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

Social Psychiatry and Psychiatric Epidemiology volume 57, pages 195–205 (2022)Cite this article

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.

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Availability of data and material

The United States Transgender Health Survey is available from http://www.ustranssurvey.org/.

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Funding

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Author information

Authors and Affiliations

  1. Department of Public Health Sciences, UNC Charlotte, 9201 University Blvd., Charlotte, NC, 28233, USA

    Robert J. Cramer, Andrea R. Kaniuka, Farida N. Yada, Franck Diaz-Garelli & Jessamyn Bowling

  2. Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA

    Ryan M. Hill

  3. Virginia Consortium Program in Clinical Psychology, Norfolk, USA

    James M. Macchia

  4. Department of Psychology, Louisiana State University, Baton Rouge, LA, USA

    Raymond P. Tucker

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  1. Robert J. Cramer
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  2. Andrea R. Kaniuka
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Contributions

Conceptualization: RC, RT, and AK; methodology: AK, FY. FD-G, and RT; formal analysis and investigation: AK, FY, FD-G, and RC; writing—original draft preparation: RC, AK, FY, RH, JB, and RT; writing—review and editing: RC, AK, FY, FD-G, RH, JB, and RT; funding acquisition: not applicable; resources: FD-G, AK, RC, and FY; supervision: FD-G and RC.

Corresponding author

Correspondence to Robert J. Cramer.

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Conflict of interest

The authors declare not conflicts of or competing interests.

Ethics approval

All human and animal studies have been approved by the appropriate ethics committee and have, therefore, been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

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Cite this article

Cramer, R.J., Kaniuka, A.R., Yada, F.N. et al. An analysis of suicidal thoughts and behaviors among transgender and gender diverse adults. Soc Psychiatry Psychiatr Epidemiol 57, 195–205 (2022). https://doi.org/10.1007/s00127-021-02115-8

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  • DOI: https://doi.org/10.1007/s00127-021-02115-8

Keywords

  • Suicide
  • Transgender
  • Gender identity
  • Discrimination
  • Social-ecological model
  • Social support