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Mental Health & Suicide

Review of suicides and gender dysphoria at the Tavistock and Portman NHS Foundation Trust: independent report - GOV.UK

UCLA Study

The UCLA study you’re referring to was conducted by the Williams Institute at UCLA School of Law, and it contributed to the narrative around suicide attempts among transgender individuals. Here’s a breakdown:
Study Overview:

  • Title: “Prevalence of substance use and mental health problems among transgender and cisgender U.S. adults: Results from a national probability sample”
  • Source: Williams Institute at UCLA School of Law
  • Publication Date: July 2023
  • Link: Williams Institute - UCLA Study
    Key Findings:
  1. Suicide Attempts:
    • 42% of transgender adults in the U.S. have attempted suicide at some point in their lifetimes.
    • 81% have thought about suicide.
    • 56% have engaged in non-suicidal self-injury.
  2. Comparative Data:
    • Transgender adults were found to be:
      • Seven times more likely to contemplate suicide,
      • Four times more likely to attempt suicide,
      • Eight times more likely to engage in non-suicidal self-injury compared to cisgender adults.
  3. Mental Health and Substance Use:
    • While transgender and cisgender adults reported similar rates of hazardous drinking and problematic drug use, transgender people were significantly more likely to experience poor mental health outcomes.
    • Transgender nonbinary adults reported higher rates of substance use and poorer mental health outcomes compared to transgender men and women.
  4. Support and Care:
    • 82% of transgender individuals had accessed formal mental health care, compared to 47% of cisgender adults.
    • About 26% of transgender people sought support from other sources like religious and spiritual leaders or alternative medicine practitioners.
      Methodology:
  • The study used data from the U.S. Transgender Population Health Survey (TransPop), which is described as the first national probability sample of transgender people in the U.S.
  • This approach means the sample was designed to be representative of the broader transgender population in the United States.
    Implications:
  • The findings underscore the significant mental health disparities faced by transgender individuals, particularly highlighting the impact of minority stress due to societal stigma, prejudice, and lack of acceptance or recognition, especially for nonbinary transgender adults.
  • The study calls for evidence-based interventions to mitigate these risks, including increasing access to gender-affirming care and improving community connectedness.
    Context and Critiques:
  • While this study provides crucial insight into the challenges faced by transgender individuals, it’s part of a broader body of research on transgender health. Critics might argue about the causality between transgender identity and mental health issues, pointing to external factors like discrimination, lack of support, and societal acceptance as major contributors to these statistics.
  • It’s also important to recognize that studies like these are snapshots in time, and while they offer valuable data, they are part of an ongoing conversation about transgender health, identity, and societal impacts.
    This study has been influential in discussions about transgender health policy, mental health support, and advocacy for transgender rights and well-being.

American Journal of Psychiatry Study

The 2019 study from the American Journal of Psychiatry that was referenced in discussions around transgender health is titled “Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study” by Bränström, R., & Pachankis, J. Here’s a breakdown of the study and its findings:
Study Overview:

  • Title: Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study
  • Authors: Richard Bränström and John E. Pachankis
  • Journal: American Journal of Psychiatry
  • Publication Date: October 2019
  • Link: American Journal of Psychiatry - Study
    Methodology:
  • Population: The study was conducted using Sweden’s national registers, examining the entire Swedish population over 11 years (2005-2015).
  • Data Sources: Swedish Total Population Register, National Patient Register, and the Prescribed Drug Register were linked to gather comprehensive health data.
  • Participants: 2,679 individuals diagnosed with gender incongruence (transsexualism or gender identity disorder) were included.
  • Focus: The study looked at the utilization of mental health services and prescriptions for mood and anxiety disorders in 2015, correlating with whether individuals had received gender-affirming hormone treatments or surgeries.
    Key Findings:
  1. Mental Health Treatment Utilization:
    • There was a noted reduction in mental health treatment utilization among transgender individuals who had undergone gender-affirming surgeries. Specifically, the study reported that the longer the time since surgery, the lower the likelihood of using mental health services, with an average reduction of 8% in mental health treatment utilization for each year following surgery.
  2. Specific Outcomes:
    • Transgender individuals with a diagnosis of gender incongruence were:
      • About six times as likely to have had a mood or anxiety disorder health care visit.
      • More than three times as likely to have received prescriptions for antidepressants and anti-anxiety medication.
      • More than six times as likely to have been hospitalized after a suicide attempt compared to the general population.
  3. Hormone Treatment vs. Surgery:
    • The study found no significant association between hormone treatment and reduced mental health treatment, unlike with surgery.
      Interpretation and Implications:
  • The authors concluded that their findings lent support to the provision of gender-affirming surgeries for transgender individuals, suggesting that such interventions might be associated with improved mental health outcomes.
    Subsequent Corrections and Critiques:
  • Reevaluation: Following the publication, several critiques regarding the study’s methodology led to a reevaluation. An erratum was issued in August 2020 stating that the original conclusions were too strong due to methodological issues, particularly around the study’s design not allowing for firm causal conclusions about the benefits of surgery on mental health.
    • Erratum Link: Erratum Notice
  • Critical Reception: Critics pointed out that the study lacked a control group, used a cross-sectional rather than longitudinal approach for the main outcome measure, and might suffer from selection bias since those who choose surgery might differ systematically from those who do not.
    This study has been pivotal in the discourse on transgender health care, highlighting both the potential benefits of gender-affirming surgeries and the complexities of interpreting health outcomes in transgender populations. However, the subsequent correction and ongoing debate emphasize the need for more nuanced and rigorous research in this field.