Intervenable Factors Associated With Suicide Risk in Transgender Persons: A Respondent Driven Sampling Study in Ontario, Canada

Greta R. Bauer; Ayden I. Scheim; Jake Pyne; Robb Travers; Rebecca Hammond


BMC Public Health. 2015;15(525) 

In This Article


Our findings support a strong effect for social exclusion, discrimination and lack of medical transition (for those needing it) on suicide ideation and attempts, and potentially on the survival of trans persons. This adds support to the larger discussion regarding social impacts on suicide risk in groups experiencing marginalization, such as Indigenous communities and sexual minorities. Our team has previously published recommendations for suicide prevention efforts with trans persons, based on descriptive analyses of these data.[2] The present analysis provides stronger support for those recommendations, including attention to social support and protection from discrimination, by showing that these effects remain after adjusting for potential confounding by background. It also suggests additional targets for intervention. Specifically, while gender recognition is recognized as a human right for trans people in Ontario,[62] we have provided the first evidence of its potential to reduce suicidality. Since our data were collected, the surgical requirement for changing the sex/gender designation on an Ontario birth certificate has been eliminated. Such legal and policy changes can be considered public health interventions worthy of longer-term evaluation. In addition, parental support has been previously associated with reduced suicide risk for sexual minority[63] and trans[64] youth, but our results demonstrate the importance of parental support for gender identity among adults, suggesting a need for all-ages family interventions. Finally, we found that among those reporting a need to medically transition through hormones and/or surgeries, suicidality was substantially reduced among those who had completed a medical transition (this involved varying procedures based on personal needs[16]). Despite potentially large reductions in risk for those completing medical transition, the period of being in process did not represent a clear mid-point in risk. While suicidal ideation was significantly reduced for those in process versus those who were planning to transition but had not begun, among the sub-group considering suicide the attempt rate was highest among those in process. These results call into question the safety of clinical practices that delay transition treatments until depressive symptoms or suicidality are well-controlled, and of procedural practices that require or result in long delays in the medical transition process, but also suggest need for supports for those who may feel suicidal while in the process of transitioning.

Our findings strongly suggest that interventions aimed at increasing social inclusion, reducing transphobic discrimination and violence, and facilitating access to medical transition should be considered as part of a comprehensive approach to suicide prevention in trans populations, and evaluated to assess effectiveness. Such interventions need not supplant individual-level or therapeutic approaches (e.g., psychotherapy, crisis services), but have the potential to reduce suicide ideation and attempts by targeting stigma and social exclusion as fundamental causes of disparities.