Suicide

  • One long-ranging study estimated a suicide rate for gender dysphoric people of 0.6%. Expand
    One long-ranging study estimated a suicide rate for gender dysphoric people of 0.6%.

    Every suicide is a tragedy, and one suicide is a suicide too many. With such a serious issue, accuracy is critical.

    A Swedish government-commissioned study [1] found that 39 of 6334 gender dysphoric individuals — 0.6% — died by suicide.

    The UK’s largest gender clinic, the Gender Identity Development Service, states that [2]

    Suicide is extremely rare.

    Similarly, the Chair of the Child and Adolescent Committee for the World Professional Association for Transgender Health (WPATH), Dr Laura Edwards-Leeper, remarks [3]:

    As far as I know there are no studies that say that if we don’t start these kids immediately on hormones when they say they want them that they are going to commit suicide. So that is misguided…in terms of needing to intervene medically to prevent suicide and doing it quickly, I know of no studies that have shown that.

    This reinforces the point that talking about suicide is not the same as dying by suicide. While there is evidence [4] that suicidal ideation is higher among gender-dysphoric youth than in the general population, an increase in suicidal ideation rates is not proof of an equal increase in suicide rates themselves.

    However, the way suicidality is reported can affect numbers of suicides. A significant body of academic research from across the world, known as the Werther Effect, has found links between certain types of reporting of suicides and increased suicide rates [5].

    REFERENCES

    [1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

    [2] Gender Identity Development Service (2021). Evidence base. [Link]

    [3] Daum, Meghan (2021). “We Feel Like We’re In The Wild West:” Parents of Gender-Questioning Kids Ask Their Own Questions. The Unspeakable Podcast, October 4, 2021. [Link]

    [4] Aitken, M., Vanderlaan, D., Wasserman, L., Stojanovski, S. & Zucker, K. (2016). Self-Harm and Suicidality in Children Referred for Gender Dysphoria. Journal of the American Academy of Child & Adolescent Psychiatry 55. [Link]

    [5] Acosta, F. J., Rodríguez, C. J., Cejas, M. R., Ramallo-Fariña, Y. & Fernandez-Garcimartin, H. (2020) Suicide Coverage in the Digital Press Media: Adherence to World Health Organization Guidelines and Effectiveness of Different Interventions Aimed at Media Professionals. Health Communication 35 (13). [Link]

  • There is no high quality evidence to suggest that the overall attempted suicide rate of transgender youth is 41%. Expand
    There is no high quality evidence to suggest that the overall attempted suicide rate of transgender youth is 41%.

    The frequently repeated claim that 41% of 6,450 transgender respondents said they had attempted suicide at some point in their lives [1] is taken from the National Transgender Discrimination Survey [2].

    However, a 2021 paper [3] notes that the participants were recruited through transgender advocacy organizations and subjects were asked to “pledge” to promote the survey among friends and family. This recruiting method yielded a large but highly skewed sample. By targeting transgender advocacy groups, the survey underrepresented the experiences of transgender individuals who are not politically engaged. Also, a very high number of the survey participants (nearly 40%) had not transitioned medically or socially at the time of the survey, and a significant number reported no intention to transition in the future.

    A 2016 article [4] analyzes the power of this 41% statistic, investigating how it has affected conversations about the injustices transgender people face and the importance of family and societal acceptance.

    REFERENCES

    [1] Turban, J. L., Beckwith, N., Reisner, S. L., & Keuroghlian, A. S. (2020). Association between recalled exposure to gender identity conversion efforts and psychological distress and suicide attempts among transgender adults. JAMA Psychiatry 77 (1): 68-76. [Link]

    [2] Grant, J. M., Mottet, L. A., Tanis, J., Harrison, J., Herman, J. L., & Keisling, M. (2011). Injustice at every turn: A report of the national transgender discrimination survey. National Gay and Lesbian Task Force; National Center for Transgender Equality. [Link]

    [3] D’Angelo, R., Syrulnik, E., Ayad, S., Marchiano, L., Kenny, D.T. & Clarke, P. (2021). One Size Does Not Fit All: In Support of Psychotherapy for Gender Dysphoria. Arch Sex Behav 50: 7-16. [Link]

    [4] Tanis, J. (2016). The power of 41%: A glimpse into the life of a statistic. Am J Orthopsychiatry, 86 (4): 373-7. [Link]

  • People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people. Expand
    People with psychiatric conditions – and sometimes neurodiverse conditions – are much more likely to die by suicide than gender dysphoric people.

