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. 2022 Jan;57(1):195-205.
doi: 10.1007/s00127-021-02115-8. Epub 2021 Jun 9.

An analysis of suicidal thoughts and behaviors among transgender and gender diverse adults

Robert J Cramer  1 , Andrea R Kaniuka  2 , Farida N Yada  2 , Franck Diaz-Garelli  2 , Ryan M Hill  3 , Jessamyn Bowling  2 , James M Macchia  4 , Raymond P Tucker  5
Affiliations

An analysis of suicidal thoughts and behaviors among transgender and gender diverse adults

Robert J Cramer et al. Soc Psychiatry Psychiatr Epidemiol. 2022 Jan.

Abstract

Purpose: Suicidal thoughts and behaviors (STBs) remain a pressing public health problem for transgender and gender diverse (TGD) persons. The goal of this study was to apply social-ecological and minority stress frameworks to identify individual and interpersonal-level TGD-specific STB risk and protective factors.

Methods: This is a secondary analysis of the 2015 United States Transgender Health Survey, a comprehensive cross-sectional health assessment of a national sample of TGD adults (N = 27,658). Chi-square and Analysis of Variance (ANOVA) were used to identify bivariate correlates of 12-month and lifetime suicidal ideation (SI) and suicide attempt (SA). Logistic regression was employed to identify the strongest STB risk and protective factors across levels.

Results: Sexual minority identification, racial minority identification, and having a disability were lifetime STB risk factors. TGD identity, sexual minority identification, racial minority identification (SA only), lower education, lower income, military experience, having a disability, and being uninsured were 12-month STB risk factors. Psychological distress was the most robust STB risk factor. Workplace discrimination, family rejection, healthcare discrimination, and childhood bias-based victimization were lifetime STB risk factors. All forms of discrimination and victimization (with the exception of family rejection for SI) were 12-month STB risk factors. Family and coworker support were protective factors for lifetime SA (but not SI) and all 12-month STBs. Being less out about TGD identity was a protective factor for STBs (except for 12-month SI).

Conclusion: Findings support social-ecological and minority stress STB risk frameworks. Recommendations are provided for a comprehensive approach to TGD suicide prevention.

Keywords: Discrimination; Gender identity; Social support; Social-ecological model; Suicide; Transgender.

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