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A national transgender health survey from China assessing gender identity conversion practice, mental health, substance use and suicidality

Nature Mental Health volume 1, pages 254–265 (2023)Cite this article

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Abstract

Gender identity conversion practice (GICP) refers to interventions that intend to alter an individual’s gender identity that is incongruent with societal expectations based on the sex assigned at birth. In this study, the term GICP refers to both professional conversion efforts (also called Gender Identity Conversion Efforts, GICE, performed by psychologists, psychiatrists and so on) and non-professional conversion efforts (performed by family members and so on). Here data were analysed from the Chinese Transgender Health Survey covering transgender, nonbinary and gender diverse (TNG) adolescents and adults, with 7,576 respondents from mainland China entering the analysis following the application of exclusion criteria. Results showed that GICP is a risk factor for multiple mental health problems including depression, anxiety, post-traumatic stress disorder symptoms, suicidal ideation and suicidal plan in the previous 12 months, suicide attempts in both the previous 12 months and in lifetime, non-suicidal self-injury in the previous 12 months, and alcohol use. Participants with experience of professional GICP reported suicide attempts more frequently than those with experience of non-professional GICP. Compared with other age groups, GICP tended to associate with more severe mental health problems in TNG aged ≤17 years old. Evidence suggests that GICP worsens the mental health problems faced by the TNG population (especially adolescents) and reveals the equivalent detrimental effects from both professional GICP and non-professional GICP. It is necessary for the public to become more aware of the devastative impact of GICP on the TNG population.

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Fig. 1: Types of GICP.
Fig. 2: Comparison of mental health problems between professional GICP and non-professional GICP.

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Data availability

Data are not publicly available due to their containing information that could compromise research participant privacy/consent. Data will be made available only to potential collaborators with ethical approval after they submit a research proposal application by contacting the corresponding authors.

Code availability

SPSS code for data analysis and R code for the adjustment of P-values are available upon request to the corresponding authors.

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Acknowledgements

We especially thank Beijing LGBT+ for their support and enthusiasm in study promotion and data collection. We thank all the participants for their contribution to this study.

Author information

Author notes

  1. These authors contributed equally: Yuanyuan Wang, Meng Han.

Authors and Affiliations

  1. Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China

    Yuanyuan Wang

  2. Vanke School of Public Health, Tsinghua University, Beijing, China

    Meng Han, Yanwen Zhang, Yinzhe Wang, Zimo Huang & Runsen Chen

  3. Institute for Healthy China, Tsinghua University, Beijing, China

    Meng Han & Runsen Chen

  4. Graduate School of Education, University of Pennsylvania, Philadelphia, PA, USA

    Yinzhe Wang

  5. Faculty of Arts and Sciences, NYU Shanghai, Shanghai, China

    Gu Li

  6. Center for Global Healthy Equity, NYU Shanghai, Shanghai, China

    Gu Li

  7. NYU-ECNU Institute for Social Development, NYU Shanghai, Shanghai, China

    Gu Li

  8. Computational Communication Collaboratory, School of Journalism and Communication, Nanjing University, Nanjing, China

    Zhihao Ma

  9. Department of Psychiatry, National Clinical Research Center for Mental Disorders, and China National Technology Institute on Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China

    Jianjun Ou

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Contributions

Y.W., M.H., J.O., G.L., Z.M. and R.C. designed the study. M.H. and Y.Z. conducted the statistical analyses and cross-checked the analyses. Yuanyuan W., M.H., Y.Z. and Yinzhe W. wrote the first draft of the manuscript. G.L., Z.H. and Z.M. provided critical input to the interpretation of the analyses. R.C. and J.O. are the principal investigators, providing resources and supervising all aspects of the project. All authors contributed to the interpretation of the analyses and the review and editing of the manuscript, and approved the submission of the final version.

Corresponding authors

Correspondence to Jianjun Ou or Runsen Chen.

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The authors declare no competing interests.

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Nature Mental Health thanks the anonymous reviewers for their contribution to the peer review of this work.

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Extended Data

Extended Data Fig. 1 Bar chart of age differences.

Age differences of the item ‘Who recommend or force you into gender identity conversion practice’.

Extended Data Fig. 2 Comparison of mental health problems associated with gender identity conversion practice among different age groups.

Note: PTSD: post-traumatic stress disorder. Asterisks indicate differences between age groups. The analysis used a Pearson’s χ2 test with a statistical significance level of 5% for a two-sided test. Significance levels were adjusted for FDR.

Extended Data Fig. 3 Distribution map of birth place of TNG participants.

The figure visually shows the distribution of participants' birthplaces in different province-level administrative divisions in Mainland China.

Extended Data Fig. 4 Distribution map of current residence of TNG participants.

The figure visually shows the distribution of participants' current living places in different province-level administrative divisions in Mainland China.

Extended Data Table 1 Prevalence of gender identity conversion practice estimated with univariate and multivariate logistic regression models
Full size table
Extended Data Table 2 Characteristics of the study population by professional and non-professional gender identity conversion practice response.
Full size table
Extended Data Table 3 Age group differences of mental health and substance use among who exposure to gender identity conversion practice
Full size table

Supplementary information

Supplementary Information

Supplementary Tables 1–3 and Figs. 1–4.

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Wang, Y., Han, M., Zhang, Y. et al. A national transgender health survey from China assessing gender identity conversion practice, mental health, substance use and suicidality. Nat. Mental Health 1, 254–265 (2023). https://doi.org/10.1038/s44220-023-00041-z

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