References | Country | Population/sample | Sample size | Demogr | Symptoms | Analysis | Results |
---|---|---|---|---|---|---|---|
Mak et al. [50] | USA | TGD | 6327 | 18–25 year old | Suicide attempts/self-inflicted injury rates | Multivariable Cox regression analyses | Incidence of the first self-harm—HR (95% CI) Overall cohort 3.25 [1.84 to 5.74] AFAB 3.76 (1.79 to 7.89) AMAB 2.57 (1.01 to 6.55) Incidence of Recurrent Self-Harm- HR (95%CI) Overall cohort 2.87 (1.65 to 4.97) AFAB TF cohort 3.57 (1.77 to 7.21) AMAB 2.13 (0.90 to 5.03) |
Thoma et al. [25] | USA | Transgender (including gender-nonconforming, nonbinary, questioning gender identity) and cisgender adolescents | 2020 (1148 TGAs) (872 CGAs) | 14–18 year old Transgender x̄ = 16.0 ± 1.2 Cisgenders x̄ = 15.9 ± 1.1 | Passive death wish; suicidal ideation; suicide plan; suicide attempt; NSSI | Descriptive statistics for suicidality outcome within gender identity groups (95%CI) Multivariate logistic regression Multivariate logistic regression adjusted models | Suicidal ideation (range): All transgender (84.8%) (82.7% to 86.9%) All cisgender (60.4%) (57.1% to 63.7%) Nonbinary assigned female (79.2%) (75.1% to 83.3%) Nonbinary assigned male (72.1%) (58.5% to 85.7%) Questioning (82.4%) (71.8% to 93.0%) NSSI (range): All transgender status (86.9%) (84.9% to 88.9%) All cisgender (59.1%) (55.8% to 62.4%) Nonbinary assigned female (87.6%) (84.2% to 91.0%) Nonbinary assigned male (76.7%) (63.9% to 89.5%) Questioning 76.5(%) (64.7% to 88.3%) 95% CI All transgender status (range) Passive death wish: 93.0% to 95.6% Suicidal ideation: 82.7% to 86.9% Planning attempt: 70.0% to 75.1% Suicide attempt: 47.4% to 53.2% NSSI: 84.9% to 88.9% Non-binary assigned female (range) Passive death wish: 89.6% to 95.0% Suicidal ideation: 58.5% to 85.7% Planning attempt: 64.9% to 74.3% Suicide attempt: 39.3% to 49.3% NSSI: 84.2% to 91.0% Non-binary male (range) Passive death wish: 75.5% to 96.5% Suicidal ideation: 58.5% to 85.7% Planning attempt: 33.7% to 63.9% Suicide attempt: 29.2% to 59.2% NSSI: 95% CI 63.9% to 89.5% All cisgender (range) Passive death wish: 74.2% to 79.8 8% Suicidal ideation: 57.1% to 63.7% Planning attempt: 46.5% to 53.1% Suicide attempt: 28.3% to 34.5% NSSI: 55.8% to 62.4% Higher OR for TGAs: Passive Death Wish (OR = 2.60) Suicidal Ideation (OR = 2.20) Planning attempt (OR = 1.82) Suicidal attempt (OR = 1.65) Attempt requiring medical care (OR = 2.01) NSSI (OR = 2.88) |
Veale et al. [52] | Canada | TNB youth; Cisgender population | 923 | 14–18 year old (n = 323) 19–25 year old (n = 600) 139 transgender girls/women (16.6%) 356 transgender boys/men (42.4%) 344 non-binary (41.0%), mostly females at birth (n = 283) | Self-harm; suicidal ideation; suicide attempts | T-test with Cohen’s d/χ2 for comparing transgender youth and general cisgender population mean scores ANOVA post hoc Tukey comparisons for mean scores: differences between subgroup | Ages 14–18 years Considering suicide (past year) BCAHS in school: 13.0% Trans youth entire sample: n = 199 65.2%; χ2(df 1) = 472.56** (p < 0.01); Effect size (RR = 5.02) Times attempted (past year) BCAHS in school: x̄ ± SD = 0.11 ± 0.47 Trans youth entire sample: n = 199 x̄ ± SD = 0.65 ± 1.00; Student’s t(198) = 7.62** (p < 0.01); Effect size (d = 1.15) At least one attempt (past year) BCAHS in school: 6.5% Trans youth entire sample: N = 199 36.1%; χ2 (d.f. 1) = 290.64** (p < 0.01); Effect size (RR = 