Socialt transitionerede børn rapporterede næsten typisk mental sundhed – i en stikprøve af støttende, rige familier

Mental sundhed og selvværd hos socialt transitionerede transkønnede unge

Kohorte- & registerstudier Ophør i barndommen Mentalt helbred & selvmord

Authors: Lily Durwood, Katie A. McLaughlin, Kristina R. Olson
Journal: Journal of the American Academy of Child & Adolescent Psychiatry
Year: 2017
Source: https://doi.org/10.1016/j.jaac.2016.10.016

Summary

This US study asked children who had socially transitioned (living fully as the other gender, with family support) to rate their own depression, anxiety and self-worth. It compared them with matched children and with their brothers and sisters. The trans children reported normal levels of depression and self-worth and slightly more anxiety; parents reported similar results. The authors contrasted this with earlier clinic studies of gender-nonconforming children who had not transitioned, which found much more distress. But families were found through support networks, were mostly well-off and supportive, and children did not need a diagnosis of gender dysphoria. With nothing measured before transition, the study cannot show social transition caused the good mental health. Later careful reviews rate this kind of evidence as low quality.

Key findings

63 socialt transitionerede transbørn i alderen 9-14 år, 63 matchede børn og 38 brødre og søstre vurderede selv deres depression og angst ved hjælp af korte spørgeskemaer.
Depression adskilte sig ikke mellem grupperne, og transbørnenes scorer lå på linje med amerikanske gennemsnit.
Transbørn rapporterede lidt mere angst, selvom forskellen kunne være tilfældig; forældre rapporterede tydeligt mere angst end hos de andre børn og over amerikanske gennemsnit.
Selvværd blandt 116 transbørn i alderen 6-14 år adskilte sig ikke fra de andre børn eller fra deres brødre og søstre.
Forældre til transbørn rapporterede lidt mere angst end børnene selv, hvilket forfatterne tog som et tegn på, at forældrene ikke skjulte problemer.
Familierne blev fundet via støttegrupper, sommerlejre og onlinefora for familier med transbørn og havde langt oftere høj indkomst.
Forfatterne siger, at de ikke kan konkludere, at social transition forårsagede resultaterne, og at problemer måske viser sig, efterhånden som børnene bliver ældre.

Abstract

OBJECTIVE: Social transitions are increasingly common for transgender children. A social transition involves a child presenting to other people as a member of the "opposite" gender in all contexts (e.g., wearing clothes and using pronouns of that gender). Little is known about the well-being of socially transitioned transgender children. This study examined self-reported depression, anxiety, and self-worth in socially transitioned transgender children compared with 2 control groups: age- and gender-matched controls and siblings of transgender children. METHOD: As part of a longitudinal study (TransYouth Project), children (9-14 years old) and their parents completed measurements of depression and anxiety (n = 63 transgender children, n = 63 controls, n = 38 siblings). Children (6-14 years old; n = 116 transgender children, n = 122 controls, n = 72 siblings) also reported on their self-worth. Mental health and self-worth were compared across groups. RESULTS: Transgender children reported depression and self-worth that did not differ from their matched-control or sibling peers (p = .311), and they reported marginally higher anxiety (p = .076). Compared with national averages, transgender children showed typical rates of depression (p = .290) and marginally higher rates of anxiety (p = .096). Parents similarly reported that their transgender children experienced more anxiety than children in the control groups (p = .002) and rated their transgender children as having equivalent levels of depression (p = .728). CONCLUSION: These findings are in striking contrast to previous work with gender-nonconforming children who had not socially transitioned, which found very high rates of depression and anxiety. These findings lessen concerns from previous work that parents of socially transitioned children could be systematically underreporting mental health problems.

Conclusion

These findings are in striking contrast to previous work with gender-nonconforming children who had not socially transitioned, which found very high rates of depression and anxiety. These findings lessen concerns from previous work that parents of socially transitioned children could be systematically underreporting mental health problems. In the discussion the authors add that they cannot conclude social transition caused the outcomes, that the children may face greater issues as they mature, and that the high-income skew of the sample limits generalisation; they suggest the results provide converging evidence that early family support is associated with positive mental health in transgender children.

Methodological limitations

Volunteer families who support transition: Trans children were found through word of mouth, support groups, camps and online forums for families of trans youth. Parents who chose to take part are probably not typical and are invested in the transition.
No diagnosis needed: Children only had to identify as the other gender and use those pronouns everywhere. Nobody checked for gender dysphoria, so this group cannot be compared with children referred to clinics.
Nothing before transition, no non-transitioned group: A one-time snapshot cannot show social transition caused the results. Comparing with earlier studies of gender-nonconforming children means comparing different groups, measured differently and chosen differently, as the authors admit.
Mostly well-off families: Families were much more often high-income, which on its own is linked to better child mental health. The lower-income group checked separately was small.
Small numbers: Only 63 trans children filled in the mental-health questionnaires. With so few, "no difference" does not prove the groups are the same, and the anxiety results were borderline.
Limited questionnaires: The short questionnaires only covered the past 7 days, the self-worth questionnaire was not very consistent, and parents and children were in separate rooms only "whenever possible".
Same data used twice: Some of the parent answers (21 trans children, 16 brothers and sisters, 18 other children) were already published in Olson et al. (Pediatrics 2016), so the two papers do not independently confirm each other.
Some children on medical treatment: Some children were on puberty blockers or cross-sex hormones, but these groups were too small to compare.
Only a snapshot in childhood: Children were assessed once. The authors note problems may appear in the teen or adult years, including if children later stop identifying as trans.
Weak evidence overall: A careful review for England's Cass Review (Hall et al., Archives of Disease in Childhood 2024) judged most studies of social transition, mostly US volunteer groups like this one, to be low quality, and found none that followed children forward with a proper comparison group.
Correction published later: A correction to the paper was published (Journal of the American Academy of Child & Adolescent Psychiatry, 2018); what it changed was not reviewed here.

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Summary

Key findings

Abstract

Conclusion