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Macedo D, McEvoy M, Crowley T, Loughhead M, Procter N. Self-harm and suicidality among trans and gender diverse youth from culturally and linguistically diverse backgrounds-A scoping review. Int J Ment Health Nurs 2024; 33:781-796. [PMID: 38291609 DOI: 10.1111/inm.13291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Revised: 12/10/2023] [Accepted: 01/04/2024] [Indexed: 02/01/2024]
Abstract
Rates of suicidality and self-harm are substantial among trans and gender diverse people, particularly among younger groups. The objective of this scoping review is to explore the state of the research conducted on determinants of mental distress, self-harm and suicidality among trans and gender diverse (TGD) youth from culturally and linguistically diverse (CALD) backgrounds. The Joanna Briggs Institute methodology for scoping reviews was used as a methodology guide. Inclusion criteria for study selection comprehended: publications on the intersectionality between gender non-conformity and cultural and linguistic diversity; focus on a young population (≤25 years of age); publications addressing self-harm and/or suicidality. Searches were conducted on eight databases and a public web search engine and yielded 474 results. Publications were screened and selected by two independent reviewers. Thematic analysis was used to identify key themes overarching the findings. The screening process yielded seven peer-reviewed studies and six research reports based on case studies, retrospective qualitative interviews, cross-sectional and longitudinal survey analyses. The key themes approached in the retrieved literature include: (1) precipitating factors for suicidality; (2) pathways contributing to self-harm and suicidality; and 3) barriers and facilitators for accessing services and mental health care. Practical actions to help mitigate suicidality among TGD youth from CALD backgrounds need to consider the impact of trauma and allow for the development of trust in the therapeutic relationship. Shifts in service delivery and policy formulation are necessary to reduce stigmatisation and potentialise the inclusion of different racial, ethnic, cultural, sexual and gender identity expressions in society.
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Affiliation(s)
- Davi Macedo
- Mental Health and Suicide Prevention Research and Education Group, UniSA, Adelaide, South Australia, Australia
| | - Monica McEvoy
- CAMHS CALD Team, Child and Adolescent Mental Health Service, Adelaide, South Australia, Australia
| | - Tim Crowley
- Complex Care and Trauma Mental Health, CAMHS, Adelaide, South Australia, Australia
| | - Mark Loughhead
- Mental Health and Suicide Prevention Research and Education Group, UniSA, Adelaide, South Australia, Australia
| | - Nicholas Procter
- Mental Health and Suicide Prevention Research and Education Group, UniSA, Adelaide, South Australia, Australia
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Kahn NF, Sequeira GM, Asante PG, Kidd KM, Coker TR, Christakis DA, Karrington B, Aye T, Conard LAE, Dowshen N, Kazak AE, Nahata L, Nokoff NJ, Voss RV, Richardson LP. Estimating Transgender and Gender-Diverse Youth Populations in Health Systems and Survey Data. Pediatrics 2024; 153:e2023065197. [PMID: 38752289 DOI: 10.1542/peds.2023-065197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/22/2024] [Accepted: 02/08/2024] [Indexed: 06/02/2024] Open
Abstract
OBJECTIVES To identify and examine demographic variation in estimates of gender-diverse youth (GDY) populations from the PEDSnet learning health system network and the Youth Risk Behavior Survey (YRBS). METHODS The PEDSnet sample included 14- to 17-years-old patients who had ≥2 encounters at a member institution before March 2022, with at least 1 encounter in the previous 18 months. The YRBS sample included pooled data from 14- to 17-year-old in-school youth from the 2017, 2019, and 2021 survey years. Adjusted logistic regression models tested for associations between demographic characteristics and gender dysphoria (GD) diagnosis (PEDSnet) or self-reported transgender identity (YRBS). RESULTS The PEDSnet sample included 392 348 patients and the YRBS sample included 270 177 youth. A total of 3453 (0.9%) patients in PEDSnet had a GD diagnosis and 5262 (1.9%) youth in YRBS self-identified as transgender. In PEDSnet, adjusted logistic regression indicated significantly lower likelihood of GD diagnosis among patients whose electronic medical record-reported sex was male and among patients who identified as Asian, Black/African American, and Hispanic/Latino/a/x/e. In contrast, in the YRBS sample, only youth whose sex was male had a lower likelihood of transgender identity. CONCLUSIONS GDY are underrepresented in health system data, particularly those whose electronic medical record-reported sex is male, and Asian, Black/African American, and Hispanic/Latino/a/x/e youth. Collecting more accurate gender identity information in health systems and surveys may help better understand the health-related needs and experiences of GDY and support the development of targeted interventions to promote more equitable care provision.
