Conversion practices linked to a greater risk of mental health symptoms, US surveys of LGBTQ+ people show

People who identify as LGBTQ+ and have undergone conversion practices – commonly known as conversion therapy – are more likely to have poor mental health, according to a study published in The Lancet Psychiatry magazine.

The findings – based on surveys of 4,426 LGBTQ+ adults in the US – suggest that people who are subjected to controversial practices that target their gender identity or sexual orientation are more likely to experience depression, PTSD and suicidal thoughts or attempts. Transgender participants generally reported more psychological symptoms.

Conversion practice is a formal, structured effort to change a person’s sexual orientation, gender identity, or gender expression. They often involve psychological, behavioral, physical, and faith-based practices.

When looking at conversion practices that target only sexual orientation or practices that target both, cisgender and transgender people have a similarly increased likelihood of experiencing symptoms of depression and PTSD. Suicidal thoughts or attempts were higher among cisgender participants subjected to both types of practices than among transgender participants, although it is unclear why, and more research is needed.

Despite widespread opposition from professional medical and mental health organizations, conversion practice still occurs in parts of the US. How often it is practiced in the US remains unclear – previous research suggests it could be between 4% and 34% of LGBTQ+ people – but significant numbers of LGBTQ+ people report experiencing conversion practices, with rates below transgender people are higher than among cisgender people. It remains legal in many parts of the world, including the United Kingdom, parts of Central and Eastern Europe, Asia and Africa.

Previous research shows that undergoing proselytizing practices is linked to mental health conditions, such as depression and suicidal thoughts and attempts. To date, no study has examined whether the mental health consequences of attempts to change an individual’s sexual orientation differ from those of attempts to change one’s gender identity. Little was also known about how the effects of these different practices differ between cisgender – people who identify with the gender assigned to them at birth – and transgender people.

“Our findings add to a body of evidence showing that conversion practices are unethical and linked to poor mental health. Protecting LGBTQ+ people from the consequences of these harmful practices will require legislation on multiple fronts, including state and federal bans. Additional measures such as support networks and targeted mental health care for survivors are also critical,” said study author Dr. Nguyen Tran, from Stanford University School of Medicine (USA).

The authors of the new study obtained data for their analysis by surveying participants in The PRIDE Study, a long-term health survey of LGBTQ+ people in the US. Participants completed questionnaires about their experiences with possible conversion practices and mental health.

Other information recorded included participants’ gender identity, sexual orientation, and the sex they were assigned at birth. Participants also reported where they live, their education level, age, ethnic and racial identity, and details about their upbringing (e.g., religious or supportive of LGBTQ+ people).

The authors used statistical analyzes to identify links between conversion practices and mental illness. Outcomes included symptoms of anxiety, depression, post-traumatic stress disorder (PTSD), and suicidal thoughts or attempts, which were assessed using established diagnostic scales.

Most participants (92%) identified as white. There were 2,504 (57%) cisgender and 1,923 (43%) transgender participants. Their ages ranged from 18 to 84 years, with an average of 31 years.

Of the 4,426 participants, 149 (3.4%) had experienced conversion practices aimed at changing their sexual orientation, 43 (1%) had undergone practices aimed at gender identity, and 42 (1%) reported both.

Participants who were subjected to conversion practices that targeted both their gender identity and their sexual orientation showed the greatest symptoms of depression, PTSD, and suicidal thoughts or attempts.

Some participants reported being subjected to proselytizing practices more often than others. They included transgender participants, people experiencing homelessness and people with lower levels of education. The practices were also more commonly reported among people with religious upbringings, people raised in communities that did not accept their gender identity, and participants from ethnic minority backgrounds.

Cisgender and transgender participants who had undergone conversion exercises had a similarly increased risk of depression and PTSD. Neither had increased symptoms of anxiety. However, cisgender participants who had undergone both forms of conversion practices were at greater risk of suicidal thoughts or attempts than transgender participants. The authors say there are several possible explanations for the observed differences in suicide risk.

Compared to the broader transgender population, participants in the PRIDE Study may be healthier and have better access to social and financial resources that reduce the likelihood of undergoing conversion practices and experiencing its harmful mental health consequences. Transgender participants who did not voluntarily participate in the PRIDE study may include those who were most adversely affected by conversion practices and had worse mental health outcomes than those who did.

There is also a possible survivorship bias among transgender participants in the PRIDE study: fewer transgender people may have lived long enough to participate in the study. Long-term studies that follow youth into adulthood are needed to gain a clearer picture of the effects of conversion practices among transgender people.

Conversion practices aimed at changing an individual’s sexual orientation were most often performed by a religious leader or organization (52%, 100/191 participants), followed by a mental health provider or organization (29%, 55/191) . Practices that addressed participants’ gender identity were most often delivered by mental health providers or organizations (54%, 46/85 participants), followed by a religious leader or organization (33%, 28/85), and both (13 %, 11/85). 85).

“Our findings suggest that effective policy interventions may require multiple legislative actions at the federal, state, and local levels, including state and federal bans on conversion practices. Educational efforts involving families, faith leaders, and mental health providers are also needed, as are support networks for LGBTQ+ youth and targeted mental health screening to identify and support conversion survivors,” Tran said.

The authors acknowledge some limitations of their study. Errors in people’s memories may have led to misclassification of some experiences in the conversion practice. Some potentially important childhood factors – such as family rejection of participants’ gender identity – were not taken into account in the analysis and should be explored in future studies. The study cohort may not include people whose mental health is most affected by the conversion practice, as this could lead to delays in their willingness to publicly share their identity or be involved in studies such as The PRIDE Study.

Jack Drescher, MD, clinical professor of psychiatry at Columbia University Medical Center (USA), who was not involved in the study, wrote in a linked commentary: “An important message from Tran and colleagues’ article is that mainstream mental health organizations must better regulate the activities of those outlier, licensed physicians who engage in proselytizing practices. The ethical guidelines of professional organizations should reflect and integrate the changing cultural beliefs and values ​​of the broader world regarding the growing acceptance of diverse sexual orientations and genders. identities.”

He adds: ‘Rather than unfounded and unhelpful clinical preoccupations with why a patient has the sexual orientation or gender identity they report, it is more clinically useful to ask how such individuals can be helped to live their lives more openly and to lead more adaptively, while always taking into account the medical dictum to first do no harm.”