Josephine Mak1, Deirdre A Shires2, Qi Zhang1, Lucas R Prieto3, Brian K Ahmedani4, Leonardo Kattari3, Tracy A Becerra-Culqui5, Andrew Bradlyn6, W Dana Flanders1, Darios Getahun5, Shawn V Giammattei7, Enid M Hunkeler8, Timothy L Lash1, Rebecca Nash1, Virginia P Quinn9, Brandi Robinson6, Douglas Roblin10, Michael J Silverberg11, Jennifer Slovis11, Vin Tangpricha12, Suma Vupputuri10, Michael Goodman1. 1. Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia. 2. School of Social Work, Michigan State University, East Lansing, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. Electronic address: shiresde@msu.edu. 3. School of Social Work, Michigan State University, East Lansing, Michigan. 4. Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan. 5. Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California. 6. Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia. 7. The Rockway Institute, Alliant International University, San Francisco, California. 8. Division of Research, Kaiser Permanente, Northern California (emerita), Oakland, California. 9. Department of Research and Evaluation, Kaiser Permanente Southern California (emerita), Pasadena, California. 10. Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland. 11. Division of Research, Kaiser Permanente, Northern California, Oakland, California. 12. School of Medicine, Emory University, Atlanta, Georgia; The Atlanta VA Medical Center, Atlanta, Georgia.
Abstract
INTRODUCTION: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS: During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged <18 years than among those aged >45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings.
INTRODUCTION: Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS: Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfemininepeople by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS: During follow-up, 4.8% of transmasculine and 3.0% of transfemininepatients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged <18 years than among those aged >45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS: Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings.
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