strain | 3 Months | 27.11 units on a scale | Standard Deviation 9.63 |
| Expressive Writing (EW) | Change in Religious Strain | Post Intervention | 26.52 units on a scale | Standard Deviation 9.49 |
| Expressive Writing (EW) | Change in Religious Strain | Baseline | 27.11 units on a scale | Standard Deviation 10.01 |
| Expressive Writing (EW) | Change in Religious Strain | 3 Months | 25.44 units on a scale | Standard Deviation 9.31 |
| Self-Affirmation (SA) | Change in Religious Strain | Baseline | 32.75 units on a scale | Standard Deviation 9.36 |
| Self-Affirmation (SA) | Change in Religious Strain | 3 Months | 29.50 units on a scale | Standard Deviation 9.61 |
| Self-Affirmation (SA) | Change in Religious Strain | Post Intervention | 31.40 units on a scale | Standard Deviation 10.62 |
Secondary
Change in Risk Taking
Risk taking impulse will be assessed using the Columbia Card Task. Participants are presented with 32 face-down cards. Some of these cards are gain cards (which add either +10 or +30 points to the participant's total score) and some of these cards are loss cards (which subtract either -250 or -750 points from the participant's total score). On each trial, the participant may turn over as many cards as desired until a loss card is encountered or the participant chooses to not turn over any more cards. As a participant turns over more cards, the probability of encountering a loss card increases. Therefore, turning over more cards constitutes greater risk taking.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: This outcome measure was never collected.
Secondary
Change in Stress
Stress will be assessed using the Perceived Stress Scale (PSS). Participants were asked to respond to the 14-item version. Participants respond to each item on a 0-4 scale and scores are obtained by reversing responses to the 7 positively stated items (items 4,5,6,7,9,10, & 13), and then summing across all scale items. Range = 0-56. Higher scores indicating higher perceived stress.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Stress | Post-Intervention | 27.03 units on a scale | Standard Deviation 9.96 |
| Control | Change in Stress | Baseline | 30.25 units on a scale | Standard Deviation 8.62 |
| Control | Change in Stress | 3 Months | 28.41 units on a scale | Standard Deviation 10.66 |
| Expressive Writing (EW) | Change in Stress | Post-Intervention | 24.70 units on a scale | Standard Deviation 9.67 |
| Expressive Writing (EW) | Change in Stress | Baseline | 29.53 units on a scale | Standard Deviation 8.4 |
| Expressive Writing (EW) | Change in Stress | 3 Months | 25.88 units on a scale | Standard Deviation 7.77 |
| Self-Affirmation (SA) | Change in Stress | Baseline | 31.61 units on a scale | Standard Deviation 9.51 |
| Self-Affirmation (SA) | Change in Stress | 3 Months | 28.69 units on a scale | Standard Deviation 9.01 |
| Self-Affirmation (SA) | Change in Stress | Post-Intervention | 26.73 units on a scale | Standard Deviation 8.58 |
Secondary
Change in Victimization
Feelings of victimization are captured using the LGBT Victimization Experiences measure. This questionnaire consists of 10 items. The LGBT victimization scale is rated on a 0 Never to 3 3+ times scale with a total score range 0-30. The total score reflects the amount of victimization one has experienced due to being known or thought to be LGBTQ. Higher scores indicate more negative experiences.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Change in Victimization | Post-Intervention | 0.30 units on a scale | Standard Deviation 0.81 |
| Control | Change in Victimization | Baseline | 1.47 units on a scale | Standard Deviation 2.16 |
| Control | Change in Victimization | 3 Months | 0.81 units on a scale | Standard Deviation 1.33 |
| Expressive Writing (EW) | Change in Victimization | 3 Months | 0.97 units on a scale | Standard Deviation 2.47 |
| Expressive Writing (EW) | Change in Victimization | Baseline | 1.33 units on a scale | Standard Deviation 2.05 |
| Expressive Writing (EW) | Change in Victimization | Post-Intervention | 0.24 units on a scale | Standard Deviation 0.56 |
| Self-Affirmation (SA) | Change in Victimization | 3 Months | 1.08 units on a scale | Standard Deviation 2.42 |
| Self-Affirmation (SA) | Change in Victimization | Post-Intervention | 0.67 units on a scale | Standard Deviation 1.65 |
| Self-Affirmation (SA) | Change in Victimization | Baseline | 2.56 units on a scale | Standard Deviation 5.42 |
Secondary
Hopelessness
Hopelessness will be measured using the Beck Hopelessness Scale (BHS). The BHS is a 20-item dichotomous scale (No = 0, Yes = 1). Items 1, 3, 5, 6, 8, 10, 13, 15 and 19 are reverse-scored. The total score is out of 20, where 20 would be the highest score and considered a negative indicator of hopelessness.
