Now in Pediatrics: New Research in Suicidality Disparities Between Transgender and Cisgender Adolescents

Suicide is the second leading cause of death among adolescents in the United States. Yet research has shown that transgender adolescents (adolescents whose true gender identity diverges from the gender assigned at birth) have higher rates of suicidal ideation and attempt than cisgender adolescents (adolescents whose gender identity is the same as the gender assigned at birth). 

In a recent study published in Pediatrics, investigators including Brian Thoma, PhD, Rachel Salk, PhD, Tina Goldstein, PhD, and Michele Levine, PhD, from Pitt Psychiatry examined suicidality between transgender and cisgender adolescents, as well as the risk for suicidality within subgroups of transgender adolescents. The study investigated a wider spectrum of suicidality to include, for the first time, three additional outcomes: passive death wish, planning a suicide attempt, and making an attempt that required medical care. Examining a history of attempts requiring medical attention is particularly important given this outcome’s association with future death by suicide. Moreover, the study incorporates nuanced gender profile categories, which distinguish between gender identity and sexual orientation, and allow participating transgender individuals to additionally identify as nonbinary, genderqueer or agender. The research team used optimized gender identity assessments to account for the distinct experiences of transgender adolescent subgroups that could predict suicidality.

Study participants comprised 2,020 transgender and cisgender adolescents between the ages of 14–18 who completed an anonymous survey, identified their gender, provided additional demographic information, and answered questions pertaining to lifetime suicidal ideation or behavior. 

Consistent with previous research, the findings of the current study revealed that transgender male and transgender female adolescents have higher rates of suicidal ideation and attempt than male and female cisgender adolescents. In addition, nonbinary adolescents assigned female at birth had higher risk for suicidal ideation and attempt than male cisgender adolescents. 

In the current study, the refined gender profiles provided the research team with a more precise picture of potential suicidality within transgender adolescent subgroups. The results indicated that transgender females have a higher risk of suicidal ideation and attempt than cisgender adolescents, though lower rates of suicidality compared with other transgender subgroups. In addition, they found that nonbinary adolescents assigned male at birth do not have a higher risk for suicidal ideation and attempt than cisgender adolescents. 

“Prior studies have often combined transgender youth into one or two groups, an approach that ignores the heterogeneity of this population,” explained Brian Thoma, PhD, the study’s lead author. “Other studies divided transgender youth based solely on their gender assigned at birth, causing transgender females and nonbinary adolescents assigned male at birth to be grouped together. This process may have obscured some subgroup differences. In our data, we analyzed suicidality rates separately for these two groups, and it is imperative that future studies of adolescent suicidality continue to use comprehensive measures of gender identity.”

Regarding the implications of the study, Dr. Goldstein remarked, “This study brings attention to distinctions among sexual and gender minority subgroups that may have important implications for enhancing suicide risk assessment and management among high-risk youth.”

Suicidality Disparities Between Transgender and Cisgender Adolescents
Thoma BC, Salk RH, Choukas-Bradley S, Goldstein TR, Levine MD, Marshal MP
Pediatrics, Vol. 144, Issue 6, 1 Dec 2019 DOI: https://doi.org/10.1542/peds.2019-1183