Self-harm and suicidality in gender-nonconforming children: A Canadian community-based parent-report study.

Abstract

No study to date has examined self-harm/suicidality in a community sample of children who express gender nonconformity (GNC). This parent-report study (N ϭ 1,923) examined self-harm/suicidality in a nonclinical community sample of 6-to 12-year-old children, including those who express marked GNC but do not have a gender dysphoria (GD) diagnosis. Child Behavior Checklist (CBCL) Items 18 ("Deliberately harms self or attempts suicide") and 91 ("Talks about killing self") measured self-harm/ suicidality. The Gender Identity Questionnaire for Children measured GNC, the CBCL measured peer relations and behavioral and emotional challenges, and the Child-Rearing Sex-Role Attitude Scale measured parents' gender-stereotypical attitudes toward child-rearing. Among children who expressed GNC most markedly, 9.1% had attempted suicide and/or self-harmed and 6.8% had suicidal ideation. These rates parallel those reported for children clinic-referred for GD. Across the sample, suicidal ideation, self-harm/suicide attempt, poor peer relations, and behavioral and emotional challenges were significantly positively correlated. Among children assigned female at birth, self-harm/suicide attempt was negatively correlated with gender-liberal parental attitudes. Binary logistic regressions showed some evidence that children who expressed GNC had higher suicidality/self-harm compared to children who were gender-conforming and did not have a mental health diagnosis; however, group effects were mostly accounted for when controlling for poor peer relations and behavioral and emotional challenges, with the latter being the strongest predictor of suicidal ideation and self-harm/suicide attempt. Thus, self-harm/ suicidality among gender-nonconforming children is likely greater in scope than previously recognized, and parental attitudes, peer relations, and behavioral and emotional challenges are important factors to consider. Public Significance StatementThis study is the first to demonstrate that the issue of suicidality/self-harm among gendernonconforming children from nonclinical, community populations is likely much greater in scope than has been previously recognized. Among children who expressed high levels of gender nonconformity, 9.1% had attempted suicide and/or self-harmed and 6.8% had suicidal ideation, which are similar to rates reported for children clinic-referred for gender dysphoria and highlights a need for awareness of this issue among individuals who regularly interact with children.

Childhood social gender transition and psychosocial well-being: A comparison to cisgender gender-variant children.

“…This finding was consistent with those of prior studies of SGT children (Kuvalanka et al, 2017) and children clinic-referred for GD (Steensma et al, 2014). As such, addressing poor relationships with peers should be a principal focus, perhaps especially for gender-variant children assigned male at birth for whom poor peer relations appears to be a particularly pertinent issue (MacMullin et al, 2019; Wallien et al, 2010).…”

“…Likewise, van der Miesen et al’s (2018) original sample of gender-variant children was at elevated risk compared to a sample of gender-stereotypical children and showed rates of clinical-range CBCL challenges that were on par with those of children referred to specialty gender services (see Zucker et al, 2014). An analysis of the van der Miesen et al sample focusing on peer relations found that gender-variant children assigned male at birth had poorer peer relations than gender-stereotypical male control children (MacMullin, Aitken, Nabbijohn, & VanderLaan, 2019). By extrapolation, SGT children may similarly be at elevated risk given their psychosocial challenges resembled those of the CGV children from van der Miesen et al…”

“…The findings to date suggest evaluation and monitoring of psychosocial challenges on a case-by-case basis is warranted regardless of transition status. Importantly, psychosocial risk extends beyond clinical populations of gender-variant children seen in specialty gender clinics to children from the community (van der Miesen et al, 2018; MacMullin et al, 2019). As such, awareness of psychosocial challenges experienced by gender-variant children should extend beyond specialty clinics and into health care and allied fields (e.g., education) more broadly.…”

Suicidality among sexual minority and transgender adolescents: a nationally representative population-based study of youth in Canada

“… 18 However, the epidemiology of suicidality among transgender and gender-nonconforming youth remains understudied in population-based samples; most research on the mental health of transgender youth comes from small community samples of help-seeking youth or targeted surveys of transgender adolescents. 5 , 19 , 20 Two population-based studies from California 21 and New Zealand 22 suggested that transgender youth are at increased risk of suicidal ideation and suicide attempt. However, only the New Zealand study 22 used the gold-standard measure of gender identity, contrasting adolescents’ sex assigned at birth with their self-identified gender.…”

Early childhood educators' beliefs about child behavior and adult outcomes related to gender and play

“…Research has shown that children and adolescents who are gender role nonconforming have higher rates of depression, suicidality, and self-harm compared to gender role conforming controls (Aitken et al, 2016;Bennett et al, 2019;MacMullin et al, 2020). Importantly, research has shown that school environments with supportive teachers can help to reduce these risks (GLSEN, 2019).…”