Humanistic and Economic Burden of Conversion Therapy Among LGBTQ Youths in the United States

Abstract

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.

Future Directions in Mental Health Treatment with Stigmatized Youth

“…Price, Bokhour, et al, 2022;Strauss et al, 2021). Therapists' lack of competency may increase their likelihood of discriminating against clients in the therapy room (e.g., microaggressions, stereotyping, misgendering)a common treatment experience for stigmatized youth and adults (Compton & Morgan, 2022;Morris et al, 2020;Nadal et al, 2016;Yeo & Torres-Harding, 2021), including sexual minority and transgender youth (Chong et al, 2021;Forsythe et al, 2022;M. A.…”

LGBTQ in Youth: A Narrative Review

“…In a paper entitled "Humanistic and economic burden of conversion therapy", SOGICE or sexual orientation and gender identity change efforts were compared with affirmative therapy and no therapy [7]. Across 28 studies on 190,695 LGBTQ adolescents, 12% experienced SOGICE for a mean of 26 months.…”

The State of the LGBTQ+ Community in Surgery

“…A recent position statement from the American Psychiatric Association (APA) has reaffirmed “the recommendation that ethical practitioners refrain from attempts to change individuals’ sexual orientation” and respect “the identities of those with diverse gender expressions.” 3 In recently published guidelines, conversion therapy is to be considered an unethical practice because of its lack of clinical validity and harmful to individuals that have been subjected to it. 3,4 While the APA has been encouraging legislation prohibiting it, currently only few states have full bans on conversion therapy. 4 The medical field has not been immune from the overall societal debate on LGBTQ+.…”

“…3 In recently published guidelines, conversion therapy is to be considered an unethical practice because of its lack of clinical validity and harmful to individuals that have been subjected to it. 3,4 While the APA has been encouraging legislation prohibiting it, currently only few states have full bans on conversion therapy. 4 The medical field has not been immune from the overall societal debate on LGBTQ+.…”

“…3,4 While the APA has been encouraging legislation prohibiting it, currently only few states have full bans on conversion therapy. 4 The medical field has not been immune from the overall societal debate on LGBTQ+. Discrimination, societal stigma, and denial of civil rights are some of the factors limiting health outcomes in the LGBTQ+ community.…”