Publications

This study examined whether Project RISE — a digital single-session intervention (SSI) focused on minority stress — produced comparable benefits across youth with single versus multiple marginalized identities. Data from 261 adolescents (ages 13–16; 51% youth of color; 68% transgender/gender-diverse) who received the intervention were analyzed, measuring changes in internalized stigma, identity pride, hopelessness, depression, and anxiety. Multiply-minoritized youth, especially gender minority youth, experienced significantly higher levels of identity pride after completing Project RISE. Gender minority participants reported elevated hopelessness, depression, and anxiety at two-week follow-up compared to cisgender peers. These findings suggest that clinicians should consider how interventions address intersectional identities and account for social support differences when selecting treatments for youth with overlapping marginalized statuses.

Structural stigma has been shown to have negative consequences on LGBTQ+ youth's mental health. Most research has focused on stigma at the national or state level, limiting understanding of how local institutions and environments influence mental health. In the current study, we sought to examine the association of multiple layers of structural stigma (e.g., at the county and state levels) on depression and anxiety severity, substance use, and mental healthcare access, for LGBTQ+ youth in the United States. Thus, we recruited 609 LGBTQ+ youth (Mage = 15.6, SDage = 1.17; 71.9% White) to complete survey measures about their mental health and access to care. Further, we extracted 2023 data from Project Implicit and the Human Rights Campaign to create factors of structural stigma at the county and state levels. Consistent with existing literature, our results demonstrate that structural stigma, particularly when examined at the county level (as opposed to the state level), may exert significant impacts on mental health outcomes such as depression, anxiety, and substance use severity for LGBTQ+ youth.

In the United States, the experience of minority stress among LGBTQ+ youth varies across regions with high and low levels of stigma (e.g., laws, policies, and cultural norms that limit the lives of individuals with stigmatized identities). Some evidence suggests that stigma can undermine response to individual-level psychosocial interventions among youth, creating the need to identify factors that may buffer against minority stressors' effects in high-stigma contexts. Social support may be one such factor. Therefore, among LGBTQ+ youth who received a digital, single-session intervention (SSI) focused on minority stress, we investigated whether structural and internalized stigma and social support predicted intervention response, independently or interactively. Specifically, we predicted that LGBTQ+ youth in environments characterized by high stigma would report weaker SSI responses. Further, we predicted that LGBTQ+ youth who perceived higher social support would report stronger SSI responses. We also tested structural stigma and social support as moderators. Using data from a previously-completed randomized evaluation, we analyzed data from 244 LGBTQ+ adolescents, aged 13–16 years, across 181 counties in 46 U.S. states, who engaged with the SSI. We created a factor representing structural stigma using confirmatory factor analysis at the county level. No evidence emerged for structural stigma or social support as a moderator of intervention effects on internalized stigma, identity pride, or mental health-related outcomes, either at post-intervention or at 2-week follow up. Results speak to the potentially broad utility of the SSI tested in this trial for LGBTQ+ youth with limited access to mental health support.

This study examined neuroanatomical correlates of depression with cognitive impairment in 153 older adults (mean age 62.8 years) at risk for suicide, including 46 with suicide attempt history, 72 with depression but no attempts, and 35 healthy controls. Using structural brain imaging and Bayesian multilevel modeling with false discovery rate correction, three distinct patterns emerged: (1) suicide attempt history combined with executive dysfunction predicted smaller volumes in temporal, parietal, occipital regions, and the hippocampus; (2) depression severity correlated with frontal and subcortical reductions; and (3) dementia-related cognitive decline predicted medial temporal volume loss. These findings reveal that suicidal behavior, depression, and dementia-related cognitive decline are accompanied by reduced brain volumes in largely non-overlapping regions that nevertheless converge on the hippocampus, suggesting it as a critical intersection point for understanding late-life suicide risk.

