A new study in the journal Pediatrics published Nov. 1 highlights the disparity between suicidal thoughts for transgender and cisgender adolescents. Dr. Brian C. Thoma of the University of Pittsburgh Department of Psychiatry led the study, which charted more than 2,000 adolescents, nearly 1,200 of whom were trans adolescents between the ages of 14 to 18.
Most significant in the new study is that it is the first to address not merely the status of transgender adolescents, but also current gender identity.
According to the study, "Although initial evidence indicates transgender adolescents have high rates of suicidality, previous studies have been limited by insufficient measurement of gender identity." Those studies indicated, "Transgender adolescents assigned female at birth could have higher rates of suicidality than transgender adolescents assigned male at birth."
This latest study builds on that by comparing suicidal ideation among transgender adolescents compared to cisgender adolescents and asking the study participants about their current gender identity. The study says, "Using comprehensive measures of gender assigned at birth and current gender identity to examine transgender adolescent suicidality, we indicate transgender males and transgender females have higher odds of suicidal ideation and attempt than their cisgender peers."
As Pediatrics explains, "Studies that we have published on transgender adolescents have raised concerns about their mental health, especially if the environment in which these teens live is not supportive."
But are transgender youth more likely to consider or attempt suicide compared to cisgender adolescents? To answer that question, Thoma studied suicidality in trans- and cisgender adolescents. The authors analyzed almost 1,200 transgender adolescents in a cross-sectional study of more than 2,000 teens categorized as cisgender male, cisgender female, transgender male, transgender female, nonbinary assigned at birth as female or male, and questioning. Those who participated in the survey were asked about suicidal ideations, plans, attempts and non-suicidal self-injury, among other aspects of suicidality.
Dr. Lewis First, Editor-in-Chief of Pediatrics, commented on the study in a blog post for the American Academy of Pediatrics. First wrote, "The findings in this study are sadly what most would expect to find given what we know — the risk of all suicidality outcomes were higher among transgender adolescents."
First also addressed what he thought pediatricians and others working with transgender adolescents should retain from the study. He said, "There are many other findings well worth your attention that will enable you to be more prepared to prevent suicidal behaviors and to advocate for the needs of all adolescents and to learn more about the associations between suicidal behaviors and gender."
This latest study adds to others that have ascertained that transgender teens are having suicidal thoughts and attempting suicide more often than their cisgender peers. Thoma's study is unique in that it uses contemporary gender identities to more specifically categorize adolescents — cisgender teen girls versus transgender teen boys versus a nonbinary teen assigned female at birth. In previous studies and surveys on adolescent mental health, transgender teens are one big group with no distinctions in how they identify.
"Transgender adolescents have been treated as this homogenous, monolithic group," said Thoma. His research studying the intersection of gender identity and mental health is the first to ask teens to answer two key questions: What is your current gender identity, and what gender were you assigned at birth?
That two-step question revealed disparities within the broad definition of transgender used in all health research. Transgender boys were at the highest risk of a suicide attempt requiring medical attention, followed by nonbinary teens assigned male at birth. Transgender girls were six times more likely than cisgender boys to have suicidal thoughts.
These disparities matter. Previous studies have relied on large national data sets like the Youth Risk Behavior Survey, a bi-annual, anonymous questionnaire the Centers for Disease Control and Prevention uses to keep tabs on health care concerns among adolescents. The 2019 questionnaire asks five questions about suicide, but only asks teenagers whether their sex is female or male. The National Survey on Drug Use and Health, another sweeping survey that collects data on adolescents and mental health, only asks whether a participant is male or female.
Thoma said it's critical for datasets like the YRBS to start asking more comprehensive questions.
"I'm hoping that work like ours can help to start that conversation," he said. "The wheels are in motion, but we have a long way to go."
If you are an LGBTQ or NB/GNC teen having suicidal thoughts, call the Trevor Project 1-866-488-73386 Trans teens and others can also call the Trans Lifeline: 1-877-565-8860