Preventing depression in trans and gender diverse young people

Opportunity

Many trans young people are confronted with barriers to accessing mental health services, including perceived and actual stigma, as well as lack of provider knowledge or experience. Digital interventions offer reliable and convenient alternatives to mainstream care, that can offer privacy and safety for at risk youth. In 2017, at the time of grant application, there were no evidence-based online interventions aimed at preventing or treating mental health difficulties in trans youth. In October 2023, the only online intervention for this cohort was one online interactive video tutorial.

SPARX-R is an evidence-based fantasy game that provides psychologically based cognitive behavioural skills to prevent depression in young people. The game had been adapted into Rainbow SPARX, for sexual minority youth, with promising results. However, this adaptation of the game did not specifically cater for the needs of trans youth. With the support of Healthway, this grant aimed to deliver research that would underpin adapting SPARX-R for use with trans youth, contributing to prevention of the onset of depression in this high-risk group.

Approach

Researchers used participatory design methodology to develop SPARX-T, a trans-specific version of SPARX-R. Led by Chief Investigators Dr Yael Perry, Professor Ashleigh Lin, Associate Professor Sam Winter and Dr Penelope Strauss, the research team consulted with a focus group of 14 trans young people to ascertain their needs relating to digital and preventive mental health interventions. Focus group participants played existing versions of the SPARX programs for a two-week period. After this, they provided feedback on the adaptations required to improve usability, relevance, engagement, and usefulness for young trans and gender diverse people.

Using feedback from focus group participants, a list of all desired changes for the new SPARX-T program was developed. This list was reviewed by the research team and edited to create a list of all feasible changes. Focus group participants were then asked to provide further feedback on whether they believed each change would be beneficial, and which changes were a high priority. These results were compiled and provided to developers to create a prototype of SPARX-T. The prototype will be used in a randomised controlled trial of SPARX-T in early 2024.

Impacts and outcomes

Central to the research was understanding what trans and gender diverse young people thought the impact of a trans-friendly version of SPARX could be. Impacts that focus group participants could see SPARX-T having included:

• Reduced feelings of isolation regarding mental health difficulties.
• Increased coping skills for mental health difficulties.
• Reduced gender dysphoria, or more skills and ability to cope with dysphoria.
• Validated experiences with gender diversity, dysphoria, and mental health challenges.
• Reduced level of experienced suicidality.
• Increased quality of relationships (with family / peers).
• Providing a sense of accomplishment in achieving personal goals.

While SPARX-T is still in the research phase, the project has impacted trans and gender diverse young people involved in the focus groups by:

• Empowering them to contribute to collaboratively develop a tool that will prevent depression in their peers.
• Connecting participants with their peers, reducing isolation from others with common experiences.
• Increasing awareness of digital technologies and support services that are used to promote mental wellbeing.
• Practicing cognitive behavioural therapy techniques in the SPARX games trialled, with many noting benefits.
• Building connections with the Freedom Centre, an organisation offering support services for LGBTQA+ young people around WA.

Adaptations requested by focus group participants that have been successfully implemented in SPARX-T include:

• Single gender-neutral options for avatars.
• Including non-binary pronouns/language.
• Increased customisability for avatars, including hair, clothes and skin colour.
• Including content on coping with gender dysphoria.
• Including a scenario that explores unsupportive parents who misgender a game participant.
• Adding links to external sites with evidence-based, helpful information for trans and gender diverse young people.
• Including messages that acknowledge the uniqueness of individual journeys.

The next stages of research for SPARX-T include a randomised controlled trial, and translation and health promotion of the product into policy and practice.

While SPARX-T has not yet been made publicly available, it has the potential to offer significant benefits to the WA community as it will be widely accessible, with the potential to reach those who have difficulty with service access, such as regional and remote trans youth, as well as those young people who are not “out” or lack parental support. Further, it could be provided as a standard resource through schools, peer led LGBTQA+ spaces or community services to all trans young people nationally.

What worked

Centring trans young people

Keeping trans young people central to the design and research process ensured that the adaptations were directly informed by the views and lived experience of trans young people themselves. Having multiple points of engagement, and in different styles (focus groups, interviews, diaries) ensured that participants were given numerous opportunities to contribute in the way most comfortable to them.

Key challenges

Changing developers caused delays

During the project, researchers received advice that the developers originally contracted to maintain and update the SPARX program were no longer being used. This meant an unplanned procurement process had to be undertaken, extending timelines. The change in developers also raised some licensing issues between new partners. Ultimately, however, the change in developers created new partnerships and perspectives on the project, that has led to a more stable and user-friendly version of the SPARX-T program.

Prioritising young people’s requested changes

Study participants provided significant helpful feedback regarding potential changes and improvements to the existing SPARX games. With a limited budget and development capabilities, not all proposed changes could be implemented, so the task of prioritising the most meaningful and critical changes was undertaken. The final adaptations were perceived by the young people as being most central to affecting their experience of game play, however, there were additional improvements and additions that were unable to be implemented at this time.

REFERENCES

1. Strauss, P., Cook, A., Winter, S., Watson, V., Wright Toussaint, D., Lin, A. (2017). Trans Pathways: the mental health experiences and care pathways of trans young people. Summary of results. Telethon Kids Institute, Perth, Australia. Available from Trans Pathways | Telethon Kids Institute

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