Mak Josephine, Shires Deirdre A, Zhang Qi, Prieto Lucas R, Ahmedani Brian K, Kattari Leonardo, Becerra-Culqui Tracy A, Bradlyn Andrew, Flanders W Dana, Getahun Darios, Giammattei Shawn V, Hunkeler Enid M, Lash Timothy L, Nash Rebecca, Quinn Virginia P, Robinson Brandi, Roblin Douglas, Silverberg Michael J, Slovis Jennifer, Tangpricha Vin, Vupputuri Suma, Goodman Michael
Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia.
School of Social Work, Michigan State University, East Lansing, Michigan; Center for Health Policy and Health Services Research, Henry Ford Health System, Detroit, Michigan.
Am J Prev Med. 2020 Oct;59(4):570-577. doi: 10.1016/j.amepre.2020.03.026. Epub 2020 Aug 12.
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.
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.
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.
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.
跨性别者和性别多样化人群常常面临歧视，可能会经历过度的情绪困扰，进而导致自杀未遂。因此，评估跨性别者和性别多样化个体中自杀未遂的发生率及潜在决定因素至关重要。
对纳入3个综合医疗系统的6327名跨性别者和性别多样化个体的纵向数据进行分析，以评估自杀未遂率。比较了男性化跨性别者和女性化跨性别者在年龄、种族/族裔方面以及根据基线心理健康状况的自杀未遂发生率。Cox比例风险模型研究了随访期间自杀未遂的发生率及预测因素。数据于2016年收集，并于2019年进行分析。
在随访期间，4.8%的男性化跨性别患者和3.0%的女性化跨性别患者至少有1次自杀未遂。年龄<18岁的患者自杀未遂率比年龄>45岁的患者高7倍多，有自杀意念或自杀未遂史的患者自杀未遂率比无此类病史的患者高3倍多，基线时有1 - 2项心理健康诊断和超过2项心理健康诊断的患者自杀未遂率比无心理健康诊断的患者高2 - 5倍。
在跨性别者和性别多样化个体中，年轻人、有过自杀意念或自杀未遂史的人以及有多种心理健康诊断的人自杀未遂风险更高。未来的研究应探讨接受性别肯定医疗保健对自杀未遂风险的影响，并确定临床环境中跨性别者和性别多样化人群自杀预防干预的目标。
