Association Between Mental Health Conditions and Postoperative Complications After Gender-Affirming Surgery.
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ABSTRACT:
SUBMITTER: Khusid E
PROVIDER: S-EPMC9520432 | biostudies-literature | 2022 Dec
REPOSITORIES: biostudies-literature
Publications
Association Between Mental Health Conditions and Postoperative Complications After Gender-Affirming Surgery.
Khusid Elizabeth E Sturgis Morgan R MR Dorafshar Amir H AH Schechter Loren S LS Olweny Ephrem O EO Cherullo Edward E EE Becerra Adán Z AZ
JAMA surgery 20221201 12
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Project description:ImportanceGender-affirming surgery is often beneficial for gender-diverse or -dysphoric patients. Access to gender-affirming surgery is often limited through restrictive legislation and insurance policies.ObjectiveTo investigate the association between California's 2013 implementation of the Insurance Gender Nondiscrimination Act, which prohibits insurers and health plans from limiting benefits based on a patient's sex, gender, gender identity, or gender expression, and utilization of gender-affirming surgery among California residents.Design, setting, and participantsPopulation epidemiology study of transgender and gender-diverse patients undergoing gender-affirming surgery (facial, chest, and genital surgery) between 2005 and 2019. Utilization of gender-affirming surgery in California before and after implementation of the Insurance Gender Nondiscrimination Act in July 2013 was compared with utilization in Washington and Arizona, control states chosen because of geographic similarity and because they expanded Medicaid on the same date as California-January 1, 2014. The date of last follow-up was December 31, 2019.ExposuresCalifornia's Insurance Gender Nondiscrimination Act, implemented on July 9, 2013.Main outcomes and measuresReceipt of gender-affirming surgery, defined as undergoing at least 1 facial, chest, or genital procedure.ResultsA total of 25 252 patients (California: n = 17 934 [71%]; control: n = 7328 [29%]) had a diagnosis of gender dysphoria. Median ages were 34.0 years in California (with or without gender-affirming surgery), 39 years (IQR, 28-49 years) among those undergoing gender-affirming surgery in control states, and 36 years (IQR, 22-56 years) among those not undergoing gender-affirming surgery in control states. Patients underwent at least 1 gender-affirming surgery within the study period in 2918 (11.6%) admissions-2715 (15.1%) in California vs 203 (2.8%) in control states. There was a statistically significant increase in gender-affirming surgery in the third quarter of July 2013 in California vs control states, coinciding with the timing of the Insurance Gender Nondiscrimination Act (P < .001). Implementation of the policy was associated with an absolute 12.1% (95% CI, 10.3%-13.9%; P < .001) increase in the probability of undergoing gender-affirming surgery in California vs control states observed in the subset of insured patients (13.4% [95% CI, 11.5%-15.4%]; P < .001) but not self-pay patients (-22.6% [95% CI, -32.8% to -12.5%]; P < .001).Conclusions and relevanceImplementation in California of its Insurance Gender Nondiscrimination Act was associated with a significant increase in utilization of gender-affirming surgery in California compared with the control states Washington and Arizona. These data might inform state legislative efforts to craft policies preventing discrimination in health coverage for state residents, including transgender and gender-diverse patients.
