Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review
Background UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently ‘detransition’. Aims To describe service users’ access to care and p...
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| Format: | Article |
| Language: | English |
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Cambridge University Press
2021-11-01
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| Series: | BJPsych Open |
| Subjects: | |
| Online Access: | https://www.cambridge.org/core/product/identifier/S205647242101022X/type/journal_article |
| _version_ | 1811156932144136192 |
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| author | R. Hall L. Mitchell J. Sachdeva |
| author_facet | R. Hall L. Mitchell J. Sachdeva |
| author_sort | R. Hall |
| collection | DOAJ |
| description |
Background
UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently ‘detransition’.
Aims
To describe service users’ access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify ‘detransitioning’.
Method
A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and ‘accessing care’ or ‘other outcome’.
Results
The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7–19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1–1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1–17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1–4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning.
Conclusions
Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported.
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| first_indexed | 2024-04-10T04:59:26Z |
| format | Article |
| id | doaj.art-ab57ce411cfe4d64979d9d4c788cf136 |
| institution | Directory Open Access Journal |
| issn | 2056-4724 |
| language | English |
| last_indexed | 2024-04-10T04:59:26Z |
| publishDate | 2021-11-01 |
| publisher | Cambridge University Press |
| record_format | Article |
| series | BJPsych Open |
| spelling | doaj.art-ab57ce411cfe4d64979d9d4c788cf1362023-03-09T12:29:17ZengCambridge University PressBJPsych Open2056-47242021-11-01710.1192/bjo.2021.1022Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note reviewR. Hall0https://orcid.org/0000-0001-5014-6321L. Mitchell1J. Sachdeva2Devon Partnership Trust, UKPlymouth Hospitals Trust, UKDevon Partnership Trust, UK Background UK adult gender identity clinics (GICs) are implementing a new streamlined service model. However, there is minimal evidence from these services underpinning this. It is also unknown how many service users subsequently ‘detransition’. Aims To describe service users’ access to care and patterns of service use, specifically, interventions accessed, reasons for discharge and re-referrals; to identify factors associated with access; and to quantify ‘detransitioning’. Method A retrospective case-note review was performed as a service evaluation for 175 service users consecutively discharged by a tertiary National Health Service adult GIC between 1 September 2017 and 31 August 2018. Descriptive statistics were used for rates of accessing interventions sought, reasons for discharge, re-referral and frequency of detransitioning. Using multivariate analysis, we sought associations between several variables and ‘accessing care’ or ‘other outcome’. Results The treatment pathway was completed by 56.1%. All interventions initially sought were accessed by 58%; 94% accessed hormones but only 47.7% accessed gender reassignment surgery; 21.7% disengaged; and 19.4% were re-referred. Multivariate analysis identified coexisting neurodevelopmental disorders (odds ratio [OR] = 5.7, 95% CI = 1.7–19), previous adverse childhood experiences (ACEs) per reported ACE (OR = 1.5, 95% CI = 1.1–1.9), substance misuse during treatment (OR = 4.3, 95% CI = 1.1–17.6) and mental health concerns during treatment (OR = 2.2, 95% CI 1.1–4.4) as independently associated with accessing care. Twelve people (6.9%) met our case definition of detransitioning. Conclusions Service users may have unmet needs. Neurodevelopmental disorders or ACEs suggest complexity requiring consideration during the assessment process. Managing mental ill health and substance misuse during treatment needs optimising. Detransitioning might be more frequent than previously reported. https://www.cambridge.org/core/product/identifier/S205647242101022X/type/journal_articleTransgendertranssexualgender identitygender dysphoriadetransition |
| spellingShingle | R. Hall L. Mitchell J. Sachdeva Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review BJPsych Open Transgender transsexual gender identity gender dysphoria detransition |
| title | Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review |
| title_full | Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review |
| title_fullStr | Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review |
| title_full_unstemmed | Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review |
| title_short | Access to care and frequency of detransition among a cohort discharged by a UK national adult gender identity clinic: retrospective case-note review |
| title_sort | access to care and frequency of detransition among a cohort discharged by a uk national adult gender identity clinic retrospective case note review |
| topic | Transgender transsexual gender identity gender dysphoria detransition |
| url | https://www.cambridge.org/core/product/identifier/S205647242101022X/type/journal_article |
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