Summary

Finnish researchers used national records to follow every young person (under 23) who came to Finland's two gender identity services between 1996 and 2019, comparing them with matched peers from the general population. Suicide was rare but more common in the gender-referred group (7 of 2,083, or 0.3%, versus 0.1%). Once the researchers accounted for how much specialist psychiatric care each person had received, the difference could easily have been chance, and those who did or did not have hormones or surgery did not clearly differ from controls. The authors conclude that mental illness, not gender dysphoria itself, drives suicide risk, and that transition has not been shown to prevent suicide. Because the result rests on a handful of deaths, and psychiatric care may partly result from gender distress, it is suggestive rather than proof.

Key findings

• شملت الدراسة جميع الـ 2,083 شخصاً دون 23 أُحيلوا إلى خدمات الهوية الجندرية في فنلندا من 1996 إلى 2019 و16,643 قريناً مطابقاً؛ وكان متوسط العمر عند الإحالة 18.5 وتمت متابعة الناس 6.5 سنوات في المتوسط.
• حدثت 55 وفاة إجمالاً، منها 20 انتحاراً؛ كانت 7 حالات انتحار (0.3%) في المجموعة المحالة بسبب الجندر و13 (0.1%) بين الأقران.
• عند مراعاة الجنس وسنة الميلاد فقط، كان معدل الانتحار في المجموعة المحالة بسبب الجندر أعلى بنحو 4 أضعاف من الأقران.
• بعد مراعاة مقدار الرعاية النفسية المتخصصة أيضاً، انكمش فرق الانتحار إلى أقل من ضعفين وقد يكون صدفة بسهولة؛ ولم تختلف الوفيات لجميع الأسباب.
• رأى 71% من الشباب المحالين بسبب الجندر مختصين نفسيين (26% أكثر من 100 مرة) مقابل 26% من الأقران؛ وارتبطت الرعاية النفسية الكثيفة جداً بنحو 11 ضعف خطر الانتحار.
• تلقى 38% هرمونات أو جراحة؛ ولم يكن خطر الانتحار لديهم أعلى من الأقران، بينما كان لدى غير المعالَجين نحو 3 أضعاف الخطر، وهو ما رأى المؤلفون أنه قد يكون صدفة بحسب اختبارهم الصارم.
• يخلص المؤلفون إلى أن التحول لم يقلل وفيات الانتحار وأن إيجاد المرض النفسي وعلاجه هو الأولوية.

Abstract

BACKGROUND: All-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is unknown. OBJECTIVE: To examine all-cause and suicide mortalities in gender-referred adolescents and the impact of psychiatric morbidity on mortality. METHODS: Finnish nationwide cohort of all <23 year-old gender-referred adolescents in 1996-2019 (n=2083) and 16 643 matched controls. Cox regression models with HRs and 95% CIs were used to analyse all-cause and suicide mortalities. FINDINGS: Of the 55 deaths in the study population, 20 (36%) were suicides. In bivariate analyses, all-cause mortality did not statistically significantly differ between gender-referred adolescents and controls (0.5% vs 0.3%); however, the proportion of suicides was higher in the gender-referred group (0.3% vs 0.1%). The all-cause mortality rate among gender-referred adolescents (controls) was 0.81 per 1000 person-years (0.40 per 1000 person-years), and the suicide mortality rate was 0.51 per 1000 person-years (0.12 per 1000 person-years). However, when specialist-level psychiatric treatment was controlled for, neither all-cause nor suicide mortality differed between the two groups: HR for all-cause mortality among gender-referred adolescents was 1.0 (95% CI 0.5 to 2.0) and for suicide mortality was 1.8 (95% CI 0.6 to 4.8). CONCLUSIONS: Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for. CLINICAL IMPLICATIONS: It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide.

Conclusion

Clinical gender dysphoria does not appear to be predictive of all-cause or suicide mortality when psychiatric treatment history is accounted for. The authors state that suicide in this population appears to be explained by psychiatric morbidity, that medical gender reassignment did not show an impact on suicide risk, and that the risk of suicide attributed to transgender identity or gender dysphoria per se may have been overestimated. It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide, and health policies should ensure professionals receive accurate information along these lines.