| S-EPMC10015311 | biostudies-literature
Project description: Not available
| S-EPMC8105843 | biostudies-literature
Project description:ImportanceTransgender and nonbinary (TNB) youths are disproportionately burdened by poor mental health outcomes owing to decreased social support and increased stigma and discrimination. Although gender-affirming care is associated with decreased long-term adverse mental health outcomes among these youths, less is known about its association with mental health immediately after initiation of care.ObjectiveTo investigate changes in mental health over the first year of receiving gender-affirming care and whether initiation of puberty blockers (PBs) and gender-affirming hormones (GAHs) was associated with changes in depression, anxiety, and suicidality.Design, setting, and participantsThis prospective observational cohort study was conducted at an urban multidisciplinary gender clinic among TNB adolescents and young adults seeking gender-affirming care from August 2017 to June 2018. Data were analyzed from August 2020 through November 2021.ExposuresTime since enrollment and receipt of PBs or GAHs.Main outcomes and measuresMental health outcomes of interest were assessed via the Patient Health Questionnaire 9-item (PHQ-9) and Generalized Anxiety Disorder 7-item (GAD-7) scales, which were dichotomized into measures of moderate or severe depression and anxiety (ie, scores ≥10), respectively. Any self-report of self-harm or suicidal thoughts over the previous 2 weeks was assessed using PHQ-9 question 9. Generalized estimating equations were used to assess change from baseline in each outcome at 3, 6, and 12 months of follow-up. Bivariate and multivariable logistic models were estimated to examine temporal trends and investigate associations between receipt of PBs or GAHs and each outcome.ResultsAmong 104 youths aged 13 to 20 years (mean [SD] age, 15.8 [1.6] years) who participated in the study, there were 63 transmasculine individuals (60.6%), 27 transfeminine individuals (26.0%), 10 nonbinary or gender fluid individuals (9.6%), and 4 youths who responded "I don't know" or did not respond to the gender identity question (3.8%). At baseline, 59 individuals (56.7%) had moderate to severe depression, 52 individuals (50.0%) had moderate to severe anxiety, and 45 individuals (43.3%) reported self-harm or suicidal thoughts. By the end of the study, 69 youths (66.3%) had received PBs, GAHs, or both interventions, while 35 youths had not received either intervention (33.7%). After adjustment for temporal trends and potential confounders, we observed 60% lower odds of depression (adjusted odds ratio [aOR], 0.40; 95% CI, 0.17-0.95) and 73% lower odds of suicidality (aOR, 0.27; 95% CI, 0.11-0.65) among youths who had initiated PBs or GAHs compared with youths who had not. There was no association between PBs or GAHs and anxiety (aOR, 1.01; 95% CI, 0.41, 2.51).Conclusions and relevanceThis study found that gender-affirming medical interventions were associated with lower odds of depression and suicidality over 12 months. These data add to existing evidence suggesting that gender-affirming care may be associated with improved well-being among TNB youths over a short period, which is important given mental health disparities experienced by this population, particularly the high levels of self-harm and suicide.
| S-EPMC8881768 | biostudies-literature
Project description:PurposeGender-affirming hormones (hormones)-the use of sex hormones to induce desired secondary sex characteristics in transgender and nonbinary (TGNB) individuals-are vital health care for many TGNB people. Some hormone providers require a letter from a mental health provider before hormone initiation. We explore the perspectives of TGNB individuals regarding the impact of the letter requirement on their experience of care.MethodsWe conducted semistructured interviews with 21 TGNB individuals who have sought or are receiving hormones. We purposively sampled respondents who were (n=12) and were not (n=8) required to provide a letter. An Advisory Board of transgender individuals guided the methodology. Interviews were transcribed verbatim and coded both inductively and deductively.ResultsWe identified three themes related to the letter requirement: (1) Mental health: While participants appreciated the importance of therapy, the letter requirement did not serve this purpose; (2) Trans identity: The process of obtaining a letter created doubt in participants' own transness, along with a resistance to the pathologization and conflation of mental illness with transness; and (3) Care relationships: The letter requirement negatively impacted the patient-provider relationship. Participants felt the need to self-censor or to perform a version of transness they thought the provider expected; this process decreased their trust in care professionals.ConclusionA letter requirement did not improve mental health and had several negative consequences. Removal of this requirement will improve access to hormones and may paradoxically improve mental health.
| S-EPMC10835159 | biostudies-literature
Project description:[This corrects the article DOI: 10.1371/journal.pone.0261039.].
