A PRISMA systematic review of adolescent gender dysphoria literature: 2) mental health

Abstract

It is unclear whether the literature on adolescent gender dysphoria (GD) provides sufficient evidence to inform clinical decision making adequately. In the second of a series of three papers, we sought to review published evidence systematically regarding the extent and nature of mental health problems recorded in adolescents presenting for clinical intervention for GD. Having searched PROSPERO and the Cochrane library for existing systematic reviews (and finding none), we searched Ovid Medline 1946 –October week 4 2020, Embase 1947–present (updated daily), CINAHL 1983–2020, and PsycInfo 1914–2020. The final search was carried out on the 2nd November 2020 using a core strategy including search terms for ‘adolescence’ and ‘gender dysphoria’ which was adapted according to the structure of each database. Papers were excluded if they did not clearly report on clinically-likely gender dysphoria, if they were focused on adult populations, if they did not include original data (epidemiological, clinical, or survey) on adolescents (aged at least 12 and under 18 years), or if they were not peer-reviewed journal publications. From 6202 potentially relevant articles (post deduplication), 32 papers from 11 countries representing between 3000 and 4000 participants were included in our final sample. Most studies were observational cohort studies, usually using retrospective record review (21). A few compared cohorts to normative or population datasets; most (27) were published in the past 5 years. There was significant overlap of study samples (accounted for in our quantitative synthesis). All papers were rated by two reviewers using the Crowe Critical Appraisal Tool v1·4 (CCAT). The CCAT quality ratings ranged from 45% to 96%, with a mean of 81%. More than a third of the included studies emerged from two treatment centres: there was considerable sample overlap and it is unclear how representative these are of the adolescent GD community more broadly. Adolescents presenting for GD intervention experience a high rate of mental health problems, but study findings were diverse. Researchers and clinicians need to work together to improve the quality of assessment and research, not least in making studies more inclusive and ensuring long-term follow-up regardless of treatment uptake. Whole population studies using administrative datasets reporting on GD / gender non-conformity may be necessary, along with inter-disciplinary research evaluating the lived experience of adolescents with GD.

Is Social Gender Transition Associated with Mental Health Status in Children and Adolescents with Gender Dysphoria?

“…We aimed to extend on past studies in a number of ways, including: (1) utilizing a larger sample of socially transitioned children and adolescents; (2) examining whether associations between mental health and social transition were moderated by birth-assigned gender and developmental stage (by including patients from early childhood through to late adolescence); and (3) utilizing clinician ratings of mental health based on a comprehensive mental health assessment-potentially reducing risk of social desirability bias and complementing past studies of this type that have relied exclusively on parent or self-report data. Our study examines correlates of social gender transition on mood and anxiety disorders, given these disorders appear to be prevalent psychiatric comorbidities among gender variant youth (Frew et al, 2021;Thompson et al, 2022). We also examined the link between social gender transition and suicide attempts, given increased prevalence of this behavior in gender variant versus cisgender young people (Biggs, 2022), and the theorized link between transition status and suicidality (Ehrensaft et al, 2018).…”

“…Collectively, these findings have been interpreted to suggest that affirming a gender variant child/adolescents' gender identity via social transition will reduce psychological difficulties often observed within gender variant populations (de Graaf et al, 2018;de Vries et al, 2016;Ehrensaft et al, 2018). The Olson et al (2016), Durwood et al (2017), and Kuvalanka et al (2017) studies suggest that social transition can be associated with normative mental health outcomes among young people with gender dysphoria, a group who have been shown to experience poorer psychological wellbeing on the whole (Tankersley et al, 2021;Thompson et al, 2022).…”

“…A recent systematic review of psychiatric comorbidities among prepubertal children diagnosed with gender dysphoria (aged 12 and under) (Frew et al, 2021) demonstrated that up to 21% met criteria for an anxiety disorder, almost half had a significant psychiatric history, and around 10% had attempted suicide. A systematic review of adolescents experiencing gender dysphoria (aged 12-18) (Thompson et al, 2022) demonstrated that comorbid mental health issues were present in 22-78%. Specifically, the prevalence of mood disorders ranged from 30 to 78%, anxiety disorders from 21 to 63%, and suicidal ideation from 12 to 74%.…”

Etiology of gender incongruence and its levels of evidence: A scoping review protocol

“…In an initial literature search, that is to say, prior to the development of this protocol, we found a dozen literature reviews and book chapters devoted to the etiology of GI [9][10][11][12][13][14][15][16][17][18][19][20][21]. Along with these reviews, other publications address the GI in a general way, devoting some sections to the subject [8,[22][23][24][25][26][27][28][29][30][31].…”

Psychological factors of gender dysphoria in adolescents: A systematic review

“…In the adolescent population, there is a discrepancy between the established sex and the preference that is felt or expressed (1). It is also necessary to take into account the time of manifestation, the characteristics present, where they stand out, and aspects such as; pretending to belong to the other sex, cross-dressing tendencies in men, or wearing visible masculine attire in women (2). Likewise, interaction with people of the opposite sex and participation in games and social activities that do not correspond to their role, to the point of observing affectations in interpersonal, school, and family relationships.…”