Abstract
Purpose:
Transgender and nonbinary (TGNB) youth report more than four times greater rates of suicide attempts compared with their cisgender peers. Gender identity acceptance from others can reduce the risk for these youth.
Methods:
Using data from a 2018 cross-sectional survey of LGBTQ youth, the current study examined the association of gender identity acceptance from others with suicide attempts among 8218 TGNB youth. Youth reported gender identity acceptance levels from parents, other relatives, school professionals, health care professionals, friends, and classmates to whom they were “out.”
Results:
Each category of adult and peer gender identity acceptance was associated with lower odds of a past-year suicide attempt, with the strongest associations within each individual category being acceptance from parents (adjusted odds ratio [aOR]=0.57) and other family members (aOR=0.51). The TGNB youth who reported gender identity acceptance from at least one adult had one-third lower odds of reporting a past-year suicide attempt (aOR=0.67), and acceptance from at least one peer was also associated with lower odds of a past-year suicide attempt (aOR=0.66). Peer acceptance was particularly impactful for transgender youth (aOR=0.47). The relationship between adult and peer acceptance remained significant after controlling for the association of each form, suggesting unique relationships for each on TGNB youth suicide attempts. Acceptance was more impactful for TGNB youth assigned male at birth compared with TGNB youth assigned female at birth.
Conclusion:
Interventions aimed at suicide prevention for TGNB youth should include efforts aimed at leveraging gender identity acceptance from supportive adults and peers in their lives.
Keywords: acceptance, gender identity, minority stress model, nonbinary youth, suicide, transgender youth
Introduction
Suicide risk among transgender and nonbinary (TGNB) youth is a public health crisis. Although the majority of representative population-based surveys of youth in the United States do not include appropriate assessments of gender identity, existing research consistently finds that TGNB youth have worse mental health and greater suicide risk compared with cisgender youth, including cisgender lesbian, gay, bisexual, queer or questioning (LGBQ) youth.1–4 The Youth Risk Behavior Survey (YRBS) included a pilot item assessing transgender identity in 2017 and found that 44% of transgender students reported seriously considering attempting suicide and 34% reported a suicide attempt.5 This compares with 16% of cisgender youth who seriously considered attempting suicide and 7% who reported a suicide attempt. This higher level of suicide risk among TGNB youth is primarily due to greater exposure to stressors based on their gender identity. The minority stress model suggests that members of stigmatized minority groups experience stressors that are specific to that group membership,6 along with other stressors generally experienced by everyone, which, in turn, relates to proximal processes such as internalized stigma and fears of rejection that impact mental health and suicide risk. This model has been used to identify unique stressors for TGNB youth such as experiences of rejection, discrimination, and victimization based on gender identity, non-affirming environments, internalized transphobia, feeling unsafe in a public restroom or bathroom discrimination, and barriers to gender affirmation such as access to legal documents or gender-affirming care that are associated with mental health and suicide risk.7–10
In addition to research that examines risk factors for suicide among TGNB youth, studies of factors that are associated with lower odds of attempting suicide among TGNB youth are also necessary to inform prevention and intervention efforts. Although protective factors and resilience are important components of the minority stress model, little work has focused on factors that might serve to reduce the risk for poor mental health and suicide.11,12 The few studies that have examined protective factors find that social support from parents and peers is among the strongest.13–15 However, although many studies have examined the role of general parent or family and peer support and connectedness,16–18 there is a dearth of research on how gender-identity acceptance, specifically, from others is associated with suicide risk among TGNB youth. Research has also supported the association between gender identity support or acceptance, in the form of support for social transitioning, and lower risk of suicidal ideation and behaviors.19
Using data from a large national sample of TGNB youth aged 13–24, the current study aimed at examining the association between gender identity acceptance from adults and peers with a past-year suicide attempt. We hypothesize that youth's perception of gender identity acceptance, from adults or peers in their lives, will be significantly associated with lower odds of a past-year suicide attempt. We further hypothesize that adult and peer gender identity acceptance will have unique associations with suicidality among TGNB youth.
