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

Abstract

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.

Critically Appraising the Cass Report: Methodological Flaws and Unsupported Claims

“…Seven systematic reviews were commissioned by the Cass Report and published in the BMJ Archives of Disease in Childhood [2][3][4][5][6][7][8] with a single systematic review protocol registered in PROSPERO for all seven reviews 9 . To evaluate their risk of bias we applied the ROBIS tool 10 as recommended by Cochrane 11,12 .…”

“…For two of the systematic reviews, this was because of the inappropriate exclusion from the synthesis of studies that were deemed to be of "low quality" according to the adapted NOS. 2,8 Using this approach, the authors excluded 48% and 36% of studies for puberty blockers and hormone therapy respectively. This practice is not recommended in systematic reviews unless explicitly pre-specified in a protocol with a clear and reasonable rationale, which was not evident in these cases.…”