Lifetime Exposure to Conversion Therapy and Psychosocial Health Among Midlife and Older Adult Men Who Have Sex With Men

Meanley, Steven; Haberlen, Sabina; Okafor, Chukwuemeka N.; Ae, Brown; Brennan-Ing, Mark; Ware, Deanna; Egan, James E.; Teplin, Linda A.; Bolan, Robert; Friedman, M. Reuel; Plankey, Michael

doi:10.1093/geront/gnaa069

Cited by 30 publications

(21 citation statements)

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“…Reports of positive change were stronger and more widely distributed than those of negative change, most strongly for depression, but also for self-esteem, social functioning, self-harm, suicidality, and alcohol/substance abuse. Of note given accounts of increased suicidality due to SOCE exposure (Meanley et al, 2020;Salway et al, 2020), participants in this study reported nine times more (21.8%) marked or extreme positive effects of SOCE on suicidal thoughts or attempts than they reported a similar degree of negative effects (2.4%).…”

Section: Psychological Well-beingmentioning

confidence: 46%

“…Examining the recruitment methods and sample characteristics of the aforementioned SOCE studies supports the hypothesis that researchers have likely investigated only one of these sexual minority subgroups at the expense of the other. Samples are often exclusively or mostly dominated by LGB identified participants (Blosnich et al, 2020;Bradshaw et al, 2015;Flentje et al, 2014;Meanley et al, 2020;Ryan et al, 2020;Salway et al, 2020) or by participants with a likelihood of much lower levels of LGB identification given recruitment venues (Jones & Yarhouse, 2011;Karten & Wade, 2010;Spitzer, 2003). SOCE researchers tend to recruit participants through the venues and networks most easily accessible to them; hence, samples usually reflect this selection bias.…”

Section: Harmonizing the Soce Literaturementioning

confidence: 99%

“…They did find, however, that SOCE in the context of psychiatry and psychotherapy was reported to be moderately to highly effective by 48% and 44% of sample consumers, respectively, although this effectiveness did not seem to be based on experiences of actual change. More recent studies have reported SOCE exposure to be associated with poorer mental health indicators among sexual minority youth (Ryan et al, 2020), adults (Blosnich et al, 2020;Salway et al, 2020), and midlife and older adults (Meanley et al, 2020).…”

Section: Introductionmentioning

confidence: 99%

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Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men

2021

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Background: Voluntary therapeutic interventions to reduce unwanted same-sex sexuality are collectively known as sexual orientation change efforts (SOCE). Currently almost all evidence addressing the contested question whether SOCE is effective or safe consists of anecdotes or very small sample qualitative studies of persons who currently identify as sexual minority and thus by definition failed to change. We conducted this study to examine the efficacy and risk outcomes for a group of SOCE participants unbiased by current sexual orientation. Methods: We examined a convenience sample of 125 men who had undergone SOCE for homosexual-to-heterosexual change in sexual attraction, identity and behavior, and for positive and negative changes in psychosocial problem domains (depression, suicidality, self-harm, self-esteem, social function, and alcohol or substance abuse). Mean change was assessed by parametric (t-test) and nonparametric (Wilcoxon sign rank test) significance tests. Results: Exposure to SOCE was associated with significant declines in same-sex attraction (from 5.7 to 4.1 on the Kinsey scale, p <.000), identification (4.8 to 3.6, p < .000), and sexual activity (2.4 to 1.5 on a 4-point scale of frequency, p < .000). From 45% to 69% of SOCE participants achieved at least partial remission of unwanted same-sex sexuality; full remission was achieved by 14% for sexual attraction and identification, and 26% for sexual behavior. Rates were higher among married men, but 4-10% of participants experienced increased same-sex orientation after SOCE. From 0.8% to 4.8% of participants reported marked or severe negative psychosocial change following SOCE, but 12.1% to 61.3% reported marked or severe positive psychosocial change. Net change was significantly positive for all problem domains. Conclusion: SOCE was perceived as an effective and safe therapeutic practice by this sample of participants. We close by offering a unifying understanding of discrepant findings within this literature and caution against broad generalizations of our results.

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Section: Psychological Well-beingmentioning

confidence: 46%

Section: Harmonizing the Soce Literaturementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men

2021

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Section: Effects Of Marriagementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men

2021

View full text Add to dashboard Cite

Background: Voluntary therapeutic interventions to reduce unwanted same-sex sexuality are collectively known as sexual orientation change efforts (SOCE). To date almost all evidence addressing the contested question whether SOCE is effective or safe has consisted of anecdotes or very small sample qualitative studies of persons who currently identify as sexual minority and thus by definition failed to change. We conducted this study to examine the efficacy and risk outcomes for a group of SOCE participants unbiased by current sexual orientation. Methods: We examined a convenience sample of 125 men who had undergone SOCE for homosexual-to-heterosexual change in sexual attraction, identity and behavior, and for positive and negative changes in psychosocial problem domains (depression, suicidality, self-harm, self-esteem, social function, and alcohol or substance abuse). Mean change was assessed by parametric (t-test) and nonparametric (Wilcoxon sign rank test) significance tests. Results: Exposure to SOCE was associated with significant declines in same-sex attraction (from 5.7 to 4.1 on the Kinsey scale, p <.000), identification (4.8 to 3.6, p < .000), and sexual activity (2.4 to 1.5 on a 4-point scale of frequency, p < .000). Over 42.7% of SOCE participants achieved at least partial remission of unwanted same-sex sexuality; full remission was achieved by 14% for sexual attraction and identification, and 26% for sexual behavior. Rates were higher among married men, but 4-10% of participants experienced increased same-sex orientation after SOCE. From 0.8% to 4.8% of participants reported marked or severe negative psychosocial change following SOCE, but 12.1% to 61.3% reported marked or severe positive psychosocial change. Net change was significantly positive for all problem domains. Conclusion: SOCE was perceived as an effective and safe therapeutic practice by this sample of participants. We close by offering a unifying understanding of discrepant findings within this literature and caution against broad generalizations of our results.

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

Forsythe

Pick

Tremblay³

et al. 2022

JAMA Pediatr

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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.

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Lifetime Exposure to Conversion Therapy and Psychosocial Health Among Midlife and Older Adult Men Who Have Sex With Men

Cited by 30 publications

References 36 publications

Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men

Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men

Efficacy and risk of sexual orientation change efforts: a retrospective analysis of 125 exposed men

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

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