Characteristics of children and adolescents with gender dysphoria for their health care: scoping review
DOI:
https://doi.org/10.26694/reufpi.v13i1.4281Keywords:
Gender dysphoria, Health professionals, Child, Adolescent, PediatricsAbstract
Objective: To identify the demographic and psychosocial characteristics of children and adolescents with gender dysphoria and of the health professionals involved in their care. Methods: Scoping review according to PRISMA-ScR with the databases Web of Science, Science Direct, Scopus, Virtual Health Library and Pubmed, using the descriptors: children, adolescents, gender dysphoria, pediatrics and health professionals. Inclusion criteria: primary and secondary research on gender dysphoria and sexual diversity in health care, with students or health professionals. Exclusion criteria: adult population, other context of health care, treatments, comorbidities and gray publication. Fifteen articles were included. Results: Children present with dysphoria around 6 years of age, with late diagnosis and treatment. They have a greater tendency toward mental health problems such as anxiety, depression and eating disorders, and family support is crucial. Health professionals have low undergraduate training, scarce continuous training and multidisciplinary work. Conclusion: It is necessary to incorporate subjects on diversity, gender identity and dysphoria into the training of health professionals, as well as continuous training with tools that allow a comprehensive approach, increasing confidence and security in the provider-patient relationship, in order to improve the well-being of children.
References
Ministry of Health (CL). Undersecretariat of Public Health. Recommendations for the implementation of the program of accompaniment for children and adolescents tran and gender nonconforming. Santiago: Ministry of Health; 2021. Available from: https: //diprece.minsal.cl/wp-content/uploads/2021/05/RECOMENDACIONES-PARA-LA-IMPLEMENTACION-DEL-PROGRAMA-DE-ACOMPANAMIENTO-PARA-NINOS-NINAS-Y-ADOLESCENTES-TRANS-Y-GENERO-NO-CONFORME.pdf
World Health Organization (WHO). Sexual Health [Internet]. Available from: https://www.who.int/es/health-topics/sexual-health
García-Leiva P. Gender Identity: Explanatory Models. Escr Psicol [Internet]. 2005;(7):71–81. Available from: https://dialnet.unirioja.es/servlet/articulo?codigo=1710824
Olivera AGC, Vilaça AF, Gonçalves DT. From transsexuality to gender dysphoria – approach protocol and guidance in primary health care. Rpmgf [Internet]. 2019;35(3):210-22. DOI: http://dx.doi.org/10.32385/rpmgf.v35i3.12105
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 5a ED. Washington, DC: Panamericana; 2014. Available from: https://www.bibliopsi.org/docs/guia/DSM%20V.pdf
ICD-11 for mortality and morbidity statistics [Internet]. Who.int. Available from: https://icd.who.int/browse11/l-m/en#/http%3A%2F%2Fid.who.int%2Ficd%2Fentity%2F411470068
Robles R, Fresán A, Vega-Ramírez H, Cruz-Islas J, Rodríguez-Pérez V, Domínguez-Martínez T, et al. Removing transgender identity from the classification of mental disorders: a Mexican field study for ICD-11. Lancet Psychiatry [Internet]. 2016;3(9):850–9. DOI: https://doi.org/10.1016/S2215-0366(16)30165-1
National Association of Transvestites and Transsexuals. (2023). Technical note on access to healthcare for transgender children: from the transpathologizing model to transspecific care. Brazil: ANTRA. Available from: https://antrabrasil.files.wordpress.com/2023/06/nota-tecnica-criancas-trans-antra.pdf
Reilly M, Desousa V, Garza-Flores A, Perrin EC. Young children with gender nonconforming behaviors and preferences. J Dev Behav Pediatr. [Internet]. 2019;40(1):60–71. DOI: https://doi.org/10.1097/DBP.0000000000000612
Wylie K, Knudson G, Khan SI, Bonierbale M, Watanyusakul S, Baral S. Serving transgender people: clinical care considerations and service delivery models in transgender health. Lancet [Internet]. 2016;388(10042):401–11. DOI: http://dx.doi.org/10.1016/S0140-6736(16)00682-6
