ArticlePDF AvailableLiterature Review

Suicide Among Transgender and Gender-Nonconforming People

Authors:

Abstract

Suicide rates are higher in those who identify as transgender or gender nonconforming (TGNC) compared to the overall population. Suicide risk factors include discrimination, family rejection, internalized transphobia, and being denied appropriate bathroom or housing access. It is important to assess the risk of suicide among transgender and gender-nonconforming patients and discuss past experiences of prejudice or maltreatment to prevent further victimization. This narrative review includes the most pertinent literature from the past 17 years on issues related to suicide among individuals who identify as TGNC. .
... Individuals who belong to minority groups often face stigma, prejudice, discrimination, and hostility due to the characteristics of the groups being in conflict with the conservative social norms of the dominant culture that frames society (Mongelli et al., 2019). In international studies, discrimination and internalized stigma have been reported to be highly associated with suicide attempts in LGBT individuals (Bochicchio et al., 2021;Mongelli et al., 2019;Narang et al., 2018). Moreover, studies have identified depression and anxiety as being positively related to suicide attempts in LGBT individuals (Bochicchio et al., 2021;Wolford-Clevenger et al., 2018). ...
... Resilience refers to a person's assets (e.g., self-esteem or coping skills) and external resources (e.g., social support or community involvement) that enable them to cope within the context of adversity (Woodford et al., 2018). Several studies have determined that suicide attempts among LGBT individuals are associated with self-esteem (Narang et al., 2018) and social support (Bochicchio et al., 2021;Narang et al., 2018;Wolford-Clevenger et al., 2018). ...
... Resilience refers to a person's assets (e.g., self-esteem or coping skills) and external resources (e.g., social support or community involvement) that enable them to cope within the context of adversity (Woodford et al., 2018). Several studies have determined that suicide attempts among LGBT individuals are associated with self-esteem (Narang et al., 2018) and social support (Bochicchio et al., 2021;Narang et al., 2018;Wolford-Clevenger et al., 2018). ...
Article
Full-text available
Purpose: To examine suicide attempts and the influencing factors among Taiwanese lesbian, gay, bisexual, and transgender (LGBT) adults during the 2018 Taiwanese referendum on same-sex issues. Research design and methods: The 2018 Taiwanese referendum was held on November 24. A cross-sectional online survey was conducted between October 2018 and February 2019. A total of 1012 self-identified LGBT adults were included in the final sample. Results: Among the 1012 Taiwanese LGBT adults, the rates of suicide attempts ranged from 9.1% to 24.4%. A younger age, being a student, having low income, having mental health issues, and having a high level of depressive symptoms were associated with a significantly higher risk of suicide attempts in the participants. Conversely, having a postgraduate degree, having high self-esteem, and perceiving support from friends and family were associated with a lower risk of suicide attempts. Conclusion: This is the first study to investigate suicide attempts among LGBT individuals and the influencing factors within the context of a same-sex marriage referendum in an Asian country. The results of this study demonstrate the importance of suicide prevention measures for the LGBT community, particularly during times of increased social stress and conflict between social groups with diverse sexual and gender identities. Clinical relevance: The results of this study suggest that nurses' and health-care providers' sensitivity toward LGBT patients and their knowledge and skills in providing culturally competent care are key factors in suicide prevention for LGBT adults. Therefore, nurses and health-care providers must be provided with training courses on culturally competent care.
... 6 Rates of suicide attempts and suicide among those who are transgender are considerably higher as compared with the overall population and may significantly impact overall mortality. 7 Bauer et al. 8 reported that 35% of transgender individuals have seriously considered suicide, and 11% have attempted suicide in the past year. Several factors, such as lack of social support, transphobia, and structural stigma, are associated with suicide in transgender individuals, 9 but depression continues to be a key risk factor for suicide in this population. ...
Article
Background: Mental health needs of transgender individuals can be complex with individual, social, and medical factors impacting symptoms. This study examines predictors of mood or anxiety problems among transgender individuals seeking hormone therapy (HT). Methods: A retrospective chart review was conducted at 2 clinics providing gender-affirming HT. Cross-sectional data from initial patient encounters (N = 311) were used in this study. Bivariate correlations and multiple logistic regression analyses were carried out. Results: Transgender women (TW) were 2.2 times more likely to have mood or anxiety problems while transgender men (TM) were 2.6 times more likely as the number of medical comorbidities increased. For both TW and TM, White race significantly increased the likelihood of mood or anxiety problems. Neither previous nor current HT were associated with mood or anxiety problems for TW and TM. However, receiving multiple gender-affirming procedures decreased the likelihood of mood or anxiety problems for TM. Conclusions: Gender-affirming care and addressing comorbidities can be important aspects of mental health needs for transgender individuals.
