Transgender Adolescent Suicide Behavior

Abstract

Objectives: Our primary objective was to examine prevalence rates of suicide behavior across 6 gender identity groups: female; male; transgender, male to female; transgender, female to male; transgender, not exclusively male or female; and questioning. Our secondary objective was to examine variability in the associations between key sociodemographic characteristics and suicide behavior across gender identity groups.

Methods: Data from the Profiles of Student Life: Attitudes and Behaviors survey (N = 120 617 adolescents; ages 11-19 years) were used to achieve our objectives. Data were collected over a 36-month period: June 2012 to May 2015. A dichotomized self-reported lifetime suicide attempts (never versus ever) measure was used. Prevalence statistics were compared across gender identity groups, as were the associations between sociodemographic characteristics (ie, age, parents' highest level of education, urbanicity, sexual orientation, and race and/or ethnicity) and suicide behavior.

Results: Nearly 14% of adolescents reported a previous suicide attempt; disparities by gender identity in suicide attempts were found. Female to male adolescents reported the highest rate of attempted suicide (50.8%), followed by adolescents who identified as not exclusively male or female (41.8%), male to female adolescents (29.9%), questioning adolescents (27.9%), female adolescents (17.6%), and male adolescents (9.8%). Identifying as nonheterosexual exacerbated the risk for all adolescents except for those who did not exclusively identify as male or female (ie, nonbinary). For transgender adolescents, no other sociodemographic characteristic was associated with suicide attempts.

Conclusions: Suicide prevention efforts can be enhanced by attending to variability within transgender populations, particularly the heightened risk for female to male and nonbinary transgender adolescents.

FIGURE 1

Percentages of self-reported suicide behavior among adolescents by gender identity. Subsamples include 0.2% (n = 202) transgender, male to female; 0.1% (n = 175) transgender, female to male; and 0.3% (n = 344) transgender, not exclusively male or female. Additionally, a small percentage of adolesscents reported that they were not sure of their gender identity (0.9% [n = 1052]; referred to as questioning), whereas 50.6% (n = 60 973) identified as female, and 48% (n = 57 871) identified as male. Different subscripts represent significant differences between groups (P < .001). ^a Female adolescents reported lower levels of suicide behavior compared to all transgender youth but higher levels compared to cisgender male adolescents. ^b Male adolescents reported the lowest levels of suicide behavior compared to all other groups. ^c Transgender, male to female, and questioning youth reported higher levels of suicide behavior compared to cisgender males and females but lower levels compared to transgender, female to male, and transgender, nonbinary youth. ^d Transgender, female to male, and transgender, nonbinary youth reported the highest levels of suicide behavior compared to all other groups.