Guided internet-based LGBTQ-affirmative cognitive-behavioral therapy: A randomized controlled trial among sexual minority men in China

May combine two claims.

Condomless anal sex was assessed over the past 30 days rather than a longer period to reduce retrospective recall bias, but this may have limited variability in HIV-transmission-risk acts.

“condomless anal sex was assessed across the past 30 days rather than over a longer period (Pachankis, Hatzenbuehler, et al., 2015) so as to guard against retrospective recall bias introduced by reporting across longer periods. Yet, this decision might have limited variability in HIV-transmission-risk acts.”

• cites Pachankis, Hatzenbuehler, et al., 2015 sourceDisputed

  The Method section (Primary Outcome Measures) says condomless anal sex was assessed over the past 90 days, not 30 days. The Analytic plan likewise describes the outcome as a past-90-day count. The cited paper therefore contradicts the assessment period attributed to it. (LLM, conf=0.92)

  Checked by a reasoning model — may be wrong.

  Experimental — accuracy not yet measured

Classified as probably not a substantial claim.

LGBTQ-affirmative CBT seeks to instill coping skills against minority stress by addressing cognitive, affective, and behavioral pathways through which minority stress drives adverse mental and behavioral health outcomes.

“Informed by minority stress theory (Brooks, 1981; Meyer, 2003), LGBTQ-affirmative CBT seeks to instill coping skills against minority stress by addressing the cognitive (e.g., negative self-schemas), affective (e.g., emotion dysregulation), and behavioral (e.g., avoidance) pathways through which minority stress drives adverse mental and behavioral health outcomes.”

• cites Brooks, 1981Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Meyer, 2003 sourceSupported

May combine two claims.

These adaptations include identity concealment, internalized stigma, and rejection hypervigilance.

“These adaptations include psychosocial processes such as identity concealment, internalized stigma, and rejection hypervigilance (Hollinsaid et al., 2022; Newcomb & Mustanski, 2010; Pachankis, Mahon, et al., 2020).”

• cites Hollinsaid et al., 2022 sourcePartly supported

  The paper’s introductory section describes hypervigilance as a response to anticipated stigma and identifies identity concealment as a response to threat. It does not describe internalized stigma as one of these adaptations; the phrase appears in the title of a work in its References. Because the citing sentence does not assign its three citations to separate items, this source supports only part of the list. (LLM, conf=0.84)

  Experimental — accuracy not yet measured
• cites Newcomb & Mustanski, 2010 sourceNot checked — no full text of the source
• cites Pachankis, Mahon, et al., 2020 sourceSupported

May combine two claims.

Minority stress adaptations can become chronic coping tendencies that manifest in emotional and behavioral avoidance (e.g., rumination, hazardous alcohol use) and maladaptive emotional processes (e.g., lack of emotion awareness) that predict depression and anxiety.

“Although these responses are initially learned through ongoing exposure to invalidating environments (Cardona et al., 2021), they can become chronic, ingrained coping tendencies that manifest in insalubrious outcomes, such as emotional and behavioral avoidance (e.g., rumination; hazardous alcohol use; Lewis et al., 2016; Szymanski et al., 2014) and the experience of maladaptive emotional processes”

• cites Lewis et al., 2016 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites Szymanski et al., 2014 sourceNot checked — no full text of the source
• cites Pachankis, Rendina, et al., 2015Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

Minority stress theory holds that environments with normative stigma and identity invalidation drive psychosocial adaptations among sexual minority individuals that can erode mental and behavioral health.

“Minority stress theory suggests that environments characterized by normative stigma and identity invalidation drive psychosocial adaptations among sexual minority individuals that can ultimately erode their mental and behavioral health (Brooks, 1981; Meyer, 2003).”

• cites Brooks, 1981Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Meyer, 2003 sourceSupported

May combine two claims.

ICBT efficacy is equivalent to face-to-face CBT while overcoming several implementation challenges of traditional CBT delivery.

“The efficacy of ICBT shows equivalence with face-to-face CBT while also overcoming several of the implementation challenges of traditional CBT delivery modalities (Andersson et al., 2014; Andersson et al., 2019; Andrews et al., 2018).”

