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Despite an increasing amount of research related to gender-affirming treatment (GAT) outcomes among transgender and gender-diverse (TGD) people (ie, people who experience discomfort or distress in the misalignment between their gender and sex assigned at birth) in recent years, the evidence base for current recommendations is suboptimal. One contributing factor is the heterogeneity in the outcomes and outcome measures used. This study seeks to address this challenge by developing a foundational core outcome set (COS) to be used for TGD adults receiving GAT in Sweden.
Recommendations from the Core Outcome Measures in Effectiveness Trials initiative will be used to address this aim in four phases. Phase 1, an umbrella review of peer-reviewed literature and international guidelines in GAT will be conducted to identify relevant outcomes. In phase 2, we will solicit input from TGD individuals through the review of patient and interest organisations’ reports and an anonymous survey to identify outcomes of personal significance. In phase 3, using the Delphi method, 2–3 rounds of assessment will be conducted where researchers, healthcare professionals, policy-makers and TGD adults rate the identified outcomes by perceived importance. In phase 4, a consensus meeting will convene representatives from all stakeholder groups to finalise the COS.
The results of this study will consist of a COS for GAT regarding TGD adults in Sweden. Participant survey responses will be evaluated using interpretive analysis to identify core outcomes. During each of the Delphi rounds, Likert-type scale ratings will be aggregated for outcomes to advance or be eliminated in each round.
The study has received ethical approval by the Swedish Ethical Review Authority (Umeå medicine department, Registration number: 2024-04672-01). The results of this study will be published open-access and disseminated through TGD interest organisations and a Swedish research network for gender dysphoria.
COMET registration number 3223.
by Katalin Gémes, Emma Pettersson, Sara Sjölund Andoff, Kristin Farrants, Emilie Friberg, Kristina Alexanderson
BackgroundStress-related disorders are common diagnoses for sickness absence (SA) and disability pension (DP) in many Western countries. Knowledge on future SA/DP trajectories among those starting such a SA spell is limited. The aims were to identify future SA/DP days trajectories among individuals starting an SA spell due to stress-related disorder and investigate socio-demographic and morbidity characteristics associated with specific trajectories.
MethodsUsing microdata from nationwide registers, we established two cohorts of all living in Sweden who started a new SA spell >14 days due to stress-related disorder in 2011 (N = 32,417) or in 2018 (N = 65,511), respectively. Group-based trajectory models were used to identify trajectories of monthly average SA/DP days during the following 13 months, separate for each cohort. We used multinomial logistic regression to investigate the associations between sociodemographic and morbidity-related predictors and trajectory membership.
ResultsWe identified six SA/DP trajectories in the two cohorts: steep drop (30.6% and 35.9% of all included in 2018 and 2011); constant fluctuating (8.7%, 11.2%); fast decrease (25.5%, 24.4%); medium decrease (18.1%, 13.1%); slow decrease (10.8%, 7.3%), and constant high (6.2%, 8.0%). The distributions of sociodemographic factors, multi-morbidity, and history of SA/DP differed between the trajectory groups. For example, compared to the steep drop trajectory, individuals in the other trajectories were more likely to be a woman, older, having had prior SA/DP or specialized outpatient healthcare visits.
ConclusionsIn these two explorative, population-wide cohorts, we identified six different trajectories of SA/DP days among all with a new SA spell with stress-related disorders. The trajectory groups differed regarding both sociodemographic and health-related covariates.
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