Autism, transgender identity may increase suicide risk among college students
Click Here to Manage Email Alerts
Key takeaways:
- Autism and transgender or gender nonconforming identity increased odds of suicidal ideation and attempts.
- The data show a need for college campuswide interventions to reduce these risks, researchers said.
College students who identified as transgender or gender nonconforming and those with autism had a greater risk for suicidal thoughts and behaviors, study results published in JAMA Network Open showed.
Findings from the cross-sectional study also revealed increased risk for suicide attempts among both those with autism and students who identified as transgender or gender nonconforming compared with nonautistic cisgender students. This risk increased even further among individuals who had both autism and identified as transgender or gender nonconforming (TGNC).
Suicidality remains a significant public health concern among youth and adults, and especially within LGBTQ+ communities.
According to Annabelle M. Mournet, MS, a graduate student clinician at Rutgers University, and colleagues, there is considerable overlap between autism and those who are TGNC — over one in four people who are TGNC meet the criteria for autism — but there is little research on how identifying with both impacts the risk for suicidal ideation and attempts.
“College students, in particular, represent a population worth investigating in relation to these topics,” they wrote. “Transgender college students have been shown to have approximately twice the risk for most mental health conditions compared with cisgender students.”
In the analysis, the researchers examined a cohort of 41,507 college students who participated in the American College Health Association National College Health Assessment from 2019 to 2023.
Within the sample, 5.81% identified as being TGNC, of whom 13.53% also identified as having autism.
Among cisgender participants, 1.58% identified as having autism.
The researchers found that TGNC identity (OR = 3.34; 95% CI, 2.99-3.73) and autism (OR = 2.06; 95% CI, 1.76-2.42) corresponded with greater odds of suicidal ideation.
Meanwhile, college students with autism who identified as cisgender (OR = 2.39; 95% CI, 1.62-3.52), those without autism and TGNC (OR = 2.74; 95% CI, 2.13-3.52) and those with autism and TGNC (OR = 3.35; 95% CI, 2.11-5.3) all had greater risk for suicide attempts vs. those cisgender individuals without autism.
Mournet and colleagues reported no significant interaction between TGNC identity and autism for suicidal thoughts.
They did find a significant interaction between the two identities on suicide attempts (OR = 0.51; 95% CI, 0.27-0.97), but students identifying as TGNC with autism showed no increased risk for suicide attempts compared with those who identified with just one of the identities.
“However, there may be specific risk factors that contribute to [suicidal behaviors and thoughts] for TGNC autistic individuals, making additional research with this vulnerable group essential,” the researchers wrote.
The results ultimately highlighted the need for interventions that support college students with autism and who are TGNC, according to the researchers.
“For instance, campus-wide efforts are needed to address risk,” Mournet and colleagues wrote. “Moreover, the results from this study have the potential to go beyond college student risk, advocating for the importance of policies that seek to reduce risk of [suicidal behaviors and thoughts] among these high-risk populations.”
Perspective
Back to TopGerard A. Baltazar, DO, FACOS, FACS
Suicide risk is a leading cause of death among American adults. Autistic individuals, individuals identifying as TGNC and those identifying as both autistic and TGNC may be at increased risk of suicidal thoughts and behaviors (STBs). Using a large college student cohort (the American College Health Association-National College Health Assessment), this study strived to understand the intersectionality of and frequency of STBs among the autistic and TGNC communities.
Analyzing a sample of 41,507 college students, the authors identified a significant association between TGNC identities and autism and found elevated risks of suicidal ideation and suicide attempts among these groups compared with the nonautistic cisgender group. Further, study participants identifying as TGNC and with autism had the highest risk of suicide attempts, whereas the lowest odds of suicidal behavior were nonautistic cisgender individuals. This large-sample study bolsters existing research, demonstrating greater odds of STBs among the autistic and TGNC communities and uniquely highlights the intersection of autism and TGNC identities.
The human mind is incredibly complex and varied, and modern society is in the process of understanding and appreciating these complexities and variations regarding autism and gender identity. While society comes to terms with the existence and value of these often-marginalized identities, studies like this one validate the mental health challenges that may be faced by individuals identifying as TGNC and with autism and offer opportunities for targeted psychiatric, social and other interventions to help save lives. Perhaps more importantly, drawn from a broad dataset of college students, this study illustrates the diversity of the human race and the need to help one another feel we are all deserving of life.
Perspective
Back to Top
Tony Thrasher, DO, MBA, CPE, DFAPA
It was a pleasure to see the authors take a more detailed look at subgroups who may have an increased rate of suicidal thoughts and behaviors. Their study is well powered with a large sample size that focuses on college enrollees who have seen a significant rise in suicide deaths over the past decade. Hence, the findings are not only relevant, but they also speak to a target group for which intervention could have a proportional impact.
There are several things to consider when examining the findings. The choice to include both suicidal thoughts and behaviors can complicate some findings because some individuals deal with the ideation and not the behavior. Additionally, it is unclear if suicidal behaviors include the entity of self-injurious behavior and/or nonsuicidal self-injury.
When examining the diagnoses queried, it should also be noted that self-report was the defining criteria. Although that speaks highly in concordance with elements of transgender patients, it is limited when considering the spectrum of autistic disorders. In other words, the authors note that the diagnosis of "autism" required only an assent from the participant, not any formal diagnostics. The authors note long-standing crossover between the two populations, but a more formal understanding of what "autistic" means to the participants would help improve the understanding/extrapolation of said data (particularly given the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition change to have all autistic variants under a spectrum per se). This is of even more importance when considering the fact that autism spectrum disorders can have a disproportionate number of self-injury instances that are not tied to a suicidal plan or endpoint.
This is a good reminder of two separate populations (those with autism and those who are transgender or gender-nonconforming) who are at increased risk for suicide in general. As such, interventions can be tailored to ease suffering and improve quality of life. This is doubly as important when noting that the participants were in a specific college location with its own precipitants and risk factors for developing new illnesses or exacerbating preexisting conditions.
Collapse
Click Here to Manage Email Alerts