Methods
Participants and procedures
Data were from an online quantitative cross-sectional survey conducted between February 2018 and September 2018. A sample of LGBTQ youth aged 13–24 who resided in the United States was recruited through Facebook and Instagram by using ads targeting those who interacted with LGBTQ-related content. Respondents completed a secure, online questionnaire that took an average of 32 min to complete. No names or identifying information were collected. Youth who completed the survey were eligible to be entered into a drawing for a $50 gift card by providing their email addresses after being routed to a separate survey. Waivers of parental consent and written consent were obtained, and youth assent or consent was obtained via an online consent form before survey commencement. The research proposal was reviewed and approved by an independent Institutional Review Board, Solutions IRB, fully accredited by the Association for the Accreditation of Human Research Protection Programs.
Measures
Gender identity
Youth's gender identity was assessed by using questions aligned with practices identified by the Williams Institute.20 Youth were first asked, “What sex were you assigned at birth? (meaning the sex showing on your original birth certificate).” Next, youth were asked “What is your gender identity? Please select all that apply,” with options: (1) man; (2) woman; (3) trans male/trans man; (4) trans female/trans woman; (5) gender queer/gender non-conforming; and (6) different identity (please state). Youth who responded that their sex assigned at birth matched their current gender identity were coded as (0) cisgender, and all others were coded as (1) TGNB. Youth who self-identified as transgender, who reported an assigned sex at birth of female and a current gender identity of man, or who reported an assigned sex at birth of male and a current gender identity of woman were all coded as transgender. Youth who self-identified as a gender queer/gender non-conforming or indicated a gender outside of available options were coded as nonbinary.
Gender identity acceptance
To assess acceptance, youth were first asked whether they had disclosed their gender identity to any of the following adults: parent(s), family member(s) other than a parent or sibling, teacher or school counselor, or doctor or other health care provider. For each category with whom they had disclosed, youth were asked to what extent they felt they accepted on a 5-point scale from “extremely accepting” to “not at all accepting.” Their responses were dichotomized to create variables comparing (1) youth with a high level of acceptance, which included youth who indicated feeling extremely or quite a bit accepted, to (0) youth with low or no acceptance, which included youth who indicated feeling moderately, a little bit, or not all accepted. An overall variable was also created to indicate youth who reported (1) a high level of acceptance from at least one adult in any of the aforementioned adult categories compared with those who reported (0) low or no acceptance from any adult in these categories. Peer gender identity acceptance was similarly assessed and coded although using peer categories: their straight friend(s), their LGBTQ friend(s), or their classmates(s). Youth who reported not disclosing their gender identity were not included in these analyses.
Suicide attempt
Past-year suicide attempt was assessed by using an item based on the Centers for Disease Control and Prevention's YRBS.21 Youth who responded that they had considered suicide in the past 12 months were asked “During the past 12 months, how many times did you actually attempt suicide?”
Demographics
We also assessed demographic variables that were thought to impact mental health outcomes. Youth were asked to report their age, using whole numbers between 13 and 24, sexual identity, using the question from the National Center for Health Statistics,22 and race/ethnicity.
Data analysis
A total of 34,808 respondents consented to complete the online survey. Youth who indicated that they lived out of the United States (n=475) and indicated that they were both straight/heterosexual and cisgender (n=294) were excluded from the sample. The data were also examined for validity, and 52 (0.15%) youth were removed for providing highly unlikely answers or entering obvious hate speech directed toward LGBTQ populations in the open-responses options. In addition, a filter was applied such that any youth who (1) completed less than half of the survey items or (2) reached the end of the survey within 3 min (n=8091) were removed. Given our focus on TGNB youth's experience with gender identity acceptance, these analyses also excluded cisgender and youth who were questioning their gender identity (n=17,678). This resulted in a final analytical sample of 8218 youth who identified as TGNB.
