Suicidality in clinic-referred transgender adolescents

Abstract

Gender and sexually diverse adolescents have been reported to be at an elevated risk for suicidal thoughts and behaviors. For transgender adolescents, there has been variation in source of ascertainment and how suicidality was measured, including the time-frame (e.g., past 6 months, lifetime). In studies of clinic-referred samples of transgender adolescents, none utilized any type of comparison or control group. The present study examined suicidality in transgender adolescents (M age, 15.99 years) seen at specialty clinics in Toronto, Canada, Amsterdam, the Netherlands, and London, UK (total N = 2771). Suicidality was measured using two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR). The CBCL/YSR referred and non-referred standardization samples from both the U.S. and the Netherlands were used for comparative purposes. Multiple linear regression analyses showed that there was significant between-clinic variation in suicidality on both the CBCL and the YSR; in addition, suicidality was consistently higher among birth-assigned females and strongly associated with degree of general behavioral and emotional problems. Compared to the U.S. and Dutch CBCL/YSR standardization samples, the relative risk of suicidality was somewhat higher than referred adolescents but substantially higher than non-referred adolescents. The results were discussed in relation to both gender identity specific and more general risk factors for suicidality.

Appendix

Clinic-Based Studies of Suicidality in Transgender Adolescents.

Study/year of Publication	N	Metric	Source	Time frame
Di Ceglie et al. [32]	69	Self-harm: 23%	Chart review	Lifetime
		Self-injurious behavior: 22%
Skagerberg et al. [33]a	97	Suicidal ideation: 17.1%	Chart review	Lifetime
		Self-harm: 32.3%	YSR
		Suicide attempts: 16.1%
Becker et al. [34]	40	Suicidal ideation: 42.2%	Chart review	Current
		Self-harm: 26.5%		Current
		Suicide attempts: 11.8%		Current
		Combined: 51.5%		Lifetime
Khatchadourian et al. [35]	84	Suicide attempts: 12%	Chart review	Lifetime
Chapman et al. [36]	43	Suicidal ideation: 51.2%	Self-report	Lifetime
		Self-harm: 41.9%
		Suicide attempts: 16.3%
Kaltiali et al. [37]	47	Suicidal ideation and self-harm (combined): 53%	Chart review	Unclear
Olson et al. [38]	49	Suicidal ideation: 51%	Self-report	Lifetime
		Suicide attempts: 30%		Lifetime
Holt et al. [39]	177	Suicidal ideation: 39.5%	Chart review	Lifetime
		Self-harm: 44.1%
		Suicide attempts: 15.8%
Peterson et al. [40]	89	Self-harm: 41.8%	Chart review	Lifetime
		Suicide attempts: 30.3%
Fisher et al. [41]	46	Multi-Attitude Suicide Tendency Scale	Self-report
		Suicidal ideation: 86.9%		Unclear
		Suicide attempts: 13.0%		Unclear
Nahata et al. [42]	79	Suicidal ideation: 74.7%	Chart review	Lifetime
		Self-harm: 55.7%
		Suicide attempts: 30.4%
Becerra-Culqui et al.[43]b	1082	Suicidal ideation: 6.2%	Chart review	Prior 6 months
		Suicidal ideation: 9.2%	(ICD-9 code)	Lifetime
		Self-harm: 3.2%		Prior 6 months
		Self-harm: 6.0%		Lifetime
Brocksmith et al. [44] (see also Chen et al. [45])	78	“Suicidality”: 10.2%	Chart review	Unclear
Allen et al. [46]	47	Ask Suicide-Screening Questions (n = 4)c	Self-report	“past few weeks”
Moyer et al. [47]	79	Suicidal ideation: 35.9%	Patient Health Questionnaire for depression (PHQ-9)	Past 2 weeks
Sorbara [48] (see also Chiniara et al. [49])	300	Suicidal ideation: 47.3%	Chart review	Lifetime
		“Active” suicidal ideation: 12.3%		Current
		Self-harm: 34.6%		Lifetime
		Suicide attempts: 14.0%		Lifetime
Bettis et al. [50]	31	Suicidal ideationd	Self-injurious Thoughts and Behaviors Inventory	Past month
		Non-suicidal self-injury: 70.1%	Questionnaire-Jr	Past 12-month frequency
			Suicidal Ideation	Lifetime
		Suicide attempt: 54.83%	Self-report	Lifetime

With the exception of Becerra-Culqui et al. [43]), Becker et al. [34], and Nahata et al. [42]), the table does not include mixed samples of children and adolescents [51,52,53,54,55,56] or of adolescents and young adults [57,58,59,60,61,62,63]. Inclusion of children would likely result in lower percentages for suicidal behavior. Surace et al. [61] reported a meta-analysis of lifetime prevalence of suicidal ideation and behavior in samples of “gender non-conforming” children, adolescents, and adults. Regarding adolescents, their meta-analysis, for reasons that are unclear, did not capture at least 11 of the clinic-based studies [32, 34,35,38, 40, 41, 44, 46,47,48] that we report on in this Appendix. For prior reviews, see [62, 63].

^aPercentages extracted from Table 3.

^bData from two healthcare systems in the United States, but the clients were not necessarily seen in a specialized gender identity clinic.

^cPercentages per item not reported.

^dDimensional multi-item measure (frequency/severity); percentage data not reported.