OBJECTIVE Effective Skills to Empower Effective Men (ESTEEM) represents the first intervention to address the psychological pathways through which minority stress undermines young sexual minority men's (SMM's) mental and sexual health using transdiagnostic cognitive-behavioral therapy. This study compared the efficacy of ESTEEM against two existing interventions. METHOD Participants were young HIV-negative SMM (N = 254; ages = 18-35; 67.2% racial/ethnic minority) experiencing a depression, anxiety, and/or stress-/trauma-related disorder and past-90-day HIV transmission risk behavior. After completing HIV testing and counseling, participants were randomized to receive 10-session ESTEEM (n = 100); 10-session community-based LGBQ-affirmative counseling (n = 102); or only HIV testing and counseling (n = 52). RESULTS For the primary outcome of any HIV transmission risk behavior at 8 months, ESTEEM was not significantly associated with greater reduction compared to HIV testing and counseling (risk ratio [RR] = 0.89, p = .52). Supportive analyses of the frequency of HIV transmission risk behavior at 8 months showed a nonsignificant difference between ESTEEM compared to HIV testing and counseling (RR = 0.69) and LGBQ-affirmative counseling (RR = 0.62). For secondary outcomes (e.g., depression, anxiety, substance use, suicidality, number of mental health diagnoses) at 8 months, ESTEEM had a larger effect size than the two comparison conditions, but these comparisons did not reach statistical significance when adjusting for the false discovery rate. Observed effect sizes for condition comparisons were smaller than the effect sizes used to power the study. In exploratory analyses, ESTEEM showed promise for reducing comorbidity. CONCLUSIONS Because the control conditions were associated with stronger effects than anticipated, and given the heterogeneous nature of transdiagnostic outcomes, the study possessed insufficient power to statistically detect the consistently small-to-moderate benefit of ESTEEM compared to the two control conditions. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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针对年轻男同性恋和双性恋男性心理和性健康的 LGBQ 肯定认知行为疗法：一项三臂随机对照试验。

目标 赋予有效男性权力的有效技能 (ESTEEM) 代表了第一个干预措施，使用跨诊断认知行为疗法来解决少数群体压力破坏年轻性少数男性 (SMM) 心理和性健康的心理途径。本研究比较了 ESTEEM 与两种现有干预措施的疗效。方法参与者是年轻的 HIV 阴性 SMM（N = 254；年龄 = 18-35；67.2% 的种族/少数民族）经历抑郁、焦虑和/或压力/创伤相关疾病和过去 90 天的 HIV 传播风险行为。完成 HIV 检测和咨询后，参与者随机接受 10 次 ESTEEM（n = 100）；10 节以社区为基础的 LGBQ 平权咨询 (n = 102)；或仅 HIV 检测和咨询 (n = 52)。结果 对于 8 个月时任何 HIV 传播风险行为的主要结果，与 HIV 检测和咨询相比，ESTEEM 与更大程度的减少没有显着相关（风险比 [RR] = 0.89，p = .52）。对 8 个月时 HIV 传播风险行为频率的支持性分析显示，ESTEEM 与 HIV 检测和咨询 (RR = 0.69) 和 LGBQ 肯定性咨询 (RR = 0.62) 相比无显着差异。对于 8 个月时的次要结果（例如，抑郁、焦虑、物质使用、自杀、心理健康诊断的数量），ESTEEM 的效应量大于两个比较条件，但这些比较在调整错误时没有达到统计显着性发现率。观察到的条件比较效应量小于用于为研究提供动力的效应量。在探索性分析中，ESTEEM 显示出减少合并症的希望。结论 由于对照条件与比预期更强的效果相关，并且考虑到跨诊断结果的异质性，该研究没有足够的能力统计检测 ESTEEM 与两种对照条件相比持续的小到中等益处。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。