Clinique finlandaise du genre : 87 % des ados demandeurs étaient nés filles et 75 % avaient un suivi psychiatrique

Deux ans de service d'identité de genre pour mineurs : surreprésentation de filles de naissance présentant de graves difficultés de développement à l'adolescence

Études de cohorte & registres Autisme, trauma & affections concomitantes Hausse des diagnostics & influence sociale

Authors: Riittakerttu Kaltiala-Heino, Maria Sumia, Marja Työläjärvi, Nina Lindberg
Journal: Child and Adolescent Psychiatry and Mental Health
Year: 2015
Source: https://doi.org/10.1186/s13034-015-0042-y

Summary

This early report from Finland's newly opened youth gender service described every young person assessed in Tampere between 2011 and 2013. Nearly nine in ten were born female, most had no gender distress in childhood, and three quarters had already needed specialist mental health care. This was often for depression, anxiety, self-harm or autism, and usually began before gender concerns appeared. The largest group developed gender distress in their teens amid wider confusion about who they were, loneliness and high hopes that transition would fix their problems. The authors said this did not match the typical patient the Dutch treatment approach was based on, and that guidelines should take it into account. The study is small and only describes, but it was one of the first to record the changed patient group, and Finland later revised its national guidance.

Key findings

Les 47 adolescents évalués en vue d'une transition de genre au service pour jeunes de Tampere en 2011-2013 ont tous été inclus ; leur âge moyen à l'arrivée était d'environ 16,6 ans.
41 des 47 (87 %) étaient nés filles, une proportion que les auteurs disent ne pas pouvoir expliquer.
75 % avaient été suivis en santé mentale spécialisée pour enfants et adolescents pour des raisons autres que la détresse de genre, et 68 % avaient d'abord consulté les services de santé mentale pour des raisons sans rapport avec le genre.
Les problèmes traités comprenaient la dépression (64 %), l'anxiété (55 %), les idées suicidaires ou l'automutilation (53 %), l'autisme (26 %) et des symptômes psychotiques comme entendre des voix (13 %).
64 % (30 sur 47) n'avaient pas de détresse de genre ni de comportement de l'autre genre dans l'enfance dont eux ou leurs parents se souvenaient, et 62 % ont commencé à s'interroger sur leur genre à 12 ans ou plus.
57 % avaient été gravement harcelés. Dans 73 % de ces cas, le harcèlement avait commencé avant toute préoccupation de genre, surtout pour des raisons sans rapport avec le genre.
Le plus grand groupe (23 sur 47) a développé une détresse de genre à l'adolescence, avec une confusion plus large sur qui ils étaient, de la solitude et de très grands espoirs que la transition résoudrait leurs problèmes.
La solitude et l'isolement social étaient le signe le plus fort d'appartenance à ce groupe : les adolescents isolés avaient environ 9 fois plus de probabilités d'en faire partie.

Abstract

BACKGROUND: Increasing numbers of adolescents present in adolescent gender identity services, desiring sex reassignment (SR). The aim of this study is to describe the adolescent applicants for legal and medical sex reassignment during the first two years of adolescent gender identity team in Finland, in terms of sociodemographic, psychiatric and gender identity related factors and adolescent development. METHODS: Structured quantitative retrospective chart review and qualitative analysis of case files of all adolescent SR applicants who entered the assessment by the end of 2013. RESULTS: The number of referrals exceeded expectations in light of epidemiological knowledge. Natal girls were markedly overrepresented among applicants. Severe psychopathology preceding onset of gender dysphoria was common. Autism spectrum problems were very common. CONCLUSION: The findings do not fit the commonly accepted image of a gender dysphoric minor. Treatment guidelines need to consider gender dysphoria in minors in the context of severe psychopathology and developmental difficulties.

Conclusion

Adolescents seeking sex reassignment represent a variety of developmental pathways differentiated by the timing of onset of gender dysphoria, psychopathology and developmental difficulties. It is important to be aware of the different groups, or developmental pathways, in gender dysphoric adolescents in order to be able to find appropriate treatment options. In the presence of severe psychopathology and developmental difficulties, medical SR treatments may not be currently advisable. Treatment guidelines need to be reviewed extended to appreciate the complex situations.

Methodological limitations

Small group: Only 47 teens (6 born male), which limits comparisons and makes figures less precise. The authors admit the data are too few for complex analyses.
One clinic: Data come from one of Finland's two youth gender services. The claim that the Helsinki service saw similar patients rests on an unpublished personal communication.
Looking back at clinic files: Records were written to care for patients, not for research, and some information was missing.
Earlier diagnoses unclear: Past mental health problems were taken from referral letters and files that often lacked a formal diagnosis. Only problems that led to treatment were counted, so the rates are probably too low.
Childhood relied on memory: Whether a teen had gender distress as a child depended on what they and their parents remembered during assessment, which may be incomplete.
Groupings made by the authors: The five pathways the authors describe were drawn up by the clinic team from case files, with no reported independent check of how cases were sorted.
No comparison group: There was no group of other teen mental health patients to compare with, so it is hard to judge how unusual these profiles are.
Describes, doesn't explain: The study is a single snapshot. It cannot show whether mental health problems cause gender distress or the reverse, and it reports no treatment results.
May not apply elsewhere: It is a Finnish public service with its own laws (legal and surgical transition only from 18). The authors note the findings cannot be applied to all gender-questioning young people.

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Summary

Key findings

Abstract

Conclusion