Table 1.
Studies in This Meta-Synthesis
| No. | Author/s | # | Ideation | Attempt | Description |
|---|---|---|---|---|---|
| 1 | Cole et al.4 | 435 | Ever: 14.48% | Analyzed incidence of Axis 1 or 2 diagnoses through retrospective chart review of self-diagnosed transsexuals who presented to Texas gender clinic since 1980. Charts included information from 1 to 2 h clinical interviews, biographical and medical questionnaires and, in some cases, psychometric inventories. The previous publication on this dataset3 reported the time period as “before treatment.” This was changed to “ever” as no patients had GRS at data collection and, in any case, none attempted after GRS. The attempt rate was also changed from 15% to 14.48% to maintain consistency in reporting findings to two decimal places wherever possible | |
| 2 | Devor5,6 | 45 | Ever: 28.89% | Ever: 22.22% | Investigated life experiences of FTM individuals using qualitative interviews conducted from 1998 to 2002. Suicidality information volunteered during the interview. This is the first needs assessment conducted on the topic of transgender health |
| 3 | Rehman et al.7 | 28 | After surgery: 7.14% | Explored post-GRS sex and surgery satisfaction among MTF patients of a New York City Hospital that received GRS from 1980 to 1994, using a mail-in questionnaire and, in some cases, interviews. Only information on the postsurgical period is reported, although it was noted that there was a marked decrease in attempts postsurgery | |
| 4 | Mathy8 | 73a | Ever: 37% | Ever: 23.30% | Examined transgender suicidality among respondents to two human sexuality surveys on MSNBC website over 1 month (2000). First was selected random sample and second invited every thousandth. Given choice between male, female, and transgender, 0.2% of each sample selected the latter and were psychosocially matched to cis male and cis female controls and lesbian and gay comparison groups |
| 5 | Singer et al.,9 Kenagy10,11 | 103 | Ever: 38.83% | Needs assessment that explored physical and mental health among Philadelphia-area transgender individuals for approximately a year (1996–1997) | |
| 6 | Kenagy and Bostwick12 | 111 | Ever: 62.16% | Ever: 26.12% | Community-based needs assessment that explored health and social service needs of Chicago transgender individuals recruited over 6 months (2000–2001). Replicated Singer et al.9 and Kenagy.10,15 Suicidality findings here amend those published in Adams et al.3 to correct for small rounding error |
| 7 | Bockting, et al.,13,14 | 181 | Past 3 years: 52% | Analyzed the impact of a Minnesotan sexual health seminar on LGBT health-risk factors by following a cohort through an intervention using a case–control element to compare transgender and cis gender respondents. All participants in the 8 seminars conducted from 1997 to 2002 were asked to complete a survey pre and postintervention and after 3 months | |
| 8 | Kenagy10,11,15 | 81 | Ever: 46.91% | Ever: 19.75% | Needs assessment that investigated health and social service needs of a Philadelphia-area transgender community using data collected over 6 months (1997) |
| 9 | Risser et al.16 | 67a | Ever: 58.21%, past 30 days: 16.42% | Ever: 29.85% | Community-based needs assessment that investigated the sexual health risks and social and sexual health status of a group of transgender women in Houston over 2 months (2002–2003) |
| 10 | Xavier,17 Xavier and Simmons,18 Xavier et al.19 | 252a | Ever: 34.92% | Ever: 16.27% | Community-based needs assessment that investigated the health and social service needs of transgender people in Washington, DC recruited over 4 months (1999–2000) |
| 11 | Clements et al.,20 Clements-Nolle et al.,21,22 | 515 | Ever: 32.23% | Examined HIV, risk behaviors, mental health, and health care use of transgender individuals in San Francisco over 5 months in 1997 | |
| 12 | Zians23 | 136 | Past year: 31.62% | Ever: 17.65% | Community-based needs assessment of the health care and social service needs of transgender individuals in San Diego conducted over 7 months in 2004 |
| 13 | Taylor24,25 | 73a | Ever: 54% | Ever: 28% | Community-based needs assessment conducted over 6 months in 2006 on transgender Manitoban and Northwestern Ontarian health and social service needs. As two-spirit encompasses Aboriginal LGB and/or transgender individuals there may be a small number of non-transgender respondents in the dataset. Participants given a choice of long or short-form questionnaire and survey party held for aboriginals |