... Transphobic hostility in public settings has detrimental biopsychosocial impacts. For instance, TGD people who experience discrimination when using a public bathroom have higher rates of attempting and completing suicide (Narang et al., 2018). Additionally, interpersonal stigma in public spaces is associated with poor health outcomes (Lampe et al., 2020). ...
Article
Full-text available
Transgender and gender diverse people (TGD) experience elevated rates of behavioral health problems, including depression, anxiety, substance misuse, and suicidality. Minority stressors (e.g., discrimination and victimization) contribute to these poor health outcomes. A salient form of discrimination is the use of gender nonaffirming language, such as using incorrect pronouns or names, yet less is known about other environmental stimuli that may be reined as affirming or nonaffirming. A recent study uncovered the impact symbols (e.g., flags, stickers) may have on invoking positive or negative feelings among TGD youth in the Midwest. Our study further investigates this phenomenon with TGD adults in Texas. During Summer 2021, 3 researchers conducted audio‐recorded semistructured focus groups and interviews with 11 participants who identified as transgender, gender nonconforming, or nonbinary. Interview topics included gender‐affirming and nonaffirming language, positive and negative experiences, nonsupportive and supportive symbolism, and coping mechanisms. In this manuscript, we present findings regarding symbolism. Within our two primary themes, supportive and nonsupportive symbolism, subthemes emerged. Supportive symbolism includes flags and signage, written and oral language and communication, and representation of diversity. Nonsupportive symbolism includes extreme patriotism and religious symbols and highly gendered settings. Further, Texas‐specific culture and a meter of safety were identified as being related to interacting with and observing an array of symbols. Symbolism can have a profound impact on someone's identity development, expression, emotions, coping mechanisms, and access to and engagement with social environments, exemplifying the importance of understanding geographic and cultural‐specific mechanisms within environments TGD people occupy.
... One such core factor is depressive symptomatology (Lewinsohn et al., 1998), which disproportionately affects both LGB individuals of color (Choi et al., 2013) and adolescents of color (Rushton et al., 2002). Thus, focusing on depressive symptoms represents a particularly important outcome to study among SGM adolescents of color, especially in light of its close link to suicide (Ferrari et al., 2013), a significant public health concern among SGM adolescents (Bostwick et al., 2014;Duncan & Hatzenbuehler, 2014;Narang et al., 2018;Sutter & Perrin, 2016). ...
Article
Objective: There is a need for more research on minority stress theory (MST) with sexual and gender minority (SGM) adolescents of color, because of their disproportionate risk for depression. Method: We recruited 1,627 SGM adolescents of color in the United States to complete measures assessing lesbian, gay, bisexual, transgender, and queer (LGBTQ) climate, LGBTQ microaggressions within one's ethnoracial community, internalized LGBTQ stigma, stress management ability, and depressive symptoms. Using structural equation modeling, a hybrid measurement-structural model was tested, indicating good model fit. Results: Multiple significant indirect pathways linking LGBTQ climate and depressive symptoms emerged. A less positive LGBTQ climate was associated with more microaggression-related stress, more internalized LGBTQ stigma, and worse stress management ability, all of which were associated with greater depressive symptoms. A serial mediation with more microaggression-related stress being associated with greater internalized LGBTQ stigma approached significance. Conclusions: Our findings generally support MST processes in terms of depressive symptoms in SGM adolescents of color, suggesting that psychosocial interventions targeting these processes may have meaningful implications for the mental health of this vulnerable group. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
... 8 These factors are an immediate concern given high suicide rates pre-COVID-19, with national attempt prevalence around 25% across adult sexual minority samples 12 and 30%-81% across adult gender minority samples (compared with an estimated 0.6% prevalence in the general population of adults in the United States). 13 Another vulnerable cohort for psychiatric sequelae is frontline health care workers, who face major stressors, including lack of autonomy, sudden redeployment, inadequate access to personal protective equipment (PPE), and fear of disease. 14 In one study, 33% of frontline health care workers had moderate anxiety, 17% had depression, and 5% reported suicidal ideation. ...