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Affiliation(s)
- Nicole F Kahn
- Seattle Children's Hospital & Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Gina M Sequeira
- Seattle Children's Hospital & Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Peter G Asante
- University of Washington School of Medicine, Seattle, Washington
| | - Kacie M Kidd
- West Virginia University School of Medicine, Morgantown, West Virginia
| | - Tumaini R Coker
- Seattle Children's Hospital & Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Dimitri A Christakis
- Seattle Children's Hospital & Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Baer Karrington
- Seattle Children's Hospital & Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
| | - Tandy Aye
- Stanford School of Medicine, Stanford, California
| | | | - Nadia Dowshen
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | - Natalie J Nokoff
- University of Colorado Anschutz Medical Campus, Aurora, Colorado
| | - Raina V Voss
- Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Laura P Richardson
- Seattle Children's Hospital & Research Institute, Seattle, Washington
- University of Washington School of Medicine, Seattle, Washington
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Masala B, Love A, Carmichael P, Masic U. Demographics of referrals to a specialist gender identity service in the UK between 2017 and 2020. Clin Child Psychol Psychiatry 2024; 29:624-636. [PMID: 37698232 DOI: 10.1177/13591045231202372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/13/2023]
Abstract
Trends in clinical referrals to specialist gender services historically comprised more assigned male at birth young people. In the last decade, this has shifted in adolescent samples to more assigned female young people. An updated review of the current patterns of referrals is important to better understand the potential changing needs of clinically referred gender-diverse children and adolescents. We assessed the demographics of referrals to the Gender Identity Development Service (GIDS) and their attendance patterns from 2017 to 2020. During this period, 9555 referrals were received in total, most were in adolescence (n = 7901, 82.7%), and more assigned female (age range = 1-18 years; M = 14.05; SD = 2.5) were referred than assigned male young people overall (n = 6823, 71.4%). A larger proportion of assigned female adolescents (assigned female: n = 5835, 62.3%, assigned male: n = 1897, 20.3%) and assigned female children (n = 988, 10.6%, assigned male: n = 640, 6.8%) were referred. For 2%, sex assigned at birth was unrecorded, 83.4% were White British and 36.6% had an unidentified ethnicity. Only 4% did not attend a first appointment, indicating the need for care from this specialist service. With more young people presenting to gender services, understanding the demographics of young people seeking gender care is vital for service provision. Future research should explore how to increase access to gender care for ethnic minorities, and how to support those accessing services.
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Affiliation(s)
- Bibi Masala
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Amy Love
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Polly Carmichael
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
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Cooper K, Mandy W, Butler C, Russell A. Phenomenology of gender dysphoria in autism: a multiperspective qualitative analysis. J Child Psychol Psychiatry 2023; 64:265-276. [PMID: 36089890 PMCID: PMC10087378 DOI: 10.1111/jcpp.13691] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/18/2022] [Indexed: 01/17/2023]
Abstract
BACKGROUND Autistic people are overrepresented in gender clinic settings, but limited evidence is available to guide clinical decision making for this patient group. We aimed to generate a comprehensive understanding of the phenomenology of gender dysphoria in autistic people. METHODS We conducted a multi-perspectival interpretative phenomenological analysis (IPA), from five different perspectives; autistic young people and adults with experience of gender dysphoria, parents of young people, and clinicians working with autistic people with gender dysphoria in both adult and young person settings (n = 68). RESULTS IPA analysis resulted in two themes, 'discovering gender identity' and 'the complexities of moving towards gender comfort'. Participants agreed that there was often an interaction between gender dysphoria and features of autism such as sensory sensitivities. There was relative consensus across groups about the need for autism adaptations to be made in gender clinics. Autistic adults were more likely to see autism as an important identity than young people, but both groups were clear that autism did not impair their understanding of gender. In contrast, some parents and clinicians working with young people expressed concern that autism did impact self-understanding. DISCUSSION While the groups tended to agree on the ways in which particular features of autism can compound gender dysphoria, there were a range of perspectives on the ways in which autism impacted on self-knowledge. CONCLUSION Recommendations for adaptations when working with autistic people with gender dysphoria are presented.
