Skip to main content
SpringerLink
Log in

A Preliminary Examination of the Association between Adolescent Gender Nonconformity and Suicidal Thoughts and Behaviors

  • Published:
Journal of Abnormal Child Psychology Aims and scope Submit manuscript

Abstract

Suicidal thoughts and behaviors are a significant health concern for adolescents. Extant research suggests that sexual and gender minority adolescents are a vulnerable population at elevated risk for suicidal thoughts and behaviors, yet to date few studies have examined the unique associations between adolescent gender nonconformity and suicide risk. This study examined data from the Youth Risk Behavior Surveillance Survey (n = 7730) to estimate the association between gender nonconformity and high school-aged adolescents’ likelihood of endorsing four distinct suicide outcomes: suicidal ideation, suicide plans, any suicide attempts, and single vs. multiple suicide attempts. Multivariate logistic regression analyses were utilized to control for other known risk factors for suicidal thoughts and behaviors, including age, sex, sexual minority status, depression symptoms, and suicidal ideation. Results revealed that gender nonconformity was significantly associated with higher odds of reporting suicidal ideation, suicide plans, and multiple suicide attempts in the past year above and beyond other known risk factors. Gender nonconformity is an understudied vulnerability factor that should be taken into consideration by researchers and clinicians seeking to understand adolescents’ risk for suicidal thoughts and behaviors.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Notes

  1. We re-ran this model excluding adolescents who endorsed having a suicide plan or attempting suicide in the past year, and the effect of gender nonconformity remained significant (OR = 1.13; 95% CI 1.04–1.24).

  2. We re-ran this model excluding adolescents who endorsed attempting suicide in the past year, and the effect of gender nonconformity remained significant (OR = 1.13; 95% CI 1.05–1.21).

References

  • Aitken, M., VanderLaan, D. P., Wasserman, L., Stojanovski, S., & Zucker, K. J. (2016). Self-harm and suicidality in children referred for gender dysphoria. Journal of the American Academy of Child & Adolescent Psychiatry, 55(6), 513–520. https://doi.org/10.1016/j.jac.2016.04001.

    Article  Google Scholar 

  • American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70(9), 832–864.

    Article  Google Scholar 

  • Bell, B. A., Onwuegbuzie, A. J., Ferron, J. M., Jiao, Q. G., Hibbard, S. T., & Kromrey, J. D. (2012). Use of design effects and sample weights in complex health survey data: A review of published articles using data from 3 commonly used adolescent health surveys. American Journal of Public Health, 102(7), 1399–1405.

    Article  PubMed  PubMed Central  Google Scholar 

  • Brener, N. D., Kann, L., Shanklin, S., Kinchen, S., Eaton, D. K., Hawkins, J., & Flint, K. H. (2013). Methodology of the youth risk behavior surveillance system—2013. Morbidity and Mortality Weekly Report: Recommendations and Reports, 62(1), 1–20.

    Google Scholar 

  • Caputi, T. L., Smith, D., & Ayers, J. W. (2017). Suicide risk behaviors among sexual minority adolescents in the United States, 2015. JAMA, 318(23), 2349–2351.

    Article  PubMed  PubMed Central  Google Scholar 

  • Centers for Disease Control and Prevention (2013). Youth Risk Behavior Survey Data. Available at: www.cdc.gov/yrbs. Accessed on October 19, 2017.

  • Centers for Disease Control and Prevention (2015a). Youth Risk Behavior Survey Data. Available at: www.cdc.gov/yrbs. Accessed on October 19, 2017.

  • Centers for Disease Control and Prevention. (2015b). Web-based injury statistics query and reporting system. CDC: National Center for Injury Prevention and Control Retrieved from www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2015-a.pdf.

    Google Scholar 

  • Centers for Disease Control and Prevention (2016). Software for analysis of YRBS data. Available at www.cdc.gov/healthyyouth/data/yrbs/pdf/yrbs_analysis_software.pdf Accessed October 19, 2017.

  • Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons. Journal of Homosexuality, 51, 53–69. https://doi.org/10.1300/J082v51n03_04.

    Article  PubMed  Google Scholar 

  • Connolly, M. D., Zervos, M. J., Barone, C. J., Johnson, C. C., & Joseph, C. L. (2016). The mental health of transgender youth: Advances in understanding. Journal of Adolescent Health, 59(5), 489–495. https://doi.org/10.1016/j.jadohealth.2016.06.012.

