Structured attempts to change an LGBTQIA+ person’s sexual orientation or gender identity – a practice commonly called “conversion therapy” – is linked to greater symptoms of depression, post-traumatic stress disorder, and suicidality, according to a study led by Stanford Medicine researchers.

The survey-based study of 4,426 people is the first to explore whether specific mental health outcomes vary by the goal of the practice and whether the recipient is cisgender (identifies as the sex they were assigned at birth), transgender, or gender diverse (identifies as neither male nor female).

“Our study found an association between recall of conversion practices and symptoms of depression, post-traumatic stress disorder, and suicide,” said postdoctoral scholar Nguyen Tran, PhD. “In particular, we saw the greatest harms in people who had been exposed to both types of conversion practices – those addressing sexual orientation and gender identity. This study highlights the need for policy changes at a federal, state, and local level, and an understanding of the lasting mental health impacts related to conversion practices.”

Tran is the lead author of the research, which was published Sept. 30 in The Lancet Psychiatry. Associate professor of medicine Mitchell Lunn, MD, is the senior author of the study. Lunn co-directs The PRIDE Study, an online, nationwide research project he launched with associate professor of obstetrics and gynecology Juno Obedin-Maliver, MD, in 2015 to amass data about the health experiences and outcomes of people who are LBGTQIA+.

Conversion attempts may include religious rituals, psychological or behavioral counseling, and aversion therapy aimed at promoting heterosexual attraction or aligning a person’s gender identity with their sex assigned at birth. Because they have not been shown to have any therapeutic benefit, these attempts are more appropriately called conversion practices or change efforts.

Banned practices

The negative mental health impacts of conversion practices have been well-documented, and major health care organizations including the American Academy of Child and Adolescent Psychiatry and the American Psychiatric Association have denounced their use. Although 23 states and the District of Columbia had banned the practices on minors as of June 2024, conversion practices remain legal in many states.

“There is no nationwide ban on conversion practices,” Lunn said. “This study adds to the growing body of evidence that these practices are correlated with significant mental health problems.”

It is estimated that between 4% and 34% of sexual and gender minority people have experienced conversion practices in the United States – often initiated during puberty or young adulthood. Reports of these practices are more prevalent among transgender and gender-diverse people.

The study surveyed 4,426 participants in The PRIDE Study – asking them if they recalled ever being subjected to conversion practices during their lifetime and, if so, what type. For the purposes of the study, conversion practices were strictly defined.

“Conversion practices are repeated, they’re structured and they are formalized,” Tran said. “Sometimes there are organizations that facilitate these practices. In contrast, if your pastor pulls you aside for a private conversation, or if your parents pressure you to change your sexual orientation or gender identity, we don’t count that as a conversion practice.”

The participants were an average age of 31; 2,504 people (57%) were cisgender, and 1,923 (43%) were transgender or gender diverse. Of the 4,426 people, 149 (3.4%) reported experiencing conversion practices meant to change their sexual orientation, 43 (1%) reported practices meant to change their gender identity and 42 (1%) reported experiencing both types of conversion practices.

The survey also asked participants about their mental health, gender identity, and sexual orientation, as well as their education level, ethnic background, and details about their childhood including whether their family and communities were supportive of their identities.

Participants who experienced formal efforts to change their sexual orientation reported more symptoms of post-traumatic stress disorder, while those who experienced efforts to change their gender identity exhibited more symptoms of depression, the study found. People who reported experiencing both forms of conversion practices had more symptoms of PTSD and suicidality.

Of the 191 people who recalled sexual orientation conversion practices, 100 (52.4%) said the practice was spearheaded by a religious leader or organization, and 55 (28.8%) said the practices were facilitated by a mental health provider or organization. In contrast, 46 of 85 people (54.1%) who recalled gender identity conversion practices said they were run by a mental health provider or organization, followed by 28 (32.9%) people who said their conversion efforts were run by a religious leader or organization.

The researchers also found that members of ethnic or racial minorities, people raised in communities that did not accept their identities, transgender people, and those with lower levels of education were more likely to have experienced conversion practices.

Pinpointing conversion practices

They conducted additional analyses to show that confounding factors that might contribute to someone’s mental health – a religious upbringing or unaccepting families or communities – weren’t enough to explain the effects observed in their study. “The preponderance of evidence indicates that conversion practices are related to negative mental health effects,” Tran said.

In addition to calling for a nationwide ban on conversion practices, the authors hope that the results of their study call attention to the specific health care needs of the LGBTQIA+ community, particularly among those who have experienced conversion practices.

“There is a greater need for mental health support among survivors of conversion practices,” Tran said. “Other studies that have explored this suggest that helping LGBTQIA+ people find supportive LGBTQIA+ networks, access affirming mental health care, and rebuild their self-esteem and embrace their gender identity or sexual orientation are perhaps important for addressing the negative mental health related to conversion practice.”

Researchers from the University of Washington, Oregon Health and Science University-Portland State University, Boston University, Boston Medical Center, Born Brown Institute, Public Democracy America, Angela’s Pulse, the Bronx Academy of Arts and Dance, and SAGE New York participated in the study

The study was funded by the National Institutes of Health (grants OT2OD025276, 20CDA35320148 and K01HL151902), the Gill Foundation, the Doris Duke Charitable Foundation and the Patient-Centered Outcomes Research Institute.