Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada

Abstract

BackgroundAcross Europe, Canada, and the United States, 22–43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact.MethodsThe Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks.ResultsAmong trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10th versus 90th percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10th percentile.ConclusionsLarge effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.

Transgender Women Living with HIV Frequently Take Antiretroviral Therapy and/or Feminizing Hormone Therapy Differently Than Prescribed Due to Drug–Drug Interaction Concerns

“…[1][2][3] Despite a 34-fold higher likelihood of having HIV among TW in the United States compared with the general population, 4 transgender people (approximately 0.4%-0.6% of the U.S. population 5,6 ) have comparatively low healthcare utilization rates 7 and may seek gender-affirming therapies (including HT and body modification services) outside of traditional, supervised medical settings. 8,9 Both HT and ART have potential side effects, and drug-drug interactions (DDI) may exist between some ART medications (such as nonnucleoside reverse transcriptase inhibitors [NNRTI] and protease inhibitors [PIs]) and HT (particularly ethinyl estradiol), 10 making unsupervised or uncoordinated HT and ART use potentially risky for TW taking feminizing HT.…”

The Role of Gender Affirmation in Psychological Well-Being Among Transgender Women

“…For example, findings suggest that transgender women who have access to transition-related medical care, such as cross-sex gender affirmative surgeries, experience improved mental health and better quality of life compared to their non-medically-transitioning counterparts (Bauer et al, 2015;de Vries et al, 2014;Gómez-Gil et al, 2012;Rotondi et al, 2011;Wilson, Chen, Arayasirikul, Wenzel, & Raymond, 2015). Further, familial support represents another important aspect of social affirmation, as findings suggest that lower rates of family rejection and greater support are significantly associated with better health outcomes, greater perceived safety in public settings, higher self-esteem, less depressive symptoms, lower suicidal ideation, and better quality of life among transgender women (Bauer et al, 2015;Factor & Rothblum, 2008;Koken et al, 2009;Ryan, Russell, Huebner, Diaz, & Sanchez, 2010).In accordance with Kozee and colleagues (2012), we propose psychological gender affirmation is also critical to the well-being of transgender populations. Kozee and colleagues (2012) posit that feeling comfortable with one's own gender identity is a facet of gender congruency, which they define as the degree to which individuals "feel genuine, authentic, and comfortable within their external appearance/presence and accept their genuine identity rather than the socially prescribed identity".…”

“…This confluence and intersection of oppressions, i.e., transmisogyny, potentially exacerbates mental health risk for transgender women. Indeed, surveys of diverse community samples of transgender women have documented associations between discrimination, depressive symptoms, selfesteem, and suicidal ideation (Bauer, Scheim, Pyne, Travers, & Hammond, 2015;Bockting et al, 2013;Gamarel, Reisner, Laurenceau, Nemoto, & Operario, 2014;Nemoto, Bödeker, & Iwamoto, 2011;Reisner et al, 2015). Some research has suggested that experiences of discrimination among transgender women may lead to greater HIV-risk behaviors (e.g.…”

Towards a new specialization in health librarianship: LGBTQ health

“…Within the context of healthcare, discrimination ranges from frequent and difficult to prove microaggressions to aggressive heteronormativity and systemic discrimination [25]. Some current examples include the refusal of Canadian Blood Services and Héma Québec to accept blood donations from men who have had sex with other men within the last five years [26], and the experiences of two-spirited people and transgender people of colour, who are not only at higher risk of violence [27,28] but who also disproportionately experience discrimination and oppression when seeking healthcare [29,30].…”