Factors associated with suicide attempts among Australian transgender adults

Abstract

Background Transgender, 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. Methods Using 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. Results Of 928 participants, 85% 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) 1.55 (1.05, 2.29), p = 0.03), had a diagnosis of depression (aOR 3.70 (2.51, 5.45), p < 0.001), desired gender affirming surgery in the future (aOR 1.73 (1.14, 2.61), p = 0.01), had experienced physical assault (aOR 2.01 (1.37, 2.95), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.23), p = 0.007). Conclusion Suicidality is associated with barriers to gender affirming care, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable timely access to gender affirming care, particularly surgical interventions, are potential areas of intervention.

Gender-affirming hormone therapy induces specific DNA methylation changes in blood

“…Transgender individuals are a highly marginalized population at higher risk of depression and antidepressant drug use [ 46 ], both of which have been associated with variation in blood DNA methylation patterns [ 47 , 48 ]. A recent meta-analysis of more than 11,000 individuals identified 3 DMPs in blood associated with depression [ 49 ], but more longitudinal studies are required to explore this phenomenon further.…”

Lived experiences of transgender forced migrants and their mental health outcomes: systematic review and meta-ethnography

“…4 These stressors are linked to poor mental health outcomes, including disproportionate rates of suicide attempts (twice those of cisgender lesbian, gay and bisexual adults and ten times those of the general adult population) and diagnosed mental health conditions such as depression, anxiety and substance use disorders. [5][6][7][8][9] In the worst cases, transgender people are forced to migrate to seek refuge in countries that offer them better legal protection, perceived safety and access to healthcare.…”

“…TFMs also described collective social, political and economic violence facilitated by states (1,2,3,4,5,6,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24). In countries of origin, statesanctioned punishments of gender non-conforming behaviour and an absence of legal protections against discrimination and abuse perpetuate a culture that makes life unliveable for many transgender people.…”

Causation and Causal Selection in the Biopsychosocial Model of Health and Disease

“…As well as being informed by epistemic and pragmatic considerations, our explanatory interests are often informed by ethical and political considerations, especially in healthcare, where promoting people's welfare and alleviating their suffering are central values. For example, in their recent research on transgender mental health, Sav Zwickl and colleagues apply a psychosocial approach to examine the causal factors associated with suicidality among transgender and nonbinary adults (Zwickl et al 2021). The context of this research pertains to the higher rates of suicidality and mental health problems among transgender and nonbinary people than among cisgender people, and so the explanatory interests guiding the research are appropriately informed by ethical and political considerations concerning health inequity, social injustice, and systemic discrimination.…”