• cites Andersson et al., 2014 sourcePartly supported

  The Abstract reports equivalent overall effects for guided ICBT and face-to-face CBT, while cautioning that equivalence has not been established for every condition. It also says many ICBT programs require only about 10–15 minutes of therapist guidance per client per week, but it does not establish that ICBT overcomes several implementation challenges of traditional CBT; some Internet formats save no therapist time. (LLM, conf=0.87)

  Experimental — accuracy not yet measured
• cites Andersson et al., 2019 sourcePartly supported

  The EVIDENCE BASE TO DATE section reports that guided ICBT tends to have effects equivalent to face-to-face CBT, but the claim omits the guided-treatment qualifier and states equivalence more definitively. The INNOVATION section describes advantages over face-to-face delivery, including less therapist time, no need for a therapy room, and less waiting. Page numbers were not available in our copy. (LLM, conf=0.86)

  Experimental — accuracy not yet measured
• cites Andrews et al., 2018 sourceSupported

May combine two claims.

Stigma and minority stress worsen the disproportionate risk of poor mental and behavioral health among sexual minority men globally, including co-occurring depression, anxiety, substance use problems, and HIV-transmission risk.

“Stigma and minority stress exacerbate the disproportionate risk of poor mental and behavioral health facing sexual minority men around the world, including co-occurring risk of depression, anxiety, substance use problems, and HIV-transmission risk (Hatzenbuehler & Pachankis, 2016; Operario et al., 2022).”

• cites Hatzenbuehler & Pachankis, 2016 sourceNot checked — no full text of the source
• cites Operario et al., 2022 sourceSupported

May combine two claims.

Treatment effects for mental and behavioral problems, minority stress, and universal risk factors were in the expected direction and consistent with previous research on LGBTQ-affirmative CBT and psychosocial interventions for sexual minority individuals.

“Overall, treatment effects for mental and behavioral problems and minority stress and universal risk factors were in the expected direction and consistent with previous research on LGBTQ-affirmative CBT specifically (Craig, Eaton, et al., 2021; Pachankis, Hatzenbuehler, et al., 2015; Pachankis, McConocha, et al., 2020) and psychosocial interventions focused on sexual minority individuals’ co-occur”

• cites Craig, Eaton, et al., 2021 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 2 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured
• cites Pachankis, Hatzenbuehler, et al., 2015 sourceSupported
• cites Pachankis, McConocha, et al., 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The rate of engagement in the ICBT condition was slightly higher than a similar US trial but lower than other studies of ICBT.

“This rate of engagement was slightly higher than a similar trial in the US (Pachankis et al., 2023), but lower than other studies of ICBT (Andrews et al., 2018).”

• cites Pachankis et al., 2023 sourceNot checked — no full text of the source
• cites Andrews et al., 2018 sourceSupported
  Experimental — accuracy not yet measured

May combine two claims.

The effect sizes for HIV-transmission risk behavior were in the small-to-medium range, consistent with previous trials of psychosocial interventions for this population.

“effect sizes for this outcome were in the small-to-medium range consistent with previous trials of psychosocial interventions for this population (Pantalone et al., 2020).”

• cites Pantalone et al., 2020 sourcePartly supported

  The Results (Meta-Analytic Results; page unavailable) report modest effects for sexual risk behavior, with category-level effect sizes in the d = .17–.23 range; the paper calls the overall pooled effects small. The Results (Summary of Intervention Results; page unavailable) also report a medium-sized effect for one condomless-sex outcome (d = 0.59), but the paper does not characterize HIV-transmission risk effects overall as small-to-medium or explicitly make the claimed comparison with previous trials. (LLM, conf=0.82)

  Experimental — accuracy not yet measured

May combine two claims.

All variables met normality assumptions except HIV-transmission-risk behavior, AUDIT, DUDIT, and SIDAS, which were zero-inflated; generalized linear mixed models with square root transformation were used for AUDIT, DUDIT, and SIDAS, and a negative binomial zero-inflated regression for HIV-transmission-risk behavior.

“All variables met assumptions of normality except for HIV-transmission-risk behavior, AUDIT, DUDIT, and SIDAS, which were zero-inflated.”

