(PS12-68) Exploring Gender and Sexual Identity-based Differences in Baseline Characteristics for OCD Patients in a Randomized Controlled Trial of Digital Mental Health Interventions

Obsessive-compulsive disorder (OCD) is an often severe, chronic, and undertreated disorder. Digital mental health interventions (DMHIs) have rapidly emerged as a pathway to improve treatment accessibility and to reduce mental health disparities, including for OCD. The prevalence of mental health disorders is higher among marginalized individuals who have faced discrimination based on gender and/or sexual orientation. Marginalized communities are often already using technology-based tools for garnering support and have been showing higher interest in using DMHIs. Still, relatively little is known about how marginalized identities may affect clinical presentation and beliefs about treatment in OCD. Understanding individual differences in OCD presentation could help us to appropriately adapt and tailor interventions to achieve better outcomes. This secondary data analysis included adults with primary OCD (N=120) living in the U.S., randomized to receive 12-weeks of either coach-guided app-based CBT for OCD or a coach-guided online health and well-being program. Baseline measures included clinician-rated OCD symptom severity (Y-BOCS, CGI) and self-reported demographics, depression (QIDS-SR), quality of life (Q-LES-Q-SF), anxiety (GAD-7), functional impairment (WSAS), substance use (MINI), treatment credibility and expectancy (CEQ), and readiness to change (URICA). For analyses, we created two binary variables: woman (n=93) vs. non-woman gender identities (n=27; i.e., man, transgender, nonbinary, questioning) and heterosexual (n=91) vs. non-heterosexual identities (n=28; i.e., lesbian, gay, bisexual, asexual, queer). We ran independent samples t-tests, chi-square, and Fisher’s exact tests to examine differences between gender and sexual orientation groups. No significant baseline differences emerged between gender groups. Relative to the heterosexual group, the sexual minority group was younger (p=.003, d=.67), endorsed greater religious obsessions (p=.021, φ=.21) and checking compulsions (p=.036, φ=.20), and reported poorer quality of life (p=.039, d=.44). There were notable trend level differences in other obsessions and compulsions, and greater alcohol use for both gender and sexual orientation comparisons. There were no significant differences in treatment credibility, expectancy, and readiness to change in either group comparison. Results suggest that individuals seeking digital treatment for OCD were largely similar across genders on included study measures, with some important differences in clinical presentation based on sexual minority status. Treatment credibility and expectancy ratings were comparable to prior app based RCT’s, with no significant differences based on gender or sexual minority status. Limitations include limited gender diversity, potentially impacting the significance of group differences. Digital interventions promise to expand mental health care and create more inclusive treatments. However, further research with more diverse samples is needed to better understand the impact of minority experiences on OCD symptoms, beliefs about treatment, and treatment outcomes.