A critical review of clinician-directed nudges.

As nudges-subtle changes to the way options are presented to guide choice-have gained popularity across policy domains in the past 15 years, healthcare systems and researchers have eagerly deployed these light-touch interventions to improve clinical decision-making. However, recent research has identified the limitations of nudges. Although nudges may modestly improve clinical decisions in some contexts, these interventions (particularly nudges implemented as electronic health record alerts) can also backfire and have unintended consequences. Further, emerging research on crowd-out effects suggests that healthcare nudges may direct attention and resources toward the clinical encounter and away from the main structural drivers of poor health outcomes. It is time to move beyond nudges and toward the development of multi-level, structurally focused interventions.

Disparities in Depression and Anxiety That Impact Self-Identified Sexual Minority People Affect a Broader Group of Same-Gender Attracted Young Adults.

PURPOSE: Prior work suggests sexual minority (e.g., gay, bisexual) young adults are at greater risk for depression and anxiety. However, the majority of said work focuses exclusively on self-reported sexual minority identity and neglects same-gender attraction. The current study aimed to characterize links between identity- and attraction-based indicators of sexual minority status and depression and anxiety in young adults, and to examine the ongoing significance of caregiver support in mental health during this key developmental period. METHODS: 386 youth (mean age = 19.92 years; SD = 1.39) reported their sexual orientation identity and experiences of attraction toward men and/or women. Participants also reported on anxiety, depression, and caregiver social support. RESULTS: While less than 16% of participants identified as sexual minority individuals, nearly half reported same-gender attraction. Self-identified sexual minority participants reported significantly higher depression and anxiety than self-identified heterosexual participants. Similarly, same-gender attracted individuals exhibited heightened depression and anxiety compared to exclusively different-gender attracted individuals. Greater caregiver social support predicted lower depression and anxiety. DISCUSSION: The present findings suggest that not only are self-identified sexual minority individuals at heightened risk for depression and anxiety symptoms, but also that this risk extends to a larger group of young people who experience same-gender attraction. These results demonstrate that better mental health supports may be needed for youth who identify as sexual minority individuals or report same-gender attraction. That higher caregiver social support was associated with lower mental illness risk suggests caregivers may be key to mental health promotion during young adulthood.