Table 2.
Extracted data from included studies on gender dysphoria and suicidality (including suicidal ideation, suicide attempts and behaviours, suicide risk)
| References | Country | Population/sample | Sample size | Demogr | Symptoms | Analysis | Results |
|---|---|---|---|---|---|---|---|
| Toomey et al. [39] | USA | Adolescents referred for GD (including AFAB, AMAB, nonbinary, questioning); Cisgender adolescents |
120 617 AMAB n = 2020 (0.2%) AFAB n = 175 (0.1%) Nonbinary n = 344 (0.3%) Questioning n = 1052(0.9%) Female n = 60,973(50.6%) Male n = 57,871(48%) |
11–19 year old x̄ = 14.7 ± 1.8 |
Suicide attempts, suicide behaviour |
Descriptive statistics χ2 χ2 in R with Post hoc comparisons Bivariate level Logistic regressions |
Rates of attempted suicide AFAB (50.8%) Nonbinary (41.8%) AMAB (29.9%) Questioning (27.9%) Female (17.6%) Male (9.8%) Association between suicide behaviour and gender identity (χ2df = 5] = 2279.2; p < 0.001)) Significant difference between groups except for AMAB and nonbinary (χ2[df = 1] = 0.08; p = 0.78), and AFAB and nonbinary (χ2[df = 1] = 3.66; p = 0.08) Rates of suicide behaviours: AFAB: (50.9% [95% CI = 45.51 to 58.17]) Nonbinary: (41.8% [95% CI = 36.57 to 47.22]) AMAB: (30.0% [95% CI = 24.06 to 36.59]) Questioning adolescents: (27.9% [95% CI = 25.27 to 30.69]) Female: (17.6% [95% CI = 17.31 to 17.91]) Male: (9.8% [95% CI = 9.59 to 10.08]) OR (95% CI) for: Female 1.37% [1.34 to 1.39] AMAB 1.27% [1.04 to 1.54] AFAB 1.84% [1.52 to 2.24] Nonbinary 1.38 [1.20 to 1.58] Questioning 1.40 [1.28 to 1.52] |
| Heino et al. [29] | Finland | Adolescents reporting transgender identity (0.2%); other/nonbinary identity (2.9%); cisgender identity (96.9%) | 1425 |
15–16 year old x̄ = 15.59 ± 0.41 |
Severe suicidal ideation |
Descriptive statistics Logistic regression for associations between transgender identity and suicidal ideation |
Transgender identity reporting severe suicidal ideation significantly more commonly than cisgender identity (14.3 vs. 1.6%, p < 0.001) OR (95% CI): Model 1 (controlling for age, sex, honesty of responding): Significant association between transgender status and severe suicide ideation Significantly higher severe suicidal ideation in people identifying themselves as transgender (OR [95% CI] = 10.8[4.0 to 28.9], p < 0.001) Model 2 (controlling for socioeconomic factors): Significant association between transgender identity and suicidal ideation = (OR [95% CI] = 9.9 [3.0 to 32.1], p < 0.001) Model 3 (controlling for depression): Significant association = (OR [95% CI] = 6.3 [1.6 to 24.9], p = 0.009); Model 4 (controlling for peer rejection and victimization): Significant association = (OR [95% CI] = 5.3 [1.3 to 22.1], p = 0.024) |
| Fisher et al. [17] | Italy |
Age-matched GDs and NTs control group |
92 GDs = 46 NRs = 46 |
GDs x̄ = 16 ± 1.49 NRs x̄ = 16.59 ± 1.11 |
Suicide risk | (ANCOVA) |
Significant difference between GDs and NRs in: “Attraction to death”: 2.98 ± 0.57 vs. 2.17 ± 0.58; F = 46.22, p < 0.0001 “Repulsion by life” scales: 3.04 ± 0.46 vs. 2.08 ± 0.56, F = 78.5, p < 0.0001 “Attraction to life” scales: 3.32 ± 0.55 vs. 4.05 ± 0.49, F = 44.14, p < 0.0001 Significant difference between GDs and NRs on the “Internalizing scale” (depression/anxiety): 62.43 ± 11.18 vs. 53.57 ± 11.64, F = 12.53 p = 0.001 |
| Yüksel et al. [51] | Turkey | Transgender adolescents | 141 diagnosed with transsexuality (DSM-IV) |
x̄ = 27.5 ± 7.16 AFAB = 99 AMAB = 42 |
Suicide attempts, suicidal ideation |
Descriptive statistics χ2 for gender differences |
Suicidal rates (%) Current suicidal thoughts 9.2% Lifetime suicidal thought (n = 78) 55.3% Suicide attempts (n = 42) 29.8% Before 21 yr of age:76.7% After 21 yr of age: 23.3% Not significant: Current suicidal thoughts AFAB-AMAB, χ2 = 0.515 Lifetime suicidal thoughts AFAB-AMAB, χ2 = 0.515 Suicide attempts AFAB-AMAB, χ2 = 0.039 |
| de Graaf et al. [24] | Canada, Netherlands, U.K | Adolescents referred for GD |
2771 Toronto (n = 260) Amsterdam (n = 266) London (n = 2245) |
Total sample x̄ = 15.99 ± 1.20 Toronto x̄ = 16.66 ± 1.75 Male N (%) 129 (49.6%) Female N (%) 131 (50.4%) Amsterdam x̄ = 15.91 ± 1.42 Male N (%) 123 ± 46.2 Female N (%) 143 ± 53.8 London x̄ = 15.93 ± 1.07 Male N (%) 685 (30.5%) Female N (%) 1560 (69.5%) |
Suicidality |
Comparative analysis Multiple linear regression analysis |
Clinic-referred sample ranges for CBCL: Item 91 (suicidal ideation) 17.9%—34.9%; Item 18 (suicidal behaviour) 7.7%—31.1% Non-referred sample ranges: Item 91: 1.4%—2.7%; Item 18: 0.6%—1.8% Clinic-referred samples ranges for YSR: Item 91 14.4–31.2.%; Item 18: 7.5–24.3% Non-referred sample ranges: Item 91: 1.5%–7.7%; Item 18: 2.2–3.9% Birth assigned sex (predictor) β = 0.105 (Toronto vs. Amsterdam) Birth assigned sex β = 0.035 (Toronto vs. London) Birth assigned sex β = 0.026 (Amsterdam vs. London) |
| Alizadeh Mohajer et al. [6] | Iran | Individuals diagnosed with GD | 21 | x̄ = 19 | Suicidal ideation |
Descriptive statistics Linear regression analysis |
Beck’s Scale for Suicide Ideation No. (%) Low Risk 4 (19.1%) High Risk 15 (71.4%) Very High Risk 2 (9.5%) Mean of total score for Beck’s Scale for Suicide Ideation: CI 95%, 11.6 [8.7 to 15.6] |
AFAB individuals assigned female at birth whose experienced gender is male, AMAB individuals assigned male at birth whose experienced gender is female, Demogr., demographics, i.e., (Age) Mean age, SD; Sex assigned at birth, df degrees of freedom, GD gender dysphoria, GDs gender dysphoric adolescents, NRs non-referred adolescents, OR odds ratio, x̄, mean, ± (SD), standard deviation