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Abstract
Objectives Conversion is a term for treatments that seek to suppress or change a person’s sexual orientation or gender. Our review focuses on transgender and gender-diverse (TGD) people. Our aims were to (1) describe the frequency, nature and structure of conversion practices; (2) document difficulties in accessing transition-related healthcare and (3) evaluate the mental health consequences of such practices and access barriers.
Method Systematic review and narrative synthesis using the Critical Appraisals Skills Programme and Joanne Briggs Institute critical appraisal tools. Data sources include Embase, MEDLINE, PsychINFO, PsychARTICLES and Web of Science between 1990 and June 2017.
Participants Studies were included that (1) document use of conversion therapies or access barriers to transition-related healthcare; and/or (2) describe how such therapeutic practices and access barriers have been applied and/or (3) evaluate the mental health impacts of such therapies and difficulties accessing transition-related healthcare. Two reviewers screened papers for eligibility. Data were then grouped according to the objectives. Narratives and themes were presented per study.
Results Seven studies met inclusion criteria. Four reports were on ‘realignment’, involving case studies or case series. Two involved psychoanalysis, one self-exposure therapy and one open-ended play psychotherapy. All four studies concerning ‘realignment’ were of poor methodological quality. The other three studies explored access barriers from the view point of TGD youth, their parents and healthcare providers. All papers reported access barriers, such as inability to access puberty-delaying medications. The papers concerning barriers to access were of good methodological quality.
Conclusion We found limited published evidence on use, nature, structure and/or health consequences of conversion therapies and access barriers to transition in TGD people. However, reports of restriction to access may indicate a more widespread problem. Research is needed into TGD people’s experiences of conversion therapy and access barriers to transition-related healthcare
Trial registration number CRD42017062149.
- Sexual And Gender Disorders
- Mental Health
- Psychiatry
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Footnotes
Patient consent for publication Not required.
Contributors MK conceived the original idea for the review, which was refined with the other authors. TW derived the search terms and strategy with assistance from BC and MK. TW undertook the review, screening and assessment of papers with assistance from BC and MK on inclusion of papers. TW wrote the first draft of the paper and all authors contributed to the final version.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests Not declared.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement No technical appendix, statistical code, and/or dataset available from the Dryad repository, as this review does not have raw data to share.