Department of Psychiatry, The Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Mental Health Institute of the Second Xiangya Hospital, Central South University, Changsha, Hunan, China; Chinese National Clinical Research Center on Mental Disorders (Xiangya), Changsha, Hunan, China; Chinese National Technology Institute on Mental Disorders, Changsha, Hunan, China; Hunan Key Laboratory of Psychiatry and Mental Health, Changsha, Hunan 410011, China; The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China; Department of Psychiatry, University of Oxford, UK.
The National Clinical Research Center for Mental Disorders & Beijing key Laboratory of Mental Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, China; Advanced Innovation Center for Human Brain Protection, Capital Medical University, Beijing, China.
J Affect Disord. 2019 Feb 15;245:1126-1134. doi: 10.1016/j.jad.2018.12.011. Epub 2018 Dec 11.
This study aims to understand suicidal ideation and suicide attempts among transgender individuals through an in-depth analysis of a nation-wide population general survey in China.
Transgender Men (TM) and Women (TW) were investigated through a cross-sectional survey. A structured questionnaire was used to investigate participants' demographic information, perceived sexuality conflicts, childhood adversity and mental health conditions. Logistic regression models were utilized to investigate risk factors associated with suicidal ideation and suicide attempts in these groups. We also conducted a quasi-meta-analysis in order to compare the prevalence of suicidal ideation and attempted suicide between general and transgender populations in China.
A total of 1309 participants across 32 provinces and municipalities in China took part in this survey, out of 2060 valid questionnaires. In this transgender population, the lifetime prevalence of suicidal ideation and an attempt at suicide were 56.4% and 16.1%, respectively. This estimated prevalence rate is far greater than in Chinese community samples. For all transgender people, disliking birth-assigned sex, seeking sex reassignment surgery, having intense conflicts with parents, lifetime history of suffering from major depressive disorder, a recent episode of depression, self-harm, and seeking mental health services were significantly associated with increased risk of suicidal ideation. An education level of high school or equivalent, being married and/or separated/divorced, having intense conflicts with parents, or self-harm and seeking mental health services were all significantly associated with increased risk of suicide attempt. Although most risk factors for TM and TW were equivalent across groups, differences were observed in both suicidal ideation and suicide attempt models.
The cross-sectional study design and lack of follow-up data are limitations of this study.
This is the first study to examine suicide within a Chinese transgender population. The clinical implications of these findings for Chinese mental health professionals are discussed. Also, the evidence from this study can be used to inform the practices of suicide prevention workers, and policy makers working with the transgender population.
本研究旨在通过对中国全国范围内的人口总体调查，深入分析了解跨性别者的自杀意念和自杀企图。
通过横断面调查对跨性别男性（TM）和女性（TW）进行研究。使用结构化问卷调查参与者的人口统计学信息、感知性取向冲突、童年逆境和心理健康状况。利用逻辑回归模型调查这些群体中与自杀意念和自杀企图相关的风险因素。我们还进行了准荟萃分析，以比较中国一般人群和跨性别者人群中自杀意念和自杀企图的发生率。
这项调查共涉及中国 32 个省、直辖市的 1309 名参与者，共收到 2060 份有效问卷。在这个跨性别者群体中，终生自杀意念和自杀企图的发生率分别为 56.4%和 16.1%。这一估计的发生率远高于中国社区样本。对于所有跨性别者，不喜欢出生时的性别、寻求性别重置手术、与父母关系紧张、有重度抑郁症病史、近期抑郁发作、自残和寻求心理健康服务，与自杀意念风险增加显著相关。高中或同等学历、已婚和/或分居/离婚、与父母关系紧张、自残和寻求心理健康服务，与自杀企图风险增加显著相关。尽管 TM 和 TW 的大多数风险因素在组间相当，但在自杀意念和自杀企图模型中都观察到了差异。
横断面研究设计和缺乏随访数据是本研究的局限性。
这是第一项在中国跨性别者人群中研究自杀的研究。这些发现对中国心理健康专业人员具有临床意义，并为预防自杀工作者和与跨性别者合作的政策制定者提供了信息。