| 14 | Landers and Gilsanz26 | 52 | Past year: 30.77% | Survey conducted for the Massachusetts Department of Public Health over 10 days in 2009 using respondents from MassEquality's e-mail list to explore the impact of the State's equal marriage law on LGBT health and security. Perhaps because of a short data collection period, the response rate was 4.2%. Transgender respondents were also forced to select either LGB or transgender and thus likely under sampled | |
| 15 | McDuffie and Brown27 | 70 | Ever: 48.57% | Ever: 8.57% | Chart review of US Veterans examined for “gender identity disturbances” by second author at Tennessee VA office from 1987 to 2007. Study likely has great deal of participant overlap with Blosnich et al.,41 Brown et al.,65 and Bukowski et al.110 In contrast with Adams et al.3 the denominator used in our analysis includes those with missing ideation data. |
| 16 | Nuttbrock et al.28 | 571 | Ever: 53.50% | Ever: 27.90% | Explored psychiatric impact of gender-related abuse across New York transwomen's life course via 2004–2009 longitudinal study. Data gathered from psychometric inventories and interviews using the Life Review of Transgender Experiences (LRTE) to obtain responses for 5 time periods (early/late adolescence, early adult/young adult, early middle age). Figures used here are for the total population's lifetime suicidality |
| 17 | Maguen and Shipherd,29 Shipherd et al.30 | 153 | Ever: 17.65% | Investigated suicidality among participants at a transgender conference in New England known to focus on ‘cross-dressers’ using a questionnaire completed at the conference. Unlike Adams et al.3 our analysis includes all respondents, regardless as to whether they answered suicidality questions | |
| 18 | Effrig et al.,31 Hayes et al.32 | 108 | Ever: 48.15% | Ever: 25% | Investigated victimization and psychological distress among transgender college students using clinical and nonclinical samples. Clinical sample comprised college counseling center patients where ‘other’ not a gender option. Nonclinical sample consisted of respondents to survey conducted by colleges aligned with counseling centers. Both used the same survey measure, but institutions varied in incentives and completion prompts. Effrig et al.31 contains contradictory figures for number and suicidality of nonclinical and clinical participants. We rationalized them to reveal a probable 108 participants in both samples. In a previous article,3 a different rate of suicidality was arrived at, because of the use of only participants that answered suicidality questions |
| 19 | Meier et al.33 | 431 | Ever: 42.69% | Investigated gender confirming hormonal treatment on FTM individuals over 3 months (2008) using primarily US respondents. Suicidality findings were calculated to be accurate to 2 decimal points and therefore differ from Adams et al.3 | |
| 20 | House et al.34 | 164 | Ever: 34.80% | Explored social and psychological experiences of sexual minorities via internet survey of LGBT respondents conducted over 1 month (2004). 14.6% of respondents were transgender and this group was compared to LGB respondents. | |
| 21 | Beemyn and Rankin,35 Testa et al.36 | 3087 | First felt transgender: 16.62% | Explored transgender individuals' life experiences with an online survey conducted over 3 months (2005–2006). Investigated if respondents felt suicidal when they first realized they were transgender and if it was negatively correlated with exposure to positive representations of transgender individuals | |
| 22 | Heinz and MacFarlane37 | 54 | Ever: 35.19% | Ever: 27.78% | Explored health and social service needs of transgender people on Vancouver Island by survey from 2010 to 2011 |
| 23 | Brown et al.38,39 | 9 | Ever: 55.56% | Ever: 11.11% | Investigated life experiences of transfeminine individuals in the Missouri-Kansas City area by semistructured qualitative interviews conducted over an unspecified time period. Suicidality information was spontaneously shared and always in the context of being pretransition |
| 24 | Moody and Smith40 | 133a | Ever: 65.41%; past year: 74.44% | Ever: 26.32% | Explored suicidality and resilience among transgender Canadians (majority from Quebec and Ontario) through online survey that used verified psychometric inventories |
| 25 | Blosnich et al.41 | 1326 | 2011: 5.13% | Tracked suicidality among transgender veterans with ICD-9 code indicating transgender-related diagnosis through analysis of US VA EHRs. Records searched from 2000 to 2011, although “suicide related-behaviors” or “events” only available for 2009–2011. Overlapping data were provided for each of these years and 2011 is reported here. a lot of overlap with McDuffie et al.,27 Brown et al.,65 and Bukowski et al.,110 although the way they collected and reported patient data differ | |
