Abstract
BackgroundAcross Europe, Canada, and the United States, 22–43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact.MethodsThe Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks.ResultsAmong trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10th versus 90th percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10th percentile.ConclusionsLarge effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.
Highlights
Across Europe, Canada, and the United States, 22–43 % of transgender people report a history of suicide attempts
Depression and anxiety disorders were excluded, as they are more likely to result from intervenable factors under study, and we hypothesized they would partially mediate their effects on suicide ideation or attempt; if we were to control for these mediators we would remove a portion of the causal effect and would produce estimates for the effects of our intervenable factors as enacted only through pathways other than depression or anxiety
Our findings provide evidence that social inclusion, protection from transphobia, and undergoing medical transition have the potential for sizeable effects on the high rates of suicide ideation and attempts in trans communities
Summary
Across Europe, Canada, and the United States, 22–43 % of transgender (trans) people report a history of suicide attempts. Studies in Canada, Europe, and the United States have reported suicide attempt prevalences within the trans population that range from 22 to 43 % over the lifetime and 9 to 10 % for the past year [2,3,4,5,6,7]. Demographic factors predictive of suicide attempts in the Canadian population overall include female sex, youth, chronic illness, lack of religiosity, and being unmarried [9]. These predictors may not hold within trans populations; for instance, among trans Ontarians, ideation and attempts did not differ by gender identity [2]. Depression and anxiety disorders were excluded, as they are more likely to result from intervenable factors under study, and we hypothesized they would partially mediate their effects on suicide ideation or attempt; if we were to control for these mediators we would remove a portion of the causal effect and would produce estimates for the effects of our intervenable factors as enacted only through pathways other than depression or anxiety
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