Young people with gender dysphoria more likely to self-harm, large study finds

A study of more than 2 million hospitalized young people found that those with gender dysphoria were far more likely to have been admitted for self-harm or suicide attempts than their peers without it.

Nadia Dowshen, MD, MSHP, co-director of the Gender and Sexuality Development Clinic at The Children’s Hospital of Philadelphia (CHOP), told Healio that transgender and nonbinary youth with gender dysphoria are admitted for suicide or self-harm “more frequently than pediatric providers may be aware of.”

Nadir Yehya, MD, associate professor of anesthesiology and critical care at CHOP, said the inspiration for the study came in a direct and tragic fashion.

“I took care of a trans patient admitted after a suicide attempt,” Yehya said. “Many staff and family did not call her by her chosen name and did not fully affirm or accept her identity. It made me think about how often this happens, and whether we are doing our best for trans and nonbinary children and adolescents at an exceedingly critical moment in their lives. This prompted the basic descriptive question of, ‘How common is this in the U.S.?’”

Using the 2016 and 2019 versions of the Kids’ Inpatient Database — a large administrative database that covers approximately 80% of pediatric inpatient admissions — Dowshen, Yehya and colleagues examined relative frequencies of suicide and self-harm diagnoses according to whether patients had one of several transgender-related or gender dysphoria diagnostic codes.

“Diagnostic codes are not the best way to identify individuals who identify as trans or nonbinary, but in a large database of several million patients with primarily insurance billing coding, it was the best we could do,” Yehya said. “Since certain factors can also affect whether someone has a suicide attempt, we controlled for several of these factors, such as age, race or ethnicity, insurance status, hospital rurality, and geographic location.”

In data comprising 2,117,296 children, adolescents and young adults aged 6 to 20 years old, the researchers found that hospitalized patients with gender dysphoria had a higher prevalence of suicide attempts compared with those without gender dysphoria in both 2016 (36% vs. 5%) and 2019 (55% vs. 4%). Self-harm was also higher in hospitalized young people with gender dysphoria.

What made the results “particularly concerning” for Yehya was that the association between gender dysphoria and suicide and self-harm attempts was also present in 6- to 12-year-old patients.

“The discrimination, shame and victimization that trans youth face should be considered as a possible etiology for any young person who is admitted to the hospital with suicidal behavior or self-harm,” Dowshen said.

“During this type of admission, there is a unique opportunity to provide care that is gender affirming at a critical time in a young person’s life. We can use this critical moment to link trans and nonbinary youth to ongoing, evidence-based, gender-affirming medical and mental health services to prevent future suicidal behavior and improve health and well-being for this vulnerable population.”

Dowshen added that it is critical to ensure that all transgender and nonbinary youth are “counted.”

“We need to have better ways of collecting gender identity data in both clinical care and research rather than relying on diagnostic codes, which do not accurately reflect the diversity of gender identity,” Dowshen said.

“We also saw major disparities in rates of diagnosis of gender dysphoria for Black youth, those who are publicly insured, and live in rural areas or the southern U.S. This likely reflects barriers to access to gender-affirming care for these youth including structural factors like racism as well as local cultural and policy environments. So, we need more research to understand these specific barriers and how we can improve access in order prevent outcomes like suicidality and achieve optimal health and well-being for trans and nonbinary youth.”

Reference:

• Mitchell HK, et al. The Lancet Child & Adolescent Health. 2022;doi:10.1016/S2352-4642(22)00280-2.
• Study suggests need for improved support for transgender and non-binary young people after hospitalization. https://www.eurekalert.org/news-releases/971372. Published Nov. 16, 2022. Accessed Nov. 22, 2022.