| 26 | Grant et al.,42,43 Haas et al.44 | 6456 | Ever: 39.92% | Community needs assessment that examined health and social service needs of the transgender population of the US from 2008 to 2009 using a survey conducted primarily online, as well as at survey parties to increase participation of hard to find populations. These figures were calculated using an n of 6456, which represents all study participants, in contract with Adams et al.3 | |
| 27 | Mereish et al.45 | 16 | Ever: 68.75% | Ever: 31.25% | Explored LGBT victimization, substance use, and suicidality among individuals at New England community health center with large LGBT practice. All patients asked to complete a 25-question survey while waiting for physical or mental health appointment over 2 years (2001–2003). Respondents identified gender as male, female, or transgender (1.10% identified as “transgender” and “sexual minority”) |
| 28 | Reisner et al. 201446 | 31 | Ever: 58.06% | Ever: 29.03% | Massachusetts community health center research on transgender health disparities using data from patient questionnaires completed before medical appointment during 1 year (2001–2002). Transgender mutually exclusive to male or female and paired with cis gender controls, matched for age (within 3 years), ethnicity, education, and income. Possible crossover with Reisner et al.;47 Reisner et al.;66 and Beckwith et al.109 |
| 29 | Reisner et al.47 | 23 | Ever: 21.74% | Boston community health center study that examined suicidality in a cohort of FTM patients screened for STDs from July to December 2007. Data obtained through a retrospective chart review and past suicide attempts documented in the EHR. Likely some crossover with Reisner et al.66 | |
| 30 | Wilson et al.,48 Santos et al.,49 de Haan et al.50 | 314 | Ever: 53.18% | Investigated access to physical, mental health and transition-related health care among transgender women in San Francisco. The data was obtained from a behavioral survey conducted via a handheld computer over 4 months in 2010. | |
| 31 | Rosser et al.,51 Perez-Brumer et al.52 | 1229 | Ever: 28.89%; past year: 4.15% | Reports on the social demographics of hidden sexual minorities and transgender-specific individual and structural suicidality risk factors by a sample recruited through an internet-based assessment of US transgender adults. The suicidality figures reported here are slightly different from Adams et al.,3 as raw participant figures were previously calculated as fractions | |
| 32 | Scanlon et al.,53 Rotondi et al.,54,55 Bauer et al.,56, 57 Scheim and Bauer,58 Bauer et al.59 | 433 | Ever: 77%; past year: 36% | Ever: 43%; past year: 10% | Trans Pulse was a community needs assessment of Ontario transgender health and social service needs conducted from 2009 to 2010 using respondent-driven sampling and data gathered by survey completed online or in person |
| 33 | Edelman et al.60 | 521 | Ever: 60% | Ever: 34%; past year: 10% | Needs assessment conducted from May 2012 to 2013 that investigated transgender residents of the Washington, DC Metro Area and update of previous study conducted in 2000 (Xavier).17 The survey questionnaire was self-administered in most cases |
| 34 | Mustanksi et al.,61 Liu and Mustanski,62 Mustanski and Liu,63 Birkett et al.64 | 21 | Ever: 52.40%; past year: 19.00% | Explored LGBT youth suicidality (33.3% <18 years), 8.86% of whom identified as MTF or FTM which, because of small size, were collapsed into a single sample. Respondents completed self-report measures and structured and administered psychiatric interviews at initial contact and after 12 months. Data were collected from 2007 to 2011. | |
| 35 | Brown and Jones65 | 5135 | Ever: 19.36% | Reports health disparities in transgender veterans who received VA health care from 1996 to 2013 and whose sex marker changed after enrolment. Suicidality determined through diagnostic code in patient file and transgender and non-transgender veterans compared 1–3. Overlap with McDuffie et al.,27 Blosnich et al.,41 and Bukowski et al.,110 although they differ in data collection and reporting. | |
| 36 | Reisner et al.66 | 180 | Ever: 31.11% | Ever: 17.22% | Assessed mental health among transgender youth (mean age 19.7), seen at Boston-area community health center from 2002 to 2011 using EHRs. Transgender respondents (FTM and MTF) matched to cis gender controls within 3 months of being noted as transgender in file and by gender identity, age, and race/ethnicity. Data used included patient registration, behavioral intake, case notes, and suicidality according to patient self-report. Possible crossover with Reisner et al.;47 Reisner et al.;46 and Beckwith et al.109 |
