A national transgender health survey from China assessing gender identity conversion practice, mental health, substance use and suicidality

Abstract

Gender identity conversion practice (GICP) refers to interventions that intend to alter an individual’s gender identity that is incongruent with societal expectations based on the sex assigned at birth. In this study, the term GICP refers to both professional conversion efforts (also called Gender Identity Conversion Efforts, GICE, performed by psychologists, psychiatrists and so on) and non-professional conversion efforts (performed by family members and so on). Here data were analysed from the Chinese Transgender Health Survey covering transgender, nonbinary and gender diverse (TNG) adolescents and adults, with 7,576 respondents from mainland China entering the analysis following the application of exclusion criteria. Results showed that GICP is a risk factor for multiple mental health problems including depression, anxiety, post-traumatic stress disorder symptoms, suicidal ideation and suicidal plan in the previous 12 months, suicide attempts in both the previous 12 months and in lifetime, non-suicidal self-injury in the previous 12 months, and alcohol use. Participants with experience of professional GICP reported suicide attempts more frequently than those with experience of non-professional GICP. Compared with other age groups, GICP tended to associate with more severe mental health problems in TNG aged ≤17 years old. Evidence suggests that GICP worsens the mental health problems faced by the TNG population (especially adolescents) and reveals the equivalent detrimental effects from both professional GICP and non-professional GICP. It is necessary for the public to become more aware of the devastative impact of GICP on the TNG population. Analysis of large-scale representative data from the Chinese National Transgender Survey finds that exposure to gender identity conversion practice is a risk factor for mental health problems, worsens mental health disorder severity and increases suicidality.