• Also stated in: § Participants · plain

  “For models fit with the AUDIT, DUDIT, and SIDAS (ordinal variables), we used generalized linear mixed effects models with square root transformation to address normality.”

• Also stated in: § Participants · plain

  “For HIV-transmission-risk behavior (a count variable), we followed best practices for zero-inflated count data and used a negative binomial zero-inflated regression model to account for the overdispersion and excess zeros (Brooks et al., 2017).”

• cites Brooks et al., 2017 sourcePartly supported

  Split into 2 atoms — 0 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 1 unverifiable. Expand the claim to see per-atom verdicts.

  Experimental — accuracy not yet measured

May combine two claims.

The control condition's weekly self-monitoring has been shown to produce reductions in depression symptoms and improvements in behavioral health outcomes.

“This type of self-monitoring has been shown to produce reductions in depression symptoms over time and yield improvement in behavioral health outcomes (Kauer et al., 2012; Livingston et al., 2017).”

• cites Kauer et al., 2012 sourcePartly supported

  The Introduction (Mechanism Underlying Self-monitoring; page unavailable) reports that depressive symptoms decreased over time in both groups, and the Results (Rumination; page unavailable) report decreased rumination in both groups. But the comparison group monitored several times daily, not weekly, and the authors attribute the shared symptom improvement to training, resources, and support rather than establishing that comparison-group self-monitoring produced it. (LLM, conf=0.88)

  Experimental — accuracy not yet measured
• cites Livingston et al., 2017 sourceCould not verify

  The Clinical Implications section describes monitoring as a possible intervention that could help people identify substance-use risks, but does not report reductions in depression symptoms or improvements in behavioral health outcomes. The Results report no detectable change in nicotine or substance-use reports between weeks; a search for depression symptoms and monitoring-related improvements found no supporting passage. (LLM, conf=0.74)

  Experimental — accuracy not yet measured

May combine two claims.

LGBTQ-affirmative ICBT demonstrated comparatively greater improvements in emotion dysregulation, extending previous intervention research on LGBTQ-affirmative CBT mechanisms and consistent with its theoretical basis.

“LGBTQ-affirmative ICBT also demonstrated comparatively greater improvements in emotion dysregulation. This finding extends the relatively scant previous intervention research that has examined the efficacy of LGBTQ-affirmative CBT on potential intervention mechanisms, in which factors such as hope and optimism have been found to be impacted (Craig, Eaton, et al., 2021; Craig, Leung, et al., 2021).”

• cites Craig, Eaton, et al., 2021 sourceSupported
• cites Craig, Leung, et al., 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The structural context in which psychotherapies are delivered is associated with psychotherapy efficacy, as shown by findings that psychotherapy is less effective for Black youth in US counties with higher anti-Black racism.

“an emerging body of research has found that the structural context in which psychotherapies are delivered is associated with psychotherapy efficacy. For instance, psychotherapy has been found to be less effective for Black youth living in U.S. counties with higher anti-Black racism (Price et al., 2022).”

• cites Price et al., 2022 sourcePartly supported

  The Discussion reports that psychotherapy interventions with majority-Black youth samples were less effective where anti-Black cultural racism was higher. But the study measured racism at the state level, not the county level; the Discussion explicitly identifies county-level analysis as future research. (LLM, conf=0.94)

  Experimental — accuracy not yet measured

Borderline on S4 (based): unclear from the text.

Greater session completion predicted greater reductions in suicidality and rumination.

“Greater session completion predicted greater reductions in suicidality and rumination.”

May combine two claims.

No significant Condition × Time interaction was observed for substance use problems or suicidal ideation, but suicidal ideation significantly decreased for all participants across the 4- and 8-month follow-ups.

“There was not a significant Condition × Time interaction observed for substance use problems or suicidal ideation; however, there was a significant reduction in suicidal ideation for all participants across the 4- and 8-month follow-ups (Table 2).”

May combine two claims.

No Condition × Time interaction was found for HIV-transmission risk behavior, meaning the decrease across 4- and 8-month follow-ups did not differ between the ICBT and assessment-only conditions.

“No Condition × Time interaction was observed, indicating that the significant decrease in HIV-transmission risk behavior across 4- and 8-month follow-ups did not differ between the LGBTQ-affirmative ICBT and assessment-only conditions (see Table 2).”

