Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, Conn. (Bränström, Pachankis); and the Department of Clinical Neuroscience, Karolinska Institutet, Stockholm (Bränström).
Am J Psychiatry. 2020 Aug 1;177(8):727-734. doi: 10.1176/appi.ajp.2019.19010080. Epub 2019 Oct 4.
Despite professional recommendations to consider gender-affirming hormone and surgical interventions for transgender individuals experiencing gender incongruence, the long-term effect of such interventions on mental health is largely unknown. The aim of this study was to ascertain the prevalence of mood and anxiety disorder health care visits and antidepressant and anxiolytic prescriptions in 2015 as a function of gender incongruence diagnosis and gender-affirming hormone and surgical treatment in the entire Swedish population.
This study used the Swedish Total Population Register (N=9,747,324), linked to the National Patient Register and the Prescribed Drug Register. Among individuals who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N=2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment. Outcome measures were mood and anxiety disorder health care visits, antidepressant and anxiolytic prescriptions, and hospitalization after a suicide attempt.
Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt. Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98).
In this first total population study of transgender individuals with a gender incongruence diagnosis, the longitudinal association between gender-affirming surgery and reduced likelihood of mental health treatment lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them.
尽管专业建议考虑为性别认同障碍的跨性别者提供性别肯定激素和手术干预，但此类干预对心理健康的长期影响在很大程度上尚不清楚。本研究的目的是确定 2015 年情绪和焦虑障碍保健就诊和抗抑郁药和抗焦虑药处方的流行率，作为整个瑞典人群中性别认同障碍诊断以及性别肯定激素和手术治疗的函数。
本研究使用了瑞典总人口登记册（N=9747324），与国家患者登记册和处方药物登记册相关联。在 2005 年至 2015 年间被诊断为性别认同障碍（即易性癖或性别认同障碍）的个体中（N=2679），根据性别肯定激素和手术治疗的时间长短，检查了 2015 年的心理健康治疗情况。结果测量为情绪和焦虑障碍保健就诊、抗抑郁药和抗焦虑药处方以及自杀未遂后的住院治疗。
与一般人群相比，性别认同障碍诊断个体情绪和焦虑障碍保健就诊的可能性约为六倍，接受抗抑郁药和抗焦虑药处方的可能性约为三倍，自杀未遂后住院治疗的可能性约为六倍。开始激素治疗后的年数与心理健康治疗的可能性无显著相关性（调整后的优势比=1.01，95%CI=0.98，1.03）。然而，最后一次性别肯定手术后时间的增加与心理健康治疗的减少相关（调整后的优势比=0.92，95%CI=0.87，0.98）。
在这项针对性别认同障碍的跨性别者的首次全人群研究中，性别肯定手术与心理健康治疗可能性降低之间的纵向关联为那些寻求性别肯定手术的跨性别者提供了支持。