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Affiliation(s)
- Kate Cooper
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, UK
| | - William Mandy
- Research Department of Clinical, Educational, and Health Psychology, London, UK
| | | | - Ailsa Russell
- Department of Psychology, Centre for Applied Autism Research, University of Bath, Bath, UK
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Manjra II, Russell I, Maninger JK, Masic U. Service user engagement by ethnicity groups at a children's gender identity service in the UK. Clin Child Psychol Psychiatry 2022; 27:1091-1105. [PMID: 35575622 DOI: 10.1177/13591045221102650] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Gender service utilisation according to ethnicity is largely under-researched. The present research looked at demographics and service user-engagement according to ethnicity of young people accessing a gender service for children. METHOD A total of 2063 (M = 14.19 years, SD = 2.59, assigned male = 556, 1495 assigned female = 1495, no-specification=12) referrals were included in the analysis. Self-defined ethnicity in financial years (FY) 2016-2017, 2018-2019, and referrer-defined ethnicity in FY 2020-2021 were compared between years, to the national UK-population, and child and adolescent mental health service (CAMHS) averages. Numbers of offered, attended and non-attended appointments were compared across the White and the ethnic minority population (EMP). RESULTS Across years 93.35% young people identified as White (higher than the CAMHS and national population averages); 6.65% as EMP. Service utilisation was similar in FY 2016-2017. In FY 2018-2019, the EMP subgroup was offered and attended more appointments compared to the White subgroup, 'did not attended' average was similar. CONCLUSIONS The majority of young people self-identified with a White ethnic-background. Service engagement was comparable between the EMP and White ethnicity subgroups in 2016-2017, while the EMP group was offered and attended more appointments in 2018-2019. Due to the low EMP group numbers, findings need to be interpreted with caution.
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Affiliation(s)
- Ilham I Manjra
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK.,4956Great Ormond Street Hospital NHS Foundation Trust, UK
| | - Ian Russell
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK.,Aldrington House, 8944Sussex Partnership NHS Foundation Trust, UK
| | - Johanna K Maninger
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK
| | - Una Masic
- Gender Identity Development Service, 9705Tavistock & Portman NHS Foundation Trust, UK
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Khadr S, Masic U, Clarke V, Lynn RM, Holt V, Carmichael P. Key socio-demographic characteristics of children and adolescents with gender dysphoria: A British Isles surveillance study. Clin Child Psychol Psychiatry 2022; 27:1106-1123. [PMID: 35746847 DOI: 10.1177/13591045221108840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The present research used linked surveillance systems (British Paediatric Surveillance Unit; and the Child and Adolescent Psychiatry Surveillance System) over a 19 month period (1 November 2011-31 May 2013) to notify of young people (4-15.9 years) presenting to secondary care (paediatrics or child and adolescent mental health services) or specialist gender services with features of gender dysphoria (GD). A questionnaire about socio-demographic, mental health, and GD features was completed. Presence of GD was then assessed by experts in the field using then-current criteria (DSM-IV-TR). Incidence across the British Isles was 0.41-12.23 per 100,000. 230 confirmed cases of GD were noted; the majority were white (94%), aged ≥12 years (75.3%), and were assigned female at birth (57.8%). Assigned males presented most commonly in pre-adolescence (63.2%), and assigned females in adolescence (64.7%). Median age-of-onset of experiencing GD was 9.5 years (IQR 5-12); the majority reported long-standing features (2-5 years in 36.1%, ≥5 years in 26.5%). Only 82.5% attended mainstream school. Bullying was reported in 47.4%, previous self-harm in 35.2%, neurodiversity in 16%, and 51.5% had ≥1 mental health condition. These findings suggest GD is rare within this age group but that monitoring wellbeing and ensuring support for co-occurring difficulties is vital.
