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Mak J, Shires DA, Zhang Q, Prieto LR, Ahmedani BK, Kattari L, Becerra-Culqui TA, Bradlyn A, Flanders WD, Getahun D, Giammattei SV, Hunkeler EM, Lash TL, Nash R, Quinn VP, Robinson B, Roblin D, Silverberg MJ, Slovis J, Tangpricha V, Vupputuri S, Goodman M. Suicide Attempts Among a Cohort of Transgender and Gender Diverse People. Am J Prev Med 2020; 59:570-577. [PMID: 32798005 PMCID: PMC7508867 DOI: 10.1016/j.amepre.2020.03.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Revised: 03/26/2020] [Accepted: 03/31/2020] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Transgender and gender diverse people often face discrimination and may experience disproportionate emotional distress that leads to suicide attempts. Therefore, it is essential to estimate the frequency and potential determinants of suicide attempts among transgender and gender diverse individuals. METHODS Longitudinal data on 6,327 transgender and gender diverse individuals enrolled in 3 integrated healthcare systems were analyzed to assess suicide attempt rates. Incidence was compared between transmasculine and transfeminine people by age and race/ethnicity and according to mental health status at baseline. Cox proportional hazards models examined rates and predictors of suicide attempts during follow-up. Data were collected in 2016, and analyses were conducted in 2019. RESULTS During follow-up, 4.8% of transmasculine and 3.0% of transfeminine patients had at least 1 suicide attempt. Suicide attempt rates were more than 7 times higher among patients aged <18 years than among those aged >45 years, more than 3 times higher among patients with previous history of suicide ideation or suicide attempts than among those with no such history, and 2-5 times higher among those with 1-2 mental health diagnoses and more than 2 mental health diagnoses at baseline than among those with none. CONCLUSIONS Among transgender and gender diverse individuals, younger people, people with previous suicidal ideation or attempts, and people with multiple mental health diagnoses are at a higher risk for suicide attempts. Future research should examine the impact of gender-affirming healthcare use on the risk of suicide attempts and identify targets for suicide prevention interventions among transgender and gender diverse people in clinical settings.
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Affiliation(s)
- Josephine Mak
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Deirdre A Shires
- School of Social Work, Michigan State University, East Lansing, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
| | - Qi Zhang
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Lucas R Prieto
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Brian K Ahmedani
- Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan
| | - Leonardo Kattari
- School of Social Work, Michigan State University, East Lansing, Michigan
| | - Tracy A Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Andrew Bradlyn
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - W Dana Flanders
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Shawn V Giammattei
- The Rockway Institute, Alliant International University, San Francisco, California
| | - Enid M Hunkeler
- Division of Research, Kaiser Permanente, Northern California (emerita), Oakland, California
| | - Timothy L Lash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Rebecca Nash
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California (emerita), Pasadena, California
| | - Brandi Robinson
- Center for Research and Evaluation, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Jennifer Slovis
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Vin Tangpricha
- School of Medicine, Emory University, Atlanta, Georgia; The Atlanta VA Medical Center, Atlanta, Georgia
| | - Suma Vupputuri
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlanta States, Rockville, Maryland
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
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Becerra-Culqui TA, Liu Y, Nash R, Cromwell L, Flanders WD, Getahun D, Giammattei SV, Hunkeler EM, Lash TL, Millman A, Quinn VP, Robinson B, Roblin D, Sandberg DE, Silverberg MJ, Tangpricha V, Goodman M. Mental Health of Transgender and Gender Nonconforming Youth Compared With Their Peers. Pediatrics 2018; 141:e20173845. [PMID: 29661941 PMCID: PMC5914494 DOI: 10.1542/peds.2017-3845] [Citation(s) in RCA: 178] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/22/2018] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Understanding the magnitude of mental health problems, particularly life-threatening ones, experienced by transgender and/or gender nonconforming (TGNC) youth can lead to improved management of these conditions. METHODS Electronic medical records were used to identify a cohort of 588 transfeminine and 745 transmasculine children (3-9 years old) and adolescents (10-17 years old) enrolled in integrated health care systems in California and Georgia. Ten male and 10 female referent cisgender enrollees were matched to each TGNC individual on year of birth, race and/or ethnicity, study site, and membership year of the index date (first evidence of gender nonconforming status). Prevalence ratios were calculated by dividing the proportion of TGNC individuals with a specific mental health diagnosis or diagnostic category by the corresponding proportion in each reference group by transfeminine and/or transmasculine status, age group, and time period before the index date. RESULTS Common diagnoses for children and adolescents were attention deficit disorders (transfeminine 15%; transmasculine 16%) and depressive disorders (transfeminine 49%; transmasculine 62%), respectively. For all diagnostic categories, prevalence was severalfold higher among TGNC youth than in matched reference groups. Prevalence ratios (95% confidence intervals [CIs]) for history of self-inflicted injury in adolescents 6 months before the index date ranged from 18 (95% CI 4.4-82) to 144 (95% CI 36-1248). The corresponding range for suicidal ideation was 25 (95% CI 14-45) to 54 (95% CI 18-218). CONCLUSIONS TGNC youth may present with mental health conditions requiring immediate evaluation and implementation of clinical, social, and educational gender identity support measures.