Robles Garcia R, Ayuso-Mateos JL. ICD-11 and the depathologization of the transgender condition. Rev Psiquiatr Salud Ment (English Ed.) [Internet]. 2019;12(2):65–7. DOI: http://dx.doi.org/10.1016/j.rpsm.2019.01.002
Garriga i Setó C. The concept of gender in the history of psychoanalysis and its clinical implications. Brocar Cuad Investig Hist. [Internet]. 2011;(35):117-56. DOI: https://doi.org/10.18172/brocar.1598
Serón T, Catalán M. Gender Identity and Mental Health. Rev. chil. neuro-psiquiatr. [Internet]. 2021; 59(3): 234-247. DOI: http://dx.doi.org/10.4067/s0717-92272021000300234
Zaliznyak M, Yuan N, Bresee C, Freedman A, Garcia MM. How early in life do Transgender Adults Begin to Experience Gender Dysphoria? Why This Matters for patients, providers, and for Our Healthcare System. Sex Med. [Internet]. 2021;9(6):100448. DOI: http://dx.doi.org/10.1016/j.esxm.2021.100448
Sumia M, Lindberg N, Työläjärvi M, Kaltiala-Heino R. Current and recalled childhood gender identity in community youth in comparison to referred adolescents seeking sex reassignment. J Adolesc [Internet]. 2017;56(1):34–9. DOI: http://dx.doi.org/10.1016/j.adolescence.2017.01.006
Mariano TSO, Moretti-Pires RO. Gender dysphoria in children: integrative literature review and recommendations for management in Primary Health Care. Rev Bras Med Fam Comunidade. [Internet]. 2018;13(40):1–11. DOI: https://doi.org/10.5712/rbmfc13(40)1653
Di Grazia M, Sammartano F, Taverna C, Knowles A, Trombetta C, Barbone F. Epidemiologic considerations on gender incongruence in adults, adolescents and children and mental health issues: A review of the literature. Sexologies. [Internet]. 2021;30(1): e61–75. DOI: https://doi.org/10.1016/j.sexol.2020.12.003
Librery of the National Congress. Law 12120 Recognizes and gives protection to the right to gender identity. Ministry of Justice and Human Rights [Internet]. Available from: https://www.bcn.cl/leychile/navegar?idNorma=1126480
Report on survey t: 1st survey for trans and gender non-conforming people in Chile. Executive summary. Santiago, Chile; 2017. Available from: https://otdchile.org/wp-content/uploads/2020/05/Informe_ejecutivo_Encuesta-T.pdf
Chambergo-Michilot D. Diaz-Barrera ME, Benites-Zapata VA. Scope reviews, reviews umbrella and review-focused synthesis of maps: methodological aspects and applications. Rev Peru Med Exp. Public Health 2021;38(1):136-42. DOI: https://doi.org/10.17843/rpmesp.2021.381.6501
PRISMA. Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews: PRISMA-ScR, Checklist. 2019. Available from: http://www.prisma-statement.org/documents/PRISMA-ScR-Fillable-Checklist_11Sept2019.pdf
Critical Appraisal Skills Programme Español (CASPe.). Case Control Study analysis Tool. Alicante, España; 2016.
PRISMA. PRISMA 2020 flow diagram for new systematic reviews which included searches of databases and registers only. Available from: http://www.prisma-statement.org/PRISMAStatement/FlowDiagram
Davis J, Hequembourg A, Paplham P. School-based nurse practitioners’ perceptions of the health care needs of transgender and gender nonconforming adolescents. J Sch Nurs [Internet]. 2021;10598405211017124. DOI: http://dx.doi.org/10.1177/10598405211017125
Soll BMB, Fontanari AM, Brandelli Costa A, Chinazzo Í, Silva DC, Guadagnin F, et al. Descriptive study of transgender youth receiving health care in the Gender Identity Program in southern Brazil. Front Psychiatry [Internet]. 2021;12:627661. DOI: http://dx.doi.org/10.3389/fpsyt.2021.627661
Moreno-Bencardino C, Zuluaga L, Perez J, Cespedes C, Forero C, Fernandez N. Gender dysphoria in the pediatric population: Initial experience of a transdisciplinary group. Rev Urol Colomb/Colomb Urol J. [Internet]. 2021;30(04): e286–92. DOI: https://doi.org/10.1055/s-0041-1730327
Jessen RS, Waehre A, David L, Stänicke E. Negotiating Gender in Everyday Life: Toward a Conceptual Model of Gender Dysphoria in Adolescents. Arch Sex Behav. [Internet]. 2021;50(8):3489–503. DOI: https://doi.org/10.1007/s10508-021-02024-6
