Objectives. To explore associations between undergoing sexual orientation or gender identity conversion efforts (SOGICE) and suicidality among young LGBTQ (lesbian, gay, bisexual, transgender, and queer or questioning) individuals. Methods. Data were derived from a 2018 online cross-sectional study of young LGBTQ individuals (13–24 years of age) residing in the United States. Multivariate logistic regression was used to determine the relative odds of suicidality among young LGBTQ individuals who experienced SOGICE (in comparison with those who did not) after adjustment for age, race/ethnicity, geography, parents’ use of religion to say negative things about being LGBTQ, sexual orientation, gender identity, discrimination because of sexual orientation or gender identity, and physical threats or harm because of sexual orientation or gender identity. Results. Relative to young people who had not experienced SOGICE, those who reported undergoing SOGICE were more than twice as likely to report having attempted suicide and having multiple suicide attempts. Conclusions. The elevated odds of suicidality observed among young LGBTQ individuals exposed to SOGICE underscore the detrimental effects of this unethical practice in a population that already experiences significantly greater risks for suicidality.

IMPORTANCE Sexual orientation and gender identity change efforts (SOGICE), also called conversion therapy, is a discredited practice attempting to convert lesbian, gay, bisexual, transgender, queer, or questioning (LGBTQ) individuals to be heterosexual and/or cisgender.OBJECTIVES To identify and synthesize evidence on the humanistic and economic consequences of SOGICE among LGBTQ youths in the US. DESIGN, SETTING, AND PARTICIPANTSThis study, conducted from December 1, 2020, to February 15, 2021, included a systematic literature review and economic evaluation. The literature review analyzed published evidence on SOGICE among LGBTQ individuals of any age. The economic model evaluated the use of SOGICE vs no intervention, affirmative therapy vs no intervention, and affirmative therapy vs SOGICE to estimate the costs and adverse outcomes for each scenario and to assess the overall US economic burden of SOGICE. Published literature and public sources were used to estimate the number of LGBTQ youths exposed to SOGICE, the types of therapy received, and the associated adverse events (anxiety, severe psychological distress, depression, alcohol or substance abuse, suicide attempts, and fatalities). EXPOSURES SOGICE (licensed or religion-based practitioners) or affirmative therapy (licensed practitioners).MAIN OUTCOMES AND MEASURES Total incremental costs and quality-adjusted life-years (QALYs) vs no intervention and total economic burden of SOGICE. RESULTS Among 28 published studies, which included 190 695 LGBTQ individuals, 12% (range, 7%-23%) of youths experienced SOGICE, initiated at a mean age of 25 years (range, 5-58 years), with a mean (SD) duration of 26 (29) months. At least 2 types of SOGICE were administered to 43% of recipients. Relative to LGBTQ individuals who did not undergo SOGICE, recipients experienced serious psychological distress (47% vs 34%), depression (65% vs 27%), substance abuse (67% vs 50%), and attempted suicide (58% vs 39%). In the economic analysis, over a lifetime horizon with a 3% annual discount rate, the base-case model estimated additional $97 985 lifetime costs per individual, with SOGICE associated with 1.61 QALYs lost vs no intervention; affirmative therapy yielded cost savings of $40 329 with 0.93 QALYs gained vs no intervention. With an estimated 508 892 youths at risk for SOGICE in 2021, the total annual cost of SOGICE is estimated at $650.16 million (2021 US dollars), with associated harms totaling an economic burden of $9.23 billion. CONCLUSIONS AND RELEVANCEThis economic evaluation study suggests that there is a high economic burden and high societal costs associated with SOGICE and identifies additional research questions regarding the roles of private and public funding in supporting this harmful practice.

This study examines the association of access to concordant identity documents with attempting suicide in the last year among transgender and nonbinary youth. Data came from 6581 transgender and nonbinary youth who completed an online survey of lesbian, gay, bisexual, transgender, or queer (LGBTQ) youth ages 13–24 residing in the United States. Multivariate logistic regression was used to determine the adjusted odds of attempting suicide in the past year based on whether or not youth were able to change their identification documents. Both wanting to update one’s documents but not being able to (aOR = 2.04, CI = 1.412–2.95; p < 0.001) and being able to update one’s documents but not having done so (aOR = 1.74, CI = 1.22–2.50; p < 0.001) were associated with greater odds of attempting suicide in the last year, compared to youth who had changed their documents. Revising the way gender is captured on legal documents may be an efficacious public health intervention to reduce suicide risk among transgender and nonbinary youth.