Suicidal and nonsuicidal self-harming thoughts and behaviors in clinically referred children and adolescents with gender dysphoria

Abstract

Background Young transgender or gender nonconforming (TGNC) children and adolescents or those with a gender dysphoria (GD) diagnosis show an increased risk of suicidal and nonsuicidal self-harming thoughts and behaviors (STBs). Data from German-speaking regions on this topic and studies comparing self- and parent-reported STBs have been scarce. The study aims were therefore to examine: (a) frequencies of self- and parent-reported STBs in a German clinical sample of children and adolescents with GD and (b) differences between age and gender groups, as well as between self- and parent-reports. Methods Two items from the Child Behavior Checklist (CBCL) and the Youth Self-Report (YSR) were used to assess self- and parent-reported STBs in a sample of 343 adolescents and 49 children who presented to the Hamburg Gender Identity Service (Hamburg GIS) between 2013 and 2019. Seventy-eight percent of the analysis sample was assigned female at birth (AFAB), and 22% were assigned male at birth (AMAB). Results Parents reported STBs on the CBCL for 16% and 6% of the cases in childhood and for 20% and 29% of the adolescent cases, respectively. STBs were self-reported by 38% and 45% of the adolescents who could report on the YSR. STBs were higher among adolescents than among children and in self-reports (YSR) compared to parent reports (CBCL). AFAB adolescents reported higher degrees of STBs than AMAB adolescents. Conclusions Children and adolescents with GD are a high-risk population for STBs, especially pubescent and AFAB individuals. Mental health professionals should screen early for STBs to prevent possible suicidal ideation-to-action transitions.

Characteristics of children and adolescents referred to specialist gender services: a systematic review

“…Over time, there is generally an increase in the ratio of birth-registered females to males being referred to child and adolescent gender services across countries (figure 3). 2 3 7 8 21 22 24 26 31–70 There is no clear sudden increase but more of a steady increase over time; however, Finland reported a higher ratio throughout. Given the number of referrals is relatively low in some services/countries, there are fluctuations in the data with the ratios increasing one year and decreasing the next.…”

“…Of those studies, the majority found higher estimates of suicide attempts and/or self-harm in birth-registered females compared with males. Six studies explored differences in suicide attempts and/or self-harm by age groups, with estimates generally higher in older age categories 41 75 81 84 97 98. Two studies explored differences in suicide attempts and/or self-harm over time in the referred populations 35 89.…”

“…There were mixed findings in the four studies combining suicide and self-harm ideation and differences between parent/carer and child/adolescent reports 50 96. Five studies explored differences in suicide and/or self-harm ideation by age groups and generally estimates were higher in older age categories 41 81 84 97 98…”

Binary and Non-binary Gender Identities, Internalizing Problems, and Treatment Wishes Among Adolescents Referred to a Gender Identity Clinic in Germany

“…Such mental health disparities have been well documented for TGNC youth. Compared to their cisgender counterparts, TGNC adolescents report more psychological difficulties or so-called behavioral and emotional problems, especially internalizing problems and elevated rates of depression, suicidality, self-harm, and eating disorders (Bechard et al, 2017 ; Connolly et al, 2016 ; de Graaf et al, 2022 ; Hartig et al, 2022 ; Levitan et al, 2019 ). Non-binary young individuals may face even more discrimination and victimization than binary TGNC individuals because their gender expression (e.g., gender-neutral pronouns and non-binary outward appearance) is more conflicting with the gender binary of either female or male (Lefevor et al, 2019 ).…”

Presenting the diagnostic background of gender dysphoria from a psychological and criminological perspective in a sexually exploited adolescent living in a children’s special foster care home

“…Ha a társas normák nem kedveznek annak, hogy a serdülő kifejezze a szenvedésnyomását, a kezeletlen GD később depresszióhoz, szorongáshoz, poszttraumatikus stresszhez, önkárosításhoz és szuicidiumhoz is vezethet (Venkataramu & Banerjee, 2021;Alberse, de Vries, Elzinga & Steensma, 2019). Egy német kutatás szerint (Hartig,Voss, Herrmann, Fahrenkrug, Bindt & Becker-Hebly, 2022) a GD-vel diagnosztizált serdülőknél egy, a szülők által kitöltött kérdőíven 20 és 28%-os arányt mutat az önkárosító magatartás és a szuicid ideáció (öngyilkos gondolatok), attól függően, hogy fiúnak vagy lánynak születtek. Ugyanez az arány magasabb önkitöltés esetén: 38 és 45%.…”