Abstract
Increasing numbers of transgender and gender diverse children and adolescents have been referred to gender identity clinics in Sweden in the past decade, and previous studies have found an association between media attention and referral counts. Whether the tone of media stories is associated with referrals is not yet known. To investigate whether positive or negative media coverage on transgender and gender diverse issues is associated with referral counts to child and adolescent gender identity clinics. In this cross-sectional study, referrals counts were collected from all 6 specialized gender identity clinics in Sweden, along with information on referral date, sex assigned at birth, and birth year. Participants were all individuals younger than 19 years, referred to a gender identity clinic between January 1, 2017, and December 31, 2019. Data were analyzed from May 2020 to September 2021. Exposures included 3 major media events related to transgender health care in 2019; 1 event was categorized as positive and 2 events were categorized as negative press coverage. Referral counts before and after each of the 3 major media events were assessed, and the moderating association of sex assigned at birth and age was examined with stratified analyses. Weekly referral counts and trends were assessed with interrupted time series analysis. Among 1784 referrals (359 referrals [21.4%] among individuals aged <13 years; 1034 referrals [72.1%] among individuals assigned female at birth and 401 referrals [27.9%] among individuals assigned male at birth), a negative association between media coverage and referral counts was found for the first of the negative media events. In the 3 months following the event, referrals decreased by 25.4% (95% CI, -31.9% to -18.9%) overall, by 32.2% (95 CI, -41.8% to -22.8%) for individuals assigned female at birth, and by 25.3% (95 CI, -32.4% to -18.3%) for individuals aged 13 to 18 years. In the interrupted time series analysis, a mean weekly decrease of 3% in the referrals was observed in the extended time interval of 39 weeks (incidence rate ratio, 0.97; 95 CI, 0.95 to 0.99). For the other 2 media events, no changes in referral counts or time trends were observed. These findings suggest that an event of negative media coverage on transgender-specific health care was negatively associated with access to health care for transgender children and adolescents; therefore, nuanced and accurate media coverage, as well as increased awareness of these mechanisms among key stakeholders, is essential.
Highlights
In recent years, the number of referrals to gender identity clinics have rapidly increased worldwide.[1,2] Gender identity clinics offer assessments and possible treatments for gender dysphoria (GD), which is characterized by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)[3] as significant suffering or impairment in functioning due to incongruence between the individual’s experienced gender and their birth-assigned sex
Among 1784 referrals (359 referrals [21.4%] among individuals aged
In the 3 months following the event, referrals decreased by 25.4% overall, by 32.2% (95 CI, −41.8% to −22.8%) for individuals assigned female at birth, and by 25.3% (95 CI, −32.4% to −18.3%) for individuals aged 13 to 18 years
Summary
The number of referrals to gender identity clinics have rapidly increased worldwide.[1,2] Gender identity clinics offer assessments and possible treatments for gender dysphoria (GD), which is characterized by the Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition)[3] as significant suffering or impairment in functioning due to incongruence between the individual’s experienced gender and their birth-assigned sex In children, this is often accentuated by the onset of puberty and development of secondary sex characteristics.[4] the increase of referrals to gender identity clinics has been especially prominent in adolescents and young adults.[5,6,7] In addition, there has been a shift in gender ratio, with a preponderance toward individuals who were assigned female at birth (AFAB).[8,9,10] Whether the increase reflects a change in the actual prevalence of GD in the population, an increase in help-seeking behavior, or a combination of both is not yet known. Several explanations that could influence care-seeking behavior among individuals with GD have been proposed, including enhanced availability of information on gender issues on the internet, decreased stigmatization and increased acceptance in society, and more accessible health care, as well as increased attention of transgender issues in media.[2,5,11]
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