Our understanding of how gender affects suicidality was developed when most scholars viewed gender as a male/female binary. However, over the last decade, scholars have begun investigating suicide in those whose gender identity does not match their sex assigned at birth.

Recent studies have shown that transgender/gender-diverse (TGD) adults share many risk factors for suicide with the general population, such as mental health concerns, substance abuse, and life stressors. However, unique risk factors for TGD individuals are also becoming more apparent through recent research. This research attempts to understand the factors that relate differently to suicidal thoughts (such as symptoms of depression) and suicidal behaviors (such as access to a firearm). This way of understanding suicide is often referred to as the ideation-to-action framework. By understanding the unique risk factors for suicide in TGD individuals, we can develop more effective prevention strategies and interventions to support this vulnerable population.

Why do Transgender People Die by Suicide?

The following are six risk factors that providers should be aware of and assess in order to better understand suicide risk in their TGD patients.

Risk Factor #1:  External minority stress

Studies have identified various factors that contribute to suicide and suicidal ideation in transgender individuals. These factors include different forms of violence, discrimination, harassment, and rejection based on one’s minority gender identity. These factors are consistently associated with increased suicidal ideation but have a weaker link to suicidal behavior. The factors that are most highly related to suicidal ideation include harassment, discrimination, social stressors such as rejection, and non-affirmation in one’s identity. On the other hand, experiences of physical and sexual violence are related to both suicidal ideation and behavior. By understanding and addressing these risk factors, we can work towards developing effective prevention strategies and interventions to support the mental health and well-being of transgender individuals.

Risk Factor #2:  Internal minority stress

Transgender/gender-diverse (TGD) individuals face unique risk factors for suicide and suicidal ideation that are experienced more internally compared to external discrimination or violence. These risk factors include internalized stigma and transphobia, which can lead to shame about being transgender. Other factors include concealment of identity and nondisclosure, expectations of social rejection, an inability to express gender, negative self-concept, and an unclear gender identity. These internal factors are particularly associated with the vulnerability for suicidal ideation, but they have a weaker link to suicidal behavior once suicidal ideation has developed. By addressing these internal risk factors through therapy, support, and affirmation of identity, we can reduce the risk of suicidal ideation and improve the mental health and well-being of TGD individuals.

Risk Factor #3:  Psychiatric morbidity

As with the general population, mental health problems are linked to an increased risk of suicide and suicidal ideation among transgender individuals. Common mental health issues that contribute to suicidal thoughts and behaviors include depression, loneliness and isolation, emotional instability, anxiety, PTSD, alcohol and drug abuse, physical and mental disabilities, and learning disabilities. Some risk factors are more closely related to suicidal behavior than others, such as substance abuse and PTSD. However, internal factors like loneliness and social isolation can also contribute to suicidal ideation. By addressing mental health issues through therapy and support, we can help transgender individuals manage these risk factors and reduce the likelihood of suicide and suicidal ideation.

Risk Factor #4:  Transition and healthcare

Gender transition is a unique and personal experience for transgender individuals, and the steps involved in the process can vary widely. These steps can range from social transition, such as dressing in one’s gender, to medical interventions like hormone therapy or surgery. However, there are certain risk factors related to the transition process and healthcare that are associated with an increased risk of suicidal thoughts and behaviors in TGD adults. These factors include not completing hormone therapy, a lack of medical interventions such as breast or genital surgery, living as one’s birth gender, identity documents that do not align with one’s gender identity, limited healthcare coverage for gender-related interventions, a lack of psychotherapy for gender dysphoria, and visual nonconformity. By addressing these factors and providing access to appropriate healthcare and support, we can help reduce the risk of suicidal ideation and improve the overall well-being of transgender individuals.

Risk Factor #5:  Reasons for living

There are certain factors that can serve as protective measures against suicidal thoughts and behaviors among transgender individuals. These include reasons for living, such as religiosity, optimism, survival coping beliefs, concerns about how loved ones would react to their suicide, fear of suicide, fear of social disapproval if one attempts suicide, and moral objections to suicide. By focusing on and strengthening these protective factors, we can help reduce the risk of suicidal ideation and behavior in transgender individuals. Additionally, providing support and resources to individuals who may be struggling with suicidal thoughts can also be helpful in preventing suicide and improving overall mental health.

Risk Factor #6:  Demographics

Certain demographic and static risk factors have been identified in studies related to suicide and suicidal ideation among transgender individuals. These include assigned female sex at birth, gender self-identification as male, and childhood gender nonconformity. Additionally, factors such as younger age, racial or ethnic minority status, education, income, employment, socioeconomic status, and sexual orientation as gay, lesbian, bisexual, or unsure have also been linked to suicidal thoughts and behaviors in this population. By taking these risk factors into consideration during patient assessments and suicide prevention efforts, healthcare providers can work to improve outcomes for transgender individuals and decrease the risk of suicide.