Efforts to change transgender individuals’ gender identity are linked to severe psychological distress and suicide attempts, according to a new study in JAMA Psychiatry.
Gender identity conversion efforts (GICE), commonly known as conversion therapy, are psychological interventions that aim to alter an individual’s gender identity such that it aligns with their sex assigned at birth.
Though the practice has been deemed unethical by professional organizations including the American Medical Association, the American Psychiatric Association and the American Academy of Pediatrics, and has been banned in several states, it is still fairly common. One recent study in the American Journal of Public Health indicates that so-called conversion therapy has occurred in every U.S. state within the past 10 years and 13.5% of transgender individuals surveyed reported exposure to gender conversion therapy.
The new JAMA Psychiatry study builds on those findings by looking at mental health outcomes among people exposed to gender conversion therapy. It looks at the same dataset as the AJPH study, composed of survey responses from 27,715 transgender adults from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico and U.S. military bases overseas.
“We’re really here just channeling the voices of over 27,000 trans and gender-diverse people who took the time to complete the survey,” says Dr. Alex Keuroghlian, senior author of the new JAMA study and director of the National LGBT Health Education Center at The Fenway Institute and the Massachusetts General Hospital Psychiatry Gender Identity Program.
The researchers analyzed a subset of 19,741 respondents in this sample who indicated that they had spoken to a professional about their gender identity. Within this group, the researchers compared mental health outcomes between those exposed to gender conversion therapy — 3,869 in all — versus those who received non-GICE therapy. These mental health outcomes included whether respondents experienced severe psychological distress over the past month, and whether they had attempted suicide or had suicidal thoughts over the past year and over their lifetimes.
The researchers found that individuals exposed to gender conversion therapy had twice the odds of having attempted suicide over their lifetime, as well as higher odds of experiencing severe psychological distress over the previous month, compared with those who received therapy that did not involve conversion efforts.
There were no differences in mental health outcomes when individuals were exposed to conversion therapy through a secular practitioner, like a therapist, or a religious practitioner, like a priest.
The researchers also analyzed the survey responses to see whether mental health outcomes differed by the age at which individuals were exposed to conversion therapy.
“There’s general consensus in the mental health field that it would not be appropriate to try and change someone’s gender identity after puberty. But there’s been more debate around prepubescent children,” explains Dr. Jack Turban, resident physician in psychiatry at the Massachusetts General Hospital and McLean Hospital and lead author of the study.
The researchers found that those who received conversion therapy before age 10 had even higher odds of having attempted suicide over their lifetime compared with those who received conversion therapy at a later point. Compared with the non-GICE group, those who were exposed to conversion therapy before the age of 10 had fourfold higher odds of a lifetime suicide attempt.
“We’re showing for the first time with the largest survey of transgender adults in the world, that any efforts to change someone’s gender identity from transgender to cisgender are associated with increased risk of suicide attempts, which, of course, is the most potentially lethal mental health outcome,” Turban says. “We hope that this will change how clinicians are trained and also support passing of state-level bans on conversion efforts, of which there are close to 20 now.”
There’s an important reporting practice journalists can take from the study, Keuroghlian adds.
“We very often fail to center trans and gender-diverse people in the conversation. So it’s a lot of other people speaking for trans and gender-diverse people, as opposed to the voice of the people whose needs we’re trying to meet,” he explains. “So I would say, whenever cisgender people pop up in media commenting on what’s best for an oppressed minority population they don’t belong to, that needs to be counterbalanced, or even placed second to, the voices of gender-diverse people.”