5.55) Self-harm Number of times (past year) BCAHS in school: x̄ ± SD = 0.41 ± 1.03 Trans youth entire sample: n = 231 x̄ ± SD = 1.87(1.27); Student’s t(230) = 17.47** (p < 0.01); Effect size (d = 1.42) At least once in the past year BCAHS in school: 16.5% Trans youth entire sample: n = 231 74.9%; χ2(d.f. 1) = 540.93** (p < .01); Effect size (RR = 4.54) Ages 19–25 Considered suicide (ever): CCHS (2012) 15.4%; TYHS (2014): n = 336 74.4%; χ2(d.f. 1) = 893.37** (p < 0.01); Effect size (RR = 4.8) Attempted suicide (ever): CCHS 3.4%; TYHS: n = 156 37.7%; χ2(d.f.1) = 552.30** (p < 0.01); Effect size (RR = 11.12) 14–18–years-old General mental health F(2,234) = 0.54 Seriously considered suicide (past year): Trans boys/men n = 90 68.9%; Trans Girls/Women n = 20; 55.0%; Non-binary n = 93; 64.5%; χ2(d.f. 2) = 1.47 Self-harm at least once in the past year Trans Boys/men n = 106 79.2% Trans Girls/Women n = 24; 50.0%; Non-binary n = 100 77.0%; χ2(d.f. 2) = 9.28* (p < .05) 19–25 years General mental health F(2,407) = 4.71 (p < 0.01) Seriously considered suicide (ever) Trans Boys/men n = 139 76.8%; Trans Girls/Women n = 65; 66.2% Non-binary n = 97; 76.7%; χ2(2) = 3.12 Self-harm at least once in the past year Trans Boys/men n = 150; 48.0%; Trans Girls/Women n = 77; 40.3%; Non-binary n = 150; 60.7%; χ2(2) = 9.78** (p < 0.01) |
Wang et al. [11] | China | TGNC (including nonbinary, questioning); Cisgender adolescents | 12 108 2111 TGNC 9997 Cisgender | x̄ = 15.8 ± 1.0 AMAB = 6518 AFAB = 5590 | Self-harm; suicidal ideation | Descriptive Statistics Linear mixed-model analysis Mixed-Effects Logistic Regression | x̄ (SD) for Self-harm and suicidal ideation: Transgender AMAB = 4.03 (6.44%); AFAB = 3.51 (5.47%) Nonbinary AMAB = 3.93 (6.69%); AFAB = 3.86(5.82) Questioning AMAB = 2.57(4.72%); AFAB = 3.17(5.12) Cisgender Boys 1.25 (3.60%); Girls 1.54 (3.79) TGNC reporting a significantly lower overall health (t11.872 = − 7.36; p < 0.001), higher suicide ideation (t11.860 = 12.22; p < 0.001), higher depression (t11.830 = 12.43; p < 0.001), anxiety symptoms (t11.847 = 11.47; p < 0.001) and higher sleep problems (t11.683 = 10.49; p < 0.001) than cisgender youth Youth AFAB reporting significantly lower level of overall health (t11.866 = − 7.91, p < 0.001), higher suicide ideation (t11.866 = 3.44 p < 0.001), higher depression (t11.827 = 3.88, p < 0.001), higher anxiety symptoms (t11.845 = 8.71, p < 0.001) and sleep problems (t11.676 = 2.79, p < 0.005) than AMAB youth Compared with cisgender boys, significantly higher incidence (OR) of Past suicide attempts for: Transgender girls: OR, 4.35; 95% CI, 2.88 to 6.56 Transgender boys: OR, 2.92; 95% CI, 2.26 to 3.76 Nonbinary AMAB: OR, 3.94; 95% CI, 2.36 to 6.55 Nonbinary AFAB: OR, 3.06; 95% CI, 1.67 to 5,63 Questioning youth AMAB: OR, 2.61; 95% CI, 1.73 to 3.94 Thoughts of self-harm for: Transgender girls: OR, 3.06; 95% CI, 2.24 to 4.19 Transgender boys: OR, 4.06; 95% CI, 3.47 to 4.74 Suicide plan in the past month for: Transgender girls: OR, 4.44; 95% CI, 2.88 to 6.83 Transgender boys: OR, 2.66; 95% CI, 2.03 to 3.50 Nonbinary youth AMAB: OR, 5.36; 95% CI, 3.22 to 8.93 Nonbinary youth AFAB: OR, 4.06; 95% CI, 2.25 to 7.30 Questioning youth AFAB: OR, 2.36; 95% CI, 1.63 to 3.43 Thoughts of suicide for: Transgender girls: OR, 3.93;95% CI, 2.88 to 5.38 Transgender boys: OR, 3.71; 95% CI, 3.10 to 4.21 Deliberate self-harm during the last month for: Transgender girls: OR, 2.74; 95% CI, 1.93 to 3.91 Transgender boys: OR, 3.06; 95% CI, 2.57 to 3.66 Nonbinary AMAB: OR, 2.56; 95% CI, 1.66 to 3.94 Nonbinary AFAB: OR, 3.06; 95% CI, 1.95 to 4.81 |
