A Plausible Explanation of Increased Suicidal Behaviors Among Transgender Youth Based on the Interpersonal Theory of Suicide (IPTS): Case Series and Literature Review

Abstract

Background: Growing data on suicidal behavior among members of the lesbian, gay, bisexual, transgender, queer, questioning, and other sexual/gender minority (LGBTQ+) communities, particularly in the transgender subgroup, demonstrate that there is a stark elevation in suicidality compared with rates in their cisgender counterparts. Among the available theories of suicide, the interpersonal theory of suicide (IPTS) is a plausible explanation for the increased suicidal behaviors among transgender youths. Objective: The objective of this study was to examine the pathologic basis of treatmentresistant suicidality in transgender youth despite favorable environments using the theoretical framework of the IPTS, supported by a literature review and case series. Methods: We conducted a literature review using PubMed and PsycInfo with key words suicidal ideation, suicidality, transgender, transgender youth, gender dysphoria, and interpersonal theory of suicide. Seventy-eight articles were retrieved, which were then narrowed down to 30 articles after non-English articles and irrelevant topics were excluded. The clinical presentations of 5 transgender youths, 11 to 17 years of age, were found to be correlated with relevant reports in the research literature, implying a plausible rationale for elevated rates of suicide. All patients and families supplied verbal consent for these case reports to be published. Results: Reasons for suicidal behavior among the patients included thwarted belongingness and perceived burdensomeness leading to perpetual suicidal behavior. The presence in these cases of the following contributing factors in the IPTS-thwarted belongingness, perceived burdensomeness, and acquired capability for suicide-suggests that such a basis exists. Perceived burdensomeness appears to have a greater correlation with developing suicidal behavior than thwarted belongingness alone, but the presence of both demonstrates the highest risk of suicidality in transgender youth. Transgender children and adolescents are at extremely high risk of suicidal behavior, but little research has been devoted to the etiology and plausible explanations for this elevated risk, despite growing awareness of and support for the problem. This review suggests further research is required on the triadic factor interactions of the IPTS model that could help us to better understand and intervene with this high-risk population.

Factors Associated with Suicidal Ideation and Suicide Attempt in Brazilian Transgender Youth

“…As discussed by the MST, perhaps gender positivity can be encouraged through community connectedness, such as minority resilience [ 26 , 28 , 45 ]. According to the IPTS [ 28 , 29 , 30 ], a feeling of belonging can be cited as positive relations, through inclusive relations and not rejections. It may be considered an important variable for mental health, and we suggest that it be further investigated in Brazil, along with other predictor variables of mental health.…”

“…A stigmatizing social environment leads transgender populations to experience gender and socially based stress, which can be distal (objective stressors, discrimination, victimization) or proximal (subjective stressors, internalized transphobia, expectations for future prejudice events). Specifically, regarding suicide, there are other theories, such as the Interpersonal Theory of Suicide (IPTS), developed by Joiner and Van Orden [ 27 ], which have also been used to understand this outcome in the transgender community [ 28 , 29 , 30 ]. There seems to be compatibility between the theories due to their focus on interpersonal factors, such as social rejection [ 28 ].…”

“…There seems to be compatibility between the theories due to their focus on interpersonal factors, such as social rejection [ 28 ]. IPTS understands lethal and nonlethal behaviors associated with suicide as arising from severe interpersonal emotional conflicts, based on thwarted belongingness and perceived burdensomeness [ 28 , 29 , 30 ].…”

“…For the IPTS [ 28 ], supportive interpersonal relationships for transgender youth play an especially important role, in view of gender explorations that are specific to this age group. Transgender youth can explore their gender identity and seek support when they feel they belong [ 29 , 30 ]. However, young transgender persons report conflicts with family and peers due to their transgender identities [ 29 , 30 ].…”

“…Transgender youth can explore their gender identity and seek support when they feel they belong [ 29 , 30 ]. However, young transgender persons report conflicts with family and peers due to their transgender identities [ 29 , 30 ].…”