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Systematic Review of Interventions to Reduce Suicide Risk in Transgender and Gender Diverse Youth

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Abstract

Transgender youth experience high rates of suicidal ideation and suicide attempts. This systematic review sought to examine interventions for suicide prevention in transgender children and adolescents. Literature related to suicide in the transgender population was systematically collected in accordance with PRISMA criteria. Searches identified studies with at least one suicide prevention method for participants ages 24 years or younger with gender identity and sex clearly defined. Primary outcomes include suicide-related thoughts and behaviors. A total of 1558 citations were identified with 17 articles meeting inclusion criteria. Interventions with potential effectiveness included a gender-affirming crisis hotline, medical care via interdisciplinary gender clinics, online media-based outreach, safety and connectedness in schools, and family system-based interventions. In the included studies, the overall quality of evidence was low and the risk of bias high. Further high-quality studies are needed.

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Abbreviations

CBCL:

Child behavior checklist

GAD-7:

Generalized anxiety disorder-7 scale

GAH:

Gender-affirming hormones

GnRHa:

Gonadotropin-releasing hormone agonists (Puberty blockers)

GWBS:

General well-being scale

LGBTQ:

Lesbian, gay, bisexual, transgender, queer

MRI:

Magnetic resonance imaging

NOS:

Newcastle–Ottawa scale

PHQ-9:

Patient health questionnaire-9 scale

YSR:

Youth self report

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Acknowledgements

Mayo Clinic LGBTQ Research Group and Nadia Dowshen, MD, MSHP for conceptual guidance. Danielle J. (Dana) Gerberi, M.L.S., AHIP, Mayo Clinic Research Librarian for literature search. Lori Solmonson, Mayo Clinic Department of Psychiatry & Psychology Research Secretary for figure and table formatting.

Author information

Authors and Affiliations

  1. Department of Child and Adolescent Psychiatry and Behavioral Sciences, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    Julie A. Christensen

  2. Oberlin College of Arts and Sciences, Oberlin, OH, USA

    Jacqueline Oh

  3. Department of Obstetrics and Gynecology, University of Iowa Hospitals & Clinics, Iowa City, IA, USA

    Katharine Linder

  4. Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA

    Reese L. Imhof

  5. Department of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Paul E. Croarkin, J. Michael Bostwick & Alastair J. S. McKean

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Correspondence to Alastair J. S. McKean.

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Appendix: Search Strategies

Appendix: Search Strategies

EBM Reviews

((transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or change or reversal or conversion or transform*))).ab,kw,ti. AND (mental* or psych* or emotion* or affect or affective or self-injur* or self-harm or self-inflict* or self-destructive or wellbeing or well-being or resilien* or cope or coping or mood* or depress* or adjust* or adapt*).ab,kw,ti. AND (age* or teen* or adolesc* or youth or young or student* or child* or minors or juvenile*).ab,kw,ti.) OR ((transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or change or reversal or conversion or transform*))).ab,kw,ti. AND "suicid*".ab,kw,ti.) Limit to English, 2000 + 

Embase (1974+)

((exp transgender/ or exp transgenderism/ or sex reassignment/ or sex transformation/ or (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or reversal or change or conversion or transform*))).ab,kw,ti.) AND (exp suicidal behavior/ or "suicid*".ab,kw,ti. or exp mental health/ or exp coping behavior/ or exp emotion/ or exp automutilation/ or exp mental disease/ or (mental* or psych* or emotion* or affect or affective or self-injur* or self-harm or self-destructive or self-inflict* or wellbeing or well-being or resilien* or cope or coping or mood* or depress*).ab,kw,ti.) AND (exp young adult/ or adolescence/ or adolescent/ or hospitalized adolescent/ or childhood/ or age/ or (age* or teen* or adolesc* or youth or young or student* or child* or minors or juvenile*).ab,kw,ti.) AND (exp suicidal behavior/ or "suicid*".ab,kw,ti.)) OR ((exp transgender/ or exp transgenderism/ or sex reassignment/ or sex transformation/ or (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or reversal or change or conversion or transform*))).ab,kw,ti.) AND (exp suicidal behavior/ or "suicid*".ab,kw,ti.)) Limit to English language, 2000 + , article or article in press.

