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Original Investigation
September 11, 2019

Association Between Recalled Exposure to Gender Identity Conversion Efforts and Psychological Distress and Suicide Attempts Among Transgender Adults

Author Affiliations
  • 1Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston
  • 2Department of Psychiatry, Massachusetts General Hospital, Boston
  • 3Department of Pediatrics, Harvard Medical School and Boston Children’s Hospital, Boston, Massachusetts
  • 4Department of Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
  • 5Department of Psychiatry, Harvard Medical School, and Massachusetts General Hospital, Boston
  • 6The Fenway Institute, Boston, Massachusetts
JAMA Psychiatry. Published online September 11, 2019. doi:10.1001/jamapsychiatry.2019.2285
Key Points

Question  Is recalled exposure to gender identity conversion efforts (ie, psychological interventions that attempt to change one’s gender identity from transgender to cisgender) associated with adverse mental health outcomes in adulthood?

Findings  In a cross-sectional study of 27 715 US transgender adults, recalled exposure to gender identity conversion efforts was significantly associated with increased odds of severe psychological distress during the previous month and lifetime suicide attempts compared with transgender adults who had discussed gender identity with a professional but who were not exposed to conversion efforts. For transgender adults who recalled gender identity conversion efforts before age 10 years, exposure was significantly associated with an increase in the lifetime odds of suicide attempts.

Meaning  The findings suggest that lifetime and childhood exposure to gender identity conversion efforts are associated with adverse mental health outcomes.

Abstract

Importance  Gender identity conversion efforts (GICE) have been widely debated as potentially damaging treatment approaches for transgender persons. The association of GICE with mental health outcomes, however, remains largely unknown.

Objective  To evaluate associations between recalled exposure to GICE (by a secular or religious professional) and adult mental health outcomes.

Design, Setting, and Participants  In this cross-sectional study, a survey was distributed through community-based outreach to transgender adults residing in the United States, with representation from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and US military bases overseas. Data collection occurred during 34 days between August 19 and September 21, 2015. Data analysis was performed from June 8, 2018, to January 2, 2019.

Exposure  Recalled exposure to GICE.

Main Outcomes and Measures  Severe psychological distress during the previous month, measured by the Kessler Psychological Distress Scale (defined as a score ≥13). Measures of suicidality during the previous year and lifetime, including ideation, attempts, and attempts requiring inpatient hospitalization.

Results  Of 27 715 transgender survey respondents (mean [SD] age, 31.2 [13.5] years), 11 857 (42.8%) were assigned male sex at birth. Among the 19 741 (71.3%) who had ever spoken to a professional about their gender identity, 3869 (19.6%; 95% CI, 18.7%-20.5%) reported exposure to GICE in their lifetime. Recalled lifetime exposure was associated with severe psychological distress during the previous month (adjusted odds ratio [aOR], 1.56; 95% CI, 1.09-2.24; P < .001) compared with non-GICE therapy. Associations were found between recalled lifetime exposure and higher odds of lifetime suicide attempts (aOR, 2.27; 95% CI, 1.60-3.24; P < .001) and recalled exposure before the age of 10 years and increased odds of lifetime suicide attempts (aOR, 4.15; 95% CI, 2.44-7.69; P < .001). No significant differences were found when comparing exposure to GICE by secular professionals vs religious advisors.

Conclusions and Relevance  The findings suggest that lifetime and childhood exposure to GICE are associated with adverse mental health outcomes in adulthood. These results support policy statements from several professional organizations that have discouraged this practice.

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