Gender congruence and psychiatric morbidity after gender-confirming health care: Relation to childhood adversities and adult stressful life events

Studies have reported a high risk of psychiatric morbidity after gender-confirming health care, but there is a dearth of studies evaluating gender congruence after these interventions. [ view full abstract ]

Studies have reported a high risk of psychiatric morbidity after gender-confirming health care, but there is a dearth of studies evaluating gender congruence after these interventions.

The aims were to study gender congruence after gender-confirming health care and to evaluate whether childhood adversities or adult stressful life events predict psychiatric morbidity post transition. [ view full abstract ]

The aims were to study gender congruence after gender-confirming health care and to evaluate whether childhood adversities or adult stressful life events predict psychiatric morbidity post transition.

In a cross sectional setting, sixty-five individuals (16 men assigned female at birth, and 49 women assigned male at birth) were evaluated after gender-confirming health care. The mean (SD) follow-up time was 7.2 (7.3) years... [ view full abstract ]

In a cross sectional setting, sixty-five individuals (16 men assigned female at birth, and 49 women assigned male at birth) were evaluated after gender-confirming health care. The mean (SD) follow-up time was 7.2 (7.3) years with a median of 4.3 (range 0.75–30.5) years.
Statistics
Descriptive data are expressed as means (SD) and medians (range) for continuous variables, and as numbers (percentages) for categorical variables. We used the Mann-Whitney U test for group comparisons of continuous or ordinal variables since the data did not meet the assumptions of a normal distribution according to the Kolmogorov-Smirnov test. For group comparisons of categorical variables, Fisher’s exact test and chi-square were used as appropriate. A logistic regression analysis was performed to test which variables were associated with a current psychiatric illness, see Results. A p-value <0.05 was regarded as significant. Missing internal data due to incomplete questionnaires are shown as differing numbers in the results. Percentages were calculated based on those who completed the respective questions. The statistic calculations were done using IBM SPSS Statistics 22 (SPSS, Chicago, IL, USA).

The study was approved by the Regional Ethical Review Board in Stockholm (2005/418-31/3; 2006/1237-32; 2015/2158-32; 2015/2158-32).

Gender congruence was assessed with the question: “Do you, after your gender reassignment, feel that your body matches your identity?” (Yes/No). Requests for retransition were measured by the question: “Would you like... [ view full abstract ]

Gender congruence was assessed with the question: “Do you, after your gender reassignment, feel that your body matches your identity?” (Yes/No).
Requests for retransition were measured by the question: “Would you like to return to your natal sex?” (Yes/No).
Clinical Global Impression Improvement Scale (CGI-I), graded from 0 (‘very much worse’) to 6 (‘very much improved’) was used to measure overall mprovement after gender-confirming medical interventions.
Psychiatric morbidity was measured with MINI interviews and traits of ADHD and autistic traits with ASRS and AQ respectivly.
Childhood adversities were divided into childhood sexual abuse, childhood maltreatment (defined as at least one experience of physical or emotional abuse), or being bullied during childhood (before 18 y). The questions read “Have you experienced any sexual abuse during childhood?”, “Have you experienced any childhood maltreatment such as physical or emotional abuse during childhood.?” and “Have you been bullied during your childhood?”, respectively. Respons options (YES/NO).
Adult Stressful life events were explored in four categories: (1) being discriminated against and/or harassed; (2) victim of a crime related to a trans background; (3) not always being accepted in the assigned;(4) being sexually abused as an adult.

All 16 men felt gender congruent post transition as compared with 41 out of 46 (89.1%) women. The median GCI-I score was 6 (equals “much improved”), with no significant gender difference. No subject wished to retransition.... [ view full abstract ]

All 16 men felt gender congruent post transition as compared with 41 out of 46 (89.1%) women. The median GCI-I score was 6 (equals “much improved”), with no significant gender difference. No subject wished to retransition. In men and women combined, 23 out of 64 (35.9%) had made a suicide attempt prior to transition, and 8 out of 64 (12.5%) made a suicide attempt post transition. Sixteen out of 65 (24.6%) subjects met criteria for any current psychiatric diagnosis, and 27 out of 65 (41.5%) subjects met criteria for any lifetime psychiatric diagnosis. Fifty-nine out of 65 (90.8%) reported at least one childhood adversity and/or adult stressful life event. Predictors (OR [95% CI]) of current psychiatric morbidity were being born abroad (18.3 [1.9–176]), childhood maltreatment and/or childhood sexual abuse (12.3 [2.0–78]), and not being accepted in the assigned gender (9.0 [1.5–52]).

The findings support the view that gender-confirming health care improve gender dysphoria, and gender incongruence. Childhood adversities and adult stressful life events were common. Born abroad, childhood maltreatment or... [ view full abstract ]

The findings support the view that gender-confirming health care improve gender dysphoria, and gender incongruence. Childhood adversities and adult stressful life events were common. Born abroad, childhood maltreatment or childhood sexual abuse, and not being accepted in the assigned gender by at least one party predicted current psychiatric morbidity. This stress the importance of continued access to psychiatric care after gender-confirming health care for those in need.