Summary

Researchers paid by NHS England for the Cass Review (a review of youth gender services) studied anonymised GP records from 2011 to 2021. They found 3,782 under-19s with a recorded diagnosis of gender dysphoria (distress about a mismatch between body and felt gender), and compared them with young people with autism or eating disorders. Recorded cases rose about 50-fold over the decade, to 8.3 per 10,000 overall and 42 per 10,000 among 17 and 18 year olds. By 2021, about twice as many girls as boys had a record. Over half (52.7%) had a record of anxiety, depression or self-harm, and depression and self-harm were more common than in the comparison groups. Few hormone prescriptions showed up in GP records. The authors call for better mental health support and GP guidance. It only counts what GPs wrote down, so it cannot show true numbers or explain the rise.

Key findings

• Từ 2011 đến 2021, tỷ lệ người từ 0 đến 18 tuổi có chẩn đoán phiền muộn giới trong hồ sơ bác sĩ gia đình ở Anh tăng từ 0,16 lên 8,3 trên 10.000, cao hơn hơn 50 lần.
• Số chẩn đoán mới mỗi năm tăng từ 0,14 lên 4,4 trên 10.000 người trẻ, tăng mỗi năm trừ năm 2020, năm đầu tiên của đại dịch COVID-19.
• Bé trai và bé gái có tỷ lệ tương tự nhau cho đến khoảng năm 2015; sau đó tỷ lệ ở các bé gái tăng nhanh hơn, và đến năm 2021 cao gấp khoảng hai lần ở các bé gái.
• Chẩn đoán hiếm gặp trước 11 tuổi và phổ biến nhất ở tuổi 17 và 18, khi khoảng 1 trên 240 người (42 trên 10.000) có hồ sơ vào năm 2021.
• Hơn một nửa (52,7%) có ghi nhận về lo âu, trầm cảm hoặc tự làm hại bản thân. Lo âu phổ biến ngang với những người trẻ mắc chứng tự kỷ hoặc rối loạn ăn uống, nhưng trầm cảm và tự làm hại bản thân phổ biến hơn, đặc biệt ở bé trai.
• Chỉ 4,7% được bác sĩ gia đình kê đơn thuốc chặn dậy thì (thuốc làm tạm dừng quá trình dậy thì) và 8,0% được kê hormone khác giới, có thể do thời gian chờ chăm sóc chuyên khoa kéo dài và việc điều trị được ghi nhận ở nơi khác.
• Tỷ lệ không có mối liên hệ rõ ràng với mức độ nghèo hay giàu của khu vực địa phương.

Abstract

Objective To examine trends in diagnosis of gender dysphoria and related conditions in children and young people attending primary care practices in England. Design Longitudinal analysis of electronic primary care records from the Clinical Practice Research Datalink (CPRD) Aurum database linked to hospital and Index of Multiple Deprivation data. Setting Primary care practices in England between 2011 and 2021. Participants 3782 patients aged 0–18 years with a recorded history of gender dysphoria/incongruence and matched comparators with autism spectrum conditions or eating disorder. Main outcome measures Incidence rates and prevalence of gender dysphoria/incongruence; prescribing rates for medical treatments; co-occurrence of anxiety, depression and self-harm. Results Between 2011 and 2021, incidence rates of recorded gender dysphoria/incongruence increased from 0.14 (95% CI 0.08 to 0.20) to 4.4 (95% CI 4.1 to 4.7) per 10 000 person years, and from 2014 the rate increased more rapidly in recorded females than males. There was no significant association between gender dysphoria/incongruence and area level deprivation. Of the 3782 children and young people with a record of gender dysphoria/incongruence, 176 (4.7%) were prescribed puberty suppressing hormones; 302 (8.0%) were prescribed masculinising/feminising hormones; and 1994 (52.7%) had a record of anxiety, depression or self-harm. Compared with matched comparators, those experiencing gender dysphoria/incongruence had similar recorded rates of anxiety and higher rates of depression and self-harm. Conclusions Recorded prevalence of gender dysphoria/incongruence increased substantially in children and young people between 2011 and 2021, particularly in recorded females. Levels of anxiety, depression and self-harm were high, indicating an urgent need for better prevention and treatment of mental health difficulties in these children.

Conclusion

The NHS in England is implementing a series of reforms in response to the Cass Review into gender identity services for children and young people, including introducing new service models and collaborative care arrangements. Our study provides information on trends in recording of gender dysphoria/incongruence and common co-occurring conditions in primary care, and can help to inform the development of local and national services. These developments should include appropriate support and guidance for primary care services, which will frequently be the first point of contact and will be responsible for coordinating care, often in the context of lengthy waits for specialist assessment. Local support networks will need to be robust as, despite the rapid increase in recorded prevalence over the last decade, gender dysphoria/incongruence remains uncommon under the age of 19 and direct clinical experience for most general practice staff is likely to remain limited. Levels of observed anxiety and depression have been increasing in children and young people in general over the last two decades for complex and contested reasons, challenging health, education and social services, and those experiencing gender dysphoria/incongruence are at particular risk. Future research should address the aetiology, pathways to diagnosis and interactions of these conditions, and explore other mental health issues and adverse social circumstances not examined in this study. Our findings highlight the need to provide comprehensive assessments, which should include screening for co-occurring conditions, of children and young people experiencing gender dysphoria/incongruence when they present to primary care, and where appropriate, for effective, coordinated interventions, supported by timely secondary and tertiary care, to address their wider mental health needs.