Trẻ em đã chuyển giới xã hội tự báo cáo sức khỏe tâm thần gần như bình thường, trong mẫu gia đình ủng hộ và khá giả

Sức khỏe tâm thần và giá trị bản thân ở thanh thiếu niên chuyển giới đã chuyển giới xã hội

Nghiên cứu thuần tập & sổ bộ Không còn cảm thấy phiền giới ở trẻ em Sức khỏe tâm thần & tự sát

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 trẻ chuyển giới xã hội từ 9–14 tuổi, 63 trẻ được ghép cặp và 38 anh chị em đã tự đánh giá trầm cảm và lo âu của mình bằng các bảng câu hỏi ngắn.
Trầm cảm không khác biệt giữa các nhóm, và điểm của trẻ chuyển giới phù hợp với mức trung bình của Hoa Kỳ.
Trẻ chuyển giới báo cáo lo âu nhiều hơn một chút, mặc dù sự khác biệt có thể là ngẫu nhiên; phụ huynh báo cáo lo âu nhiều hơn rõ rệt so với những trẻ khác, và cao hơn mức trung bình của Hoa Kỳ.
Giá trị bản thân của 116 trẻ chuyển giới từ 6–14 tuổi không khác với những trẻ khác hoặc với anh chị em của chúng.
Phụ huynh của trẻ chuyển giới báo cáo lo âu nhiều hơn một chút so với chính các em, điều mà các tác giả coi là dấu hiệu cho thấy phụ huynh không che giấu vấn đề.
Các gia đình được tìm thấy qua các nhóm hỗ trợ, trại hè và diễn đàn trực tuyến dành cho gia đình có trẻ chuyển giới, và có thu nhập cao thường xuyên hơn nhiều.
Các tác giả cho biết họ không thể kết luận rằng chuyển giới xã hội đã gây ra các kết quả, và các vấn đề có thể xuất hiện khi trẻ lớn hơn.

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