May combine two claims.

For participants with low internalized stigma, HIV-transmission risk behavior scores improved significantly from baseline to 4 months in the ICBT condition (MD = 1.55, SE = 0.040, p = 0.001) but not in the assessment-only condition (MD = 0.55, SE = 0.32, p = 0.49).

“for participants with low levels of internalized stigma, we observed significant improvements in HIV-transmission risk behavior scores between baseline and 4-month follow-up for participants in the LGBTQ-affirmative ICBT condition (Mean Difference [MD] = 1.55, SE = 0.040, p = 0.001), but not for those in the assessment-only condition (MD = 0.55, SE = 0.32, p = 0.49).”

May combine two claims.

A greater number of sessions completed was associated with greater reductions in suicidal ideation at 4-month follow-up and rumination at 8-month follow-up.

“Greater number of sessions completed was associated with greater reductions in suicidal ideation at the 4-month follow-up and rumination at the 8-month follow-up.”

May combine two claims.

Effect sizes for mental and behavioral health outcomes were medium and in the expected direction.

“Effect sizes for these outcomes were medium and in the expected direction (see Figure 2).”

May combine two claims.

Within the ICBT condition, significant Time × Sessions Completed interactions were found for suicidal ideation and rumination, but not for other outcomes.

“In analyses conducted within the LGBTQ-affirmative ICBT condition, we found significant Time × Sessions Completed interactions when predicting suicidal ideation (SIDAS) and rumination (RRS), but no other outcomes.”

May combine two claims.

Participants assigned to LGBTQ-affirmative ICBT showed significantly greater improvements in depression symptoms, anxiety symptoms, and alcohol use problems at 8-month follow-up, and in depression and anxiety symptoms at 4-month follow-up, compared to the assessment-only condition.

“For participants assigned to LGBTQ-affirmative ICBT, we found significantly greater improvements in mental health (i.e., depression symptoms, anxiety symptoms) and behavioral health (i.e., alcohol use problems) at 8-month follow-up (and at 4-month follow-up for depression symptoms and anxiety symptoms) compared to the assessment-only condition.”

May combine two claims.

Concealment motivation and acceptance concerns did not moderate Condition × Time interaction effects for HIV-transmission risk behavior at 4- or 8-month follow-up.

“Concealment motivation and acceptance concerns did not moderate Condition × Time interaction effects for HIV-transmission risk behavior at 4- or 8-month follow-up.”

May combine two claims.

Condition × Time effects were observed for acceptance concerns and internalized stigma, indicating relative improvements for ICBT compared to assessment-only at 4 months for acceptance concerns (d = −0.36) and at 8 months for internalized homonegativity (d = −0.28).

“Condition × Time effects were observed for acceptance concerns and internalized stigma, indicating relative improvements in these minority stress mechanisms for participants in the LGBTQ-affirmative ICBT condition compared to the assessment-only condition at 4-month (acceptance concerns, d = −0.36) and 8-month follow-up (internalized homonegativity, d = −0.28, see Figure 2).”

May combine two claims.

Internet coverage reaches 76.4% of citizens in China, and 99.8% have mobile phone access.

“Furthermore, with the rapid development of information technology, internet coverage now reaches 76.4% of citizens in China, and 99.8% have access via mobile phone (China Internet Network Information, 2023).”

• cites China Internet Network Information, 2023Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

LGBTQ-affirmative CBT is typically delivered by therapists one-on-one or in small groups, which challenges widespread implementation.

“Although emerging evidence has shown LGBTQ-affirmative CBT to be a promising intervention for addressing the downstream consequences of minority stress on sexual minority individuals’ co-occurring psychosocial health problems, it has typically been delivered by therapists one-on-one or in small group settings, thereby challenging its widespread implementation (Pachankis, Harkness, Jackson, et al.,”

• cites Pachankis, Harkness, Jackson, et al., 2022Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

A recent US randomized controlled trial with sexual minority young adults found small, non-significant effects for LGBTQ-affirmative ICBT compared with assessment-only control, but larger and statistically significant comparative effects for participants in US locales with high normative anti-LGBTQ bias.

