New research published in CMAJ today indicates that transgender and nonbinary adolescents are at a significantly higher risk of suicidal ideation and suicide attempts than their cisgender peers.
In Canada, suicide is the second greatest cause of mortality among teenagers and young people aged 15 to 24. Sexual minority adolescents – those who are attracted to the same gender or several genders or identify as lesbian, gay, bisexual, or queer — are also more likely to experience mental health problems, suicidal ideation, and suicide attempts.
“The transition from adolescence to adulthood is a very stressful time for all young people,” according to Dr. Ian Colman, one of the co-authors, “but particularly for gender and sexual minority teens. These findings, showing dramatic increases in suicide risk, should sound a clarion call that additional support is needed.”
Researchers used data from the national 2019 Canadian Health Survey on Children and Kids to expand the knowledge base on the risk of suicide ideation and attempts in transgender and nonbinary youth.
The study comprised 6800 15–17-year-olds, the majority of whom (99.4 percent) were cisgender (meaning they identify as the gender assigned at birth) and 0.6 percent were transgender (meaning they identify as a gender other than that assigned at birth).
The majority of respondents (78.6 percent) were heterosexual, with 14.7 percent attracted to several genders, 4.3 percent undecided, 1.6 percent of girls attracted to females, and 0.8 percent of boys attracted to boys.
In all, 14 percent of teenagers reported suicidal thinking in the preceding year, and 6.8 percent had tried suicide earlier. When compared to cisgender youth, transgender youth were 5 times more likely to have thought about suicide and 7.6 times more likely to have tried to kill themselves.
“A really concerning finding is that,” adds coauthor Fae Johnstone, “more than half of all transgender youth reported seriously considering suicide in the previous 12 months. This is a crisis, and it shows just how much more needs to be done to support transgender young people.”
The researchers also discovered that the percentage of teenagers who expressed some level of attraction to more than one gender was significantly higher than in previous studies. This could be due to the fact that this survey looked at attraction to different genders rather than self-reported sexual identity, or it could be due to the fact that bisexuality is becoming less stigmatized. This group was also more than twice as likely to have considered suicide.
Overall, 4.3 percent of adolescents said they were unsure about their sexual desire, which is referred to as “questioning.”
“Given that the exploration of romantic and sexual relationships is a major developmental task of adolescence,” explains main author Dr. Mila Kingsbury, “it is perhaps unsurprising that many begin to question sexual attraction and orientation during this time.”
The connection between suicidality and sexual or gender minority status was partially explained by the bullying or cyberbullying these adolescents encountered.
The study’s results are similar to those of the only other nationally representative study on the subject, which found that transgender teens in New Zealand are five times more likely to try to kill themselves.
“Suicide prevention programs specifically targeted to transgender, nonbinary and sexual minority adolescents, as well as gender-affirming care for transgender adolescents, may help reduce the burden of suicidality among this group,” agrees Johnstone.
“Given that these associations were partially mediated through the experience of bullying, systemic change in the form of primary prevention programs aimed at public awareness and promoting inclusivity,” according to the authors, “may lead to a reduction of the experience of minority stress among sexual minority and transgender youth, reducing their risk of poor mental health and suicidality.”
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