A systematic review and meta-analysis of interventions addressing sexual and gender minority stress

Sexual and gender minority (SGM) populations experience health disparities linked to minority stress (socially-based stressors), including proximal (e.g., SGM internalized stigma) and distal stressors (e.g., negative bias from non-SGM people toward SGM individuals). We synthesized and evaluated the effectiveness of interventions reducing proximal and distal SGM stress.

We followed PRISMA and Joanna Briggs Institute guidelines (CRD42024604568). Five databases were searched and eligible studies evaluated interventions reducing minority stress with sufficient data for effect size estimation. We estimated three-level multivariate meta-regression models for distal and proximal minority stress using restricted maximum likelihood estimation and robust standard error estimates.

Fifty-one studies (31 distal, 20 proximal) with 11253 participants (SGM n = 3168) were included. Distal stress interventions yielded a null-to-small pooled effect (g = 0.185, 95% CI = 0.078, 0.292). Psychological interventions had a small effect (g = 0.361, 95% CI = 0.178, 0.544) and outperformed psychoeducation and social contact-based interventions (-0.257 < β < -0.221, p < 0.05). For proximal minority stress, although the overall pooled effect was nonsignificant (g = 0.071, 95% CI = -0.154, 0.297) the intervention × outcome interaction was (Wald Q = 4.661, p = 0.005). Narrative therapy targeting identity affirmation showed a large pooled effect (g = 1.846, 95% CI = 1.032, 2.659). Pairwise contrasts using this intervention-outcome combination as reference indicated that psychoeducation and psychological interventions had greater effects on internalized stigma and perceived social support (2.172 < β < 2.719, p < 0.05).

Psychological interventions may reduce both proximal and distal stress. However, aligning interventions to specific minority stressors may yield greater benefit on SGM populations' health.