Transgender and nonbinary youth were much more likely to be admitted to hospital after a suicide attempt or self-harm, according to a study published in the Lancet Child & Adolescent Health medical journal on Wednesday, as healthcare access for trans youth comes under fire and politicians push the issue to the forefront of the culture war.
The researchers used national databases from 2016 and 2019 to examine over 2 million instances of young people aged 6 to 20 years old being hospitalized for any reason, and identified transgender and nonbinary youth as those with diagnoses of gender dysphoria.
Trans and nonbinary youth were four to five times more likely to have been admitted for a suicide attempt or self-harm than those without gender dysphoria, the researchers found.
Rates of suicidality were notably higher among hospitalized youth with gender dysphoria compared to those without across both years studied, 36% versus 5% in 2016 and 55% versus 4% in 2019.
Similarly, the prevalence of self-harm was higher among youth with gender dysphoria, 13% versus 1% in 2016 and 15% versus 1% in 2019.
Dr. Nadir Yehya, a physician at the Children’s Hospital of Philadelphia and one of the study’s authors, said the study confirms existing evidence that suicide attempts and self-harm “are more common among transgender or nonbinary young people.”
Healthcare providers should work to reduce discrimination in order to protect this vulnerable group, Yehya added, including using patients’ affirmed names and chosen pronouns, providing gender-affirming care and following up with targeted services for self-harm.
What We Don’t Know
The researchers said their methods raised difficulties when identifying trans and nonbinary youth, which may have distorted the findings. Using a diagnosis of gender dysphoria to identify trans and nonbinary youth is imperfect, they note, as not all trans and nonbinary youth will experience dysphoria and not all those experiencing dysphoria will be formally diagnosed. The proportion of young people with gender dysphoria has risen in recent years—0.16% in 2016 to 0.48% in 2019—though it is low and differs markedly across the population, which the researchers say could reflect disparities in accessing gender-affirming care or heightened discrimination. Youth who were Black, Hispanic or Latinx, or other minority ethnic and racial groups were less likely to be diagnosed with gender dysphoria, for example, as were those from economically disadvantaged households, the South or those who used rural hospitals. Nevertheless, the researchers said their findings align with existing research on suicidal thoughts among trans and nonbinary people and highlight the impact of regional and state-level culture and policy on health.
The study, which the researchers said is the first to use a national database to examine the issue, comes at a time when gender-affirming care for American youth is increasingly under attack. Many states have moved to curtail access to gender-affirming care for youth and the matter has become a political flashpoint across much of the country. Evidence clearly and repeatedly shows higher rates of mental health problems among trans and nonbinary youth, particularly those of color. Major medical societies almost universally reject efforts to ban affirming care as dangerous, cruel and unscientific. The use of puberty-blocking drugs, which has become particularly controversial, involves likely life-altering treatment with relatively scant evidence on long-term consequences. Inaction can come at a cost as well, however, and the interventions have numerous documented benefits for trans and nonbinary individuals.
What To Watch For
The researchers said the increasing number of youth diagnosed with gender dysphoria across the years studied does not necessarily mean more youth experience gender dysphoria. Instead, the researchers said the increase more likely signposts the increasing societal acceptance of a diverse array of gender identities and increasing access to gender-affirming medical and mental health services.
If you or someone you know is in crisis and needs immediate help, call the National Suicide Prevention Lifeline at 1-800-273-TALK (8255). Learn more about suicide prevention and ways you can help someone who might be at risk for self-harm.
They Paused Puberty, but Is There a Cost? (NYT)
What the Science on Gender-Affirming Care for Transgender Kids Really Shows (Scientific American)