Self-harm and suicidality in Dutch children referred for gender dysphoria

In recent years, there has been focused attention on the prevalence of suicidal ideation, self-harm, and suicide attempts among adolescents with gender dysphoria. Only two studies, however, have examined the prevalence of... [ view full abstract ]

In recent years, there has been focused attention on the prevalence of suicidal ideation, self-harm, and suicide attempts among adolescents with gender dysphoria. Only two studies, however, have examined the prevalence of suicidality among children with gender dysphoria. Holt et al. (2016) used case file data on 41 children between the ages of 5-11 years and found that 14.6% had a history of suicidal ideation and 17.0% had a history of either self-harm (14.6%) or suicide attempts (2.4%). Aitken et al. (2016) used two items from the Child Behavior Checklist (CBCL) ("Talks about killing self"; "Deliberately harms self or attempts suicide") in a sample of 572 children referred clinically for gender dysphoria to a gender identity clinic in Toronto and compared the rates of these two behaviors to that of their siblings (n = 425) and referred (n = 878) and non-referred children (n = 903) from the U.S. CBCL standardization sample. Aitken et al. found that both the children with gender dysphoria and the referred children had a significantly higher rate of suicidality than the siblings and non-referred children. The strongest predictors of suicidality were age (older) and number of other behavioral and emotional problems.

The aim of the present study was to examine the generality of the Aitken et al. (2016) findings by studying the prevalence of suicidality, and correlates, in a sample of Dutch children attending another specialized gender... [ view full abstract ]

The aim of the present study was to examine the generality of the Aitken et al. (2016) findings by studying the prevalence of suicidality, and correlates, in a sample of Dutch children attending another specialized gender identity clinic.

The sample consisted of 582 Dutch children referred clinically for gender dysphoria. The comparison groups were referred (n = 2118) and non-referred (n = 843) children from a Dutch standardization sample. For the two... [ view full abstract ]

The sample consisted of 582 Dutch children referred clinically for gender dysphoria. The comparison groups were referred (n = 2118) and non-referred (n = 843) children from a Dutch standardization sample. For the two comparison groups, we excluded those children (n = 45) for whom the parent rated CBCL Item 110 ("Wishes to be of opposite sex") as present. For the primary analyses, only children between the ages of 6-12 years were retained, because age 6 was the lower-bound age of the standardization samples. For secondary analyses, however, we were able to analyze the data for an additional 49 children with gender dysphoria who were younger than age 6.

The two CBCL items pertaining to suicidality were coded as either present (Somewhat/sometimes true or Very true/often true) or absent (Not true), based on a 0-2 point response scale. We also computed a sum score of the two... [ view full abstract ]

The two CBCL items pertaining to suicidality were coded as either present (Somewhat/sometimes true or Very true/often true) or absent (Not true), based on a 0-2 point response scale. We also computed a sum score of the two suicidality items. We also examined the sum of all other items rated as a 1 or a 2 and a 3-item metric of poor peer relations.

The percentage of children whose parent (primarily the mother) endorsed the two suicidality was significantly higher in the gender-dysphoric group and in the referred group compared to the non-referred group. For suicidal... [ view full abstract ]

The percentage of children whose parent (primarily the mother) endorsed the two suicidality was significantly higher in the gender-dysphoric group and in the referred group compared to the non-referred group. For suicidal talk, the percentages were 11.4%, 9.6%, and 1.4%, respectively (p < .001). For self-harm/suicide attempts, the percentages were 2.7%, 3.7%, and 0.4%, respectively (p < .001). Paired contrasts showed that the gender-dysphoric group did not differ significantly from the referred group on both items. There were very clear age effects. For the gender-dysphoric group, suicidal talk ranged from a low of 1.0% in the 7-year-olds to a high of 5.3% in the 9-year-olds; for self-harm/suicide attempts, the age group range was from a low of 7.4% among 10-year-olds to a high of 19.7% among 12-year-olds. For number of behavioral and emotional problems in general, the referred group had, on average, the highest number of problems and the non-referred group the lowest, with the gender-dysphoric group intermediate. For the metric of poor peer relations, both the gender dysphoric and referred groups had a higher total score than the non-referred children. The between-groups difference in suicidality remained significant even when controlling for number of overall behavioral and emotional problems.

Compared to non-referred children, both children referred for gender dysphoria and children referred for other clinical reasons had a higher rate of parent-reported suicidality than non-referred children. This basic finding... [ view full abstract ]

Compared to non-referred children, both children referred for gender dysphoria and children referred for other clinical reasons had a higher rate of parent-reported suicidality than non-referred children. This basic finding replicated Aitken et al. (2016), who studied North American samples. Although the percentage of parent-reported suicidal attempts was quite low, they were still substantially higher than the percentage in the non-referred group. The percentage of parent-reported suicidal ideation was, however, much higher. The degree of parent-reported suicidality remained significant even when controlling for number of other behavioral and emotional problems. As children with gender dysphoria approach adolescence, the percentage who show some elements of suicidality become similar to what has been found in Dutch adolescents with gender dysphoria (Steensma et al., 2016). Our data suggest that children with gender dypshoria should probably be routinely be screened for the presence of suicidality and, when such behavior is reported, it should be subject to a more thorough clinical evaluation to identify its proximal and distal sources. When compared to the suicidality data on the Toronto sample, the Dutch gender-dysphoric children had lower rates of suicidality but so did the referred sample when compared to the U.S. referred sample.