    Article  Google Scholar 

  • Franklin, J. C., Ribeiro, J. D., Fox, K. R., Bentley, K. H., Kleiman, E. M., Huang, X., et al. (2017). Risk factors for suicidal thoughts and behaviors: A meta-analysis of 50 years of research. Psychological Bulletin, 143(2), 187–232.

    Article  PubMed  Google Scholar 

  • Gartner, R. E., & Sterzing, P. R. (2018). Social ecological correlates of family-level interpersonal and environmental microaggressions toward sexual and gender minority adolescents. Journal of Family Violence, 33(1), 1–16.

    Article  PubMed  Google Scholar 

  • Gender Identity in U.S. Surveillance Group. (2014). Best practices for asking questions to identify transgender and other gender minority respondents on population-based surveys. Los Angeles, CA: The Williams Institute. Retrieved from. http://thewilliamsinstitute.law.ucla.edu.libproxy.lib.unc.edu/wp-content/uploads/geniuss-report-sep-2014.pdf.

    Google Scholar 

  • Gill, A. M., & Frazer, M. S. (2016). Health risk behaviors among gender expansive students: Making the case for including a measure of gender expression in population-based surveys. Washington, DC: Advocates for Youth.

    Google Scholar 

  • Goldblum, P., Testa, R. J., Pflum, S., Hendricks, M. L., Bradford, J., & Bongar, B. (2012). The relationship between gender-based victimization and suicide attempts in transgender people. Professional Psychology: Research and Practice, 43, 468–475. https://doi.org/10.1037/a0029605.

    Article  Google Scholar 

  • Goldston, D. B., Daniel, S. S., Erkanli, A., Heilbron, N., Doyle, O., Weller, B., et al. (2015). Suicide attempts in a longitudinal sample of adolescents followed through adulthood: Evidence of escalation. Journal of Consulting and Clinical Psychology, 83(2), 253–264. https://doi.org/10.1037/a0038657.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hendricks, M. L., & Testa, R. J. (2012). A conceptual framework for clinical work with transgender and gender nonconforming clients: An adaptation of the minority stress model. Professional Psychology: Research and Practice, 43, 460–467. https://doi.org/10.1037/a0029597.

    Article  Google Scholar 

  • Hom, M. A., Joiner Jr., T. E., & Bernert, R. A. (2016). Limitations of a single-item assessment of suicide attempt history: Implications for standardized suicide risk assessment. Psychological Assessment, 28(8), 1026–1030.

    Article  PubMed  Google Scholar 

  • Klonsky, E. D., May, A. M., & Saffer, B. Y. (2016). Suicide, suicide attempts, and suicidal ideation. Annual Review of Clinical Psychology, 12, 307–330. https://doi.org/10.1146/annurev-clinpsy-021815-093204.

    Article  PubMed  Google Scholar 

  • Leon, A. C., Friedman, R. A., Sweeney, J. A., Brown, R. P., & Mann, J. J. (1990). Statistical issues in the identification of risk factors for suicidal behavior: The application of survival analysis. Psychiatry Research, 31(1), 99–108.

    Article  PubMed  Google Scholar 

  • Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., et al. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49(2), 115–123. https://doi.org/10.1016/j.jadohealth.2011.02.005.

    Article  Google Scholar 

  • Meier, S. C., & Labuski, C. M. (2013). The demographics of the transgender population. In International Handbook on the Demography of Sexuality (pp. 289-327). Springer, Dordrecht, The Demographics of the Transgender Population.

  • Mendez-Bustos, P., de Leon-Martinez, V., Miret, M., Baca-Garcia, E., & Lopez-Castroman, J. (2013). Suicide reattempters: A systematic review. Harvard Review of Psychiatry, 21(6), 281–295. https://doi.org/10.1097/HRP.0000000000000001.

    Article  PubMed  Google Scholar 

  • Meyer, I. H. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: Conceptual issues and research evidence. Psychological Bulletin, 129(5), 674–697. https://doi.org/10.1037/0033-2909.129.5.674.

    Article  PubMed  PubMed Central  Google Scholar 

  • Miranda, R., Scott, M., Hicks, R., Wilcox, H. C., Munfakh, J. L. H., & Shaffer, D. (2008). Suicide attempt characteristics, diagnoses, and future attempts: Comparing multiple attempters to single attempters and ideators. Journal of the American Academy of Child & Adolescent Psychiatry, 47(1), 32–40. https://doi.org/10.1097/chi.0b013e31815a56cb.

