Conversion Practice Linked to Poor Mental Health Among Sexual, Gender Minority Adults

Nguyen K. Tran, PhD

Credit: Stanford University School of Medicine

A recent study found conversion therapy is linked to poorer mental health.¹

People in the LGBTQ+ community may undergo conversion practice as an effort to change gender identity, sexual orientation, or both through structured psychological, behavioral, physical, and faith-based practices. Many mental health organizations in the US oppose conversion practice, yet prior research showed around 4% to 34% of people who identify as LGBTQ+ undergo this therapy. Transgender individuals have greater rates of conversion therapy than cisgender individuals.

Studies have shown undergoing conversion therapy is linked to mental health conditions, such as depression and suicidal thoughts. However, it was unknown whether the link between conversion therapy and poor mental health applied to those receiving this therapy for sexual orientation or gender identity—or both. Investigators sought to examine the individual and joint association of conversion practice recall.

“Our findings add to a body of evidence that shows conversion practice is unethical and linked with poor mental health,” said lead investigator Nguyen K. Tran, PhD, of Stanford University School of Medicine, in a press release. ² “Protecting LGBTQ+ people from the impacts of these harmful practices will require multi-pronged legislation, including state and federal bans. Additional measures such as support networks and targeted mental health support for survivors are also vital.”

Investigators conducted The PRIDE study, a cross-sectional, US-based, online, prospective cohort study of sexual and gender minority adults who were recruited through social media, digital advertisements, and sexual and gender minority community-based events and organizations.¹ The study included 4426 participants who completed lifetime questionnaire in 2019 – 20 and another questionnaire in 2020 – 21.

Among the sample, 92% identified as White, 10.4% identified as having multiple ethnoracial identities, and 43.4% were transgender and gender diverse. Participants were aged 18 – 84 years, with a mean age of 31.7 years.

The exposure was lifetime recall of conversion practice targeting either gender identity, sexual orientation, or both, compared with those who had no conversion practice. Investigators measured mental health outcomes through the Generalized Anxiety Disorder 7-item scale, Patient Heath Questionnaire 9-item (depression) scale, Post-Traumatic Stress Disorder Checklist 6-term scale, and Suicide Behaviors Questionnaire-Revised Scale.

The study used linear regression to assess the link between conversion practice recall and mental health symptoms. The analysis adjusted for demographic and childhood factors and stratified between cisgender, transgender, and gender-diverse groups. The team also completed sensitivity analyses to assess for potential unmeasured confounders.

In total, 3.4% of participants reported sexual orientation-related conversion practice, 1% reported gender identity-related conversation practice, and 1% reported both orientation-related and gender identity-related conversation practice.

Recalls of both orientation-related and gender identity-related conversation practice were associated with greater post-traumatic stress disorder (95% confidence interval [CI], 0.94 – 4.74) and suicidality (95% CI, 0.95 – 3.32). However, recalls of sexual orientation-related conversion practice alone were most linked to greater PTSD symptoms (95% CI, 0.22 – 1.98), and recalls of gender identity-related conversion were most linked to greater depressive symptoms (95% CI, 1.03 – 5.46).

The team found the only associations for suicidality differed between cisgender, transgender, and gender-diverse participants. However, participants who were gender diverse demonstrated greater mental health symptoms. The sensitivity analysis showed the findings were moderately robust to potential unmeasured confounders.

“Our findings suggest that effective policy interventions may need multi-pronged legislative actions at the federal, state, and local levels, including state and federal bans on conversion practice,” Tran said.² “Educational efforts involving families, religious leaders, and mental health providers are also needed, as are support networks for LGBTQ+ youths and targeted mental health screening to identify and support survivors of conversion practice.”

References

1. ^{Tran, N, Lett, E, Cassese, B, et al. Conversion practice recall and mental health symptoms in sexual and gender minority adults in the USA: a cross-sectional study. The Lancet. 2024. DOI: 10.1016/S2215-0366(24)00251-7}
2. ^{The Lancet Psychiatry: Conversion Practice Linked to Greater Risk of Mental Health Symptoms, Surveys Of LGBTQ+ People In The USA Suggest. EurekAlert! September 30, 2024. https://www.eurekalert.org/news-releases/1059455. Accessed October 1, 2024.}