    A Swedish study [1] found that suicide rates for personality disorder, schizophrenia, substance addiction, bipolar and (among males) depression and autism were all higher than suicide rates for gender dysphoric people:

    These high suicide rates for schizophrenia are confirmed by another study [2] which puts the lifetime risk of suicide death for schizophrenics at 5.6%. This study also finds “the absolute risk of suicide in different psychiatric disorders to vary from 2% to 8%, higher for men than for women and highest for men and women with bipolar disorder, unipolar affective disorder, schizophrenia, and schizophrenialike disorder.”

    REFERENCES

    [1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

    [2] Nordentoft, M., Madsen, T. & Fedyszyn, I. (2015). Suicidal behavior and mortality in first-episode psychosis. J Nerv Ment Dis. 203 (5): 387-92. [Link]

  • Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors. Expand
    Suicide rarely has one cause: it is difficult for statistical studies on suicide to extricate gender dysphoria from other factors.

    A Swedish study [1] points out that it is “difficult to distinguish one [gender dysphoria] from the other [mental health conditions] with regard to suicide risk.”

    A 2019 study [2] finds that “adolescents referred for gender dysphoria show higher rates of suicidality when compared to non-referred adolescents, but are much more similar to referred adolescents (presumably, the vast majority were cisgender) in general.”

    REFERENCES

    [1] Swedish National Board of Health and Welfare (2020). Utvecklingen av diagnosen könsdysfori: Förekomst, samtidiga psykiatriska diagnoser och dödlighet i suicid. Socialstyrelsen. [Link]

    [2] Zucker, K. J. (2019). Adolescents with Gender Dysphoria: Reflections on Some Contemporary Clinical and Research Issues. Archives of Sexual Behavior 48 (5). [Link]

  • There is little evidence that medical transition decreases suicidality. Expand
    There is little evidence that medical transition decreases suicidality.

    When it comes to gender dysphoric children, there is little evidence that medical transition decreases suicide rates. There is little evidence to assert that puberty blockers are necessary to prevent suicide [1].

    After sex reassignment surgery, one study showed that adult transsexual clients were 4.9 times more likely to have made a suicide attempt and 19.1 times more likely to have died from suicide, after adjusting for prior psychiatric comorbidity [2]. Similarly, an Australian paper [3] notes that many patients have poor outcomes which put them at risk of suicide.

    A prominent study [4] claiming that medical transition alleviated suicidality had to be corrected [5], to clarify that it proved “no advantage of surgery” in this regard.

    A long-term Swedish study [6] finds that post-operative transgender people have “considerably higher risks” for suicidal behavior.

    Similarly, a study in the European Journal of Endocrinology [7] demonstrates that suicide rates among transgender male-to-females were 51% higher than the general population.

    REFERENCES

    [1] Biggs, M. (2020). Puberty Blockers and Suicidality in Adolescents Suffering from Gender Dysphoria. Archives of Sexual Behavior (49): 2227–2229. [Link]

    [2] Zucker, K.J., Lawrence, A.A., Kreukels, B.P. (2016). Gender Dysphoria in Adults. Annu Rev Clin Psychol. 12: 217-47. [Link]

    [3] D’Angelo, R. (2018). Psychiatry’s ethical involvement in gender-affirming care. Australasian Psychiatry 26 (5): 460-463. [Link]

    [4] Bränström, R. & Pachankis, J. E. (2019). Reduction in Mental Health Treatment Utilization Among Transgender Individuals After Gender-Affirming Surgeries: A Total Population Study. American Journal of Psychiatry 177 (8): 727-734. [Link]

    [5] American Journal of Psychiatry (2020). Correction to Bränström and Pachankis. Published online: 1 August 2020. [Link]

    [6] Dhejne, C., Lichtenstein, P., Boman, M., Johansson, A. L. V., Långström, N., & Landén, M. (2011). ‘Long-term follow-up of transsexual persons undergoing sex reassignment surgery: Cohort study in Sweden’. PLoS ONE, 6(2). [Link]

    [7] Asscheman, H., Giltay, E. J., Megens, J. A. J., de Ronde, W., van Trotsenburg, M. A. A. & Gooren, L. J. G. (2011). A long-term follow-up study of mortality in transsexuals receiving treatment with cross-sex hormones. European Journal of Endocrinology 164 (4). [Link]