Becerra-Culqui et al. [53] | USA | TGNC; cisgender youth | 1082 Transfeminine Cohort = 427; 73% Reference males = 4206; 72% Reference females = 4204; 72‰) Transmasculine Cohort = 655; 88% Reference males = 6448; 88% Reference females = 6459; 88% | 10–17 year old | Suicidal ideation; self-inflicted injuries | Logistic Regression | Prevalence Ratios (RPs): Transfeminine subjects compared with reference males for suicidal ideation: 54 (95% CI 18 to 218); For self-inflicted injuries: 70 (95% CI 9.0 to 159). Transmasculine subjects compared with reference males for suicide ideation: 45 [95% CI 23 to 97) For self-inflicted injuries: 144 (95% CI 14 to 4338) |
Bechard et al. [54] | Canada | Adolescents diagnosed with Gender Identity Disorder (GID) (DSM-IV-TR) | 50 | 13–20 year old x̄ = 16.9 Individuals assigned male at birth = 17 Individuals assigned female at birth = 33 | Self-harm, suicidal ideation, and suicide attempts | Descriptive statistics | n(%) Suicidal ideation = 31 (62%) Self-harm = 18 (36%) Suicide attempt(s) = 13 (26%) |
Kozlowska et al. [21] | Australia | Children and Adolescents referred for GD; Healthy Cisgenders | 79 (GD) 155 (CIS) | GDs: 8.42–15.92 year old x̄ = 12.84 ± 1.90 Median = 13.33 Biological males = 33 (41.8%) Biological females (XX) = 46 (58.2%) CIS: 8.33–15.97 yr old x̄ = 12.9 | Suicidal ideation, self-harm, suicide attempts | Descriptive statistics T-test/χ2 | Suicidal ideation (past or current): n = 33 (41.8%) History of self-harm: n = 39 (16.3%) Suicide attempts: n = 8 (10.1%) Depressive disorder: n = 49 (62.0%) Anxiety disorder: n = 50 (63.3%) Significantly higher (t[61.79] = 11.946; p < 0.001) Depression, Anxiety, and Stress Scale total scores between youth with GD and cis-controls Significant difference between children with high (57/79; 72.2%) and low (22/79; 27.8%) levels of gender distress for: History of self-harm (χ2 = 11.86; p < 0.001); Suicidal ideation (χ2 = 6.98; p = 0.008) |
Skagerberg et al. [22] | U.K | Adolescents referred for GD | 125 | x̄ = 13.56 ± 3.24 54.8% individuals assigned male at birth 45.2% individuals assigned female at birth | Suicide attempts; self-harming thoughts and behaviours | Descriptive statistics χ2 | Self-harm (24%); Thoughts of self-harm (14%); Suicide attempts (10%) Males 16–18 yr of age (n = 20) Thoughts of self-harm (37%) Self-harm (26%) Females 12–15 yr of age n = 30) Thought of self-harm (10%) Self-harm (37%) Suicide attempts (17%) Actual self-harm more common in individuals assigned female at birth than individuals assigned male at birth (χ2[1] = 6.84, p < 0.01) No significant difference between individuals assigned female at birth and individuals assigned male at birth for suicide attempts (χ2[1] = 0.87, p > 0.05) |
Hartig et al. [30] | Germany | TGNC adolescents referred for GD | 343 | 11–18 year old x̄ = 15.47 ± 1.51 Male at birth (n = 56) x̄ = 15.69 ± 1.58 Female at birth (n = 287) x̄ = 15.42 ± 1.50 | Risk of suicidal (suicidal ideation, suicide attempts) and non-suicidal self-harming thoughts and behaviours (STBs) | Descriptive statistics | CBCL parent-reported STBs for Item 18 (suicidal behaviour): Often (9.5%); Sometimes (20%) Total = 29% Youth self-reported STBs: often (19%), sometimes (26%), Total = 45% CBCL parent-reported STBs for Item 91 (suicidal ideation): Often (2%); Sometimes (18%); Total = 20% Youth self-reported STB: Often (13%), Sometimes (25%); Total = 38% |
