Suicidal ideation and suicide attempts among a convenience sample of trans persons: an analysis of protective and risk factors

Suicidal ideation is a complex and multi-factorial problem. From a bio-psycho-social explanatory model, suicidal behavior is influenced by biological, psychological, psychiatric and social risk factors. The predisposing... [ view full abstract ]

Suicidal ideation is a complex and multi-factorial problem. From a bio-psycho-social explanatory model, suicidal behavior is influenced by biological, psychological, psychiatric and social risk factors. The predisposing factors (biological and psychological) and the triggering factors (social and psychiatric factors) in combination of the absence of the protective factors, constitute a high risk for suicidal behavior (Portzky, van Autreve, & van Heeringen, 2010).

International research has shown the vulnerability among transgender people to develop psychological problems and suicide thoughts. A prevalence of suicide attempts between 22% and 41% is reported in recent studies based on convenience samples (Whittle, et.al, 2008; Grant, et al., 2010; Haas, Rodgers, & Herman, 2014; Motmans, et.al, 2009).

From this research canon, the need to distinguish the risk factors and protective factors around suicidal ideation for trans persons, becomes clear.

This study aims at measuring the current prevalence of suicidal thoughts and suicide attempts in the population of LGBT persons, with a specific focus of analysing the protective and risk factors for the group of... [ view full abstract ]

This study aims at measuring the current prevalence of suicidal thoughts and suicide attempts in the population of LGBT persons, with a specific focus of analysing the protective and risk factors for the group of self-identified trans respondents.

An online anonymous survey with a cross-sectional design was conducted aimed at a self-identified LGBT population, aged 16 year and older. The survey was online from September 2015 until February 2016. The survey was... [ view full abstract ]

An online anonymous survey with a cross-sectional design was conducted aimed at a self-identified LGBT population, aged 16 year and older. The survey was online from September 2015 until February 2016.

The survey was distributed using triangulation techniques and by snow-ball sampling: the survey was announced with leaflets and posters through the LGBT communities, among the patients of a transgender info centre, a well as through a large (social) media campaign, using press releases and statements by popular media and political figures.

Through multivariate logistical regressions analyses, using the statistical software ‘IBM SPSS Statistics 23’, we distinguished the independent protective and risk factors for lifetime suicidal ideation in the group of self-identified trans respondents.

The survey contained seven main parts: (1) socio-demographic background variables (2) sexual and gender identity (3) openness about sexual/gender identity (4) social networks (5) experiences with homophobia / trans phobia (6)... [ view full abstract ]

The survey contained seven main parts:
(1) socio-demographic background variables
(2) sexual and gender identity
(3) openness about sexual/gender identity
(4) social networks
(5) experiences with homophobia / trans phobia
(6) psychological well being [internalized homonegativity inventory (IHNI), stigma consciousness (Stigma Consciousness Questionnaire (SCQ), General Health Questionnaire (GHQ-12)
(7) suicide thoughts, life time and last year, Beck Scale for Suicidal Ideation (BSS)
(8) coping strategies (Utrechtse Coping Lijst, UCL).

In total 1541 respondents started the study, of which 1013 completed the survey. The convenience sample used for the analysis contains 248 self-identified trans persons, with an almost even distribution of sex assigned at birth. Based on the gender identity, the following groups could be distinguished: trans men (n=51), trans women (n=93), gender queer persons (n=82), other (n=13), male (n=8) or female (n=1) transvestites. The latter four groups were grouped together into one group, labelled 'gender variant' respondents (n=104).

Of the 248 respondents, 80.2% (n=199) report to have had at least once suicide thoughts in their life, of which 57.3% in the last year. 38.7% (n=96) report at least one life time suicide attempt, of which 32.3% (n=31) in the... [ view full abstract ]

Of the 248 respondents, 80.2% (n=199) report to have had at least once suicide thoughts in their life, of which 57.3% in the last year. 38.7% (n=96) report at least one life time suicide attempt, of which 32.3% (n=31) in the last year.

No significant correlation could be found between suicide thoughts/attempt (either life time or last year) with the identity groups (trans men, trans women or gender variant). Similarly, no significant difference could be found in suicide thoughts or attempt (either life time or last year) between gender conforming groups (trans men/women) and gender variant respondents, between sex assigned at birth, or between sexual orientation groups.

The analyses showed the independent effect of the current reaction of the mother towards the gender identity of the respondent (p=.033) and having a passive reaction pattern (p=.001) on increasing the risk on life time suicide attempts. A (very) negative current reaction by the mother increases the chance of a suicide attempt with 5.050 times. (This effect could not be found for the initial reaction, nor for the reaction by any other family member). A more passive reaction pattern (1 unit higher score on the UCL-scale) results in an increase by 1.484 times.

The results show an alarming high rate of suicide thoughts and attempts among the convenience sample of self-identified trans persons. As confirmed by other authors (Portzky & van Heeringen, 2009; Portzky, van Autreve & van... [ view full abstract ]

The results show an alarming high rate of suicide thoughts and attempts among the convenience sample of self-identified trans persons. As confirmed by other authors (Portzky & van Heeringen, 2009; Portzky, van Autreve & van Heeringen, 2010), having a passive reaction pattern showed a higher relative chance on suicidal behavior.
Our results do not confirm that experiences of harassment or being bullied, and feelings of being rejected are in general significant predictors of suicidal behavior, as have been showed by others (Haas, Rodgers & Herman, 2014; Heylens et al., 2013). Only in the group of respondents assigned male at birth, the influence of being threatened or harassed could be found.
Moody & Smith (2013) have confirmed the important role of social support by family as a protective factor for life time suicide behavior. In our study, only the current reaction of the mother could be identified as an independent factor.
A last remarkable result was the high amount of trans respondents identifying as gender queer (33.1%). This gave us the possibility to compare gender identity groups, although we could not find specific protective or risk factors for this group, in comparison for the group of trans men or trans women.