All analyses were run by using SPSS version 26.23 To address missing data, variables were imputed by using multiple imputations; however, suicide attempts and gender identity acceptance were not imputed given their focus in this study. We provide actual sample sizes used in each analysis in our tables. Chi-square tests of independence were run to examine the difference in reports of a suicide attempt in the past 12 months by TGNB youth who reported high gender identity acceptance compared with TGNB youth who reported low or no acceptance for each category of adults and peers. Adjusted logistic regression models were run to determine the association of each category of gender identity acceptance on a past-year suicide attempt after adjusting for the associations of age, sex assigned at birth, sexual identity, and race/ethnicity. In addition, two adjusted logistic regression models were run to examine the association between having at least one highly accepting adult and at least one highly accepting peer and the likelihood of a past-year suicide attempt. As a follow-up analysis, these models were also run separately for (1) transgender and (2) nonbinary youth and also separately for TGNB youth (1) assigned male at birth and (2) assigned female at birth. In a final model, both adult and peer acceptance were included.
Results
Youth sample characteristics are presented in Table 1. Sixty-two percent of the TGNB youth in this sample reported having disclosed their gender identity to at least one adult, with 68% reporting that at least one of these adults was highly accepting of their gender identity. This is in comparison to 87% of the TGNB youth in the sample who reported having disclosed their gender identity to at least one peer, with 94% reporting at least one of these peers was highly accepting.
Table 1.
Sample Demographics
| Demographic | % (n) |
|---|---|
| Age | |
| 13–17 | 55.1 (4533) |
| 18–24 | 44.9 (3688) |
| Race/ethnicity | |
| White | 71.9 (5908) |
| Hispanic/Latinx | 12.0 (984) |
| Asian/Pacific Islander | 2.7 (224) |
| Black/African American | 2.1 (173) |
| Native/Indigenous | 0.8 (64) |
| Multiracial | 8.6 (705) |
| Sex assigned at birth | |
| Male | 17.9 (1472) |
| Female | 82.1 (6738) |
| Gender identity | |
| Nonbinary | 56.1 (4611) |
| Transgender | 43.9 (3610) |
| Sexual identity | |
| Gay or lesbian | 26.3 (2087) |
| Straight | 198 (2.5) |
| Bisexual | 2315 (29.2) |
| Something else | 42.1 (3339) |
| At least one accepting adult | 68.0 (3447) |
| At least one accepting peer | 94.4 (6760) |
Overall, 29% of TGNB youth in the sample reported at least one suicide attempt in the past 12 months. When examined across levels of acceptance, TGNB youth who felt extremely accepted reported, on average, half the rate of past-year suicide attempts across all categories compared with youth who felt not at all accepted (Table 2). After dichotomization, the proportion of TGNB youth reporting a suicide attempt in the past year was significantly lower among those who reported having gender identity acceptance compared with those who were not accepted for all individual categories of adults and peers, in both bivariate and multivariate models (Table 3). The strongest associations were found in acceptance from parents (adjusted odds ratio [aOR]=0.57) and other family members (aOR=0.51). Further, as shown in Table 4, significantly greater proportions of TGNB youth with low or no adult or peer acceptance attempted suicide in the past year compared with those who had high acceptance.
Table 2.
