Division of Child and Adolescent Psychiatry, Massachusetts General Hospital, Boston.
Department of Psychiatry, Massachusetts General Hospital, Boston.
JAMA Psychiatry. 2020 Jan 1;77(1):68-76. doi: 10.1001/jamapsychiatry.2019.2285.
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.
重要性：性别认同转换疗法（GICE）作为一种可能对跨性别者造成伤害的治疗方法，已经引发了广泛的争论。然而，GICE 与心理健康结果之间的关联在很大程度上仍不清楚。 目的：评估经世俗或宗教专业人员回忆的 GICE 暴露与成年心理健康结果之间的关联。 设计、地点和参与者：在这项横断面研究中，通过基于社区的外展向居住在美国的跨性别成年人分发了一份调查，代表了来自全美 50 个州、哥伦比亚特区、美属萨摩亚、关岛、波多黎各和海外美军基地的人群。数据收集于 2015 年 8 月 19 日至 9 月 21 日的 34 天内进行。数据分析于 2018 年 6 月 8 日至 2019 年 1 月 2 日进行。 暴露情况：回忆中的 GICE 暴露。 主要结局和测量指标：前一个月的严重心理困扰，用 Kessler 心理困扰量表（定义为得分≥13）衡量。前一年和一生中的自杀意念、自杀尝试和需要住院治疗的自杀尝试等指标。 结果：在 27715 名接受调查的跨性别者中（平均[标准差]年龄，31.2[13.5]岁），11857 名（42.8%）出生时被指定为男性。在 19741 名（71.3%）曾与专业人士谈论过自己性别认同的人中，有 3869 名（19.6%；95%CI，18.7%-20.5%）报告一生中曾接受过 GICE。与非 GICE 疗法相比，回忆中的终生暴露与前一个月严重心理困扰的几率更高相关（校正优势比[aOR]，1.56；95%CI，1.09-2.24；P<0.001）。与回忆中的终生暴露相关的还有一生中自杀尝试的几率更高（aOR，2.27；95%CI，1.60-3.24；P<0.001），以及 10 岁前接受暴露的几率更高（aOR，4.15；95%CI，2.44-7.69；P<0.001）。在比较世俗专业人员与宗教顾问的 GICE 暴露时，未发现显著差异。 结论和相关性：研究结果表明，一生中及儿童时期接受 GICE 与成年后的不良心理健康结果相关。这些结果支持了几个专业组织的政策声明，这些组织反对这种做法。
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