Time frame: Baseline, Post Intervention, 3 Months
Population: Data analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Hopelessness | Post-Intervention | 6.93 units on a scale | Standard Deviation 6.31 |
| Control | Hopelessness | Baseline | 7.00 units on a scale | Standard Deviation 6.08 |
| Control | Hopelessness | 3 Months | 5.85 units on a scale | Standard Deviation 5.8 |
| Expressive Writing (EW) | Hopelessness | Post-Intervention | 4.88 units on a scale | Standard Deviation 4.87 |
| Expressive Writing (EW) | Hopelessness | Baseline | 5.14 units on a scale | Standard Deviation 4.28 |
| Expressive Writing (EW) | Hopelessness | 3 Months | 5.19 units on a scale | Standard Deviation 5.07 |
| Self-Affirmation (SA) | Hopelessness | Baseline | 7.44 units on a scale | Standard Deviation 6.07 |
| Self-Affirmation (SA) | Hopelessness | 3 Months | 7.77 units on a scale | Standard Deviation 7 |
| Self-Affirmation (SA) | Hopelessness | Post-Intervention | 7.80 units on a scale | Standard Deviation 6.51 |
Secondary
Lesbian, Gay, Bisexual (LGB) Identity
LGB identity will be measured using the 'LGB Identity Centrality' instrument.The measure consists of 4 items that are rated on a scale of 1-7. The summed scores have a range of 4-28 and the higher score would indicate a stong agreement (positive) with the centrality of one's LGB identity.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed as intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Lesbian, Gay, Bisexual (LGB) Identity | Post-Intervention | 19.91 units on a scale | Standard Deviation 5.17 |
| Control | Lesbian, Gay, Bisexual (LGB) Identity | Baseline | 22.44 units on a scale | Standard Deviation 6.08 |
| Control | Lesbian, Gay, Bisexual (LGB) Identity | 3 Months | 20.74 units on a scale | Standard Deviation 4.92 |
| Expressive Writing (EW) | Lesbian, Gay, Bisexual (LGB) Identity | Post-Intervention | 17.33 units on a scale | Standard Deviation 5.95 |
| Expressive Writing (EW) | Lesbian, Gay, Bisexual (LGB) Identity | Baseline | 18.47 units on a scale | Standard Deviation 5.36 |
| Expressive Writing (EW) | Lesbian, Gay, Bisexual (LGB) Identity | 3 Months | 17.00 units on a scale | Standard Deviation 5.81 |
| Self-Affirmation (SA) | Lesbian, Gay, Bisexual (LGB) Identity | Baseline | 20.11 units on a scale | Standard Deviation 5.67 |
| Self-Affirmation (SA) | Lesbian, Gay, Bisexual (LGB) Identity | 3 Months | 18.27 units on a scale | Standard Deviation 7.48 |
| Self-Affirmation (SA) | Lesbian, Gay, Bisexual (LGB) Identity | Post-Intervention | 18.27 units on a scale | Standard Deviation 7.08 |
Secondary
Perceived Support
Perceived social support is measured using the Multidimensional Scale of Perceived Social Support (MSPSS). The MSPSS is a 12 item instrument that uses a scale 1-7 to rate each item. The scoring is done by taking the average of the items- therefore a score of 7 indicates the highest level of perceived social support.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Perceived Support | 3 Months | 5.12 units on a scale | Standard Deviation 1.39 |
| Control | Perceived Support | Baseline | 5.11 units on a scale | Standard Deviation 1.3 |
| Control | Perceived Support | Post-Intervention | 5.10 units on a scale | Standard Deviation 1.08 |
| Expressive Writing (EW) | Perceived Support | 3 Months | 5.53 units on a scale | Standard Deviation 1.01 |