Past-Year Suicide Attempts Among Transgender and Nonbinary Youth Across Levels of Gender Identity Acceptance; Mean (Standard Deviation)
| Not at all accepting | A little bit accepting | Moderately accepting | Quite a bit accepting | Extremely accepting | |
|---|---|---|---|---|---|
| Parental acceptance (n=3693) | 0.43 (0.49) | 0.33 (0.47) | 0.27 (0.44) | 0.24 (0.43) | 0.22 (0.41) |
| Other family acceptance (n=2402) | 0.48 (0.50) | 0.39 (0.49) | 0.26 (0.44) | 0.23 (0.42) | 0.24 (0.43) |
| School professional acceptance (n=2879) | 0.47 (0.50) | 0.48 (0.50) | 0.34 (0.48) | 0.29 (0.45) | 0.31 (0.46) |
| Healthcare professional acceptance (n=2184) | 0.48 (0.50) | 0.42 (0.49) | 0.30 (0.46) | 0.31 (0.46) | 0.24 (0.43) |
| Straight friend acceptance (n=4294) | 0.57 (0.50) | 0.40 (0.49) | 0.32 (0.47) | 0.27 (0.45) | 0.28 (0.45) |
| LGBTQ friend acceptance (n=6058) | 0.64 (0.50) | 0.41 (0.50) | 0.36 (0.48) | 0.31 (0.46) | 0.28 (0.45) |
| Classmate acceptance (n=2532) | 0.59 (0.49) | 0.39 (0.49) | 0.31 (0.46) | 0.22 (0.41) | 0.30 (0.46) |
Table 3.
Past-Year Suicide Attempts Among Youth Whose Gender Identity Was Accepted or Not
| One or more suicide attempts % (n) | χ2 (df), p-value | aOR (95% CI) | |
|---|---|---|---|
| Parental acceptance (n=3692) | |||
| Low to no acceptance | 34.1 (782) | χ2 (1)=47.53, p<0.001 | 0.57 (0.49–0.67) |
| High acceptance | 23.4 (328) | ||
| Other family acceptance (n=2401) | |||
| Low to no acceptance | 35.5 (606) | χ2 (1)=35.69, p<0.001 | 0.51 (0.42–0.63) |
| High acceptance | 23.1 (161) | ||
| School professional acceptance (n=2877) | |||
| Low to no acceptance | 38.7 (402) | χ2 (1)=23.92, p<0.001 | 0.67 (0.57–0.79) |
| High acceptance | 29.8 (548) | ||
| Health care professional acceptance (n=2183) | |||
| Low to no acceptance | 34.7 (262) | χ2 (1)=13.36, p<0.001 | 0.68 (0.56–0.83) |
| High acceptance | 27.2 (389) | ||
| Straight friend acceptance (n=4293) | |||
| Low to no acceptance | 35.5 (428) | χ2 (1)=25.82, p<0.001 | 0.66 (0.57–0.76) |
| High acceptance | 27.6 (854) | ||
| LGBTQ friend acceptance (n=6056) | |||
| Low to no acceptance | 37.9 (124) | χ2 (1)=11.94, p=0.001 | 0.67 (0.53–0.85) |
| High acceptance | 28.7 (1648) | ||
| Classmate acceptance (n=2531) | |||
| Low to no acceptance | 38.0 (593) | χ2 (1)=48.71, p<0.001 | 0.58 (0.48–0.69) |
| High acceptance | 24.6 (238) | ||
χ2(df) refers to chi-square (degree of freedom).
aOR, adjusted odds ratio; CI, confidence interval.
Table 4.
Proportion of Transgender and Nonbinary Youth Who Attempted Suicide in the Past Year Among Youth Who Had at Least One Adult or One Peer Who Accepted Their Gender Identity Compared with Those Who Were Not Accepted
| One or more suicide attempts % (n) | χ2 (df), p-value | |
|---|---|---|
| Adult acceptance (n=4409) | ||
| Little to no acceptance | 36.2 (507) | χ2 (1)=31.00, p<0.001 |
| High acceptance | 27.9 (841) | |
| Peer acceptance (n=6202) | ||
| Little to no acceptance | 38.0 (128) | χ2 (1)=13.61, p<0.001 |
| High acceptance | 28.6 (1677) | |
The adjusted logistic regression model exploring the association of gender identity acceptance from at least one adult on a suicide attempt in the past year, adjusting for demographic variables, found that TGNB youth who reported gender identity acceptance by at least one adult had 33% lower odds of attempting suicide in the past year compared with their TGNB peers who were not accepted (aOR=0.67, Table 5). The analogous model that examined the impact of peer gender identity acceptance on past-year suicide attempts found that TGNB youth who reported being highly accepted by at least one of their peers had 34% lower odds (aOR=0.66) of attempting suicide in the past year compared with TGNB youth who did not have this acceptance (Table 6).