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Affiliation(s)
- Sophie Khadr
- Institute of Child Health, 11700University College London, London, UK
| | - Una Masic
- Gender Identity Development Service, 9705Tavistock and Portman NHS Trust, London, UK
| | - Venetia Clarke
- Institute of Child Health, 11700University College London, London, UK
| | - Richard M Lynn
- Institute of Child Health, 11700University College London, London, UK
| | - Victoria Holt
- Child and Adolescent Mental Health Service, 158987Royal Free Hospital, London, UK
| | - Polly Carmichael
- Gender Identity Development Service, 9705Tavistock and Portman NHS Trust, London, UK
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Manjra II, Masic U. Gender diversity and autism spectrum conditions in children and adolescents: A narrative review of the methodologies used by quantitative studies. J Clin Psychol 2021; 78:485-502. [PMID: 34553777 DOI: 10.1002/jclp.23249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 07/06/2021] [Accepted: 09/08/2021] [Indexed: 11/08/2022]
Abstract
AIM This narrative review aimed to analyse the methodologies used by quantitative studies to evaluate their evidence for the association between gender diversity and autism spectrum conditions (ASC) in child and adolescent population samples. METHOD A systematic search was conducted for papers published between 2010 and 2020. RESULTS Fifteen papers met the inclusion criteria; all reported associations between their defined versions of gender diversity and ASC. Gender diversity was characterised as "dysphoria", "variance", and/or "diverse", and was correlated across ASC categories of "symptoms", "traits", or "empathising and systemising styles of thinking". Multiple diagnostic criteria and/or nonspecific, adult administrated measures were used to quantify youth gender experiences and ASCs. CONCLUSION Interpretations of the findings are discussed in relation to critical appraisal of methodologies used including data collection and deduction, the characteristics of the sample population, the usage of comparison groups, and the overall quality of statistical reporting amongst others.
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Affiliation(s)
- Ilham I Manjra
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
| | - Una Masic
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, UK
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Pulice-Farrow L, Gonzalez KA, Lindley L. 'None of my providers have the slightest clue what to do with me': Transmasculine individuals' experiences with gynecological healthcare providers. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 22:381-393. [PMID: 37808533 PMCID: PMC10553369 DOI: 10.1080/26895269.2020.1861574] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Background: Transgender individuals experience barriers to accessing healthcare including financial difficulties, lack of insurance, and discrimination and victimization by medical providers. Transmasculine patients face unique challenges and are more at risk for reproductive pathology resulting from a lack of regular gynecological care. Presently, a dearth of research exists on the needs of transmasculine patients in gynecological healthcare settings. While the literature on experiences of transmasculine individuals has focused on physical health and risk factors for this population, this study focuses on the information that transmasculine individuals want their gynecologists to know when working with trans patients. Aim: The aim of the present study was to explore the lived experiences of transmasculine individuals in order to understand what they feel their medical providers need to know about their experiences seeking gynecological care. Method: Participants included 167 adults who identified as masculine of center or trans men ranging in age from 18 - 56 (M = 27.99, SD = 6.06). Participants completed an online survey and responded to open-ended questions about their gynecological healthcare experiences. Qualitative responses were analyzed via thematic analysis. Results: Results revealed four information-salient themes, including: 1) Patient comfort levels; 2) Language; 3) Provider assumptions; and 4) Provider knowledge. Conclusions: Findings suggest that gynecologists are key in both exacerbating barriers and creating more affirming spaces for transmasculine patients. Discussion of the results focuses on the ways that providers can improve the gynecologic healthcare experiences of their transmasculine patients.