| S-EPMC10259783 | biostudies-literature
Project description:ImportanceWhile changes in federal and state laws mandating coverage of gender-affirming surgery (GAS) may have led to an increase in the number of annual cases, comprehensive data describing trends in both inpatient and outpatient procedures are limited.ObjectiveTo examine trends in inpatient and outpatient GAS procedures in the US and to explore the temporal trends in the types of GAS performed across age groups.Design, setting, and participantsThis cohort study includes data from 2016 to 2020 in the Nationwide Ambulatory Surgery Sample and the National Inpatient Sample. Patients with diagnosis codes for gender identity disorder, transsexualism, or a personal history of sex reassignment were identified, and the performance of GAS, including breast and chest procedures, genital reconstructive procedures, and other facial and cosmetic surgical procedures, were identified.Main outcome measuresWeighted estimates of the annual number of inpatient and outpatient procedures performed and the distribution of each class of procedure overall and by age were analyzed.ResultsA total of 48 019 patients who underwent GAS were identified, including 25 099 (52.3%) who were aged 19 to 30 years. The most common procedures were breast and chest procedures, which occurred in 27 187 patients (56.6%), followed by genital reconstruction (16 872 [35.1%]) and other facial and cosmetic procedures (6669 [13.9%]). The absolute number of GAS procedures rose from 4552 in 2016 to a peak of 13 011 in 2019 and then declined slightly to 12 818 in 2020. Overall, 25 099 patients (52.3%) were aged 19 to 30 years, 10 476 (21.8%) were aged 31 to 40, and 3678 (7.7%) were aged12 to 18 years. When stratified by the type of procedure performed, breast and chest procedures made up a greater percentage of the surgical interventions in younger patients, while genital surgical procedures were greater in older patients.Conclusions and relevancePerformance of GAS has increased substantially in the US. Breast and chest surgery was the most common group of procedures performed. The number of genital surgical procedures performed increased with increasing age.
| S-EPMC10448302 | biostudies-literature
Project description:IntroductionMuch has been published on the surgical and functional results following Gender Affirming Surgery ('GAS') in trans individuals. Comprehensive results regarding sexual wellbeing following GAS, however, are generally lacking.AimTo review the impact of various GAS on sexual wellbeing in treatment seeking trans individuals, and provide a comprehensive list of clinical recommendations regarding the various surgical options of GAS on behalf of the European Society for Sexual Medicine.MethodsThe Medline, Cochrane Library and Embase databases were reviewed on the results of sexual wellbeing after GAS.Main outcomes measureThe task force established consensus statements regarding the somatic and general requirements before GAS and of GAS: orchiectomy-only, vaginoplasty, breast augmentation, vocal feminization surgery, facial feminization surgery, mastectomy, removal of the female sexual organs, metaidoioplasty, and phalloplasty. Outcomes pertaining to sexual wellbeing- sexual satisfaction, sexual relationship, sexual response, sexual activity, enacted sexual script, sexuality, sexual function, genital function, quality of sex life and sexual pleasure- are provided for each statement separately.ResultsThe present position paper provides clinicians with statements and recommendations for clinical practice, regarding GAS and their effects on sexual wellbeing in trans individuals. These data, are limited and may not be sufficient to make evidence-based recommendations for every surgical option. Findings regarding sexual wellbeing following GAS were mainly positive. There was no data on sexual wellbeing following orchiectomy-only, vocal feminization surgery, facial feminization surgery or the removal of the female sexual organs. The choice for GAS is dependent on patient preference, anatomy and health status, and the surgeon's skills. Trans individuals may benefit from studies focusing exclusively on the effects of GAS on sexual wellbeing.ConclusionThe available evidence suggests positive results regarding sexual wellbeing following GAS. We advise more studies that underline the evidence regarding sexual wellbeing following GAS. This position statement may aid both clinicians and patients in decision-making process regarding the choice for GAS. Özer M, Toulabi SP, Fisher AD, et al. ESSM Position Statement "Sexual Wellbeing After Gender Affirming Surgery". Sex Med 2022;10:100471.
| S-EPMC8847816 | biostudies-literature
Project description:PurposeAdolescence is a phase when young people begin to explore their gender identity. Adolescents who identify as a gender minority are vulnerable to experiencing mental health problems due to stigmatization of their identity.MethodsA population-wide study compared gender minority and cisgender students (aged 13-14 years) self-reported symptoms of probable depression, anxiety, and conduct disorder, and auditory hallucinations, including the distress and frequency of hallucinations.ResultsGender minority students compared to cisgender students had four times the odds of reporting a probable depressive disorder, anxiety disorder, auditory hallucinations, but not conduct disorder. Of those who reported a hallucination, gender minority students were more likely to report hearing them daily but were no more likely to find them distressing.DiscussionGender minority students experience a disproportionate burden of mental health problems. Services and programming should be adapted to better support gender minority high-school students.