Table 5.
Multivariate Logistic Model Examining the Association of a Suicide Attempt in the Past Year with Adult Acceptance; n=4409, −2 Log Likelihood=5169.52, Nagelkerke R2=0.08
| B | SE | aOR (95% CI) | |
|---|---|---|---|
| Age (13–17 ref.) | −0.91 | 0.07 | 0.40 (0.35–0.46) |
| Race/ethnicity (White ref.) | |||
| Hispanic/Latinx | 0.34 | 0.10 | 1.41 (1.17–1.72) |
| Black | −0.03 | 0.26 | 0.97 (0.58–1.60) |
| Asian/Pacific Islander | 0.01 | 0.22 | 1.01 (0.66–1.56) |
| American Indian/Alaskan Native | 0.98 | 0.35 | 2.66 (1.33–5.29) |
| Two or more | 0.28 | 0.11 | 1.33 (1.06–1.66) |
| Assigned female sex | 0.22 | 0.07 | 1.25 (1.03–1.53) |
| Sexual identity (gay or lesbian ref.) | |||
| Straight | −0.33 | 0.18 | 0.72 (0.51–1.03) |
| Bisexual | −0.14 | 0.09 | 0.87 (0.73–1.04) |
| Something else | −0.30 | 0.09 | 0.74 (0.63–0.88) |
| Accepted by at least one adult | −0.39 | 0.07 | 0.67 (0.59–0.77) |
B represents the parameter coefficient.
SE, standard error.
Table 6.
Multivariate Logistic Model Examining the Association of a Suicide Attempt in the Past Year with Peer Acceptance; n=6202, −2 Log Likelihood=7164.14, Nagelkerke R2=0.07
| B | SE | aOR (95% CI) | |
|---|---|---|---|
| Age (13–17 ref.) | −0.92 | 0.06 | 0.40 (0.35–0.45) |
| Race/ethnicity (White ref.) | |||
| Hispanic/Latinx | 0.31 | 0.09 | 1.36 (1.15–1.61) |
| Black | 0.17 | 0.20 | 1.19 (0.81–1.75) |
| Asian/Pacific Islander | −0.01 | 0.18 | 0.99 (0.70–1.41) |
| American Indian/Alaskan Native | 0.59 | 0.28 | 1.80 (1.03–3.13) |
| Two or more | 0.29 | 0.10 | 1.33 (1.10–1.62) |
| Assigned female sex | 0.22 | 0.08 | 1.25 (1.07–1.46) |
| Sexual identity (gay or lesbian ref.) | |||
| Straight | −0.22 | 0.17 | 0.80 (0.57–1.11) |
| Bisexual | −0.08 | 0.08 | 0.93 (0.80–1.08) |
| Something else | −0.18 | 0.07 | 0.83 (0.72–0.96) |
| Accepted by at least one peer | −0.41 | 0.12 | 0.66 (0.52–0.84) |
B represents the parameter coefficient.
