People identifying as LGBTQ+ who have undergone conversion practice – commonly known as conversion therapy – are more likely to experience poor mental health.
This is according to a study – “Global, regional, and national burden of stroke and its risk factors, 1990–2021: a systematic analysis for the Global Burden of Disease Study 2021” by Nguyen K Tran, Elle Lett, Barbara Cassese, et al – that appeared in The Lancet Psychiatry.
The researchers used data from participants of The PRIDE Study, a long-term health study of LGBTQ+ people in the US; they completed questionnaires about their experiences of conversion practice, if any, and mental health.
Conversion practice is a formal, structured attempt to alter a person’s sexual orientation, gender identity, or gender expression. It often involves psychological, behavioral, physical, and faith-based practices.
When looking at conversion practices aimed only at sexual orientation or practices aimed at both, cisgender and transgender people have a similarly increased likelihood of experiencing symptoms of depression and PTSD. Suicidal thoughts or attempts were higher in cisgender participants subjected to both types of practices than in transgender participants, though it is unclear why, and more research is needed.
Despite widespread opposition from professional medical and mental health organizations, conversion practice still occurs in parts of the US. How often it is practiced in the USA remains unclear – previous research suggests it may be between 4% and 34% of LGBTQ+ people – but significant numbers of LGBTQ+ people report experiencing conversion practice, with rates higher among transgender people compared to cisgender people. It remains legal in many parts of the world, including the UK, parts of Central and Eastern Europe, Asia, and Africa.
Previous research suggests that undergoing conversion practice is linked with mental health conditions, such as depression and suicidal thoughts and attempts. Until now, no studies have examined if the mental health impacts of efforts to alter an individual’s sexual orientation differ from those attempting to change someone’s gender identity. Little was also known about how the effects of these different practices differ between cisgender – people who identify as the sex they were assigned at birth – and transgender people.
The study’s findings included:
- Of the 4,426 participants, 149 (3.4%) had experienced conversion practice aimed at altering their sexual orientation, 43 (1%) had undergone practices targeting gender identity, and 42 (1%) reported both.
- Participants who had been subjected to conversion practice targeting both their gender identity and sexual orientation had the greatest symptoms of depression, PTSD, and suicidal thoughts or attempts.
- Some participants reported being subjected to conversion practice more than others. These included transgender participants, people experiencing homelessness, and those with lower levels of education.
- The practices were also more commonly reported among people with religious upbringings, those raised in communities not accepting of their gender identity, and participants from minority ethnic backgrounds.
- Cisgender and transgender participants who had undergone conversion practice had a similarly increased likelihood of depression and PTSD. Neither had increased symptoms of anxiety.
- Cisgender participants who had undergone both types of conversion practice had a greater risk of suicidal thoughts or attempts than transgender participants.
- Conversion practice aimed at altering an individual’s sexual orientation was most often delivered by a religious leader or organization (52%, 100/191 participants), followed by a mental health provider or organization (29%, 55/191).
- Practices targeting participants’ gender identity were most commonly delivered by mental health care providers or organizations (54%, 46/85 participants), followed by a religious leader or organization (33%, 28/85) and both (13%, 11/85).
“Our findings add to a body of evidence that shows conversion practice is unethical and linked with poor mental health. 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,” said Tran.
Tran added that ““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. 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.”
Writing in a linked Comment, Jack Drescher, MD, Clinical Professor of Psychiatry at Columbia University Medical Center (USA), who was not involved in the study, said: “An important message… is that mainstream mental health organizations need to do a better job of regulating the activities of those outlier, licensed clinicians who engage in conversion practices… professional organizations’ ethical guidelines should mirror and integrate the wider world’s changing cultural beliefs and values regarding the growing acceptance of diverse sexual orientations and gender identities.”
He added that “rather than unwarranted and unhelpful clinical preoccupations with asking why a patient has the sexual orientation or gender identity that they are reporting, it is more clinically useful to ask how to help such individuals more openly and adaptively live their lives, while always keeping in mind the medical dictum to first do no harm.”