“In further support of this possibility, although a recent randomized controlled trial with sexual minority young adults across the US found small, non-significant effects for LGBTQ-affirmative ICBT compared to an assessment-only control, LGBTQ-affirmative ICBT’s comparative effects were larger and statistically significant for participants living in US locales with high degrees of normative anti-L”

• cites Pachankis et al., 2023 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The trial protocol was pre-registered on ClinicalTrial.gov (NCT04718194).

“The trial protocol was pre-registered on ClinicalTrial.gov (NCT04718194).”

May combine two claims.

Structural stigma toward Chinese sexual minority men includes lack of legal protections for same-sex marriage, inclusive sex education, or recourse to discrimination.

“Structural stigma toward Chinese sexual minority men includes a lack of legal protections for same-sex marriage, inclusive sex education, or recourse to discrimination (Joint United Nations Development Programme, 2018; Miles-Johnson & Wang, 2018).”

• cites Joint United Nations Development Programme, 2018Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Miles-Johnson & Wang, 2018 sourceNot checked — no full text of the source

May combine two claims.

Implementation of LGBTQ-affirmative CBT is hindered in high-stigma, low-access contexts like China by lack of LGBTQ-affirmative providers and mental health providers, geographically dispersed LGBTQ communities, and normative fears of accessing LGBTQ-specific spaces.

“Implementation is further hindered by high-stigma, low-access resource contexts such as those in China, which often lack LGBTQ-affirmative providers and mental health providers in general, have geographically dispersed LGBTQ communities, and instill normative fears of accessing LGBTQ-specific spaces (Pan et al., 2020; X. Xu et al., 2017).”

• cites Pan et al., 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites X. Xu et al., 2017Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Classified as probably not a substantial claim.

This research lays the groundwork for testing LGBTQ-affirmative CBT, as adapted for Chinese sexual minority men, using an ICBT delivery platform suited to this context.

“This research lays the groundwork for LGBTQ-affirmative CBT, as adapted for Chinese sexual minority men, to be tested using the efficient ICBT delivery platform particularly suited to this context.”

• AssumptionRests on an assumption: LGBTQ-affirmative CBT has never been tested in high-stigma contexts like China using online delivery.

May combine two claims.

The Chinese social environment is collectivistic and emphasizes conformity to social norms and traditional family values including heterosexual marriage and procreation.

“The social environment in China can be characterized as a collectivistic culture with an emphasis on conforming to social norms and traditional family values including heterosexual marriage and procreation (Sun, Budge, et al., 2020; Sun et al., 2021).”

• cites Sun, Budge, et al., 2020 sourceNot checked — no full text of the source
• cites Sun et al., 2021 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

An unstructured covariance matrix was used in the generalized linear mixed effect models.

“We used an unstructured covariance matrix (Fitzmaurice et al., 2011).”

• cites Fitzmaurice et al., 2011 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

All analyses were conducted using R version 4.0.2.

“All analyses were conducted using R (version 4.0.2).”

May combine two claims.

The five counselors were trained by the developer of LGBTQ-affirmative CBT and had delivered original LGBTQ-affirmative CBT in person with fidelity.

“all therapists were trained by the developer of LGBTQ-affirmative CBT and have delivered original LGBTQ-affirmative CBT in-person with fidelity (Pan et al., 2021), and practiced each module with each other before engaging with participants.”

• cites Pan et al., 2021 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The SIDAS-Chinese had Cronbach's alphas of 0.79, 0.89, and 0.79 at baseline and 4- and 8-month follow-up.

“Cronbach’s alphas were 0.79, 0.89, and 0.79 at baseline and 4- and 8-month follow-up, respectively.”

Classified as probably not a substantial claim. May combine two claims.

A random number table generated with SPSS 26.0 was used to randomly assign participants 1:1 with block size two.

“A random number table was generated using SPSS 26.0 to randomly assign participants to intervention or control conditions using a 1:1 ratio with block size of two.”

May combine two claims.

Acceptance concerns showed the strongest comparative reductions among minority stress mechanisms between conditions, while internalized stigma showed delayed comparative reductions emerging at 8-month follow-up.