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Affiliation(s)
- Lex Pulice-Farrow
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Kirsten A. Gonzalez
- Department of Psychology, University of Tennessee, Knoxville, Tennessee, USA
| | - Louis Lindley
- Department of Counseling Psychology, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Pang KC, de Graaf NM, Chew D, Hoq M, Keith DR, Carmichael P, Steensma TD. Association of Media Coverage of Transgender and Gender Diverse Issues With Rates of Referral of Transgender Children and Adolescents to Specialist Gender Clinics in the UK and Australia. JAMA Netw Open 2020; 3:e2011161. [PMID: 32721030 PMCID: PMC7388018 DOI: 10.1001/jamanetworkopen.2020.11161] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
IMPORTANCE Specialist gender clinics worldwide have witnessed an increase in referrals of transgender and gender diverse (TGD) children and adolescents, but the underlying factors associated with this increase are unknown. OBJECTIVE To determine whether increases in TGD young people presenting to specialist gender clinics are associated with related media coverage. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study was conducted at 2 publicly funded, pediatric specialist gender services, one located in the UK and the other in Australia. Participants were all children and adolescents aged 0 to 18 years, referred between January 1, 2009, and December 31, 2016, to their respective gender services in the UK and Australia. Data analysis was performed in April 2019. EXPOSURES Media coverage of TGD issues. MAIN OUTCOMES AND MEASURES Referral rates from each gender service were compared with local TGD-related media coverage during the study period. RESULTS Referral data for 5242 TGD young people were obtained (4684 in the UK, of whom 1847 [39.4%] were assigned male at birth and 2837 [60.6%] were assigned female at birth; 558 in Australia, of whom 250 [44.8%] were assigned male at birth and 308 [55.2%] were assigned female at birth), and a total of 2614 news items were identified (UK, 2194; Australia, 420). The annual number of TGD young people referred to both specialist gender clinics was positively correlated with the number of TGD-related local media stories appearing each year (Spearman r = 1.0; P < .001). Moreover, weekly referral rates in both the UK for week 1 (β̂ = 0.16; 95% CI, 0.03-0.29; P = .01) and Australia for week 2 (β̂ = 0.12; 95% CI, 0.04-0.20; P = .003) showed evidence of association with the number of TGD-related media items appearing within the local media. There was no evidence of association between referrals and media items appearing 3 weeks beforehand. Media predominantly focused on TGD issues showed some association with increased referral rates. Specifically, TGD-focused stories showed evidence of association with referral numbers at week 1 (β̂ = 0.16; 95% CI, 0.04-0.28; P = .007) and week 2 (β̂ = 0.23; 95% CI, 0.11-0.35; P < .001) in Australia and with referral numbers at week 1 (β̂ = 0.22; 95% CI, 0.01-0.44; P = .04) in the UK. No evidence of association was found between media peripherally related to TGD issues and referral rates. CONCLUSIONS AND RELEVANCE This study found evidence of an association between increasing media coverage of TGD-related topics and increasing numbers of young people presenting to gender clinics. It is possible that media coverage acts as a precipitant for young people to seek treatment at specialist gender services, which is consistent with clinical experiences in which TGD young people commonly identify the media as a helpful source of information and a trigger to seek assistance.
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Affiliation(s)
- Ken C. Pang
- Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, Australia
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
- Inflammation Division, The Walter and Eliza Hall Institute of Medical Research, Parkville, Australia
| | - Nastasja M. de Graaf
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, the Netherlands
| | - Denise Chew
- Department of Adolescent Medicine, Royal Children’s Hospital, Parkville, Australia
| | - Monsurul Hoq
- Clinical Sciences Theme, Murdoch Children’s Research Institute, Parkville, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Australia
| | - David R. Keith
- Sloan School of Management, Massachusetts Institute of Technology, Cambridge
| | - Polly Carmichael
- Gender Identity Development Service, Tavistock and Portman NHS Foundation Trust, London, United Kingdom
| | - Thomas D. Steensma
- Department of Medical Psychology, Amsterdam UMC, Amsterdam, the Netherlands
- Center of Expertise on Gender Dysphoria, Amsterdam UMC, Amsterdam, the Netherlands
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de Graaf NM, Carmichael P. Reflections on emerging trends in clinical work with gender diverse children and adolescents. Clin Child Psychol Psychiatry 2019; 24:353-364. [PMID: 30482053 DOI: 10.1177/1359104518812924] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
Gender is a fast-evolving and topical field which is often the centre of attention in the media and in public policy debates. The current cultural and social climate provides possibilities for young people to express themselves. Gender diverse young people are not only developing new ways of describing gender, but they are also shaping what is required of clinical interventions. Emerging cultural, social and clinical trends, such as increases in referrals, shifts in sex ratio and diversification in gender identification, illustrate that gender diverse individuals are not a homogeneous group. How do evolving concepts of gender impact the clinical care of gender diverse young people presenting to specialist gender clinics today?
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Affiliation(s)
- Nastasja M de Graaf
- Gender Identity Development Service (GIDS), The Tavistock and Portman NHS Foundation Trust, UK
| | - Polly Carmichael
- Gender Identity Development Service (GIDS), The Tavistock and Portman NHS Foundation Trust, UK
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