Empirically supported affirmative psychological interventions for transgender and non-binary youth and adults: A systematic review

Expósito-Campos, Pablo; Pérez-Fernández, José Ignacio; Salaberría, Karmele

doi:10.1016/j.cpr.2022.102229

Cited by 19 publications

(18 citation statements)

References 70 publications

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“…Overall, guidelines describe a care pathway similar to the original Dutch protocol that involves psychosocial care for prepubertal children followed by hormonal interventions for adolescents who meet specific criteria, provided by a specialist multidisciplinary team 41. This approach continues to dominate clinical guidance despite lack of high-quality evidence regarding treatments,42–50 or exploring alternative care models 5…”

Section: Discussionmentioning

confidence: 99%

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Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)

Taylor,

Hall,

Heathcote

et al. 2024

Arch Dis Child

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BackgroundIncreasing numbers of children and adolescents experiencing gender dysphoria/incongruence are being referred to specialist gender services and there are various published guidelines outlining approaches to clinical care.AimTo examine the recommendations about the management of children and/or adolescents (age 0-18) experiencing gender dysphoria/incongruence in published guidelines or clinical guidance. A separate paper examines the quality and development of guidelines.MethodsA systematic review and narrative synthesis. Databases (Medline, Embase, CINAHL, PsycINFO, Web of Science) were searched to April 2022 and web-based searches and contact with international experts continued to December 2022, with results assessed independently by two reviewers. The Appraisal of Guidelines for Research and Evaluation tool was used to examine guideline quality.Results23 guidelines/clinical guidance publications (1998–2022) were identified (4 international, 3 regional, 16 national). Guidelines describe a similar care pathway starting with psychosocial care for prepubertal children, puberty suppressants followed by hormones for eligible adolescents and surgical interventions as these adolescents enter adulthood. In general, there is consensus that adolescents should receive a multidisciplinary assessment, although clear guidance about the purpose or approach is lacking. There are differing recommendations about when and on what basis psychological and medical interventions should be offered. There is limited guidance about what psychological care should be provided, about the management of prepubertal children or those with a non-binary gender identity, nor about pathways between specialist gender services and other providers.ConclusionsPublished guidance describes a similar care pathway; however, there is no current consensus about the purpose and process of assessment for children or adolescents with gender dysphoria/incongruence, or about when psychological or hormonal interventions should be offered and on what basis.PROSPERO registration numberCRD42021289659.

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Section: Discussionmentioning

confidence: 99%

“…Such guidance may help reduce barriers to equitable and evidence-based care. However, limited research about psychosocial care for this population may prevent development of evidence-based guidance 42–44…”

Section: Discussionmentioning

confidence: 99%

Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)

Taylor,

Hall,

Heathcote

et al. 2024

Arch Dis Child

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“…MEDLINE (see online supplemental table 1), Embase and PsycINFO through OVID, CINAHL Complete through EBSCO and Web of Science (Social Science Citation Index) were searched (13–23 May 2021; updated 27 April 2022). The reference lists of eligible studies and any relevant identified systematic reviews were also checked 27 28…”

Section: Methodsmentioning

confidence: 99%

Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review

Heathcote,

Taylor,

Hall

et al. 2024

Arch Dis Child

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BackgroundNational and international guidelines recommend that psychosocial support should be a key component of the care offered to children and adolescents experiencing gender dysphoria/incongruence. However, specific approaches or interventions are not recommended.AimTo identify and summarise evidence on the outcomes of psychosocial support interventions for children and adolescents (age 0-18) experiencing gender dysphoria/incongruence.MethodsSystematic review and narrative synthesis. Database searches (MEDLINE; EMBASE; CINAHL; PsycINFO; Web of Science) were performed in April 2022, with results assessed independently by two reviewers. Peer-reviewed articles reporting the results of studies measuring outcomes of psychosocial support interventions were included. Quality was assessed using the Mixed Methods Appraisal Tool.ResultsTen studies were included. Half were conducted in the US, with others from Australia, Canada, New Zealand and the UK. Six were pre–post analyses or cohort studies, three were mixed methods, and one was a secondary analysis of intervention data from four trials. Most studies were of low quality. Most analyses of mental health and psychosocial outcomes showed either benefit or no change, with none indicating negative or adverse effects.ConclusionsThe small number of low-quality studies limits conclusions about the effectiveness of psychosocial interventions for children/adolescents experiencing gender dysphoria/incongruence. Clarity on the intervention approach as well as the core outcomes would support the future aggregation of evidence. More robust methodology and reporting is required.PROSPERO registration numberCRD42021289659.

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“…Several randomized controlled studies support basing mental healthcare for gender minorities on the minority stress model ([61–65,69 ▪▪ ] for a review). These new models of care make explicit the links between minority stress and various mental health symptoms, address internalized stigma, foster a positive self-identity, and strengthen links with supportive communities [66 ▪ ,67]. Minority stress model based mental health support can be learned and shared using a workbook (The Queer Mental Health Workbook by Dr Brendan J. Dunlop).…”

Section: Managementmentioning

confidence: 99%

Eating disorders in transgender and gender diverse people: characteristics, assessment, and management

Keski-Rahkonen

2023

Current Opinion in Psychiatry

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Purpose of review This review summarizes recent research on eating disorders among gender minorities, transgender and gender diverse people. The focus is on research published in 2022 and the first half of 2023. Recent findings Up to 1.2% of young people and 0.3–0.5% of adults identify as transgender, and 2.7–8.4% of young people and 0.3–4.5% of adults report some degree of gender diversity. About 20–50% of transgender and gender diverse people report engaging in disordered eating and >30% screen positive for eating disorder symptoms, and 2–12% have received an eating disorder diagnosis from a health professional. Many transgender and gender diverse people describe eating disorder symptoms as a way of coping with gender dysphoria. They also report high levels of mental and behavioral symptoms, particularly mood and anxiety disorders, suicidal thoughts and behaviors, trauma-related symptoms and disorders, alcohol and substance use, and autism. Gender minorities frequently experience discrimination, victimization, and violence, primarily sexual and physical violence. The minority stress model attributes mental health symptoms to these factors. Promising interventions based on the minority stress model have recently become available, but more research is needed on how to support transgender and gender diverse people with eating disorders. To manage eating disorders in this population, gender-affirming care should be combined with specialist eating disorder treatment. Summary Gender minorities are at high risk for eating disorders. Future studies should assess what is the most appropriate treatment for transgender and gender diverse people with eating disorders.

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Empirically supported affirmative psychological interventions for transgender and non-binary youth and adults: A systematic review

Cited by 19 publications

References 70 publications

Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)

Clinical guidelines for children and adolescents experiencing gender dysphoria or incongruence: a systematic review of recommendations (part 2)

Psychosocial support interventions for children and adolescents experiencing gender dysphoria or incongruence: a systematic review

Eating disorders in transgender and gender diverse people: characteristics, assessment, and management

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