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Affiliation(s)
- Tracy A Becerra-Culqui
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Yuan Liu
- Departments of Biostatistics and Bioinformatics and
| | - Rebecca Nash
- Epidemiology, Rollins School of Public Health, and
| | - Lee Cromwell
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia
| | | | - Darios Getahun
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Shawn V Giammattei
- Rockway Institute, Alliant International University, San Francisco, California
| | - Enid M Hunkeler
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | | | - Andrea Millman
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Virginia P Quinn
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, California
| | - Brandi Robinson
- Center for Clinical and Outcomes Research, Kaiser Permanente Georgia, Atlanta, Georgia
| | - Douglas Roblin
- Mid-Atlantic Permanente Research Institute, Kaiser Permanente Mid-Atlantic States, Rockville, Maryland
| | - David E Sandberg
- Department of Pediatrics, Medical School, University of Michigan, Ann Arbor, Michigan; and
| | - Michael J Silverberg
- Division of Research, Kaiser Permanente, Northern California, Oakland, California
| | - Vin Tangpricha
- Emory School of Medicine, Emory University, Atlanta, Georgia
- Atlanta Veterans Affairs Medical Center, Atlanta, Georgia
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Ehrensaft D, Giammattei SV, Storck K, Tishelman AC, Keo-Meier C. Prepubertal social gender transitions: What we know; what we can learn—A view from a gender affirmative lens. Int J Transgend 2018. [DOI: 10.1080/15532739.2017.1414649] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Affiliation(s)
- Diane Ehrensaft
- University of California, San Francisco, Child and Adolescent Gender Center, San Francisco, California, USA
| | - Shawn V Giammattei
- Alliant International University, Rockway Institute, San Francisco, California, USA
- Quest Family Therapy, Santa Rosa, California, USA
| | | | - Amy C Tishelman
- Boston Children's Hospital, Division of Endocrinology, Boston, Massachusetts, USA
| | - Colton Keo-Meier
- Department of Psychology, University of Houston, Houston, Texas, USA
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Abstract
Dualistic notions about gender and sexuality have permeated the field of couple and family therapy. These binary constructions have been limiting for everyone, especially those who fall outside the male/female dichotomy. This article examines the impact of these binary notions, especially on transgender and gender-creative individuals, couples, and families. Current theory and research in the field as they relate to gender identity, sexuality, and gender minority stress in couples and families are presented. Case examples are used to illustrate affirmative approaches to treatment issues such as coming out, safety, grief and loss, redefining relationships, and social/medical transitions that may arise for transgender or gender nonconforming (TGNC) individuals, couples, and families.
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Affiliation(s)
- Shawn V Giammattei
- Online Certificate Program in LGBT Mental Health & Human Services, San Francisco, CA
- Rockway Institute for LGBT Psychology, California School of Professional Psychology at Alliant International University, San Francisco, CA
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