Wednesday, April 06, 2022

Reporting the Opposite of What Your Study Says

"Truly Alarming" was the comment from the statistician who sent me this. 

From Jesse Singal,yet one more liberal increasingly going off the reservation: Researchers Found Puberty Blockers And Hormones Didn’t Improve Trans Kids’ Mental Health At Their Clinic. Then They Published A Study Claiming The Opposite. 

It is from a study in JAMA out of University of Washington-Seattle. It makes repeated claims, some of them explicit and dramatic, that gender-affirming mental health care reduced depression and suicide. Its own data says there was no such reduction.  Thank you Jesse. 

Among the kids who went on hormones, there isn’t genuine statistical improvement here from baseline to the final wave of data collection. At baseline, 59% of the treatment-naive kids experienced moderate to severe depression. Twelve months later, 56% of the kids on GAM experienced moderate to severe depression. At baseline, 45% of the treatment-naive kids experienced self-harm or suicidal thoughts. Twelve months later, 37% of the kids on GAM did. These are not meaningful differences: The kids in the study arrived with what appear to be alarmingly high rates of mental health problems, many of them went on blockers or hormones, and they exited the study with what appear to be alarmingly high rates of mental health problems. (Though as I’ll explain, because the researchers provide so little detailed data, it’s hard to know exactly how dire the kids’ mental health situations were.) 

As depression and suicidality fluctuate over time and often revert to the mean from the panic point where someone desperately seeks care, I would argue that there is some chance that even these insignificant improvements might be illusory. We are in a culture where people get angry if you don't give them what they think they deserve from treatment, and such folks can get worse and blame it on their clinic or doctor.  I have seen many people come in a "crisis" hoping to get a medical marijuana card, or a referral for an expensive treatment their insurance won't pay for, such as transcranial magnetic stimulation.  When we don't obey them, they get worse. Sometimes this is manipulative but not always.  I wouldn't assume that. Our trans patients were one of the three overlapping categories of people who got outraged if we didn't do what they said. In those cases it is again, not necessarily instrumental or manipulative when they do this.  Given their personality structure, they really do believe they have been disaffirmed to such an extent that they are staring into the abyss, fearing annihilation. Hence the repeated trans complaint of "denying my very existence."  Because they do not see the world as we do, they do not use these words to mean the same thing that you or I would. Feelings in the moment are everything, and it is not merely immaturity or lack of a limit-setting by their parents that causes this. It may not be true, but it does really feel that way to them.

And come to think of it, if you have a gender identity that is a house of cards, assembled from things other teenagers say, plus your feelings and your still-limited actual experience in the world, there is some truth to its being in danger of annihilation.  Those of us coming from another world not founded on social media can insist there is a more solid world it would be better to depend upon, but they have little experience with it.

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