Prevalence of Suicide Ideation and its Relationship with Depression among Transgender Population

Abstract

Depression is one of the most frequently diagnosed psychiatric illnesses, which remains a big cause of mortality and morbidity among all groups of population. 1 Things are not different in our part of the world as depression remains a common mental health illness in our population. 2 If untreated, it may lead to serious consequences including severe depression with psychotic illness, physical problems and even suicide. [3][4][5] Transgender is a broad term which includes the people with all types of gender identity disorder. ICD-11 coins a new term for this group of people, i.e. gender incongruence. In United States of America, 390/100,000 individuals are believed to be transgenders. 6 Census of 2017 has shown that more than 10,000 transgender subjects exist in Pakistan. They suffer from various health issues including the HIV, drug dependence, and various mental health problems. 7,8 Previous research highlights the presence of depression and suicide ideation among the transgender population. Depression, suicide and other mental health indices are very high among the transgender population as compared to controls even in a developed country like USA. 9 Another study showed suicide attempt rate as 32-50% among the transgender population of our neighboring country India. This was also coupled with increased rate of depression among the target population. 10 Oswalt et al. concluded in a large study that all mental health illnesses including schizophrenia are found more among the transgender as compared to heterosexual controls. 11 Depression and suicidal ideation, if remain unaddressed for long, may result in poor life quality and even leading to death. 12 Suicidality and depression have some common biological pathways, which explain one of the bases of their comorbidity. Role of genetics, alteration in the hypothalamic-pituitary-adrenal (HPA) axis, dysregulation of serotonin metabolism and receptors and neuroimmunological basis are some of the factors which contribute in development of both depression and suicidality. 13 In addition to the biological factors, depression also leads to suicidal ideation and suicidality by psychological and social pathways. 14 Ideas of self harm are also part of diagnostic criteria for depression in

Factors associated with suicide attempts among Australian transgender adults

“…Self-reported lifetime diagnoses of depression were high in our participants, and this was associated with an over 300% increased odds of reporting a lifetime suicide attempt. Similarly, a lifetime history of major depressive disorder has been significantly associated with increased risk of suicidal ideation and attempted suicide in trans people worldwide [8,9]. Depression in trans people is multifaceted, and there are various contributing factors; including discrimination, disclosure, social support, access to gender affirming healthcare, substance use and socioeconomic factors [57].…”

“…Suicide attempts and suicide deaths occur due to a complex interaction between biological, psychological and psychosocial risk factors. This may include genetic predisposition to depression and anxiety [8,9], minority stress and stressful life events, unemployment and financial stress [10][11][12], quality of support networks [13][14][15][16][17], discrimination, violence [18][19][20] and barriers to accessing healthcare and support services [21].…”

A 2020 Review of Mental Health Comorbidity in Gender Dysphoric and Gender Non-Conforming People

“…Four of them studied suicide attempt [44][45][46][47], five suicidal ideation [45][46][47][48][49] and one of them [47] included other concepts such as passive ideation of death or non-suicidal self-harm attempts. Claes, et al [50] show the relationship between non-suicidal self-harm attempts with psychological factors and interpersonal problems, in transsexual people between 17 and 77 years old, and in Azeem, et al [46] the prevalence of suicidal ideation in the trans adult population is related with the coexistence of depression. Three papers [47][48][49] included minors in the sample, and in one [49] exclusively minors.…”

“…All papers excepting two [46,47] considered different variables such as internalized transphobia, demographic and psychological variables or concomitant mental illnesses, and their relationship with the prevalence of the previously mentioned concepts.…”

A influência dos aspectos biopsicossociais nas elevadas taxas de suicídio da população transgênero

“…Outros critérios são: preferência por atividades colocadas como do gênero oposto, uso de roupas não conformativas com o gênero de desígnio e forte rejeição a sua anatomia sexual (DSM, 2013). Na prática, a disforia de gênero é, como dito anteriormente, uma condição de extremo sentimento de inadequação e ansiedade, sendo que diversos estudos apontam a relação inadequação ou disforia de gênero com depressão e ideações suicidas (AZEEM R, et al, 2019;ZELUF G, et al, 2018;PETERSON CM, et al, 2016). Crianças diagnosticadas com disforia de gênero exibem índices elevados de depressão, ansiedade e do controle de impulsos, ocorrendo o mesmo em adultos, incluindo-se abuso de substâncias ilícitas e também pessoas que apresentam disforia de gênero de início tardio podem apresentar maiores sofrimentos e ambivalência sobre a cirurgia de redefinição de sexo e de maiores insatisfações pós-cirurgia (SADOCK BJ, et al, 2017).…”