“this study found that acceptance concerns, also sometimes referred to as rejection sensitivity (Pachankis et al., 2008), showed the strongest comparative reductions of the minority stress mechanisms between conditions, whereas internalized stigma showed delayed comparative reductions between conditions, emerging at the 8-month follow-up.”

• cites Pachankis et al., 2008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Decisional Balance for Condom Use Scale had Cronbach's alphas of 0.75, 0.79, and 0.78 at baseline and 4- and 8-month follow-up.

“Cronbach’s alphas were 0.75, 0,79, and 0.78 at baseline and 4- and 8-month follow-up, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The AUDIT had Cronbach's alphas of 0.89, 0.84, and 0.85 at baseline and 4- and 8-month follow-up.

“Cronbach’s alphas were 0.89, 0.84, and 0.85 at baseline and 4- and 8-month follow-up, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Neither participants nor counselors were masked to condition assignment due to the nature of the treatment.

“Neither participants nor counselors were masked to condition assignment given the nature of the treatment.”

Classified as probably not a substantial claim.

Effect sizes for linear mixed models were calculated as the difference in mean pre-post change between the immediate intervention and assessment-only control conditions, divided by the pooled baseline standard deviation.

“Effect sizes (d) for linear mixed models were calculated as mean pre-post change in the immediate intervention condition minus the mean pre-post change in the assessment-only control condition, divided by the pooled baseline standard deviation (Morris, 2008).”

• cites Morris, 2008 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The Condom Self-Efficacy Scale-Traditional Chinese had Cronbach's alphas of 0.92, 0.94, and 0.90 at baseline and 4- and 8-month follow-up.

“Cronbach’s alphas for this measure were 0.92, 0.94, and 0.90 at baseline and 4- and 8-month follow-up, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The Chinese GAD-7 had Cronbach's alphas of 0.91, 0.93, and 0.91 at baseline and 4- and 8-month follow-up.

“Cronbach’s alphas were 0.91, 0.93, and 0.91 at baseline and 4- and 8-month follow-up, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing).

All counseling was supervised weekly by a bicultural and bilingual psychologist to ensure fidelity throughout the trial.

“All counseling was supervised by a psychologist with a bicultural and bilingual background (Chinese and English) who provided weekly group supervision to ensure fidelity throughout the trial.”

May combine two claims.

The control condition was a weekly assessment of mood, minority stress, and behavioral health, which was relatively active.

“a weekly assessment of mood and minority stress and behavioral health was selected as a relatively active control group.”

May combine two claims.

The present effect sizes for depression, anxiety, and alcohol use problems were much larger than those in the most similar previous US trial of LGBTQ-affirmative ICBT, which found no significantly greater improvement for these outcomes compared to assessment-only.

“However, the present effect sizes were much larger than those found in the most similar previous study of LGBTQ-affirmative ICBT delivered in the US using the same delivery platform, research design, and control condition. In that study, LGBTQ-affirmative ICBT yielded no significantly greater improvement in depression or anxiety symptoms or alcohol use problems compared to the assessment-only”

• cites Pachankis et al., 2023 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

A data and safety monitoring board composed of US and Chinese researchers reviewed and monitored study data, participant safety, and adverse events.

“Study data, participants’ safety, and adverse events were reviewed and monitored by a data and safety monitoring board composed of researchers with relevant expertise in the US and China.”

May combine two claims.

No participant tested positive for HIV, and one participant in the assessment-only condition tested positive for syphilis at all three timepoints.

“no participant tested positive for HIV and one participant in the assessment-only condition tested positive for syphilis at all three timepoints (consistent with the type of syphilis test used here, in which a positive result does not necessarily indicate a new infection).”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Parental consent was not required for participants aged 16-17 in China, but no participant under 18 took part.

“parental consent is not required for participants ages 16–17 living in China; however, no participant under age 18 participated in this study.”

• cites China Medical Products Administration, 2020Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

This moderation finding contradicts previous US research on LGBTQ-affirmative CBT, in which participants with higher internalized stigma benefited more from the intervention for depression, anxiety, heavy alcohol use, and HIV-transmission-risk behavior.