This study examined whether digital single-session interventions (SSIs), offered via social media advertisements, could help narrow mental health treatment gaps for rural adolescents with depression symptoms. In a randomized controlled trial of 2,322 adolescents aged 13–16 across three intervention conditions, social media recruitment achieved population-representative reach, with 12.5% of participants from rural areas. Rural participants completed interventions at comparable rates to urban peers, rated them equally acceptable, and demonstrated similar depression symptom improvements. However, social media ads resulted in relative underrepresentation of youths from rural areas who hold minoritized racial/ethnic identities. These findings suggest that digital SSIs distributed through social media may effectively bridge rural-urban disparities in mental health access, though targeted efforts are warranted to better engage racial and ethnic minority youth in rural regions.

Transgender and nonbinary (TNB) individuals in the United States encounter substantial employment and economic disparities. Through interviews with 26 TNB young adults, this study examines how these inequities develop through workplace interactions. Findings reveal that routine hiring processes and structural constraints made participants vulnerable to interactional stigmatization and subsequent discrimination. Participants responded to anticipated stigma through various strategies, from changing careers to withdrawing from employment altogether. Access to supportive management, organizational structure, and individual gender presentation influenced one's capacity to navigate workplace stigma. These stigmatization processes both perpetuate economic disadvantage by constraining career prospects and function as minority stressors that harm mental health, illustrating how inequality gets relationally constructed within organizational settings.

Sexual and gender minority (SGM) adolescents face elevated suicide risk, with structural homophobia potentially driving disparities in suicidal thoughts and behaviors. This study examined how state-level indicators of structural homophobia correlate with suicidal ideation and behavior in a nationwide sample of 1,837 LGBTQ+ youth ages 14–18. SGM adolescents who lived in states with higher levels of structural homophobia had higher odds of reporting lifetime suicidal ideation and suicidal planning after controlling for demographic factors. However, lifetime suicide attempts showed no significant association with structural homophobia levels. These findings highlight that policies, social conditions, and attitudes supporting LGBTQ+ inclusion could mitigate suicidal ideation among SGM adolescents, underscoring suicide risk reduction as a pressing public health concern.

Objectives: To examine the relationship between childhood traumatic experiences and early and late-onset suicidal behavior among depressed older adults. Design: Cross-sectional study. Participants: 224 adults aged 50+ (M = 62.5 years) recruited into three depressed groups — 84 suicide attempters, 44 suicide ideators, and 58 non-suicidal comparisons — and 38 non-psychiatric healthy controls. Measurements: The Childhood Trauma Questionnaire measured experiences of childhood trauma including emotional abuse, physical abuse, emotional neglect, physical neglect, and sexual abuse. Results: Attempters were separated into early- and late-onset based on age of first attempt using a statistical algorithm that identified a cutoff age of 30. Early-onset attempters experienced more childhood emotional abuse and neglect than late-onset attempters and were more likely to have experienced multiple forms of abuse. They also experienced more emotional abuse and neglect than all comparison groups, and more often met criteria for current or lifetime PTSD. Late-onset attempters had similar levels of childhood trauma as other depressed groups. Conclusions: There are distinct pathways to suicidal behavior in older adults based on their age of first suicide attempt, and trauma experienced in childhood has long-lasting emotional and behavioral consequences, even into late life.

This study examined whether suicidal ideation patterns in older depressed adults could predict future suicide attempts or death by suicide. Using Latent Profile Analysis, 337 depressed adults (ages 50–93) were followed for up to 14 years, with suicidal ideation assessed annually. Four distinct ideation profiles emerged: chronic severe ideators showed the highest risk (HR = 5.75) of suicide attempt or death, followed by highly variable ideators (HR = 3.21), compared to those with rapidly improving ideation. Current ideation severity at baseline did not fully explain risk — the pattern of ideation over time mattered significantly. Chronic severe ideators displayed the most severe dysfunction across personality, social characteristics, and impulsivity measures. These findings demonstrate that assessing ideation trajectories over months or years provides clinically relevant information beyond snapshot assessments, enabling better identification of high-risk individuals despite similar baseline severity levels.