사회적으로 전환한 아동이 자가 보고한 정신 건강은 거의 보통 수준 - 지지적이고 부유한 가정의 표본에서

사회적으로 전환한 트랜스젠더 청소년의 정신 건강과 자기 가치

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

사회적으로 전환한 9~14세 트랜스 아동 63명, 짝지은 아동 63명, 형제자매 38명이 짧은 설문지로 자신의 우울과 불안을 평가했습니다.
우울은 집단 간에 차이가 없었고, 트랜스 아동의 점수는 미국 평균과 비슷했습니다.
트랜스 아동은 불안을 약간 더 많이 보고했지만 차이는 우연일 수 있었습니다. 부모는 다른 아동보다 분명히 더 많은 불안을 보고했고 미국 평균보다 높았습니다.
6~14세 트랜스 아동 116명의 자존감은 다른 아동이나 형제자매와 차이가 없었습니다.
트랜스 아동의 부모는 아동 본인보다 불안을 약간 더 많이 보고했는데, 저자들은 이를 부모가 문제를 숨기지 않았다는 신호로 받아들였습니다.
가족들은 지지 모임, 여름 캠프, 트랜스 아동 가족을 위한 온라인 포럼을 통해 찾았고, 고소득인 경우가 훨씬 더 많았습니다.
저자들은 사회적 전환이 결과를 일으켰다고 결론지을 수 없으며, 아동이 자라면서 문제가 나타날 수 있다고 말합니다.

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