Rivierduinen Institute for Mental Health Care, Sandifortdreef 19, 2333 ZZ Leiden, the Netherlands.
Department of Psychiatry and Neuropsychology, School for Mental Health and Neuroscience, Maastricht University Medical Center, P.O. Box 616, 6200 MD Maastricht, the Netherlands.
Psychol Med. 2023 Dec;53(16):7923-7932. doi: 10.1017/S0033291723002088. Epub 2023 Aug 4.
The stressful minority position of transgender persons may result in a high risk of psychosis. Conflicting data suggest that the observed risk depends on setting of recruitment. We assessed the relative risk of non-affective psychotic disorder (NAPD) in a large, representative cohort of transgender persons.
This cohort was composed using: data on legal sex change from the Dutch population registry and data on dispensing of cross-sex hormones (route 1), and a registry of insurance claims from mental health care including persons with a diagnosis of gender identity disorder (DSM-IV) or gender dysphoria (DSM-5) (route 2). They were matched by sex at birth, calendar year and country of birth to controls from the general population. Transgender persons ( = 5564) and controls ( = 27 820), aged 16-60 years at 1 January 2011, were followed until the first insurance claim for NAPD in 2011-2019.
The incidence rate ratio (IRR) of NAPD for transgender persons selected exclusively through route 1 ( = 3859, IRR = 2.00, 95%-CI 1.52-2.63) was increased, but significantly lower than the IRRs for those selected exclusively through route 2 ( = 694, IRR = 22.15, 95%-CI 13.91-35.28) and for those found by both routes ( = 1011, IRR = 5.17, 95%-CI 3.57-7.49; value for differences in IRR < 0.001).
This study supports the social defeat-hypothesis of NAPD. The results also show the presence of a substantial number of transgender persons with severe psychiatric problems who have not (yet) taken steps to gender-affirmative care.
跨性别者的压力少数派地位可能导致患精神病的风险很高。相互矛盾的数据表明，观察到的风险取决于招募的环境。我们评估了一个大型代表性跨性别者队列中非情感性精神病障碍（NAPD）的相对风险。
该队列是通过以下两种方式构建的：荷兰人口登记处的合法性别变更数据和跨性别激素配给数据（途径 1），以及包括性别认同障碍（DSM-IV）或性别焦虑症（DSM-5）诊断在内的精神保健保险索赔登记册（途径 2）。他们按出生时的性别、日历年份和出生国与普通人群中的对照相匹配。2011 年 1 月 1 日年龄在 16-60 岁的跨性别者（=5564 人）和对照（=27820 人）在 2011-2019 年期间随访，直到他们首次获得 NAPD 的保险索赔。
仅通过途径 1 选择的 NAPD 的发病率比（IRR）（=3859，IRR=2.00，95%-CI 1.52-2.63）升高，但明显低于仅通过途径 2 选择的 NAPD 的 IRR（=694，IRR=22.15，95%-CI 13.91-35.28）和同时通过两种途径选择的 NAPD 的 IRR（=1011，IRR=5.17，95%-CI 3.57-7.49； 值<0.001）。
这项研究支持 NAPD 的社会挫败假说。结果还表明，存在大量患有严重精神问题但尚未（尚未）采取性别肯定护理措施的跨性别者。
