A Swedish total population study linked years since surgery to less mental health treatment; the journal corrected it

This is the largest study on the question and the one whose headline was formally corrected. The row carries both facts, because a reader who meets the first without the second has been misled.

Significant findings

The study "used the Swedish Total Population Register (N=9,747,324), linked to the National Patient Register and the Prescribed Drug Register." Among people "who received a diagnosis of gender incongruence (i.e., transsexualism or gender identity disorder) between 2005 and 2015 (N=2,679), mental health treatment in 2015 was examined as a function of length of time since gender-affirming hormone and surgical treatment."

The baseline finding: "Compared with the general population, individuals with a gender incongruence diagnosis were about six times as likely to have had a mood and anxiety disorder health care visit, more than three times as likely to have received prescriptions for antidepressants and anxiolytics, and more than six times as likely to have been hospitalized after a suicide attempt."

The treatment finding: "Years since initiating hormone treatment was not significantly related to likelihood of mental health treatment (adjusted odds ratio=1.01, 95% CI=0.98, 1.03). However, increased time since last gender-affirming surgery was associated with reduced mental health treatment (adjusted odds ratio=0.92, 95% CI=0.87, 0.98)."

The authors' conclusion as published: the association "lends support to the decision to provide gender-affirming surgeries to transgender individuals who seek them."

The correction

PubMed lists an erratum: "Correction to Bränström and Pachankis", American Journal of Psychiatry 2020;177(8):734, in the same issue as the paper, alongside eleven published comments and the authors' reply. The correction's text is paywalled and was not read for this row, so its wording is not reproduced here. What can be said is that the surgery finding above was formally corrected by the journal after letters challenged the analysis, and that the abstract on PubMed still reads as originally published. Read the correction beside the abstract.

The other direction

Even as published, the study is a single year's outcomes, 2015, plotted against time since treatment. It is not a before-and-after comparison of the same people. The eight percent per year figure is an association across different people at different distances from surgery, and people who had surgery long ago differ from people who had it recently in more ways than time. The hormone result, no association, is reported in the same abstract and gets less attention.

What this does not show

It does not compare treatments, does not recommend any, and after the correction cannot be cited for its headline surgery claim without qualification. It does not report on people who sought surgery and did not have it.

Worth asking

When a finding is corrected, does the correction travel as far as the headline did?