Department of Psychology, University of Miami, Coral Gables, FL, USA.
Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA.
J Gen Intern Med. 2023 May;38(6):1357-1365. doi: 10.1007/s11606-022-07996-2. Epub 2023 Jan 17.
Transgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences.
To examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals.
Data were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation.
29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018.
Demographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ[5, n=25,959]=906.454, p<0.001).
TGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.
与顺性别个体相比，跨性别和性别多样化（TGD）个体经历更严重的心理困扰，自杀风险可能更高。现有文献主要由小样本研究组成，这些研究没有评估亚组差异。
比较四个 TGD 群体与顺性别个体报告的自杀意念发生率。
从专门从事性和性别少数群体健康的社区卫生中心接受初级保健的患者的电子健康记录中提取数据。使用逻辑回归检查社会人口统计学变量与当前自杀意念存在之间的关系。
2015 年至 2018 年期间在美国东北部一家社区卫生中心接受护理的 29988 名患者。
人口统计学问卷，9 项患者健康问卷。
年龄较小、性和性别少数身份以及公共/基于赠款的保险与自杀意念的可能性显著增加有关。与顺性别男性相比，跨性别男性（OR=2.08；95%CI=1.29-3.36；p=.003）、跨性别女性（OR=3.08；95%CI=2.05-4.63；p<.001）、出生时被指定为男性的非二元（NB）个体（OR=3.55；95%CI=1.86-6.77；p<001）和出生时被指定为女性的 NB 个体（OR=2.49；95%CI=1.52-4.07；p<001），在控制年龄、种族、民族、性取向和保险状况后，都报告当前自杀意念的可能性显著增加。与顺性别男性（6.1%）和女性（6.6%）相比，跨性别女性（23.6%）和 NB AMAB 个体（26.7%）报告自杀意念的比例更高，与顺性别男性（17.4%）相比，差异也有统计学意义（χ[5，n=25959]=906.454，p<0.001）。
即使考虑了年龄、种族、民族、性取向和保险状况，TGD 患者自杀意念的风险显著增加。研究结果表明，按出生时的性别分配存在不同的风险特征。在为 TGD 患者服务的环境中，应优先考虑对自杀意念进行一致评估和干预。
