Understanding harms associated with gender identity conversion efforts among transgender and nonbinary individuals: The role of preexisting mental well-being

Abstract

Background: Affirmation of gender identity is critical for the mental health and overall well-being of transgender and nonbinary (TNB) persons. Gender identity conversion efforts (GICE), an outlawed practice for licensed professionals in numerous U.S. jurisdictions, have been associated with negative mental health and substance use outcomes. Limited previous literature examining GICE exposure has been criticized for failing to distinguish mental well-being for TNB persons before or after GICE. Our study builds on current literature by examining differences in TNB persons’ psychosocial risk indicators based on their GICE exposure, accounting for pre-GICE mental well-being. Methods: We conducted a secondary data analysis using the 2015 U.S. Transgender Survey (N = 25,810), the largest available national survey aimed at understanding TNB persons’ experiences. Using logistic regression models, we examined how GICE exposure (disaggregated by temporal precedence of initial suicide attempts) is related to health (psychological distress, extra-medical prescription use, healthcare avoidance), socio-structural (public restroom avoidance, housing instability), and interpersonal outcomes (sexual assault, emotional and physical intimate partner violence (IPV)). Results and conclusions: Initiating a suicide attempt post-GICE or in the absence of GICE were the only consistently significant predictors of poor outcomes across all domains compared to participants who never experienced GICE or attempted suicide. Findings suggest, however, that a combination of GICE with a history of suicide attempts (pre- or post-GICE) was indicative of the highest risk across outcomes, highlighting the particularly hazardous nature of combining poor mental well-being and GICE exposures. Our study adds much-needed complexity to our understanding of how GICE exposure’s role in the well-being of TNB persons may differ related to their pre-GICE mental health. Our findings add further credence to previous studies identifying harms associated with GICE exposure, regardless of pre-GICE mental well-being.