    Article  Google Scholar 

  • National Action Alliance for Suicide Prevention: Research prioritization task force. (2014). A prioritized research agenda for suicide prevention: An action plan to save lives. Rockville MD: National Institute of Mental Health and Research Prioritization Task Force.

    Google Scholar 

  • Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal behavior. Epidemiologic Reviews, 30(1), 133–154.

    Article  PubMed  Google Scholar 

  • Nock, M. K., Green, J. G., Hwang, I., McLaughlin, K. A., Sampson, N. A., Zaslavsky, A. M., & Kessler, R. C. (2013). Prevalence, correlates, and treatment of lifetime suicidal behavior among adolescents: Results from the National Comorbidity Survey Replication Adolescent Supplement. JAMA Psychiatry, 70(3), 300–310. https://doi.org/10.1001/2013.jamapsychiatry.55.

    Article  PubMed  Google Scholar 

  • Perez-Brumer, A., Day, J. K., Russell, S. T., & Hatzenbuehler, M. L. (2017). Prevalence and correlates of suicidal ideation among transgender youth in California: Findings from a representative, population-based sample of high school students. Journal of the American Academy of Child & Adolescent Psychiatry, 56(9), 739–746. https://doi.org/10.1016/j.jaac.2017.06.010.

    Article  Google Scholar 

  • Prinstein, M. J., Nock, M. K., Simon, V., Aikins, J. W., Cheah, C. S., & Spirito, A. (2008). Longitudinal trajectories and predictors of adolescent suicidal ideation and attempts following inpatient hospitalization. Journal of Consulting and Clinical Psychology, 76(1), 92–103. https://doi.org/10.1037/0022-006X.76.1.92.

    Article  PubMed  PubMed Central  Google Scholar 

  • Rieger, G., & Savin-Williams, R. C. (2012). Gender nonconformity, sexual orientation, and psychological well-being. Archives of Sexual Behavior, 41, 611–621. https://doi.org/10.1007/s10508-011-9738-0.

    Article  PubMed  Google Scholar 

  • Rieger, G., Linsenmeier, J. A., Gygax, L., & Bailey, J. M. (2008). Sexual orientation and childhood gender nonconformity: Evidence from home videos. Developmental Psychology, 44, 46–58. https://doi.org/10.1037/0012-1649.44.1.46.

    Article  PubMed  Google Scholar 

  • Silverman, M. M., Berman, A. L., Sanddal, N. D., O'Carroll, P. W., & Joiner, T. E. (2007). Rebuilding the tower of babel: A revised nomenclature for the study of suicide and suicidal behaviors: Part 2: Suicide-related ideations, communications, and behaviors. Suicide & Life-Threatening Behavior, 37(3), 264–277.

    Article  Google Scholar 

  • Wylie, S. A., Corliss, H. L., Boulanger, V., Prokop, L. A., & Austin, S. B. (2010). Socially assigned gender nonconformity: A brief measure for use in surveillance and investigation of health disparities. Sex Roles, 63(3–4), 264–276. https://doi.org/10.1007/s11199-010-9798-y.

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

This material is based upon work supported by the National Science Foundation Graduate Research Fellowship Program under Grant No. 1256065. Any opinions, findings, and conclusions or recommendations expressed in this material are those of the author(s) and do not necessarily reflect the views of the National Science Foundation.

Author information

Authors and Affiliations

  1. Department of Psychology and Neuroscience, The University of North Carolina at Chapel Hill, 235 E. Cameron Avenue, Chapel Hill, NC, 27599, USA

    Leigh A. Spivey & Mitchell J. Prinstein

Authors
  1. Leigh A. Spivey
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Mitchell J. Prinstein
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Leigh A. Spivey.

Ethics declarations

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from parents of all individual participants included in the YRBSS.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Spivey, L.A., Prinstein, M.J. A Preliminary Examination of the Association between Adolescent Gender Nonconformity and Suicidal Thoughts and Behaviors. J Abnorm Child Psychol 47, 707–716 (2019). https://doi.org/10.1007/s10802-018-0479-6

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10802-018-0479-6

Keywords

Search

Navigation