Supporting positive mental health and adaptation after transgender medical transition – new perspectives on care and research

Rationale: There are around 30-60 thousand transgender individuals in the Netherlands. Transgender individuals generally report increased levels of mental health problems including suicidality, when compared with normative populations. Although medical transition substantially decreases mental health problems, individual treatment outcomes are difficult to predict and many report residual psychiatric problems over time. In order to improve mental health outcomes, transgender individuals repeatedly called for the development of psychotherapeutic follow-up to support integrating body-mind, dealing with social stressors and the new life after transition. At present, limited knowledge and treatments outside the medical treatment paradigm have been developed however. The concept of positive (mental) health, as “the ability adapt and self-manage”, is considered a valuable starting point to develop such aftercare. Objectives: The two central questions in this project will be: (I) What positive/negative post-transition adaptation strategies can be identified in transgender individuals?, and (II) how can these insights, along with other individual characteristics, be translated into an accessible aftercare intervention supporting positive mental health? The project objectives include obtaining in-depth insights in the post-transition adaptation of a large variety of transgender individuals, as well as the response shifts in experiences/needs, the role adaptation plays in mental health outcomes, and in the characteristics of people at risk for negative adaptation (eg, by cultural background, type of psychiatric problems). Another objective is to develop an evidence-based intervention to improve adaptive ability based on personalized needs (ie, in different relevant areas of life). The project’s knowledge and clinical targets will be extracted directly from transgender individuals’ lived experiences during the post-transition period. Methods: The project will take a mixed-method participatory approach by following up on transgender individuals at a point where they are usually discharged from clinical care (after medical transition). Specific outcomes will be defined participatory with transgender community members. A cross-sectional quantitative study aims to objectify 150-200 individuals’ adaptation, mental health and several moderating factors using validated questionnaires. Furthermore, a longitudinal qualitative study will follow 20-30 individuals for three years and interview them periodically on the situations they occur with, adaptive strategies, mental health outcomes and healthcare needs. These outcomes will be related to personal factors to better predict/personalize the need for mental health care. The project’s insights will be used to develop a (pilot) personalized evidence-based intervention to support adaptive ability. This will be done using the research findings and existing tools, and will be done in collaboration with patient advisers, mental health professionals and the social medicine department. Expected outcomes: Based on the scarce literature and findings in other populations, positive adaptive strategies are expected to strongly correlate with positive mental health outcomes, both directly as well as through improved social support, increased self-esteem and higher transgender self-acceptance (or even pride). Adaptive and maladaptive strategies are expected to be both general (eg, avoidant behavior) or transgender-specific (eg, feelings of identity shame/stigma). Based on the scientific insights on adaptation and its the relationship with positive mental health, as well as the expressed aftercare needs by the participants, significant input for a clinical tool is expected to be yielded. In dialogue with the community advisory board and multiple rounds with health care stakeholders, a solid and easy-to-use clinical tool will be developed. Community involvement: Transgender individuals will be (and have been) involved in all steps of the project, either as participant, individual adviser, as member of the advisory board or as Transvisie patient support group. Time and travel expenses will be reimbursed for all ways of contribution.