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Датски регистър: опитите за самоубийство са 7,7 пъти, а самоубийствата 3,5 пъти повече при трансджендър хора за 42 г.

Трансджендър идентичност, опити за самоубийство и смъртност в Дания

Кохортни и регистърни проучванияПсихично здраве и самоубийства
Authors
Annette Erlangsen, Anna Lund Jacobsen, Anne Ranning, Alex Lauridsen Delamare, Merete Nordentoft, Morten Frisch
Journal
JAMA
Year
2023
Source
https://doi.org/10.1001/jama.2023.8627

Summary

Danish researchers linked national records covering 6.7 million people over 42 years. They found 3,759 transgender people from hospital diagnoses or legal gender changes and compared their suicide attempts and deaths with everyone else's. Taking only age, birth sex and time period into account, transgender people had about 7.7 times the rate of hospital-treated suicide attempts, 3.5 times the suicide rate (12 deaths) and about twice the death rate from any cause. The gaps shrank over time but were still there in the latest decade, when transition care was widely available. The authors partly blame the stress of being a minority. But the study did not account for the much higher rates of mental illness in the transgender group, had no data on hormones or surgery, and found people mostly through hospital diagnoses. It shows higher risk, not its cause.

Key findings

  • От 6,66 милиона родени в Дания хора, проследявани за 42 години, 3759 (0,06%) са идентифицирани като трансджендър, типично на 22-годишна възраст.
  • Лекуваните в болница опити за самоубийство са 498 срещу 71 на 100 000 души годишно, около 7,7 пъти по-често, въз основа на 92 трансджендър души, направили опит.
  • Смъртните случаи от самоубийство са 75 срещу 21 на 100 000 души годишно, около 3,5 пъти по-често, въз основа на 12 смъртни случая сред трансджендър хора, всички родени като мъже.
  • Смъртните случаи от каквато и да е причина са около два пъти по-чести, най-вече поради 245 смъртни случая, несвързани със самоубийство (около 1,9 пъти по-често).
  • През 2010–2021 г. нивата все още са по-високи: опитите за самоубийство са около 6,6 пъти, смъртните случаи от самоубийство около 2,8 пъти (2000–2021 г.) и всички смъртни случаи около 1,7 пъти по-чести.
  • Хората, идентифицирани само чрез правна промяна на пола, имат повече опити за самоубийство (около 5 пъти повече), но нямат допълнителни смъртни случаи от други причини или общо, за разлика от намерените чрез болнични записи.
  • Психичното и физическото заболяване са умишлено невзети предвид, така че цифрите показват общи връзки, а не ефекта на самото да си трансджендър.

Abstract

IMPORTANCE: Prior studies have suggested that transgender individuals may be a high-risk group with respect to suicide attempt and mortality, but large-scale, population-based investigations are lacking. OBJECTIVE: To examine in a national setting whether transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals. DESIGN, SETTING, AND PARTICIPANTS: Nationwide, register-based, retrospective cohort study on all 6 657 456 Danish-born individuals aged 15 years or older who lived in Denmark between January 1, 1980, and December 31, 2021. EXPOSURE: Transgender identity was determined through national hospital records and administrative records of legal change of gender. MAIN OUTCOMES AND MEASURES: Suicide attempts, suicide deaths, nonsuicidal deaths, and deaths by any cause during 1980 through 2021 were identified in national hospitalization and causes of death registers. Adjusted incidence rate ratios (aIRRs) with 95% CIs controlling for calendar period, sex assigned at birth, and age were calculated. RESULTS: The 6 657 456 study participants (50.0% assigned male sex at birth) were followed up during 171 023 873 person-years. Overall, 3759 individuals (0.06%; 52.5% assigned male sex at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed up during 21 404 person-years, during which 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths occurred. Standardized suicide attempt rates per 100 000 person-years were 498 for transgender vs 71 for nontransgender individuals (aIRR, 7.7; 95% CI, 5.9-10.2). Standardized suicide mortality rates per 100 000 person-years were 75 for transgender vs 21 for nontransgender individuals (aIRR, 3.5; 95% CI, 2.0-6.3). Standardized suicide-unrelated mortality rates per 100 000 person-years were 2380 for transgender vs 1310 for nontransgender individuals (aIRR, 1.9; 95% CI, 1.6-2.2), and standardized all-cause mortality rates per 100 000 person-years were 2559 for transgender vs 1331 for nontransgender individuals (aIRR, 2.0; 95% CI, 1.7-2.4). Despite declining rates of suicide attempts and mortality during the 42 years covered, aIRRs remained significantly elevated in recent calendar periods up to and including 2021 for suicide attempts (aIRR, 6.6; 95% CI, 4.5-9.5), suicide mortality (aIRR, 2.8; 95% CI, 1.3-5.9), suicide-unrelated mortality (aIRR, 1.7; 95% CI, 1.5-2.1), and all-cause mortality (aIRR, 1.7; 95% CI, 1.4-2.1). CONCLUSIONS AND RELEVANCE: In this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population.

Conclusion

In this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population. Despite declining rates over 42 years, adjusted rate ratios remained elevated through 2021. The authors suggest the excess may partly reflect minority stress, and recommend suicide-prevention efforts including encouraging help-seeking and reducing structural discrimination.