The effectiveness and acceptability of empirically supported treatments in gender minority youth across four randomized controlled trials.

Abstract

Objective: Gender minority youth (i.e., children/adolescents whose gender identity and/or expression is inconsistent with their birth-assigned sex) experience elevated rates of emotional and behavioral problems relative to cisgender youth (who identify with their birth-assigned sex), which are not intrinsic to gender identity but attributable to unique minority stressors. Although empirically-supported treatments have proven effective in treating these mental health concerns generally, randomized controlled trials have not examined effects for gender minority youth.Method: To address this gap, we pooled data from clinically-referred youth (N = 432; M(SD)age = 10.6(2.2); 55.1% White) assigned to empirically-supported treatment conditions across four previous randomized controlled trials of modular psychotherapy. A proxy indicator of gender identity (i.e., youth's wish to be the opposite sex) was used to classify gender minority (n = 64) and cisgender (n = 368) youth. Youth-and caregiver-reported pretreatment internalizing and externalizing problems, treatment effectiveness on these domains, and treatment acceptability were compared across groups.Results: Gender minority youth reported more severe pretreatment internalizing and externalizing problems compared to cisgender youth; in contrast, their caregivers reported less severe problems. Though treatment was equally effective for both groups on most outcomes, gender minority youth's caregiver-reported externalizing problems improved more slowly and less reliably, and their self-reported internalizing problems were more likely to remain clinically elevated. Further, gender minority youth reported lower treatment satisfaction.Conclusions: While findings suggest that empirically-supported treatments may effectively address many mental health problems for gender minority youth, they also underscore the need for treatment enhancements that improve acceptability and outcomes.Public Significance Statement: This study examined the effectiveness and acceptability of empirically-supported mental health treatments for gender minority youth (who endorsed a wish to be the opposite sex) and cisgender youth. Gender minority youth reported more severe problems before treatment, demonstrated slower improvement in caregiver-reported behavior problems, and endorsed lower treatment satisfaction. Findings support the potential need for provider-focused trainings relevant to gender minority youth.

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

“…One additional study meeting the inclusion criteria was identified from citation searches 32. Therefore, 10 studies were included in this review 32–41…”

“…There were four cohort studies,36 39–41 two pre–post studies32 34 (one of which included analysis of open-ended survey responses in addition to outcome data34), three mixed methods,33 35 37 and one was a secondary analysis of intervention group data from four randomised controlled trials (RCTs)38 (the individual RCTs were excluded because they presented combined results for those experiencing and not experiencing gender dysphoria/incongruence). Five studies included a comparator group of children and/or adolescents not experiencing gender dysphoria/incongruence36 38–41 and one included a historical cohort of adolescents with gender dysphoria/incongruence 33. Half of the studies were conducted in the US (n=5),32 35 38 40 41 two in the UK36 37 and single studies from Australia,33 Canada34 and New Zealand 39 Table 1.…”

Treatment personalization can promote mental health equity by addressing stigma.

“…Pertinent to Venturo-Conerly et al's review, these inequities have been demonstrated in youth modular psychotherapy. Specifically, Hollinsaid et al (2020) found that gender minority youth across four randomized controlled trials of modular psychotherapy exhibited less symptom reduction and lower treatment satisfaction compared to cisgender youth.…”

Future Directions in Mental Health Treatment with Stigmatized Youth

“…To improve our field's ability to examine stigma in all intervention research, we conclude with recommendations for broader mental health treatment research: 1. To facilitate analyses of treatment outcomes for different stigmatized groups (e.g., Hollinsaid et al, 2020), recruit large and diverse samples of youth reflecting multiple stigmatized identities and comprehensively collect data on these identities (Kataoka et al, 2010;Lau et al, 2010;Santelli et al, 2003).…”