Summary

Clinicians from a new gender service at a Sydney children's hospital describe the first 79 children and teens they assessed. Most were struggling: about four in ten had thought about suicide, six in ten had anxiety or depression, and one in seven was autistic. Family histories often included conflict, a parent with mental illness, separation from someone close, bullying, and abuse or neglect. The team also describes how hard it is to work in a polarised climate. This included pressure to drop a whole-person assessment of body, mind and family, and the difficulty of telling gender distress apart from anxiety, depression or sexual abuse. The authors call for mental health care that takes past trauma into account. It is a useful account from a hospital team, but it describes one clinic's patients with no comparison group, and the figures rest on the team's own assessments.

Key findings

• 8~15세 아동·청소년 79명이 뉴사우스웨일스주의 새로 설립된 성별 서비스에서 평가를 받았습니다. 출생 성별로 남아 1명당 여아가 약 1.4명이었습니다.
• 42%가 자살을 생각했고, 16%가 자해했으며, 10%가 자살을 시도했습니다.
• 다른 상태도 흔했습니다. 불안 63%, 우울 62%, 행동 문제 35%, 자폐 14%였습니다.
• 힘든 어린 시절 경험이 잦았습니다. 가족 갈등 66%, 정신질환이 있는 부모 63%, 이별로 가까운 사람을 잃음 60%, 괴롭힘 54%였습니다.
• 아동의 39%는 학대나 방임의 이력이 있었습니다.
• 임상의들은 전인적 접근을 포기하라는 압력, 안전에 대한 걱정, 성별 불쾌감을 불안, 우울, 성적 학대와 구별하기 어려움을 보고했습니다.
• 저자들은 성별과 관련된 고통과 함께 해결되지 않은 트라우마와 상실을 다루는 진료를 권고합니다.

Abstract

This prospective study examines the clinical characteristics of children (n = 79; 8.42–15.92 years old; 33 biological males and 46 biological females) presenting to a newly established, multidisciplinary Gender Service in New South Wales, Australia, and the challenges faced by the clinicians providing clinical services to these patients and their families. The clinical characteristics of the children were comparable to those described by other paediatric clinics providing gender services: a slight preponderance of biological females to males (1.4: 1); high levels of distress (including dysphoria about gender), suicidal ideation (41.8%), self-harm (16.3%), and suicide attempts (10.1%); and high rates of comorbid mental health disorders: anxiety (63.3%), depression (62.0%), behavioural disorders (35.4%), and autism (13.9%). The developmental stories told by the children and their families highlighted high rates of adverse childhood experiences, with family conflict (65.8%), parental mental illness (63.3%), loss of important figures via separation (59.5%), and bullying (54.4%) being most common. A history of maltreatment was also common (39.2%). Key challenges faced by the clinicians included the following: the effects of increasingly dominant, polarized discourses on daily clinical practice; issues pertaining to patient and clinician safety (including pressures to abandon the holistic [biopsychosocial] model); the difficulties of untangling gender dysphoria from comorbid factors such as anxiety, depression, and sexual abuse; and the factual uncertainties present in the currently available literature on longitudinal outcomes. Our results suggest the need to bring into play a biopsychosocial, trauma-informed model of mental health care for children presenting with gender dysphoria. Ongoing therapeutic work needs to address unresolved trauma and loss, the maintenance of subjective well-being, and the development of the self.

Conclusion

Our results suggest the need to bring into play a biopsychosocial, trauma-informed model of mental health care for children presenting with gender dysphoria. Ongoing therapeutic work needs to address unresolved trauma and loss, the maintenance of subjective well-being, and the development of the self.