| 37 | Olson et al., 2015,67 Olson68 | 96 | Ever: 51.04% | Ever: 30.21% | Investigated physiological and psychological health among transgender youth (age 12–24, mean 19.2) who presented for gender services at Los Angeles children's hospital (Feb 2011–June 2013). Psychosocial health assessed with computer-assisted self-administered survey and psychometric items and physiologic health from patient files |
| 38 | Kuper69 | 1956 | Ever: 95.50%; past year: 80.20% | Ever:: 32.30%; Past year: 10.40% | Reported on suicidality and gender development among gender nonconforming youth and young adults from across the United States through an online survey. These findings are slightly different from Adams et al.3 because of an error in transcription |
| 39 | Weir70 | 5 | Ever: 40% | Ever: 20% | Examined impact of violence on trans people and their supports using participants from Alberta and Saskatchewan recruited through online snowball sampling online. Data obtained from administered questionnaires and semistructured interviews. Suicidality data appear to have arisen during interviews |
| 40 | Tebbe and Moradi71 | 335a | Past year: 71.90% | Ever: 28.10% | Compared US transgender and cis gender college students stress coping strategies using data from national intercollegiate study that distributed surveys to random selection of over 100,000 college students at 73 different institutions in Spring 2011. Transgender cohort consisted of those who identified as neither male nor female. Three participants appeared to be intersex |
| 41 | Lehavot et al.72 | 212 | Ever: 54.72%; past year: 56.60% | Ever: 32.08% | Examined the life experiences of US transgender veterans recruited online through an anonymous online survey (Feb–May 2014) |
| 42 | Grossman et al.73 | 129 | Ever: 40.31% | Ever: 22.48% | Explored suicidality among transgender and gender nonconforming youth from three US cities (Nov 2011–Oct 2012) using snowball sampling and an administered survey. Suicidality data obtained through components of Interpersonal Needs Questionnaire |
| 43 | Reisner et al.,74 Katz-Wise et al.75 | 452 | Ever: 32.74% | Investigated change in attraction and social determinants of mental health in Massachusetts transgender adults from August to December 2013 using an online survey | |
| 44 | Lytle et al.76 | 174 | Past year: 31.03% | Past year: 17.82% | Explored transgender college students self-violence and depression with data from US National College Health Assessment survey (Fall 2008–Spring 2009) |
| 45 | Dowshen et al.77 | 66 | Past year: 15.60% | Past year: 7.80% | Investigated behavioral risk factors and health status of HIV-positive youth using a sample of adolescents and young adults from select US cities. Data were gathered using “computer-assisted self-interviews” from December 2009 to June 2012 |
| 46 | James et al.78 | 27,715 | Ever: 82%; past year: 48% | Ever: 40%; past year: 7% | Compared US transgender and cis gender college students stress coping strategies using data from national intercollegiate study that distributed surveys to random selection of >100,000 college students at 73 different institutions in Spring 2011. Transgender cohort consisted of those who identified as neither male nor female |
| 47 | Nemoto et al.,79 Operario and Nemoto,80 Nemoto et al.,81Glynn et al.82 | 573 | Ever: 54.97% | Ever: 33.33% | Study undertaken over 8 months (2000–2001) and from 2004 to 2006 that recruited primarily San Franciscan transgender women of color (African American, Latina, Asian/Pacific Islander) with histories of sex work. The research focused on the HIV impact, socioeconomic status, victimization, and physical and mental health |
| 48 | Xavier et al.,83 Goldblum et al.,84 Testa et al.,85 Barboza et al.86 | 350 | Ever: 63.71% | Ever: 25.43% | Explored the health and service needs of transgender Virginians through online and paper questionnaires administered over 10 months (2005–2006) |
| 49 | Trujillo et al.87 | 78 | Ever: 38.46% | Reported on beneficial effects of social support on transgender mental health using data obtained from a US national online survey (Feb 2013–April 2014) | |
| 50 | Brown et al.88 | 11 | Ever: 18.18% | An extension of an earlier study completed by the lead author (Brown et al.38.39 this publication reports on Mid-Western trans masculine individuals. Suicidality information was garnered from the semistructured interviews | |
| 51 | Fredriksen-Goldsen et al.,89 Fredriksen-Goldsen et al.,90 Hoy-Ellis et al.91 | 174 | Ever: 71.10% | Explored social and psychological experiences of sexual minorities in an internet survey of LGBT respondents over 1 month (2004). The transgender and lesbian, gay, and bisexual respondents were compared | |
| 52 | Irwin et al.,92 Su et al.,93 Brennan et al.94 | 83 | Ever: 73.49% | Ever: 44.58% | Community-based participatory research project arising out of a 2010 analysis of LGBT suicidal ideation and health disparities (11.9% transgender, where options were male, female, and/or transgender) |