Ovid MEDLINE(R) 1946 to Present and Epub Ahead of Print, In-Process & Other Non-Indexed Citations and Ovid MEDLINE(R) Daily

((exp Transgender Persons/ or Transsexualism/ or Sex Reassignment Surgery/ or (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or reversal or change or conversion or transform*))).ab,kw,ti.) AND (exp Suicide/ or "suicid*".ab,kw,ti. or mental health/ or resilience, psychological/ or Stress, Psychological/ or exp Emotions/ or exp Mental Disorders/ or exp Self-Injurious Behavior/ or (mental* or psych* or emotion* or affect or affective or self-injur* or self-harm or self-destructive or self-inflict* or wellbeing or well-being or resilien* or cope or coping or mood* or depress* or adjust* or adapt*).ab,kw,ti.) AND (Adolescent Psychiatry/ or Adolescent/ or Psychology, Adolescent/ or Adolescent, Hospitalized/ or Child Psychiatry/ or Child/ or Psychology, Child/ or exp Young Adult/ or (age* or teen* or adolesc* or youth or young or student* or child* or minors or juvenile*).ab,kw,ti.)) OR ((exp Transgender Persons/ or Transsexualism/ or Sex Reassignment Surgery/ or (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or reversal or change or conversion or transform*))).ab,kw,ti.) AND (exp Suicide/ or "suicid*".ab,kw,ti.)) Limit to English language and yr = "2000 -Current" and journal article.

PsycINFO

((exp transgender/ or gender reassignment/ or transsexualism/ or (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or change or reversal or conversion or transform*))).ab,id,ti.) AND (exp suicide/ or exp suicidal ideation/ or exp suicide prevention/ or exp suicidology/ or "suicid*".ab,id,ti. or coping behavior/ or "resilience (psychological)"/ or exp mental health/ or exp well-being/ or psychological stress/ or "stress and coping measures"/ or exp emotions/ or exp self-destructive behavior/ or exp mental disorders/ or (mental* or psych* or emotion* or affect or affective or self-injur* or self-harm or self-inflict* or self-destructive or wellbeing or well-being or resilien* or cope or coping or mood* or depress* or adjust* or adapt*).ab,id,ti.) AND (exp Adolescent Psychiatry/ or exp Adolescent Psychotherapy/ or exp Adolescent Psychology/ or (age* or teen* or adolesc* or youth or young or student* or child* or minors or juvenile*).ab,id,ti.)) or ((exp transgender/ or gender reassignment/ or transsexualism/ or (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) adj1 (reassign* or change or reversal or conversion or transform*))).ab,id,ti.) AND ((exp suicide/ or exp suicidal ideation/ or exp suicide prevention/ or exp suicidology/ or "suicid*".ab,id,ti.)) Limit to English language and journal article and yr = "2000-Current".

