["Journal of Child Psychology and Psychiatry, EarlyView. ", "\n\nBackground\nSexual and gender minority youth (SGMY) often experience discrimination and stigma related to their sexual orientation or gender identity. This increases their vulnerability to HIV, poor mental health outcomes, including suicide, and low uptake of HIV prevention through bidirectional causal relationships that suggest integrating mental health support with HIV prevention. This study evaluates the impact of three intervention strategies (automated text messages, online peer support, and coaching) on secondary mental health outcomes among SGMY.\n\n\nMethods\nFrom May 2017 to August 2019, 895 SGMY (40% Black, 29% Latino) ages 16–24 years were enrolled in Los Angeles and New Orleans via 13 community sites and social media. Participants were randomized to: (a) automated text‐messaging and monitoring (AMM), (b) AMM plus online peer support (AMM + PS), (c) AMM plus strengths‐based coaching by telehealth or in‐person by near‐peers (AMM + C), or (d) all three interventions (AMM + PS + C). The interventions targeted HIV risk reduction primary outcomes and mental health and substance secondary outcomes. Assessments occurred over 24 months (70%–90% retention). Multivariate regressions compared interventions' efficacy on depression, anxiety, and mental health services use using intent‐to‐treat models stratified by high risk mental health (HRMH; n = 342; 38% with history of suicide attempts or psychiatric hospitalization) and low risk mental health (LRMH; n = 553; 62%).\n\n\nResults\nParticipants reported mild anxiety and depression symptoms over time. At baseline, HRMH youth had more symptoms and greater service use than LRMH peers. Both outcomes significantly declined over time across groups. The two coaching arms were associated with an increased number of times receiving mental health specialist services among LRMH compared to HRMH youth.\n\n\nConclusions\nWhile over a third of SGMY (38%) reported past mental health events, recent symptoms of anxiety and depression were mild. Interventions did not significantly reduce symptoms or stabilize mental health service use, though coaching promoted greater services utilization among LRMH youth.\n\n"]