Correlates of suicide ideation and behaviors among transgender people: A systematic review guided by ideation-to-action theory

Abstract

Transgender people are at high risk for suicide ideation, attempts, and deaths compared to the general population. Several correlates of suicide ideation and attempts have been identified empirically to understand this increased risk. However, few attempts have been made to systematically review this literature. Further, a theory to understand and identify targetable factors for intervention has rarely been applied to this population. In the first systematic review guided by ideation-to-action frameworks of suicide, we systematically reviewed the literature from January 1991 to July 2017 regarding correlates of suicide ideation, attempts, and deaths among transgender people. To be included in the review, articles must have been reported in English, reported on empirical data, included a sample or subsample of transgender people, and reported separately on correlates of suicide ideation, attempts, or deaths. Two independent reviewers searched three major databases, references of included articles, and unpublished literature, which produced 45 articles for review. The review suggested that ideation-to-action frameworks would be worth investigating within this population, with attention to sources of psychological pain, social connectedness, and capacity/capability for suicide unique to this population. Additionally, other aspects of cultural identity were often studied (e.g., race, religion), suggesting the need to understand intersectionality of identities among transgender people and their effects on suicide risk. Finally, the review highlighted important limitations of the literature, namely measurement of suicide ideation and attempts and sampling method, which future work should seek to improve.

Preferences in Information Processing, Marginalized Identity, and Non-Monogamy: Understanding Factors in Suicide-Related Behavior among Members of the Alternative Sexuality Community

“…For instance, a recent systematic review of discrimination and mental health concluded that heterosexist prejudice, compared to racial prejudice, was most influential on SRB among sexual and gender minority (SGM) Black persons [48]. Also, another review of transgender and gender minority suicide showed that multiple marginalized statuses pertaining to race and religion were uniquely important factors among gender diverse persons [49]. Thus, we examined the SRB risk and protective factor patterns for the following set of marginalized identities among members of the alternative sexuality community: race, sexual orientation, gender, education level, and ethnicity.…”

Suicidal Thoughts and Behaviors Among Transgender Adults in Relation to Education, Ethnicity, and Income: A Systematic Review

“…However, 20 address the issue primarily among youth or children; as secondary or incidental to another issue (e.g., HIV), a single aspect of a larger topic (e.g., transgender health); or among sexual minorities writ large (e.g., LGBT). The five meta-analyses and systematic reviews that primarily assessed SITBs among transgender adults are Marshall et al, 116 Virupaksha et al, 117 McNeil et al, 118 Wolford-Clevenger et al, 119 and Adams et al 3 Two 116,118 account for review parameters (exclusion of gray literature) but fail to identify a number of studies and, in one case, count a single data set multiple times. One 117 includes gray literature, but only selects articles freely available online and relevant to the review title, without explaining how the latter was systematized.…”

“…One 117 includes gray literature, but only selects articles freely available online and relevant to the review title, without explaining how the latter was systematized. One 119 identifies factors (attempts, behavior, and deaths) correlated with transgender SITBs in literature published between 1991 and January 2017 but does not analyze data on SITBs in this literature. One 3 presents an earlier stage of this research, which excludes literature published since February 2016 and does not focus on the impact of ethnicity, income, or education on SITBs.…”

Suicide in Transgender Veterans: Prevalence, Prevention, and Implications of Current Policy

“…Only in the past decade have empirical studies of suicide risk and resilience in transgender veterans been conducted. Extant work has focused primarily on understanding the prevalence of STBs in this population, with less attention to risk and resiliency factors (Wolford-Clevenger, Frantell, Smith, Flores, & Stuart, 2018). The lack of research is unsurprising given that transgender individuals were not able to openly serve in the military without fear of discharge until 2016, when DoD instruction (DoDI) 1300.28 and directive-type memorandum 16-005 were issued (U.S.…”

“…Candidate factors to study in the transgender veteran population could include clinical (e.g., onset of SI, plans for SI, risk-taking behaviors; Nock et al, 2018), individual-difference (pain tolerance and fearlessness of death; Joiner, 2005), and practical factors (access to and familiarity with means for suicide; Klonsky & May, 2015). A recent systematic review of static and dynamic suicide risk factors identified in the broader transgender suicide literature used the ideation-to-action framework as its guiding theoretical lens (Wolford-Clevenger et al, 2018). This review identified predictors of SA history that may also serve as factors that facilitate the transition from suicidal thoughts to behaviors (although none were tested in this manner in the extant literature).…”