Gender Identity and Gender Dysphoria: Establishing Knowledge of Healthcare Professionals Working with Children Using Structured Interviews

Background

Gender identity is an individuals’ innate sense of being male, female, neither, or any combination of both. Gender dysphoria arises from incongruence between gender identity and birth-assigned gender, leading to intense distress and increased risk of psychiatric illness and suicide. The size of the transgender population is estimated to be between 0.4-1.3% of the general population. Despite increasing public awareness and rising referral rates, formal training in this area is lacking.

Objective

In recognition of this increasing problem, we conducted structured interviews among healthcare professionals at Abertawe Bro Morgannwg University Health Board to determine the baseline knowledge of issues surrounding gender identity.

Method

A 20-question, 10-minute structured interview was developed comprising three question types (open, multiple choice and true/false) structured around four themes:

· Definitions surrounding gender identity

· Child development and clinical presentation of gender dysphoria

· Referral pathways and timing of intervention

· Legal issues and their implications

A team of 3 peer-reviewed interviewers questioned 72 participants in February 2017, spanning various specialties (Paediatrics, Mental Health, Emergency Medicine, Surgery and Family medicine) and professions (Doctors, Nurses, Allied Health professionals).

Results

Many interviewees were unfamiliar with terminology surrounding gender identity, 60% being unaware of any services available to children on the NHS. The majority of Mental Health and Family Medicine professionals had a fundamental awareness of gender issues, legalities and referral pathways; however, paediatric specialists did not score significantly higher than other professionals.

Conclusion

General awareness of gender identity issues amongst professionals is limited, with our review suggesting that knowledge of paediatricians at our health board is no broader than that of professionals in other specialties. Given the rising referral rates of children with gender issues, there is a need for raising awareness of the subject amongst all professionals working with children.