Article
Purpose: This study measured mental health disparities in a Bronx, New York sample of frontline health care workers collected May-July, 2020, during the first wave of the COVID-19 pandemic. Methods: Using survey data (N = 741), we compared demographics, COVID-19 stressors, and adverse mental health outcomes between sexual and gender minority (SGM, n = 102) and non-SGM (n = 639) health care workers through chi-square/Kruskal-Wallis tests, crude/adjusted odds, and prevalence ratios. Results: SGM frontline health care workers had significantly higher depression, anxiety, impact of COVID-19, and psychological distress. Income (lower), age (younger), and COVID-19 stressors accelerated differences. Conclusion: Health care systems should support SGM frontline health care workers through affirming trauma-informed programming.
... In addition, TGD persons have a 40% lifetime suicide attempt rate, 9 times that of the general US population. 35 Depression and anxiety are common comorbidities in patients with MS, with a lifetime prevalence of depression of 50%, which is often associated with poor quality of life. 36 Therefore, regular screening for mood symptoms is essential to competent care. ...
Article
Background: People living with multiple sclerosis (MS) face challenges coping with chronic illnesses, and transgender (TGD) persons living with MS may experience additional unique challenges and barriers to care. Medical biases toward TGD people are widely reported, and best practices in TGD MS care have not been identified. Methods: A case report of a TGD person living with MS is reviewed that helped to identify and inform us regarding the unique aspects of their clinical and psychological care needs. We conducted a systematic review of the literature according to the standard methods in PubMed. The literature was reviewed and summarized for relevant topics related to the unique care needs of TGD persons living with MS, and proposed care recommendations were created. Results: We used the aforementioned case to identify and inform the special care needs and subsequently describe proposed recommendations to achieve inclusive comprehensive care of TGD persons with MS. The importance of providing an inclusive environment, comprehensive care, mental health screening, domestic violence screening, and case coordination are highlighted with the goal of providing best practice recommendations for the comprehensive inclusive care of TGD persons living with MS. Conclusions: The lack of published guidance on the care of TGD persons living with MS and our informative case have led to the proposed recommendations for the care of TGD persons living with MS.
... It identified employment discrimination, 5 discrimination in healthcare services 6 and a higher suicide rate 7 in this population. Higher rates of suicidal behaviour have also been described in other transgender contexts 8 9 and are associated with discrimination and family rejection 10 . Trans Pulse also showed that racial/ethnic and gender discrimination can increase HIV infection risk in transgender people. ...
Article
Full-text available
Introduction Transgender identity is poorly accepted in France, and data on living conditions and the daily difficulties transgender people encounter are scarce. This lack of data reinforces their invisibility in social life, contributes to their stigmatisation and probably increases the burden of HIV infection, especially for HIV-positive transgender people (TRHIV). The main objective of the community-based research study ANRS Trans&HIV is to identify personal and social situations of vulnerability in TRHIV, the obstacles they encounter in terms of access to and retention in medical care, and their gender affirmation and HIV care needs. Methods and analysis ANRS Trans&HIV is a national, comprehensive, cross-sectional survey of all TRHIV currently being followed in HIV care units in France. TRHIV women are exclusively included in the quantitative component, and TRHIV men in the qualitative component. Data are collected by community-based interviewers and will be analysed to explore patient care pathways and living conditions in the TRHIV population with regard to gender affirmation and HIV. Data collection began in October 2020 and should be completed in December 2021. The statistical analyses techniques used will be adapted to each of the study’s objectives and to the type of data collected (cross-sectional ( questionnaires ) and retrospective ( biographical trajectory )). The study’s results will provide a greater understanding of TRHIV health needs in order to suggest possible national recommendations for comprehensive HIV and gender affirmation medical care. Ethics and dissemination ANRS Trans&HIV was approved by Inserm’s Ethical Evaluation Committee (no 20-694 on 12 May 2020) and is registered with the National Commission on Informatics and Liberty under number 2518030720. Potential participants are informed about the study through an information note provided by their attending HIV physician. All results published in peer-reviewed journals will be disseminated to the HIV transgender community, institutional stakeholders and healthcare providers. Trial registration number NCT04849767 .