Wagner S, Panagiotakopoulos L, Nash R, Bradlyn A, Getahun D, Lash TL, Roblin D, Silverberg MJ, Tangpricha V, Vupputuri S, Goodman M. Progression of Gender Dysphoria in Children and Adolescents: A Longitudinal Study. Pediatrics. [Internet]. 2021;148(1): e2020027722. DOI: https://doi.org/10.1542/peds.2020-027722
Pazos Guerra M, Gómez Balaguer M, Gomes Porras M, Hurtado Murillo F, Solá Izquierdo E, Morillas Ariño C. Transsexuality: transitions, transitions and regrets in Spain. Endocrinol Diabetes Nutr (Engl). [Internet]. 2020;67(9):562–7. DOI: https://doi.org/10.1016/j.endinu.2020.03.008
Collins CA. Pediatric nurse practitioners’ attitudes/beliefs and knowledge/perceived competence in caring for transgender and gender-nonconforming youth. J Spec Pediatr Nurs [Internet]. 2021;26(2): e12321. DOI: https://doi.org/10.1111/jspn.12321
Carabez R, Kim JE. LGBT youth in foster care and the critical advocacy role of Public Health Nurses. Public Health Nurs. [Internet]. 2020;37(5):750–6: DOI: https://doi.org/10.1111/phn.12757
Rider GN, McMorris BJ, Gower AL, Coleman E, Brown C, Eisenberg ME. Perspectives from Nurses and Physicians on Training Needs and Comfort Working With Transgender and Gender-Diverse Youth. J Pediatr Health Care. [Internet]. 2019;33(4):379-385. DOI: https://doi.org/10.1016/j.pedhc.2018.11.003
Laiti M, Pakarinen A, Parisod H, Hayter M, Sariola S, Salanterä S. Supporting LGBTQ+ Students: A Focus Group Study with Junior High School Nurses. J Sch Nurs. [Internet]. 2022. DOI: https://doi.org/10.1177/10598405221086035
Gerritse K, Hartman L, Antonides MF, Wensing-Kruger A, de Vries ALC, Molewijk BC. Moral challenges in transgender care: A thematic analysis based on a focused ethnography. Arch Sex Behav [Internet]. 2018;47(8):2319–33. DOI: https://doi.org/10.1007/s10508-018-1287-3
Hughes E, Rawlings V, McDermott E. Mental health staff perceptions and practice regarding self-harm, suicidality and help-seeking in LGBTQ youth: Findings from a cross-sectional survey in the UK. Issues Ment Health Nurs. [Internet]. 2018;39(1):30–6. DOI: https://doi.org/10.1080/01612840.2017.1398284
Kameg BN, Nativio DG. Gender dysphoria in youth: An overview for primary care providers. J Am Assoc Nurse Pract. [Internet]. 2018;30(9):493-498. DOI: https://doi.org/10.1097/JXX.0000000000000068
Heard J, Morris A, Kirouac N, Ducharme J, Trepel S, Wicklow B. Gender dysphoria assessment and action for youth: Review of health care services and experiences of trans youth in Manitoba. Paediatr Child Health. [Internet]. 2018;23(3):179-84. DOI: https://doi.org/10.1093/pch/pxx156.
Olson J, Schrager SM, Belzer M, Simons LK, Clark LF. Baseline physiologic and psychosocial characteristics of transgender youth seeking care for gender dysphoria. J Adolesc Health [Internet]. 2015;57(4):374–80. DOI: http://dx.doi.org/10.1016/j.jadohealth.2015.04.027
Feldman J, Goldberg, J. Transgender Primary Medical Care. International Journal of Transgenderism. [Internet]. 2009;9(3):3- 34. DOI: https://doi.org/10.1300/J485v09n03_02
Makadon HJ. Ending LGBT invisibility in health care: the first step in ensuring equitable care. Cleve Clin J Med. [Internet]. 2011;78(4):220–4. DOI: http://dx.doi.org/10.3949/ccjm.78gr.10006
Brennan AMW, Barnsteiner J, Siantz ML de L, Cotter VT, Everett J. Lesbian, gay, bisexual, transgendered, or intersexed content for nursing curricula. J Prof Nurs [Internet]. 2012;28(2):96–104. DOI: http://dx.doi.org/10.1016/j.profnurs.2011.11.004
Bosse JD, Nesteby JA, Randall CE. Integrating sexual minority health issues into a health assessment class. J Prof Nurs [Internet]. 2015;31(6):498–507. DOI: http://dx.doi.org/10.1016/j.profnurs.2015.04.007
Gatica G, Almonte C. Therapeutic interventions in gender dysphoria in children and adolescents. Rev Chil Psiquiatr Neurol Infanc Adolesc. [Internet]. 2015;26(2): 121-32. Available from: https://www.sopnia.com/wp-content/uploads/2021/05/Revista-SOPNIA_201502.pdf#page=121