Scopus

(((TITLE-ABS-KEY (transgender* OR trans-gender* OR nonbinary OR non-binary OR transsexual* OR trans-sexual* OR transperson* OR trans-person* OR transpeople* OR trans-people* OR gender-variant OR genderqueer OR gender-queer OR intersex OR inter-sex OR two-spirit OR gender-identit* OR gender-nonconform* OR gender-non-conform* OR gender-dysphori* OR bigender* OR agender* OR ((sex OR gender) W/1 (reassign* OR change OR reversal OR transform* OR conversion)))) AND (TITLE-ABS-KEY (suicide* OR mental* OR psych* OR emotion* OR affect OR affective OR self-injur* OR self-harm OR self-destructive OR self-inflict* OR wellbeing OR well-being OR resilien* OR cope OR coping OR mood* OR depress* OR adjust* OR adapt*)) AND (TITLE-ABS-KEY (age* OR teen* OR adolesc* OR youth OR young OR student* OR child* OR minors OR juvenile*))) OR ((TITLE-ABS-KEY (transgender* OR trans-gender* OR nonbinary OR non-binary OR transsexual* OR trans-sexual* OR transperson* OR trans-person* OR transpeople* OR trans-people* OR gender-variant OR genderqueer OR gender-queer OR intersex OR inter-sex OR two-spirit OR gender-identit* OR gender-nonconform* OR gender-non-conform* OR gender-dysphori* OR bigender* OR agender*)) AND (TITLE-ABS-KEY (suicid*)))) AND (TITLE-ABS-KEY (suicid*)) AND (LIMIT-TO (SRCTYPE, "j")) AND (LIMIT-TO (DOCTYPE, "ar")) AND (LIMIT-TO (PUBYEAR, 2020) OR LIMIT-TO (PUBYEAR, 2019) OR LIMIT-TO (PUBYEAR, 2018) OR LIMIT-TO (PUBYEAR, 2017) OR LIMIT-TO (PUBYEAR, 2016) OR LIMIT-TO (PUBYEAR, 2015) OR LIMIT-TO (PUBYEAR, 2014) OR LIMIT-TO (PUBYEAR, 2013) OR LIMIT-TO (PUBYEAR, 2012) OR LIMIT-TO (PUBYEAR, 2011) OR LIMIT-TO (PUBYEAR, 2010) OR LIMIT-TO (PUBYEAR, 2009) OR LIMIT-TO (PUBYEAR, 2008) OR LIMIT-TO (PUBYEAR, 2007) OR LIMIT-TO (PUBYEAR, 2006) OR LIMIT-TO (PUBYEAR, 2005) OR LIMIT-TO (PUBYEAR, 2004) OR LIMIT-TO (PUBYEAR, 2003) OR LIMIT-TO (PUBYEAR, 2002) OR LIMIT-TO (PUBYEAR, 2001) OR LIMIT-TO (PUBYEAR, 2000)) AND (LIMIT-TO (LANGUAGE, "English")) AND (LIMIT-TO (EXACTKEYWORD, "Gender Identity") OR LIMIT-TO (EXACTKEYWORD, "Adolescent") OR LIMIT-TO (EXACTKEYWORD, "Young Adult") OR LIMIT-TO (EXACTKEYWORD, "Transgender") OR LIMIT-TO (EXACTKEYWORD, "Major Clinical Study") OR LIMIT-TO (EXACTKEYWORD, "Transgender Persons") OR LIMIT-TO (EXACTKEYWORD, "Transsexualism") OR LIMIT-TO (EXACTKEYWORD, "Suicide") OR LIMIT-TO (EXACTKEYWORD, "Sex Reassignment")).

Web of Science

(TS = (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) NEAR/1 (reassign* or reversal or change or conversion or transform*))) AND TS = (suicid* or mental* or psych* or emotion* or affect or affective or self-injur* or self-harm or self-destructive or self-inflict* or wellbeing or well-being or resilien* or cope or coping or mood* or depress* or adjust* or adapt*) AND TS = (age* or teen* or adolesc* or youth or young or student* or child* or minors or juvenile*)) OR ((TS = (transgender* or trans-gender* or nonbinary or non-binary or transsexual* or trans-sexual* or transperson* or trans-person* or transpeople* or trans-people* or gender-variant or genderqueer or gender-queer or intersex or inter-sex or two-spirit or gender-identit* or gender-nonconform* or gender-non-conform* or gender-dysphori* or bigender* or agender* or ((sex or gender) NEAR/1 (reassign* or reversal or change or conversion or transform*))) AND TS = (suicid*)) Limit to English, Article, 2000 + 

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Christensen, J.A., Oh, J., Linder, K. et al. Systematic Review of Interventions to Reduce Suicide Risk in Transgender and Gender Diverse Youth. Child Psychiatry Hum Dev (2023). https://doi.org/10.1007/s10578-023-01541-w

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  • DOI: https://doi.org/10.1007/s10578-023-01541-w

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