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

Abstract

Background: Very little research has described risk of suicidal ideation and suicide attempt among transgender youth using high-quality, nationally representative data. We aimed to assess risk of suicidality among transgender and sexual minority adolescents in Canada. Methods: We analyzed a subsample of adolescents aged 15–17 years from the 2019 Canadian Health Survey on Children and Youth, a nationally representative, cross-sectional survey. We defined participants’ transgender identity (self-reported gender different from sex assigned at birth) and sexual minority status (self-reported attraction to people of the same gender) as exposures, and their self-reported previous-year suicidal ideation and lifetime suicide attempt as outcomes. Results: We included 6800 adolescents aged 15–17 years, including 1130 (16.5%) who indicated some degree of same-gender attraction, 265 (4.3%) who were unsure of their attraction and 50 (0.6%) who reported a transgender identity. Compared with cisgender, heterosexual adolescents, transgender adolescents showed 5 times the risk of suicidal ideation (95% confidence interval [CI] 3.63 to 6.75; 58% v. 10%) and 7.6 times the risk of suicide attempt (95% CI 4.76 to 12.10; 40% v. 5%). Among cisgender adolescents, girls attracted to girls had 3.6 times the risk of previous-year suicidal ideation (95% CI 2.59 to 5.08) and 3.3 times the risk of having ever attempted suicide (95% CI 1.81 to 6.06), compared with their heterosexual peers. Adolescents attracted to multiple genders had 2.5 times the risk of suicidal ideation (95% CI 2.12 to 2.98) and 2.8 times the risk of suicide attempt (95% CI 2.18 to 3.68). Youth questioning their sexual orientation had twice the risk of having attempted suicide in their lifetime (95% CI 1.23 to 3.36). Interpretation: We observed that transgender and sexual minority adolescents were at increased risk of suicidal ideation and attempt compared with their cisgender and heterosexual peers. These findings highlight the need for inclusive prevention approaches to address suicidality among Canada’s diverse youth population.

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

“…Of the participants, 72.3% had seriously thought about taking their own life, 42.7% had attempted suicide, and 57.6% had depressive symptoms. The high rates found in this Brazilian sample are in line with those found in other countries, such as the United States [ 6 , 7 , 40 , 41 ], China [ 8 ], Canada [ 9 ], the United Kingdom [ 7 ], Australia [ 7 ], Japan [ 7 ], and New Zealand [ 5 ]. However, in China [ 8 ], in a binary sample, trans women had significantly higher rates of mental illness than trans men, and our study found no significant difference between genders.…”

“…In China [ 8 ], a survey of young transgender persons found a prevalence of 56.4% for a history of suicidal ideation and 16.1% reported a history of suicide attempts. In Canada [ 9 ], a nationally representative population-based study with young people found that transgender adolescents were at an increased risk of suicidality when compared to their cisgender peers, with 5 times the risk of suicidal ideation and 7.6 times the risk of ever having attempted suicide.…”

“…As stated earlier, there are mental health disparities when compared with the young cisgender population [ 5 , 6 , 9 ]. Some disparities can be associated with stigma, harassment, and victimizing experiences of transphobia.…”

Identifying patterns of substance use and mental health concerns among adolescents in an outpatient mental health program using latent profile analysis

“…This is consistent with incidence and prevalence of substance use increasing with age [ 5 , 13 , 42 ]. Further, adolescents who were cis-gender girls, transgender or gender diverse, or who endorsed LGBTQ status had higher odds of being in profiles characterized by more severe and frequent emotional and behavioral disorder symptoms (with or without substance use) [ 19 , 20 , 43 ]. However, these associations were stronger for the low substance use/high emotional and behavior disorder symptom profile than for the profile high in both.…”

“…Female adolescents may be more likely to report co-occurring concerns [ 7 ], while transgender or gender diverse adolescents experience greater vulnerability to substance use and mental health concerns [ 19 ]. Both transgender and sexual minority adolescents experience significantly higher rates of suicidality [ 20 ]. Further, severe mental illnesses are often defined by the presence of psychotic symptoms, trauma-related disorders, and/or clinical indicators of acute risk including harm to self, harm to others, and need for hospitalization [ 21 ].…”