To further explore the impact of our demographic variables on this relationship, we added interaction terms that included both age and gender identity to the model. We found no significant interaction between age and gender identity acceptance from adults (aOR=1.11; 95% confidence interval [CI]: 83–1.49, p=0.47) or from peers (aOR=0.84; 95% CI: 0.51–1.37, p=0.48). There was, however, a significant interaction between gender identity and gender identity acceptance from adults (aOR=1.41; 95% CI: 1.17–1.71, p<0.001) and gender identity acceptance from peers (aOR=1.49; 95% CI: 1.32–1.68, p<0.001). As a follow-up to determine differential relationships for transgender youth compared with youth who only identified as nonbinary, adjusted logistic regression models were performed to examine (1) the association of gender identity acceptance from at least one adult and (2) the association of gender identity acceptance from at least one peer, on a suicide attempt in the past year, adjusting for demographic variables (not Tabled). Transgender youth with acceptance from at least one adult had 39% lower odds of attempting suicide in the past year (aOR=0.61) compared with their transgender peers who were not accepted, and nonbinary youth with acceptance from at least one adult were 33% less likely to do so (aOR=0.67). Acceptance from at least one peer was associated with more than half the odds of attempting suicide in the past year for transgender youth (aOR=0.47), whereas nonbinary youth with at least one accepting peer had 31% lower odds of attempting suicide in the past year (aOR=0.69) compared with nonbinary youth without acceptance.
Additional follow-up analyses were conducted to examine differential relationships for TGNB youth assigned male at birth compared with TGNB youth assigned female at birth (not Tabled). The TGNB youth assigned male at birth with acceptance from at least one adult had 40% lower odds of attempting suicide in the past year compared with TGNB youth who were not accepted (aOR=0.60), and TGNB youth assigned female at birth with acceptance from at least one adult had 29% lower odds of attempting suicide compared with those who were not accepted (aOR=0.71). Acceptance from at least one peer was associated with 46% lower odds of attempting suicide in the past year for TGNB youth assigned male at birth (aOR=0.54) and 27% lower odds of attempting suicide in the past year for TGNB youth assigned female at birth (aOR=0.73).
A final adjusted logistic regression analysis was conducted to examine the unique association of adult and peer acceptance for TGNB youth (Table 7). When both forms of gender identity acceptance were included in the model along with the demographic variables, acceptance from both at least one adult (aOR=0.70) and at least one peer (aOR=0.54) remained significantly associated with a lower likelihood of attempting suicide in the past year among TGNB youth.
Table 7.
Multivariate Logistic Model Examining the Association of a Suicide Attempt in the Past Year with Adult Acceptance and Peer Acceptance; n=4287, −2 Log Likelihood=5020.95, Nagelkerke R2=0.08
| B | SE | aOR (95% CI) | |
|---|---|---|---|
| Age (13–17 ref.) | −0.90 | 0.07 | 0.41 (0.35–0.47) |
| Race/ethnicity (White ref.) | |||
| Hispanic/Latinx | 0.35 | 0.10 | 1.42 (1.16–1.73) |
| Black | 0.33 | 0.26 | 1.03 (0.62–1.72) |
| Asian/Pacific Islander | −0.00 | 0.22 | 1.00 (0.64–1.55) |
| American Indian/Alaskan Native | 1.05 | 0.36 | 2.85 (1.42–5.73) |
| Two or more | 0.29 | 0.11 | 1.34 (1.07–1.68) |
| Assigned female sex | 0.22 | 0.10 | 1.24 (1.01–1.52) |
| Sexual identity (gay or lesbian ref.) | |||
| Straight | −0.29 | 0.18 | 0.75 (0.52–1.07) |
| Bisexual | −0.12 | 0.09 | 0.90 (0.73–1.06) |
| Something else | −0.28 | 0.09 | 0.75 (0.63–0.90) |
| Accepted by at least one adult | −0.36 | 0.07 | 0.70 (0.63–0.80) |
| Accepted by at least one peer | −0.65 | 0.18 | 0.54 (0.37–0.74) |
B represents the parameter coefficient.
