‘Unethical’ conversion therapy tied to ‘poor mental health’

Key takeaways:

• Conversion therapy aimed at sexual orientation or gender identity increased symptoms of suicidality and PTSD.
• The findings show a need for legislative and educational efforts, researchers said.

Individuals exposed to conversion practice to alter sexual orientation or gender identity have significantly higher risk for developing symptoms of multiple mental health conditions, study results published in Lancet Psychiatry showed.

The data reveal these symptoms are even more pronounced among transgender and gender-diverse individuals, according to study investigators.

“Our findings add to a body of evidence that shows conversion practice is unethical and linked with poor mental health,” Nguyen K. Tran, PhD, MPH, a social epidemiologist at Stanford University School of Medicine, said in a press release.

Conversion practice still occurs in the United States despite opposition from professional medical and mental health organizations, although it is unclear how often it is used, the release noted.

According to 2022 survey data from The Trevor Project, 17% of LGBTQ+ youth reported being threatened with or subjected to conversion therapy.

In the cross-sectional analysis, Tran and colleagues used questionnaire data from the prospective PRIDE Study cohort comprising sexual and gender minority adults to determine links between conversation practices — targeted at either sexual orientation or gender identity — and mental health outcomes like depression, anxiety, suicidal ideation or attempts and PTSD.

The analysis included 4,426 participants aged 18 to 84 years, including 43% transgender individuals.

Among participants, 3.4% reported undergoing only sexual orientation-related conversion practice, 1% reported undergoing only gender identity-related conversion practice and 1% reported undergoing both.

The researchers found a strong association between recalling both forms of conversion practice and increased symptoms associated with symptoms of PTSD (beta = 2.84; 95% CI, 0.94-4.74), suicidality (beta = 2.14; 95% CI, 0.95-3.32) and depression (beta = 2.48; 95% CI, 0.26-4.78).

The combination of these therapies could create an adverse environment for sexual and gender minority participants, “contributing to delays in sexual and gender minority identity development, self-hatred, isolation from supportive communities and delays in adopting a positive self-perception, which can result in worsening mental health,” Tran and colleagues wrote.

Recalling only sexual orientation-related conversion practice corresponded with greater symptoms of PTSD (beta = 1.1; 95% CI, 0.22-1.98), whereas recalling only gender identity-related conversion practice had links to greater depressive symptoms (beta = 3.24; 95% CI, 1.03-5.46).

Transgender and gender-diverse individuals reported greater mental health symptoms overall vs. cisgender participants, although cisgender participants exposed to either type of conversion therapy were likelier to attempt suicide or have suicidal thoughts (beta = 2.69; 95% CI, 0.42-4.97).

Religious leaders or organizations delivered conversion practices most often (52.4%), whereas conversion practices targeted at gender identity more frequently came from mental health practitioner or organization (54.1%).

The researchers acknowledged a couple study limitations. For example, they were not able to determine how the frequency and length of conversion therapy was associated with mental health symptoms, whereas recall bias may have resulted in misclassification of conversation practice experiences.

Tran and colleagues also added that PRIDE study participants may have been healthier and had greater access to social and financial resources compared with the gender diverse and transgender population.

Ultimately, “our findings suggest that effective policy interventions may need multipronged legislative actions at the federal, state, and local levels, including state and federal bans on conversion practice,” Tran said in the release. “Educational efforts involving families, religious leaders and mental health providers are also needed, as are support networks for LGBTQ+ youths and targeted mental health screening to identify and support survivors of conversion practice.”

References:

• Conversion practice linked to greater risk of mental health symptoms, surveys of LGBTQ+ people in the USA suggest. Available at: https://med.stanford.edu/news/all-news/2024/09/conversion-practices-lgbt.html. Published Sept. 30, 2024. Accessed Sept. 30, 2024.
• Tran N, et al. Lancet Psychiatry. 2024;doi:10.1016/S2215-0366(24)00251-7.
• 2022 National Survey on LGBTQ Youth Mental Health. Available at: https://www.thetrevorproject.org/survey-2022/#conversion-therapy. Accessed Sept. 30, 2024.