“This finding contradicts previous research on LGBTQ-affirmative CBT delivered to sexual minority men in the US, in which participants with higher levels of internalized stigma benefited more from the intervention in terms of depression, anxiety, heavy alcohol use, and HIV-transmission-risk behavior (Millar et al., 2016).”

• cites Millar et al., 2016 sourceNot checked — no full text of the source

May combine two claims.

These findings are among the first to suggest potential minority stress mechanisms within studies of LGBTQ-affirmative interventions and are consistent with at least one other intervention focused on internalized stigma.

“These findings are among the first to suggest potential minority stress mechanisms within studies of LGBTQ-affirmative interventions and are consistent with the results of at least one other intervention – a brief psychoeducational intervention focused squarely on internalized stigma – showing efficacy for improving that outcome (Lin & Israel, 2012).”

• cites Lin & Israel, 2012 sourceNot checked — no full text of the source

May combine two claims.

The significant impact of LGBTQ-affirmative ICBT on acceptance concerns suggests promise for addressing interpersonal forms of minority stress, perhaps particularly common in collectivistic cultural contexts where interpersonal relations and acceptance by others are important in self-construction.

“The fact that LGBTQ-affirmative ICBT exerted significant impact on acceptance concerns suggests its promise in addressing interpersonal forms of minority stress perhaps particularly common in collectivistic cultural contexts where interpersonal relations and acceptance by others are important in one’s construction of self (Sun et al., 2021; Xu et al., 2023).”

• cites Sun et al., 2021 sourceNot checked — no full text of the source
• cites Xu et al., 2023Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

Probably not a substantial claim: may not pass S3 (load-bearing).

The Chinese PHQ-9 had Cronbach's alphas of 0.86 at all three assessments.

“Cronbach’s alphas were 0.86, 0.86, and 0.86 at baseline and 4- and 8-month follow-up, respectively.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The study was approved by the Yale University Human Subjects Committee and the Institutional Review Board of the Behavioral and Nursing Research of Central South University, and all participants provided informed consent.

“The study was reviewed and approved by the Yale University Human Subjects Committee (2000029433) and the Institutional Review Board of the Behavioral and Nursing Research of Central South University (E2021128). All participants provided informed consent.”

Classified as probably not a substantial claim.

The analysis followed an intent-to-treat principle, with participants analyzed according to their assigned condition regardless of retention.

“we used an intent-to-treat analysis in which data were analyzed according to participants’ treatment assignment regardless of their retention.”

May combine two claims.

Participants in the LGBTQ-affirmative ICBT condition completed an average of 6.63 sessions, and half completed all 10 sessions; two withdrew after completing no or one session.

“Participants in the LGBTQ-affirmative ICBT condition completed a mean of 6.63 (SD = 3.88) sessions and half (50.0%) completed all 10 sessions; two participants withdrew after completing no or one session, respectively.”

May combine two claims.

The trial took place during the COVID-19 pandemic in Hunan Province, China, with travel restrictions and lockdowns in place, which may have influenced intervention efficacy.

“this trial was conducted during the COVID-19 pandemic in Hunan Province, China, and travel restrictions and lockdowns (e.g., in residential quarters and schools) were in place (Xinhua, 2021), which led to known decrease of sexual activities and other behavioral risks (i.e., alcohol and substance use problems; Yang et al., 2022).”

• cites Xinhua, 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Yang et al., 2022 sourceNot checked — no full text of the source

May combine two claims.

LGBTQ-affirmative CBT primarily targets minority stress as a transdiagnostic source of co-occurring psychosocial health risks and does not specifically focus on HIV-transmission-risk behaviors such as consistent condom use; it assumes these outcomes will improve through promoting minority stress coping.

“LGBTQ-affirmative CBT primarily addresses minority stress as a transdiagnostic source of sexual minority individuals’ co-occurring psychosocial health risks. In so doing, the treatment does not specifically focus on HIV-transmission-risk behaviors, such as consistent condom use, but rather assumes that these outcomes will be improved as a result of promoting minority stress coping (Pachankis, Hark”

• cites Pachankis, Harkness, Jackson, et al., 2022Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

May combine two claims.

The trial was powered to detect effect sizes of at least d = 0.40, but this power calculation assumed general linear models that the count outcome for HIV-transmission-risk behavior did not meet.