Peterson et al. [55] | USA | Adolescents diagnosed with GD | 96 (AFAB = 54, AMAB = 31, Nonbinary/gender fluid = 15 | 12–22 year-old, x̄ = 17.1 ± 2.3 | Suicide attempts; self-injurious behaviours | Descriptive statistics χ2 | N (%) History of suicide attempt = 27 (30.3%) History of self-injurious behaviours = 40(41.8%) Depressive disorder (n = 36, 38%) Generalized anxiety disorder (n = 15, 16%) Significant difference for AFAB reporting more suicide attempt and self-harm compared with AMAB respectively: (χ2 = 9.38, p < 0.05; χ2 = 8.73, p < .05) |
H. K. Mitchell et al. [56] | USA | TNB adolescents referred for GD | 798,994 | 13–20 year old | Suicidality; self-harm; suicidality and self-harm combined | Multivariable Poisson regression models | 2016 cohort OR [95% CI] Association with suicidality Unadjusted 6.19 [5.80 to 6.60]; Adjusted 3.80 [3.52 to 4.10] Association with self-harm Unadjusted 3.80 [3.13 to 4.61]; Adjusted 2.68 [2.17 to 3.30] Association with suicidality or self-harm Unadjusted 5.71 [5.30 to 6.06]; Adjusted 3.59 [3.35 to 3.85] 2019 cohort OR [95% CI] Association with suicidality Unadjusted 4.71 [4.58 to 4.85]; Adjusted 3.23 [3.12 to 3.34] Association with self-harm Unadjusted 4.21 [3.85 to 4.61]; Adjusted 2.90 [2.62 to 3.21] Association with suicidality or self-harm Unadjusted 4.58 [4.46 to 4.69]; Adjusted 3.15 [3.06 to 3.25] |
Karvonen et al. [57] | Finland | Gender-referred adolescents (GR) and adolescents mental health referred (MHR) | GR = 84 MHR = 293 | GR x̄ = 16.2 ± 1.3 MHR x̄ = 15.6. ± 1.6 p = 0.002 More birth-assigned females in the GR group than in the MHR group (84.5% vs. 64.2%, p < 0.001) | Suicidal ideation and talk, suicide attempt; self-harming behaviours | ANOVA | Suicidal ideation and talk GR = 70.2%; MHR = 50.5%; p = 0.001 OR [95% CI] Model 1 controlled for age and sex = 1.8 [1.0 to 3.1]; p = 0.04 OR [95% CI] Model 2 controlled for age, sex, family and child welfare contacts = 2.8 [1.6 to 5.2]; p = 0.001 Suicide attempt GR = 10.7%; MHR = 8.9%; p = 0.37 OR [95% CI] Model 1 controlled for age and sex = 1.0 [0.5 to 2.3]; p = 0.93 OR [95% CI] Model 2 controlled for age, sex, family and child welfare contacts = 1.1 [0.4 to 2.8]; p = 0.9 Self-harming behaviours GR = 61.4%; MHR = 39.2%; p = < 0.001 R [95% CI] Model 1 controlled for age and sex = 1.9 [1.1 to 3.2]; p = 0.02 OR [95% CI] Model 2 controlled for age, sex, family and child welfare contacts = 2.2 [1.2 to 4.0]; p = 0.007 Depression GR = 67.9%; MHR = 59.0%; p = 0.09 OR [95% CI] Model 1 controlled for age and sex = 1.0 [0.6 to 1.7]; p = 0.97 OR [95% CI] Model 2 controlled for age, sex, family and child welfare contacts = 1.7 [0.9 to 3.0]; p = 0.1 |
Tordoff et al. [58] | USA | TNB adolescents | 104, AMAB = 63; AFAB = 27; Nonbinary/gender fluid = 10; Questioning = 4 | 13–20 year old x̄ = 15.8 ± 1.6 | Self-harm; suicidal thoughts | Descriptive statistics | No. (%) Self-harm or suicidal thoughts at baseline = 45 (43.2%) Depression at baseline 0–4 (minimal) = 14 (13.5%) 5–9 (mild) = 27 (26.0%) 10–14 (moderate) = 22 (21.2%) 15–19 (moderately severe) = 11 (10.6%) ≥ 20 (severe) = 26 (25.0%) Missing = 4 (3.8%) Anxiety at baseline 0–4 (minimal) = 20 (19.2%) 5–9 (mild) = 28 (26.9%) 10–14 (moderate) = 20 (19.2%) 15–19 (moderately severe) = 11 (10.6%) ≥ 20 (severe) = 32 (30.8%) Missing = 4 (3.8%) |