| S-EPMC10824667 | biostudies-literature
Project description:ImportanceEnhanced Recovery After Surgery (ERAS) care has been reported to be associated with improvements in outcomes after colorectal surgery compared with traditional care.ObjectiveTo determine the association between ERAS protocols and outcomes in patients undergoing elective colorectal surgery.Design, setting, and participantsThe Postoperative Outcomes Within Enhanced Recovery After Surgery Protocol (POWER) Study is a multicenter, prospective cohort study of 2084 consecutive adults scheduled for elective colorectal surgery who received or did not receive care in a self-declared ERAS center. Patients were recruited from 80 Spanish centers between September 15 and December 15, 2017. All patients included in this analysis had 1 month of follow-up.ExposuresColorectal surgery and perioperative management were the exposures. Twenty-two individual ERAS items were assessed in all patients, regardless of whether they were included in an established ERAS protocol.Main outcomes and measuresThe primary study outcome was moderate to severe postoperative complications within 30 days after surgery. Secondary outcomes included ERAS adherence, mortality, readmissions, reoperation rates, and hospital length of stay.ResultsBetween September 15 and December 15, 2017, 2084 patients were included in the study. Of these, 1286 individuals (61.7%) were men; mean age was 68 years (interquartile range [IQR], 59-77). A total of 879 patients (42.2%) presented with postoperative complications and 566 patients (27.2%) developed moderate to severe complications. The number of patients with moderate or severe complications was lower in the ERAS group (25.2% vs 30.3%; odds ratio [OR], 0.77; 95% CI, 0.63-0.94; P = .01). The overall rate of adherence to the ERAS protocol was 63.6% (IQR, 54.5%-77.3%), and the rate for patients from hospitals self-declared as ERAS was 72.7% (IQR, 59.1%-81.8%) vs non-ERAS institutions, which was 59.1% (IQR, 50.0%-63.6%; P < .001). Adherence quartiles among patients receiving the highest and lowest ERAS components showed that the patients with the highest adherence rates had fewer moderate to severe complications (OR, 0.34; 95% CI, 0.25-0.46; P < .001), overall complications (OR, 0.33; 95% CI, 0.26-0.43; P < .001), and mortality (OR, 0.27; 95% CI, 0.07-0.97; P = .06) compared with those who had the lowest adherence rates.Conclusions and relevanceAn increase in ERAS adherence appears to be associated with a decrease in postoperative complications.
| S-EPMC6506896 | biostudies-literature
Project description:BackgroundAn unintended consequence of COVID-19 quarantine preventive measures, is the increased prevalence of anxiety and depression. The purpose of this study was to examine the association between COVID-19 preventive behaviors and mental health conditions.MethodsA cross-sectional study was conducted using secondary data collected weekly from US adults aged 18 and older nationwide as part of the COVID-19 Household Impact Survey (CIS) from the University of Chicago. Logistic regression examined associations between COVID-19 preventive behaviors (wearing a face mask, washing or sanitizing hands, and keeping six-feet distance from those outside their household), mental health conditions (self-reporting feeling nervous, anxious, or on edge, feeling lonely, and feeling hopeless about the future and a history of a mental health condition) and demographic factors.ResultsMajority of study participants were under 60 years (62.2%), female (55.8%), and non-Hispanic White (72.2%). Overall, participants more likely to have followed all three COVID-19 measures were those who reported high psychological distress compared to those with low distress for feeling anxious (adj. OR 1.16, 95% CI: 1.06-1.28, p = 0.002), lonely (adj. OR 1.12, 95% CI: 1.02-1.23, p = 0.019) or hopeless (adj. OR 1.10, 95% CI: 1.00-1.21, p = 0.043) for more than a day during the past 7 days.ConclusionOur findings highlight that individuals with mental health conditions reported more psychological distress. Specifically, feeling depressed, anxious, lonely, and hopeless were triggered and exacerbated as a result of the pandemic and may have long-term effects on general well-being and productivity. Therefore, our findings have important implications on the need to include mental health promotion as part of pandemic response efforts. This includes developing policies and allocating funding so as to ensure sustainable mental health interventions and support, public and provider education on the importance of screening for mental health issues.
| S-EPMC10403101 | biostudies-literature