Mc Callion S, Smith S, Kyle H, Shaikh MG, Wilkinson G, Kyriakou A. An appraisal of current service delivery and future models of care for young people with gender dysphoria. Eur J Pediatr. [Internet]. 2021;180(9):2969–76. DOI: http://dx.doi.org/10.1007/s00431-021-04075-2
Sharek D, Huntley-Moore S, McCann E. Education needs of families of transgender young people: A narrative review of international literature. Issues Ment Health Nurs [Internet]. 2018;39(1):59–72. DOI: http://dx.doi.org/10.1080/01612840.2017.1395500
Drescher J, Byne W. Gender dysphoric/gender variant (GD/GV) children and adolescents: summarizing what we know and what we have yet to learn. J Homosex. [Internet]. 2012;59(3):501–10. DOI: http://dx.doi.org/10.1080/00918369.2012.653317
Menvielle EJ, Rodnan LA. A therapeutic group for parents of transgender adolescents. Child Adolesc Psychiatr Clin N Am [Internet]. 2011;20(4):733–43. DOI: http://dx.doi.org/10.1016/j.chc.2011.08.002
González-Gómez A, Sellán-Soto C. Gender dysphoria in children and adolescents: narrative review. [Final degree thesis]. Madrid: Autonomous University of Madrid, 2018. Available from: https://repositorio.uam.es/bitstream/handle/10486/684876/gonzalez_gomez_andreatfg.pdf?sequence=1&isAllowed=y
Hurtado-Murillo, F. Gender Dysphoria in childhood and adolescents: Clinical Practice Guideline. Rev Esp Endocrinol Pediatr. [Internet]. 2015;6 Suppl (1):45-52. DOI: https://doi.org/10.3266/RevEspEndocrinolPediatr.pre2015.Apr.283
McGuire JK, Anderson CR, Toomey RB, Russell ST. School climate for transgender youth: a mixed method investigation of student experiences and school responses. J Youth Adolesc. [Internet]. 2010;39(10):1175–88. DOI: http://dx.doi.org/10.1007/s10964-010-9540-7
Clark TC, Lucassen MFG, Bullen P, Denny SJ, Fleming TM, Robinson EM, et al. The health and well-being of transgender high school students: results from the New Zealand adolescent health survey (Youth’12). J Adolesc Health [Internet]. 2014;55(1):93–9. DOI: http://dx.doi.org/10.1016/j.jadohealth.2013.11.008
Castillo Muñoz L, Cuadrado F. Transgender people's perception of health care. Index enferm [Internet]. 2020;29(1–2):13–7. DOI: http://dx.doi.org/10.4321/s1132-12962020000100004
Abeln B, Love R. Considerations for the care of transgender individuals. Nurs Clin North Am [Internet]. 2019;54(4):551–9. DOI: http://dx.doi.org/10.1016/j.cnur.2019.07.005
Rondahl G. Students inadequate knowledge about lesbian, gay, bisexual and transgender persons. Int J Nurs Educ Scholarsh [Internet]. 2009;6(1):1-15. DOI: http://dx.doi.org/10.2202/1548-923X.1718
Gridley SJ, Crouch JM, Evans Y, Eng W, Antoon E, Lyapustina M, et al. Youth and Caregiver Perspectives on Barriers to Gender-Affirming Health Care for Transgender Youth. J Adolesc Health. [Internet]. 2016;59(3):254–61. DOI: https://doi.org/10.1016/j.jadohealth.2016.03.017
Gauché Marchetti XA, Lovera Parmo DA. The right to gender identity of children and adolescents beyond Law 21.120: expansions from a rights-based approach. Ius Prax [Internet]. 2022;28(1):122–40. DOI: http://dx.doi.org/10.4067/s0718-00122022000100122
Ravetllat Ballesté I. Equally different: the gender identity of children and adolescents in Chile. Ius Prax. [Internet]. 2018;24(1):397–436. DOI: http://dx.doi.org/10.4067/s0718-00122018000100397
González Díaz F, Catalán Águila M, Pantoja de Prada V. Health assessment of trans people situation in Chile: an invisible reality. CMS. [Internet]. 2018;58(2):49-55. Available from: https://cuadernosms.cl/index.php/cms/article/view/282
Singh SM, Gatzke N. The nurse practitioner’s role in the management of gender dysphoria among youth. J Nurse Pract [Internet]. 2021;17(5):540–4. DOI: http://dx.doi.org/10.1016/j.nurpra.2021.01.020
Forcier M, Johnson M. Screening, identification, and support of gender non-conforming children and families. J Pediatr Nurs [Internet]. 2013;28(1):100–2. DOI: http://dx.doi.org/10.1016/j.pedn.2012.11.001
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