Differences in Methods of Suicide Death Among Transgender and Nontransgender Patients in the Veterans Health Administration, 1999–2016

Abstract

Background: Limited research suggests that rates of suicide death among transgender people may be higher than their nontransgender peers. Objective: The objective of this study was to compare rates of suicide deaths by different means between transgender and nontransgender patients. Research Design: This secondary analysis used VHA administrative and electronic health record (EHR) data from October 1, 1999 through December 31, 2016. Subjects: Transgender patients (n=8981) were categorized as such based on a set of International Classification of Disease codes, and a comparison sample was selected by randomly choosing 3 nontransgender patients (n=26,924). Measures and Analyses: Cause and date of death data are from the National Death Index. Because of low frequencies amid different methods of suicide death, we combined categories into self-poisoning; hanging, strangulation and suffocation; discharge of firearms; and self-harm by all other and unspecified means. We conducted Cox regression analyses to model time-to-event for each method of suicide, adjusted for age, sex based on EHR, race, ethnicity, marital status, and whether patients had ever been diagnosed with depression. Results: Among transgender patients, 73 died by suicide (22 female EHR-based sex, 51 male EHR-based sex), and among nontransgender patients, 71 died by suicide (4 female EHR-based sex, 67 male EHR-based sex). In adjusted models, transgender patients had significantly greater hazards of death by self-poisoning and firearms than their nontransgender peers. Conclusions: Differences in methods of suicide death suggest that firearms and self-poisoning may be specific areas of concern for transgender individuals experiencing suicidal crisis, which underscore needs for examining effective delivery of evidence-based care.

The Relationship Between Gender Identity, Economic Stressors, Social Support, Concurrent Substance Use and Suicidal Ideation

“…The ndings of this cross-sectional study in a large sample of middle-aged adults document the impact of social and economic stressors and highlight disparities related to SI. These results are consistent with research on gender minorities and demonstrate the elevated risk of suicide among this oftenunderrepresented population [29][30]. These signi cant associations between gender identity, concurrent substance use, social support, and economic hardship in relation to suicide risk are critical when developing both public and clinical interventions.…”

Queering health services research

“…For example, most include minority stress theory as an explanation for gender-and sexual orientation-related health inequities. [18][19][20][21][22][23][24] A few also point toward the influence of structural determinants, such as homophobia and transphobia, as important explanations for the existence of…”

“…Six articles in Medical Care clearly focus on the intersections of identities as important in explaining LGBTQ+ health inequities. [19][20][21][22][23][24] However, few studies examine the mechanisms through which interlocking structural determinants, such as cisheterosexism and racism, shape health and health care experiences.…”

“…Of those that engage theory, most rely on non‐queer theoretical foundations. For example, most include minority stress theory as an explanation for gender‐ and sexual orientation‐related health inequities 18–24 . A few also point toward the influence of structural determinants, such as homophobia and transphobia, as important explanations for the existence of LGBTQ+ health inequities.…”

“…Although 12 of the 42 articles articulate the need for intersectional analysis, few implement a full intersectional approach in their methods. Six articles in Medical Care clearly focus on the intersections of identities as important in explaining LGBTQ+ health inequities 19–24 . However, few studies examine the mechanisms through which interlocking structural determinants, such as cisheterosexism and racism, shape health and health care experiences.…”