Transgender people exposed to gender identity conversion are more likely to attempt suicide, says study
Trying to change a person's gender identity to match the sex assigned at their birth has been associated with adverse mental health outcomes in adulthood, including acute psychological distress, and a lifetime of suicide attempts.
Those who experience gender identity conversion efforts are more than two times likely to attempt suicide during their lifetime, and nearly twice as likely to have severe psychological distress, according to a study involving 27,715 transgender adults in the US.
Those who are exposed to gender identity conversion efforts before the age of 10 are four times more likely to attempt suicide throughout their lifetime, says the study, which suggests that such early exposure to conversion efforts is associated with increased lifetime odds of suicide attempts.
This, says the team, also indicates that rejection of gender identity may have more profound consequences at earlier stages of development. It calls for a better understanding of the associations between "stage of development at the time of exposure to gender identity conversion efforts" and the risk of lifetime suicide attempts.
"Transgender persons are those whose sex assigned at birth differs from their gender identity, the inner sense of their own gender. According to a study by the Williams Institute, approximately 1.4 million (0.6%) adults in the US identify as transgender," says the study published in JAMA Psychiatry.
It further says, "This study is the first, to our knowledge, to show an association between exposure to Gender Identity Conversion Efforts (GICE) — lifetime and childhood — and adverse mental health outcomes among transgender adults in the US."
"We found that recalled lifetime exposure to GICE was highly prevalent among adults: 14.0% of all transgender survey respondents and 19.6% of those who had discussed gender identity with professional reported exposure to GICE," the study says.
According to the team — which includes researchers from Massachusetts General Hospital, Boston and Harvard Medical School and Boston Children’s Hospital, Boston; among others — gender identity conversion therapy refers to "psychological interventions with a predetermined goal" to change a person's gender identity to align with their sex assigned at birth.
Several US states have passed legislation banning conversion therapy for gender identity. Professional organizations, including the American Medical Association, the American Psychiatric Association, the American Academy of Child & Adolescent Psychiatry, and the American Academy of Pediatrics have labeled the practice unethical and ineffective.
Despite these policy statements, however, the question of whether to ban gender identity conversion therapy remains a contentious policy debate.
"Gender identity conversion efforts have been widely debated as potentially damaging treatment approaches for transgender persons. The association of GICE with mental health outcomes, however, remains largely unknown," according to the team.
"The current study used the largest cross-sectional survey to date of transgender adults living in the US to assess whether recalled lifetime exposure to GICE is associated with adverse mental health outcomes, including suicide attempts," says the research team.
It adds, "The study also assessed whether recalled childhood exposure to GICE before the age of 10 years is associated with adverse mental health outcomes in adulthood."
The data set includes responses from transgender adults who reside in the US, with representation from all 50 states, the District of Columbia, American Samoa, Guam, Puerto Rico, and US military bases overseas.
The participants were asked, "Did any professional (such as a psychologist, counselor, or religious advisor) try to make you identify only with your sex assigned at birth (in other words, try to stop you being trans)?" This recalled exposure, say the researchers, is referred to in the study as gender identity conversion efforts.
According to the analysis, of the 27,715 US transgender survey respondents, 11,857 were assigned male sex at birth, and 3,869 reported exposure to gender identity conversion efforts.
Among 19,751 respondents who had discussed their gender identity with a secular or religious professional, 3,869 reported exposure to gender identity conversion efforts in their lifetime. Further, of these individuals, 1,361 said that such conversion efforts were enacted by a religious advisor.
"Such exposure was associated with severe psychological distress during the previous month and prior suicide attempts during their lifetime compared with transgender adults who reported talking about their gender identity with a professional but were not exposed to conversion efforts," the findings say.
"After adjusting for statistically significant demographic variables, lifetime exposure to GICE was significantly associated with multiple adverse outcomes, including severe psychological distress during the previous month (adjusted odds ratio 1.56) and lifetime suicide attempts (adjusted odds ratio 2.27)," add the findings.
Many experts have expressed concern that early exposure to GICE may lead to persistent feelings of shame because of physicians and parents defining gender-expansive experience as unacceptable.
In the current study, overall, 206 survey respondents — who reported discussing their gender identity with a professional — also said that they had exposure to gender identity conversion efforts before the age of 10 years.
"Exposure to conversion efforts before 10 years was significantly associated with several measures of suicidality, including lifetime suicide attempts (adjusted odds ratio 4.15)," says the study.
Researchers say that their findings support policy statements from several professional organizations that have discouraged this practice. Among all the respondents, there were no statistically significant differences in outcomes between those who were exposed to conversion efforts enacted by religious advisors and those exposed to GICE by secular professionals.
"Respondents from more socioeconomically disadvantaged backgrounds (for example, low educational attainment or low household income) more commonly reported exposure to GICE," the study says.
"These individuals may have been more likely to receive GICE, or exposure to GICE may have been so damaging that they were impaired in educational, professional, and economic advancement," the findings add.