J Psychiatr Pract. 2022 Jan 6;28(1):3-13. doi: 10.1097/PRA.0000000000000604.
Growing data on suicidal behavior among members of the lesbian, gay, bisexual, transgender, queer, questioning, and other sexual/gender minority (LGBTQ+) communities, particularly in the transgender subgroup, demonstrate that there is a stark elevation in suicidality compared with rates in their cisgender counterparts. Among the available theories of suicide, the interpersonal theory of suicide (IPTS) is a plausible explanation for the increased suicidal behaviors among transgender youths.
The objective of this study was to examine the pathologic basis of treatment-resistant suicidality in transgender youth despite favorable environments using the theoretical framework of the IPTS, supported by a literature review and case series.
We conducted a literature review using PubMed and PsycInfo with key words suicidal ideation, suicidality, transgender, transgender youth, gender dysphoria, and interpersonal theory of suicide. Seventy-eight articles were retrieved, which were then narrowed down to 30 articles after non-English articles and irrelevant topics were excluded. The clinical presentations of 5 transgender youths, 11 to 17 years of age, were found to be correlated with relevant reports in the research literature, implying a plausible rationale for elevated rates of suicide. All patients and families supplied verbal consent for these case reports to be published.
Reasons for suicidal behavior among the patients included thwarted belongingness and perceived burdensomeness leading to perpetual suicidal behavior. The presence in these cases of the following contributing factors in the IPTS-thwarted belongingness, perceived burdensomeness, and acquired capability for suicide-suggests that such a basis exists. Perceived burdensomeness appears to have a greater correlation with developing suicidal behavior than thwarted belongingness alone, but the presence of both demonstrates the highest risk of suicidality in transgender youth. Transgender children and adolescents are at extremely high risk of suicidal behavior, but little research has been devoted to the etiology and plausible explanations for this elevated risk, despite growing awareness of and support for the problem. This review suggests further research is required on the triadic factor interactions of the IPTS model that could help us to better understand and intervene with this high-risk population.
越来越多的研究数据表明，女同性恋、男同性恋、双性恋、跨性别、酷儿、疑问者和其他性/性别少数群体（LGBTQ+）群体的成员，尤其是跨性别亚群，存在自杀行为发生率明显升高的现象，与顺性别者相比，自杀率明显更高。在现有的自杀理论中，人际理论（IPT）是解释跨性别青年自杀行为增加的一个合理假说。
本研究旨在通过人际理论的理论框架，结合文献复习和病例系列研究，探讨尽管环境有利，但为何跨性别青年的治疗抵抗性自杀率仍然很高。
我们使用 PubMed 和 PsycInfo 进行了文献复习，使用的关键词包括自杀意念、自杀倾向、跨性别、跨性别青年、性别焦虑和人际理论。检索到 78 篇文章，经过排除非英语文章和不相关主题后，将范围缩小至 30 篇。我们发现，5 名 11 至 17 岁的跨性别青年的临床表现与研究文献中的相关报告相关，这表明存在提高自杀率的合理理由。所有患者及其家属均口头同意发表这些病例报告。
患者自杀行为的原因包括归属感受挫和感知负担过重，导致持续的自杀行为。这些病例中存在人际理论的以下促成因素——归属感受挫、感知负担过重和获得自杀能力，这表明存在这种基础。感知负担过重与发展自杀行为的相关性似乎大于归属感受挫，但两者同时存在表明跨性别青年的自杀风险最高。跨性别儿童和青少年自杀风险极高，但针对这一风险增加的病因学和合理解释的研究很少，尽管对这一问题的认识和支持日益增加。这篇综述表明，需要进一步研究人际理论模型的三重因素相互作用，以帮助我们更好地理解和干预这一高风险人群。
