Division of Psychiatry, University College London, London, London, UK.
Marie Curie Palliative Care Research Department, Division of Psychiatry, University College London, London, UK.
BMJ Open. 2018 Dec 22;8(12):e022425. doi: 10.1136/bmjopen-2018-022425.
Conversion is a term for treatments that seek to suppress or change a person's sexual orientation or gender. Our review focuses on transgender and gender-diverse (TGD) people. Our aims were to (1) describe the frequency, nature and structure of conversion practices; (2) document difficulties in accessing transition-related healthcare and (3) evaluate the mental health consequences of such practices and access barriers.
Systematic review and narrative synthesis using the Critical Appraisals Skills Programme and Joanne Briggs Institute critical appraisal tools. Data sources include Embase, MEDLINE, PsychINFO, PsychARTICLES and Web of Science between 1990 and June 2017.
Studies were included that (1) document use of conversion therapies or access barriers to transition-related healthcare; and/or (2) describe how such therapeutic practices and access barriers have been applied and/or (3) evaluate the mental health impacts of such therapies and difficulties accessing transition-related healthcare. Two reviewers screened papers for eligibility. Data were then grouped according to the objectives. Narratives and themes were presented per study.
Seven studies met inclusion criteria. Four reports were on 'realignment', involving case studies or case series. Two involved psychoanalysis, one self-exposure therapy and one open-ended play psychotherapy. All four studies concerning 'realignment' were of poor methodological quality. The other three studies explored access barriers from the view point of TGD youth, their parents and healthcare providers. All papers reported access barriers, such as inability to access puberty-delaying medications. The papers concerning barriers to access were of good methodological quality.
We found limited published evidence on use, nature, structure and/or health consequences of conversion therapies and access barriers to transition in TGD people. However, reports of restriction to access may indicate a more widespread problem. Research is needed into TGD people's experiences of conversion therapy and access barriers to transition-related healthcare TRIAL REGISTRATION NUMBER: CRD42017062149.
转化是指试图抑制或改变一个人的性取向或性别认同的治疗方法。我们的综述重点关注跨性别和性别多样化（TGD）人群。我们的目的是：（1）描述转化实践的频率、性质和结构；（2）记录在获得与过渡相关的医疗保健方面所面临的困难；（3）评估这种做法和获得障碍对心理健康的影响。
使用批判性评估技能计划和乔安妮·布里格斯研究所的批判性评估工具进行系统综述和叙述性综合。数据来源包括 1990 年至 2017 年 6 月期间的 Embase、MEDLINE、PsychINFO、PsychARTICLES 和 Web of Science。
包括以下研究：（1）记录使用转化疗法或过渡相关医疗保健的准入障碍；和/或（2）描述这些治疗实践和准入障碍是如何应用的；和/或（3）评估这些疗法对心理健康的影响以及过渡相关医疗保健的准入困难。两名评审员筛选符合条件的论文。然后根据目标对数据进行分组。按研究报告叙述和主题呈现。
有 7 项研究符合纳入标准。有 4 项报告涉及“再调整”，涉及病例研究或病例系列。有 2 项涉及精神分析，1 项涉及自我暴露疗法，1 项涉及开放式游戏心理疗法。所有 4 项涉及“再调整”的研究均存在方法学质量差的问题。另外 3 项研究从 TGD 青年、他们的父母和医疗保健提供者的角度探讨了准入障碍。所有论文都报告了准入障碍，例如无法获得延迟青春期的药物。关于获得障碍的论文具有良好的方法学质量。
我们发现有关 TGD 人群中转化疗法的使用、性质、结构和/或健康后果以及过渡相关医疗保健准入障碍的文献证据有限。然而，对准入限制的报告可能表明存在更广泛的问题。需要研究 TGD 人群对转化疗法和过渡相关医疗保健的准入障碍的体验。
CRD42017062149。