Article
Objectives: To illustrate possible improvements in recording of gender identity, we investigated discrepancies between gender identity from medical examiner (ME) death investigations and sex as recorded in the final death record. Design: Evaluation of a database used to record information related to medicolegal death investigation with matching to state vital records. Kappa analysis was used to measure concordance between both systems. Setting: The Portland, Oregon, metro area (Clackamas, Multnomah, and Washington Counties) and deaths investigated by the Offices of each County Medical Examiner between January 2011 and September 2020. Intervention: Epidemiologists identified incongruous data that have significant negative implications for transgender populations. Epidemiologists identified key actions that, if taken by death investigators, death record software, and the federal death certificate form, will rectify harmful data discrepancies. Main outcome measure: Concordance of gender identity and sex in ME data and death record, respectively. Results: We identified 51 deaths in transgender persons; the majority were classified as transgender female (71%). The κ statistic was -0.0657, indicating poor concordance between the gender identity in ME investigation and the death certificate in vital records. Conclusions: Information gathered via medicolegal death investigations is foundational to effective public health/public safety response; MEs and coroners are often the first to document emerging health threats. Discrepancies in official death records impede accurate surveillance of a population disproportionately at risk of violent death.
Article
Study objectives: Transgender or gender nonconforming (TGNC) identity is associated with higher burden of sleep disorders relative to cisgender identity. However, the role of gender-affirming therapy (GAT) in sleep disorders is poorly understood. This study examined relationships between TGNC identity, transition, and sleep disorders among TGNC and cisgender youth. Methods: This retrospective cross-sectional study utilized a large US-based administrative claims database (de-identified Optum Clinformatics Data Mart Database) to identify youth aged 12-25 years who obtained a diagnosis of TGNC identity and those who pursued GAT. Descriptive statistics estimated distributions of demographic and health characteristics by gender identity. Unadjusted and age-adjusted logistic regression models were used to examine associations between TGNC identity, GAT, and sleep disorders. Results: This study included 1,216,044 youth, of which 2,603 (0.2%) were identified as TGNC. Among the 1,387 TGNC who pursued GAT, 868 and 519 were identified as transmasculine and transfeminine, respectively. Adjusted analysis showed increased odds of insomnia (OR=5.4, 95% CI 4.7, 6.2), sleep apnea (OR=3.0, 95% CI 2.3, 4.0), and other sleep disorders (OR=3.1, 95% CI 2.5, 3.9) in TGNC relative to cisgender youth. Decreased odds of any sleep disorder were observed in the TGNC youth on GAT (OR=0.5, 95% CI 0.4, 0.7) relative to those not on GAT. Conclusions: This study demonstrated a high burden of sleep disorders in TGNC youth in comparison to cisgender. However, GAT may confer a protective effect on sleep disorders among TGNC youth. Longitudinal assessments of sleep disorders prior to and post-GAT are needed to uncover their temporal relationships.
Article
Introduction Suicide rates for sexual minorities are higher than the heterosexual population. The purpose of this study is to explore circumstances surrounding suicide completion to inform future intervention strategies for suicide among lesbian, gay, bisexual and transgender (LGBT) individuals. Materials and Methods We completed a retrospective analysis of data from the National Violent Death Reporting System (NVDRS) from 2013-2017. Victims identified as transgender were considered separately. We stratified analysis by identified sex of the victim for the LGB population. Results Of the 16,831 victims whose sexual orientation or transgender status was known: 3886 (23.1%) were identified as female, 12,945 (76.9%) were identified as male. 479 (2.8%) were identified as LGBT; of these, 53 (11%) were transgender. LGBT victims were younger than non-LGBT victims. Male LGB victims were more likely to have a history of prior suicide attempts, past or current mental illness diagnosis, and were less likely to use firearms than male heterosexual victims. Female LGB victims were more likely to have problems in an intimate partner relationship than heterosexual women, while LGB men were more likely to have problems in family or other relationships. Transgender victims were again more likely to have mental health problems and a history of prior attempts, but less likely to have intimate partner problems and more likely to have a history of child abuse. Conclusions These results highlight the importance of promoting suicide interventions that recognize the complex intersection between stated gender, sex, and sexuality and the different cultural impacts these identities can have.
ResearchGate has not been able to resolve any references for this publication.