In the Journals

Transgender youth nearly twice as likely to report suicidal thoughts

Amaya Perez-Brumer

More than a third of transgender high school students in California reported having suicidal thoughts in the past year, almost twice that of their cisgender peers, according to new research.

These findings highlight an urgent need for school-based mental health services to help protect transgender students from suicidal ideation, the researchers wrote.

Due to a lack of high-quality population-based research on suicidal ideation among transgender youth, Amaya Perez-Brumer, MSc, of the Mailman School of Public Health at Columbia University, New York, and colleagues evaluated data on more than 910,000 high school students who participated in the 2013 to 2015 California Healthy Kids Survey, and a weighted subsample of almost 36,000 students representative of the state’s student population. In each sample, 1.33% and 1.1% identified as transgender, respectively.

Researchers found that 33.73% of transgender students reported suicidal ideation within the past 12 months compared with 18.85% of cisgender students (P < .001). Adjusted analysis within the representative sample showed transgender students were 2.99 (95% CI, 2.25-3.98) times as likely as cisgender students to report suicidal ideation.

Perez-Brumer noted that this is the first study in the United States to use representative data that includes measures of gender identity to document disparities in suicidal ideation.

“It is crucial that studies of adolescent health include measures of gender identity alongside sexual orientation to better understand and create programs to address the needs of these youth across the United States,” she said in a press release.

The lack of surveys, especially population-based surveys, is one of the main challenges in LGBTQ research, Perez-Brumer told Healio.com/Psychiatry.

“This is due to a variety of reasons, including stigma, which prevents many school districts from asking these questions,” she said. “However, current research shows that we can accurately assess gender identity among youth. Our study underscores the importance of other states incorporating measures of gender identity into existing population-based surveys to provide further insight into how to better support the mental health needs of gender minority youth.”

Additionally, the study showed that increased rates of depression and victimization may in part explain the higher risk for suicidal ideation among transgender students. Adjusted analysis showed that depressive symptoms (adjusted OR = 5.44; 95% CI, 1.81-16.38) and victimization (aOR = 2.66; 95% CI, 1.26-5.65) were significantly associated with an increased risk for suicidal ideation in transgender students.

“Like all students, transgender youth deserve to be safe and supported at school,” Stephen T. Russell, PhD, fellow researcher with the department of human development and family sciences at the University of Texas, Austin, said in the press release. “These results show that reducing depression and victimization for transgender students should significantly reduce their suicide-related risk.”

In a related editorial, Nicole A. Sitkin, BS, of Yale School of Medicine, and Dinora Murota, BA, of University of California, wrote that depression and victimization measures mediated the association between gender identity and suicidal ideation, but only somewhat, which highlights that additional influences may impact mental health and suicidality in transgender students. These may include structural stigmas, like prevention of using preferred bathrooms and pronouns, and familial attitudes and behaviors, they wrote.

Perez-Brumer and colleagues concluded that school-based interventions are urgently needed to increase access to mental health services, train faculty and staff on the needs of transgender students, and address the disparate rates of depression and victimization.

“In general, those providing support and mental health care to youth, including psychiatric health care providers, should consider the unique experiences of transgender youth, especially in relation to negative school experiences, and be sure to assess rates of depression and suicidality among these youth,” Perez-Brumer told Healio.com/Psychiatry. “Mental health care providers also need to be better trained in how to offer services that are affirming of transgender youth.” – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.

Amaya Perez-Brumer

More than a third of transgender high school students in California reported having suicidal thoughts in the past year, almost twice that of their cisgender peers, according to new research.

These findings highlight an urgent need for school-based mental health services to help protect transgender students from suicidal ideation, the researchers wrote.

Due to a lack of high-quality population-based research on suicidal ideation among transgender youth, Amaya Perez-Brumer, MSc, of the Mailman School of Public Health at Columbia University, New York, and colleagues evaluated data on more than 910,000 high school students who participated in the 2013 to 2015 California Healthy Kids Survey, and a weighted subsample of almost 36,000 students representative of the state’s student population. In each sample, 1.33% and 1.1% identified as transgender, respectively.

Researchers found that 33.73% of transgender students reported suicidal ideation within the past 12 months compared with 18.85% of cisgender students (P < .001). Adjusted analysis within the representative sample showed transgender students were 2.99 (95% CI, 2.25-3.98) times as likely as cisgender students to report suicidal ideation.

Perez-Brumer noted that this is the first study in the United States to use representative data that includes measures of gender identity to document disparities in suicidal ideation.

“It is crucial that studies of adolescent health include measures of gender identity alongside sexual orientation to better understand and create programs to address the needs of these youth across the United States,” she said in a press release.

The lack of surveys, especially population-based surveys, is one of the main challenges in LGBTQ research, Perez-Brumer told Healio.com/Psychiatry.

“This is due to a variety of reasons, including stigma, which prevents many school districts from asking these questions,” she said. “However, current research shows that we can accurately assess gender identity among youth. Our study underscores the importance of other states incorporating measures of gender identity into existing population-based surveys to provide further insight into how to better support the mental health needs of gender minority youth.”

Additionally, the study showed that increased rates of depression and victimization may in part explain the higher risk for suicidal ideation among transgender students. Adjusted analysis showed that depressive symptoms (adjusted OR = 5.44; 95% CI, 1.81-16.38) and victimization (aOR = 2.66; 95% CI, 1.26-5.65) were significantly associated with an increased risk for suicidal ideation in transgender students.

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“Like all students, transgender youth deserve to be safe and supported at school,” Stephen T. Russell, PhD, fellow researcher with the department of human development and family sciences at the University of Texas, Austin, said in the press release. “These results show that reducing depression and victimization for transgender students should significantly reduce their suicide-related risk.”

In a related editorial, Nicole A. Sitkin, BS, of Yale School of Medicine, and Dinora Murota, BA, of University of California, wrote that depression and victimization measures mediated the association between gender identity and suicidal ideation, but only somewhat, which highlights that additional influences may impact mental health and suicidality in transgender students. These may include structural stigmas, like prevention of using preferred bathrooms and pronouns, and familial attitudes and behaviors, they wrote.

Perez-Brumer and colleagues concluded that school-based interventions are urgently needed to increase access to mental health services, train faculty and staff on the needs of transgender students, and address the disparate rates of depression and victimization.

“In general, those providing support and mental health care to youth, including psychiatric health care providers, should consider the unique experiences of transgender youth, especially in relation to negative school experiences, and be sure to assess rates of depression and suicidality among these youth,” Perez-Brumer told Healio.com/Psychiatry. “Mental health care providers also need to be better trained in how to offer services that are affirming of transgender youth.” – by Adam Leitenberger

Disclosures: The authors report no relevant financial disclosures.