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Gender congruence and psychiatric morbidity after gender-affirming health care: Relation to childhood adversities and adult stressful life events

Dhejne, C1; Görts Öberg, K2; Arver, S3; Kardell, M4; Werner, S5; Landén, M6

1: ANOVA, Karolinska University Hopsital and Department of Medicine/Hudding, Karolinska Institutet, Stockholm Sweden; 2: ANOVA, Karolinska University Hopsital and Department of Medicine/Huddinge, Karolinska Institutet, Stockholm Sweden; 3: ANOVA, Karolinska University Hopsital and Department of Medicine/Huddinge, Karolinska Institutet, Stockholm Sweden; 4: Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg sweden; 5: Department of Medicine/Huddinge, Karolinska Institutet; 6: Institute of Neuroscience and Physiology, Sahlgrenska University Hospital, Gothenburg, and Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden

Objectives: Studies have reported a high risk of psychiatric morbidity after gender-confirming health care, but there is a dearth of studies evaluating gender congruence after these interventions. The aims were to study gender congruence after gender-confirming health care and to evaluate whether childhood adversities or adult stressful life events predict psychiatric morbidity post transition.
Material and Methods: Sixty-five individuals (16 men assigned female at birth, and 49 women assigned male at birth) were evaluated after gender-confirming health care. The mean (SD) follow-up time was 7.2 (7.3) years with a median of 4.3 (range 0.75–30.5) years. We assessed experienced gender congruence, clinical global improvement (GCI-I), psychiatric morbidity, suicidal attempts, and experiences of childhood adversities and adult stressful life events.
Results: All 16 men felt gender congruent post transition as compared with 41 out of 46 (89.1%) women. The median GCI-I score was 6 (equals “much improved”), with no significant gender difference. In men and women combined, 23 out of 64 (35.9%) had made a suicide attempt prior to transition, and 8 out of 64 (12.5%) made a suicide attempt post transition. Sixteen out of 65 (24.6%) subjects met criteria for any current psychiatric diagnosis, and 27 out of 65 (41.5%) subjects met criteria for any lifetime psychiatric diagnosis. Fifty-nine out of 65 (90.8%) reported at least one childhood adversity and/or adult stressful life event. Some childhood adversities swas reported by more than three quarters of the participants. Childhood sexual abuse was reported by nine of 64 (14%). At least one adult stressful life event was reported by more than three quarters of the participants. Predictors (OR [95% CI]) of current psychiatric morbidity were being born abroad (18.3 [1.9–176]), childhood maltreatment and/or childhood sexual abuse (12.3 [2.0–78]), and not being accepted in the assigned gender (9.0 [1.5–52]).
Conclusion: The findings support the view that gender-confirming health care improve gender dysphoria, and gender incongruence. Predictors for psychiatric morbidity after transition were immigrant status, childhood maltreatement/childhood sexual abuse and trans specific not being accepted in the assigned gender. The results stress the importance of continued access to psychiatric care after gender-confirming health care for those in need.


Disclosure:

Work supported by industry: no.

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