Transgender adults have a high risk for adverse mental health outcomes, with a 41% lifetime prevalence of suicide attempts among this population. Although state-level bans on GICE have focused on licensed mental health professionals, nonlicensed religious counselors continue to practice GICE.
Jack L. Turban, MD, MHS, from the division of child and adolescent psychiatry, Massachusetts General Hospital, Boston, and colleagues conducted a survey-based, cross-sectional study involving 27,715 transgender individuals (mean age, 31.2 years; 42.8% assigned male sex at birth). The study investigated mental health outcomes based on lifetime and childhood exposure to GICE, as well as potential differences between religious vs secular practitioners. Mental health outcome was evaluated with the Kessler Psychological Distress Scale, as well as a range of other factors, including suicidal ideation, suicide attempts in the previous year, and substance use.
Lifetime exposure to GICE was common among transgender adults: 14% of all survey respondents reported exposure, and of the 19,741 (71.3%) respondents who had spoken with a professional about their gender identity, 3869 (19.6%) had been exposed to GICE.
Compared with exposure to non-GICE therapy, recalled lifetime exposure to GICE was associated with severe psychological distress in the previous month (P < 0.001). Recalled exposure to GICE at any point and before the age of 10 years was associated with higher risk of lifetime suicide attempts (both at P < 0.001). However, there was no significant difference between exposure to GICE by secular professionals and by religious counselors.
The investigators theorized that increased stigma-related stress from GICE may elevate emotion dysregulation, interpersonal dysfunction, and maladaptive cognition in accordance with the minority stress framework. Socioeconomically disadvantaged respondents were more likely to report GICE exposure, a finding that requires further research.
The study is limited by its cross-sectional design. It is also possible that transgender individuals with internalized transphobia or worse mental health are more likely to seek GICE independently.
The study authors concluded, “Our results support the policy positions of the American Academy of Child and Adolescent Psychiatry, the American Psychiatric Association, the American Academy of Pediatrics, and the American Medical Association, which state that gender identity conversion therapy should not be conducted for transgender patients at any age.”
Turban JL, Beckwith N, Reisner SL, Keuroghlian AS. Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults [published online September 11, 2019]. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2019.2285.