Abstract
BackgroundTransgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies.MethodsUsing a non-probability snowball sampling approach, a total of 928 trans adults completed a cross-sectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide.ResultsOf 928 participants, 73% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.54 (1.04, 2.28), p = 0.03), had a diagnosis of depression (aOR 3.43 (2.16, 5.46), p < 0.001), desired gender affirming surgery in the future (aOR 1.71 (1.134, 2.59), p = 0.01), had experienced physical assault (aOR 2.00 (1.37, 2.93), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.22), p = 0.007).ConclusionSuicidality is associated with desiring gender affirming surgery in the future, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable access to gender affirming care, particularly surgical interventions, are potential areas of intervention.
Highlights
Transgender, including gender diverse and non-binary people, referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm
Responses were received from all states and territories of Australia, with the majority residing in major city areas
While the self-reported suicide attempt rate of trans participants is 10-times higher than that reported for the general Australian population, this rate converges with data on Australian trans youth and similar cohort studies conducted in Euro-Western settings [6, 41,42,43]
Summary
Transgender, including gender diverse and non-binary people, referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. Transgender, including gender diverse and non-binary (trans) people are a highly marginalised group in our community with alarmingly high rates of suicidality (ideation and non-fatal behaviours) and mental health morbidities [1,2,3]. Suicide attempts and suicide deaths occur due to a complex interaction between biological, psychological and psychosocial risk factors This may include genetic predisposition to depression and anxiety [8, 9], minority stress and stressful life events, unemployment and financial stress [10,11,12], quality of support networks [13,14,15,16,17], discrimination, violence [18,19,20] and barriers to accessing healthcare and support services [21]
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