Discussion
The TGNB youth are at an increased risk for suicide attempts, even when compared with their cisgender LGBQ peers.3 The minority stress model posits that support can ameliorate the negative impact that stigma has on the mental health and suicide risk of TGNB youth. Previous studies have demonstrated the protective impact of social support, and specifically sexual identity support, on LGBTQ youth's mental health24,25; however, a few studies have specifically examined identity-based acceptance,26,27 and, to date, there has been a lack of studies that specifically focus on gender identity acceptance as a form of support. The current study adds to the literature by finding that TGNB youth who had at least one accepting adult in their life had 33% lower odds of attempting suicide in the past 12 months. Although much of the research on gender identity acceptance has focused on parents, the current study's findings highlight that although acceptance among parents is important, adult interventions should go far beyond that. Prior studies have found that trusted adults can impact TGNB youth's feelings of safety and absenteeism from school28,29 and TGNB youth's access to affirming services.30 These findings suggest that interventions should engage school and health care professionals in training that promotes gender-identity knowledge and acceptance. These professionals' acceptance was associated with 33% and 32% lower odds of attempting suicide, respectively.
The current findings also highlight the importance of peer acceptance in reducing suicide attempts among TGNB youth. Not only did more TGNB disclose their gender identity to a peer compared with an adult, but also TGNB youth who had at least one peer who was accepting of their gender identity had 34% lower odds of attempting suicide in the past year. Peer acceptance was particularly impactful for transgender youth, specifically those who had 54% lower odds of attempting suicide in the past year when they reported having at least one peer who was accepting of their gender identity. Although previous studies have shown the impact of peer acceptance, and specifically sexual orientation acceptance, for LGBTQ youth overall,26 these findings go further to show the importance of gender identity acceptance as a distinct and important protective factor for reducing TGNB youth suicide risk. They further highlight the need for safe social spaces where TGNB youth can express their identities and be supported by their peers.
Further, although acceptance was associated with significantly lower odds of a past-year suicide attempt among all TGNB youth, it appears to have a larger impact on suicide attempts among TGNB youth assigned male at birth compared with those assigned female birth. This could be due to society's greater acceptance of a spectrum of gender expression and gender nonconformity for those assigned female at birth compared with those assigned male at birth,31 so acceptance of gender identity is more meaningful and protective for youth assigned male at birth.
The significance of both peer and adult gender identity support in the same model suggests that support from peers and adults has unique, though relatively comparable, contributions in reducing risk for TGNB youth suicide. This finding further suggests the need to engage both adults and youth in efforts to ameliorate poor mental health outcomes among TGNB youth by providing them with information and skills for supporting young TGNB people. Resources should be available particularly in school and workplace settings, where efforts can target both peers and adults through efforts aimed at staff, students, and employers.
Limitations
Though this study comes with a host of strengths, including a large sample of TGNB youth from across the United States, the findings must still be considered in the context of certain limitations. First, these data are cross-sectional and therefore, temporality cannot be determined. For example, it is possible that a suicide attempt could mobilize support around the youth who was in distress. Further, we only sampled a small group of adults who could be in these youth's lives and may be accepting, which excluded other potential relationships including mentors, neighbors, coaches, and individuals working in youth-serving organizations.
Conclusions
We must begin to focus our research efforts on positive things that can be done to counter the negative experiences faced by TGNB youth. The current findings highlight the impact that acceptance can have in the lives of many TGNB young people and suggest that although everyone might not be accepting, if at least one person in their life is, it is associated with a significantly lower risk for suicide. With these findings in mind, prevention efforts should be aimed at finding ways to increase the availability of accepting adults and peers for TGNB, either by training existing adults and peers in their lives how to express their acceptance or by connecting TGNB youth with those who are.
Abbreviations Used
- aOR
adjusted odds ratio
- CI
confidence interval
- LGBQ
lesbian, gay, bisexual, queer or questioning
- SE
standard error
- TGNB
transgender and nonbinary
- YRBS
Youth Risk Behavior Survey
Author Disclosure Statement
No competing financial interests exist.
Funding Information
No funding was received for this study.
Cite this article as: Price MN, Green AE (2023) Association of gender identity acceptance with fewer suicide attempts among transgender and nonbinary youth, Transgender Health 8:1, 56–63, DOI: 10.1089/trgh.2021.0079.
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