OBJECTIVES : Sexual orientation and/or gender identity change efforts (SOGICE) are dangerous, discredited practices that attempt to change LGBTQ individuals to be heterosexual and/or cisgender. This systematic literature review identified and synthesized published evidence on the humanistic and economic consequences of SOGICE.

METHODS : EMBASE and MEDLINE were searched in accordance with the Preferred Reporting Item for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using Population, Intervention & Comparators, Outcomes and Study Design (PICOS) criteria to identify relevant studies reporting SOGICE practices, consequences, and costs published between database inception and December 2020. Bibliographic searches were also conducted to capture all relevant data. Weighted averages of results were calculated.

RESULTS : Among 197 records screened, 28 studies, covering 75,075 subjects and published between 1969 and 2020, met PICOS criteria. Overall, 11.7% (range 7% to 23%) of study subjects experienced SOGICE, including individual or group psychotherapy (31% to 100%), inpatient SOGICE (7.1%), and SOGICE administered by religious leaders (18% to 81%). SOGICE was initiated at a mean age of 25 years (range 5 to 58), with a mean duration of 43 months. At least 2 types of SOGICE were administered to 43% of recipients, with 15% undergoing >3 modalities. Relative to LGBTQ individuals who did not undergo SOGICE, recipients experienced severe consequences, including serious psychological distress (47% vs 34%), depression (65.4% vs 26.6%), problematic substance use (66.7% vs 49.5%), attempted suicide (58% vs 39%; odds ratio of 2.27), and attempted suicide resulting in moderate/severe injury (67% higher odds). The mean cost of SOGICE was $7,105 (range $0 to $52,000). No published studies have quantified the direct or indirect economic burden of the consequences of SOGICE.

CONCLUSIONS : This evidence review confirmed the grave harm stemming from SOGICE and identified additional research questions, including the role of private and public funding in supporting this practice and its long-term humanistic and economic consequences.