Conversion practice linked to higher risk of mental health symptoms, US surveys of LGBTQ+ people suggest

According to a study published in Lancet psychiatry newspaper.

The findings, based on surveys of 4,426 LGBTQ+ adults in the United States, suggest that people subjected to controversial practices targeting their gender identity or sexual orientation may be more likely to suffer from depression, PTSD and suicidal thoughts or attempts. Transgender participants reported greater mental health symptoms overall.

Conversion practice is a formal, structured attempt to change a person’s sexual orientation, gender identity, or gender expression. This often involves psychological, behavioral, physical, and faith-based practices.

When looking at conversion practices targeting sexual orientation alone or practices targeting both, cisgender and transgender people have an equally increased likelihood of experiencing symptoms of depression and PTSD. Suicidal thoughts or attempts were higher among cisgender participants subjected to both types of practices than among transgender participants, although it is unclear why and more research is needed.

Despite widespread opposition from professional medical and mental health organizations, the practice of conversion is still present in parts of the United States. How often it is practiced in the United States remains unclear (past research suggests it may affect between 4% and 34% of LGBTQ+ people), but significant numbers of LGBTQ+ people report being victims of conversion practices, with higher rates among transgender people than cisgender people. It remains legal in many parts of the world, including the United Kingdom, parts of Central and Eastern Europe, Asia and Africa.

Previous research suggests that the practice of conversion is linked to mental health problems, such as depression and suicidal thoughts and attempts. To date, no studies have examined whether the mental health impacts of efforts to change an individual’s sexual orientation differ from those aimed at changing a person’s gender identity. Little was also known about how the effects of these different practices differ between cisgender people (people who identify with the sex they were assigned at birth) and transgender people.

“Our findings add to a body of evidence that shows the practice of conversion is unethical and linked to poor mental health. Protecting LGBTQ+ people from the impacts of these harmful practices will require multi-jurisdictional legislation “Additional measures such as support networks and targeted mental health support for survivors are also essential,” said study author Dr. Nguyen Tran. , from the Stanford University School of Medicine (United States).

The authors of the new study obtained data for their analysis by surveying participants in the PRIDE study, a long-term study of the health of LGBTQ+ people in the United States. Participants completed questionnaires about their experiences with conversion practice, if any, and about their mental health.

Other information recorded included participants’ gender identity, sexual orientation, and the sex they were assigned at birth. Participants also reported where they live, their education level, age, ethnic and racial identity, and details about their upbringing (e.g., religious or LGBTQ+ friendly).

The authors used statistical analysis to identify associations between the practice of conversion and mental health problems. Outcomes were symptoms of anxiety, depression, posttraumatic stress disorder (PTSD), and suicidal thoughts or attempts, which were assessed using established diagnostic scales.

Most participants (92%) identified as White. There were 2,504 (57%) cisgender and 1,923 (43%) transgender participants. Their ages ranged from 18 to 84 years, with an average of 31 years.

Of the 4,426 participants, 149 (3.4%) had undergone conversion practices aimed at changing their sexual orientation, 43 (1%) had undergone practices targeting gender identity, and 42 (1%) reported the two.

Participants who had been subjected to conversion practices targeting both their gender identity and sexual orientation had the greatest symptoms of depression, PTSD, and suicidal thoughts or attempts.

Some participants reported being subjected to conversion practices more than others. These included transgender participants, homeless people, and people with lower levels of education. These practices were also more frequently reported among people with religious upbringings, those raised in communities not accepting of their gender identity, and participants from minority ethnic backgrounds.

Cisgender and transgender participants who had undergone conversion practice had an equally increased risk of depression and PTSD. Neither had increased anxiety symptoms. However, cisgender participants who had experienced both types of conversion practices had a higher risk of suicidal thoughts or attempts than transgender participants. The authors say there are several possible explanations for the observed differences in suicide risk.

Compared to the broader transgender population, PRIDE study participants may be healthier and have better access to social and financial resources that reduce their likelihood of undergoing conversion practice and experiencing its consequences. adverse effects on mental health. Transgender participants who did not volunteer to participate in the PRIDE study may include those who are most affected by conversion practices and have poorer mental health outcomes than those who did.

There is also potential survivorship bias among transgender participants in the PRIDE study: fewer transgender people may have lived long enough to participate in the study. Long-term studies that follow youth into adulthood are needed to get a clearer picture of the effects of conversion practices among transgender people.

Conversion practices aimed at changing an individual’s sexual orientation were most often provided by a religious leader or organization (52%, 100/191 participants), followed by a mental health provider or organization (29% , 55/191). Practices targeting participants’ gender identity were most often implemented by mental health care providers or organizations (54%, 46/85 participants), followed by a religious leader or organization (33%, 28/85) and both (13%, 11/85).

“Our findings suggest that effective policy interventions may require multi-pronged legislative actions at the federal, state, and local levels, including state and federal bans on conversion practices. Educational efforts involving families, religious leaders, and providers Mental health services are also needed, as are support networks for LGBTQ+ youth and targeted mental health screening to identify and support survivors of conversion practices,” Tran said.

The authors acknowledge certain limitations to their study. Errors in people’s memories may have led to misclassification of some conversion practice experiences. Some potentially important factors during childhood, such as family rejection of participants’ gender identity, were not considered in the analysis and should be examined in future studies. The cohort studied may not include people whose mental health has been most impacted by conversion practices, as this could delay their willingness to publicly share their identity or participate in studies such as the PRIDE study.

In a related comment, Jack Drescher, MD, clinical professor of psychiatry at Columbia University Medical Center (US), who was not involved in the study, said: “An important message from the article by Tran and colleagues is that mainstream mental health organizations need to better regulate the activities of licensed and outlier clinicians who engage in conversion practices…ethical guidelines of professional organizations should reflect and incorporate the beliefs and values changing cultures around the world regarding the growing acceptance of diverse sexual orientations and genders. identities.”

He adds: “Rather than the unwarranted and unnecessary clinical concerns of asking why a patient has the sexual orientation or gender identity they state, it is more clinically useful to ask how to help these individuals to live their lives in a more open and adaptive way, while keeping in mind the medical dictum that first do no harm. »