“this study was powered to detect effect sizes of at least d = 0.40, but under assumptions of general linear models not met by the HIV-transmission-risk behavior count outcome.”

May combine two claims.

The trial was conducted during the COVID-19 pandemic in Hunan Province, China, when travel restrictions and lockdowns were in place, which led to a known decrease in sexual activities and other behavioral risks such as alcohol and substance use problems.

“this trial was conducted during the COVID-19 pandemic in Hunan Province, China, and travel restrictions and lockdowns (e.g., in residential quarters and schools) were in place (Xinhua, 2021), which led to known decrease of sexual activities and other behavioral risks (i.e., alcohol and substance use problems; Yang et al., 2022).”

• cites Xinhua, 2021Not matched

  Couldn’t be matched to a paper in Crossref, so it can’t be checked.

• cites Yang et al., 2022 sourceNot checked — no full text of the source

Probably not a substantial claim: may not pass S3 (load-bearing).

The random number table was sealed in sequentially numbered opaque envelopes before baseline surveys.

“Prior to the baseline surveys, the random number table was sealed in sequentially numbered and opaque envelopes.”

May combine two claims.

LGBTQ-affirmative CBT can have a powerful impact on the mental and behavioral health of young Chinese sexual minority men and can be delivered and disseminated in similar high-stigma contexts with limited affirmative mental health resources.

“suggesting that LGBTQ-affirmative CBT can have a powerful impact on the mental and behavioral health of young Chinese sexual minority men, with capability for being delivered and disseminated in similar high-stigmatized contexts with limited affirmative mental health resources.”

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Because stigma can hinder access to identity-specific services, LGBTQ-affirmative ICBT might be particularly well-suited to addressing minority stress and related mental and behavioral health risks in high-stigma contexts such as China.

“Because stigma can hinder access to identity-specific services, LGBTQ-affirmative ICBT might be particularly well-suited to addressing minority stress and related mental and behavioral health risks in context such as China where stigma is high.”

May combine two claims.

Treatment engagement did not significantly moderate the primary outcome of HIV-transmission-risk behavior, nor depression and anxiety, which was inconsistent with a similar US study.

“Treatment engagement did not yield significant moderating effects in the primary outcome of HIV-transmission-risk behavior, nor in depression and anxiety, which was inconsistent with a similar study in the U.S. (Pachankis et al., 2023).”

• cites Pachankis et al., 2023 sourceNot checked — no full text of the source

May combine two claims.

The culturally adapted Chinese version of LGBTQ-affirmative ICBT showed medium-to-large comparative effects on most mental and behavioral health outcomes assessed, and small-to-medium comparative effects on several minority and universal mechanisms.

“this study finds that Chinese culturally adapted LGBTQ-affirmative ICBT demonstrated medium-to-large comparative effects across most assessed mental and behavioral health outcomes, as well as small-to-medium comparative effects across several minority and universal mechanisms.”

Probably not a substantial claim: may not pass S2 (checkable).

Individual-level interventions delivered to stigmatized populations might need to be adapted to address structural determinants underlying disproportionate mental and behavioral health burdens.

“Such findings suggest that individual-level interventions delivered to stigmatized populations might need to be adapted to address the structural determinants that might underlie much of the disproportionate mental and behavioral health burden among these populations (Hatzenbuehler & Pachankis, 2021).”

• cites Hatzenbuehler & Pachankis, 2021 sourceNot checked — no full text of the source

Classified as probably not a substantial claim. May combine two claims.

Because neither suicidal ideation nor rumination was significant in the efficacy analyses, a higher intervention dosage might be necessary to change these perhaps ingrained cognitive-affective processes.

“Neither suicidal ideation nor rumination were significant in the efficacy analyses, suggesting that a higher intervention dosage might be necessary to effect change in these perhaps ingrained cognitive-affective processes.”

May combine two claims.

Increased participant engagement was related to greater reductions in suicidal ideation at 4-month follow-up and greater reduction in rumination at 8-month follow-up.

“However, increased participant engagement was related to greater reductions in suicidal ideation at the 4-month follow-up and greater reduction in rumination at the 8-month follow-up.”