| Expressive Writing (EW) | Perceived Support | Post-Intervention | 5.34 units on a scale | Standard Deviation 0.93 |
| Expressive Writing (EW) | Perceived Support | Baseline | 5.35 units on a scale | Standard Deviation 0.94 |
| Self-Affirmation (SA) | Perceived Support | 3 Months | 5.09 units on a scale | Standard Deviation 1.65 |
| Self-Affirmation (SA) | Perceived Support | Post-Intervention | 5.03 units on a scale | Standard Deviation 1.44 |
| Self-Affirmation (SA) | Perceived Support | Baseline | 4.89 units on a scale | Standard Deviation 1.4 |
Secondary
Rumination
Rumination will be assessed using the Ruminative Response Scale - Brooding Subscale (RRS). This scale is modified from the original measure where only items 5, 10, 13, 15 and 16 are used. Each item is scored by respondents on a scale of 1 to 4. To get the overall score, the 5 items are summed; total scores range from 5-20, with higher scores indicating greater brooding and rumination (related to depression) in an individual.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Rumination | Post-Intervention | 11.58 units on a scale | Standard Deviation 3.57 |
| Control | Rumination | Baseline | 12.39 units on a scale | Standard Deviation 3.68 |
| Control | Rumination | 3 Months | 11.44 units on a scale | Standard Deviation 4.86 |
| Expressive Writing (EW) | Rumination | Post-Intervention | 11.67 units on a scale | Standard Deviation 3.48 |
| Expressive Writing (EW) | Rumination | Baseline | 12.97 units on a scale | Standard Deviation 3.48 |
| Expressive Writing (EW) | Rumination | 3 Months | 10.81 units on a scale | Standard Deviation 3.81 |
| Self-Affirmation (SA) | Rumination | Baseline | 13.03 units on a scale | Standard Deviation 3.55 |
| Self-Affirmation (SA) | Rumination | 3 Months | 11.81 units on a scale | Standard Deviation 3.62 |
| Self-Affirmation (SA) | Rumination | Post-Intervention | 12.10 units on a scale | Standard Deviation 4.41 |
Secondary
Self Injury.
Self injury behaviors will be assessed with the item that asks: How many times in the past 3 months/past week have you engaged in self-harm behavior (e.g., cutting, biting, burning, hitting self) with the intent of harming, but not killing, yourself? Reported are the frequency of self-harm behaviors/self-injury reported by participants. Original title: Change in Self Injury.
Time frame: Baseline, Post Intervention (day 5), and 3 Months.
Population: Data were analyzed intention to treat.
| Arm | Measure | Group | Value (MEAN) | Dispersion |
|---|---|---|---|---|
| Control | Self Injury. | Post-Intervention | 0.12 self-harm behaviors | Standard Deviation 0.48 |
| Control | Self Injury. | Baseline | 0.61 self-harm behaviors | Standard Deviation 1.5 |
| Control | Self Injury. | 3 Months | 0.26 self-harm behaviors | Standard Deviation 0.71 |
| Expressive Writing (EW) | Self Injury. | Post-Intervention | 0.21 self-harm behaviors | Standard Deviation 1.22 |
| Expressive Writing (EW) | Self Injury. | Baseline | 1.36 self-harm behaviors | Standard Deviation 5.11 |
| Expressive Writing (EW) | Self Injury. | 3 Months | 0.97 self-harm behaviors | Standard Deviation 4.45 |
| Self-Affirmation (SA) | Self Injury. | Baseline | 0.94 self-harm behaviors | Standard Deviation 2.11 |
| Self-Affirmation (SA) | Self Injury. | 3 Months | 1.27 self-harm behaviors | Standard Deviation 3.97 |
| Self-Affirmation (SA) | Self Injury. | Post-Intervention | 0.07 self-harm behaviors | Standard Deviation 0.25 |