| 53 | Kattari et al.,95 Seelman et al.,96 Seelman et al.97 | 417 | Past year: 34.05% | Past year: 9.35% | Examined health disparities among Colorado transgender adults using a self-completed survey conducted over 7 months in 2014 |
| 54 | Veale et al.98,99,100 | 600 | Ever: 55.67%; past year: 51.00% | Ever: 25.50%; past year: 26.17% | Investigated Canadian transgender youths health using a self-administered online survey conducted from Oct 1, 2013 to May 31, 2014. The older youth (19–25) are reported on here |
| 55 | Swanbrow Becker et al.101 | 47 | Ever: 55%; past year: 24% | Ever: 34%; past year: 4.30% | This case–control study reported on the stress coping strategies of US transgender college students in comparison with their cis gender peers. Data were collected from a national intercollegiate study that distributed electronic surveys to a random selection of >100,000 college students at 73 different institutions in the Spring of 2011. The transgender cohort consisted of those who identified as neither male nor female. Suicidality was assessed over the life time and “recently” using single questions |
| 56 | Testa et al.102 | 816a | Ever: 79.20%; past year: 56.10% | Ever: 45.80% | Investigated effects of stress and resilience among transgender and gender nonconforming individuals on mental and physical health using data obtained from Canadian and US adults through online surveys. Seven intersex participants were included in this dataset |
| 57 | Bouris and Hill103 | 28 | Past year: 17.86% | Chicago study compared gender and sexual minority participants to investigate relationship between youth and their mother figure as means of promoting resilience and exploring minority stress. Participants completed interviewer-administered questionnaire between August 2013 and 2014 | |
| 58 | Lytle et al., 2017104 | 18 | Past year: 61.11% | Explored suicidality and help seeking behavior among transgender youth from the Trevor Project's social network using an online questionnaire during August 2012. Individuals who experienced suicidality in past 14 days were excluded | |
| 59 | Gowin et al.105 | 45 | Ever: 55.56% | First attempt to investigate transgender suicidality solely among asylum seekers. Reviewed 2012 US asylum files of Mexican transwomen identified according to stated gender identity or behaviors. Suicidality data garnered from these records | |
| 60 | Redinger106 | 252 | Past year: 11.9% | Recruited transgender Montana High School students to complete a questionnaire on Montana sex education curriculum. Data collected from 2015 to 2016. Respondents were asked to comment on their suicidality in relation to being a high school student. | |
| 61 | Gaither et al.107 | 330 | Ever: 2.12% | Retrospectively reviewed the charts of MTF patients presented for primary GRS to a US high volume surgeon from 2011 to 2015. Patient charts were reviewed pre, intra, and postoperatively for medical morbidities, including a history of suicidality | |
| 62 | Herman et al.108 | 92,000 | Ever: 34% | Ever: 22% | Reports data obtained from telephone interview survey (2015–2016 California Health Interview Survey). Findings extrapolated to statistically valid California-wide estimate of transgender health data |
| 63 | Beckwith et al.109 | 145 | Ever: 13.79% | Investigated relationship between GRS and suicide using EHRs of binary gendered patients from larger randomly selected sample of transgender patients that presented to at least 1 health care visit to a Boston community health center (July 1, 2010 to June 30, 2015). Possible crossover with Reisner et al.46,47,66 | |
| 64 | Bukowski et al.110 | 5072 | Ever: 18.36% | Explores health of transgender veterans who received VA treatment from 1997 to 2014 using data from EHRs where records indicated any of 4 ICD-9 transgender-related diagnostic codes. Suicidality determined from diagnostic code in patient file. Study has quite a bit of overlap with McDuffie et al.,27 Blosnich et al.,41 and Brown et al.,65 although they differ in how they collected and reported on data |
In all cases, the y-axis of each figure represents the proportion of the cohort population. The data sets are organized from left to right, by increasing suicidality figure found by each study.
a
These studies seem to have included intersex and/or cis gender respondents, without allowing for their suicidality data to be individually assessed.
EHR, electronic health record; FTM, female to male; GRS, gender reassignment surgery, alternatively known as gender affirming surgery; ICD, International Classification of Diseases; MTF, male to female; VA, veterans administration.