Taiwán: riesgo de muerte por suicidio 4 veces mayor en personas trans, y 2,6 veces mayor que en sus hermanos

Mortalidad en personas transgénero: un estudio de cohorte de Taiwán con comparación con población emparejada y con hermanos

Estudios de cohorte y registros Salud mental y suicidio Autismo, trauma y condiciones concurrentes

Authors: Chih-Wei Hsu, Yang-Chieh Brian Chen, Liang-Jen Wang, Mu-Hong Chen, Yao-Hsu Yang, Chih-Sung Liang, Po-Yen Chen, Edward Chia-Cheng Lai
Journal: The Lancet Regional Health – Western Pacific
Year: 2025
Source: https://doi.org/10.1016/j.lanwpc.2025.101715

Summary

Using Taiwan's national health insurance records, researchers followed about 3,900 people diagnosed with gender identity disorder by psychiatrists. They compared their deaths with matched members of the public and with their own non-trans brothers and sisters. Over about nine years, trans people had a 40% higher death rate than the public and about four times the suicide rate. Deaths from accidents and illness were not higher. Compared with siblings, who share family background and genes, overall deaths were no higher, but suicide was still about 2.6 times higher. Depression, anxiety and other mental illnesses were several times more common in the trans group, and taking depression into account shrank the suicide link the most. The study is careful and the sibling comparison is a strength. But it rests on just 35 suicides and has no data on hormones or surgery.

Key findings

El estudio siguió a 3.906 personas diagnosticadas al menos dos veces por un psiquiatra de trastorno de la identidad de género (edad media de unos 25 años; 71 % legalmente varones) y a 15.624 personas emparejadas durante unos 9,5 años de media.
La enfermedad mental era mucho más común en el grupo trans: depresión 41 % frente a 6 %, ansiedad 29 % frente a 6 %, trastorno bipolar 7 % frente a 1 % y psicosis 7 % frente a 1 %.
En comparación con la población general, las personas trans tenían un 40 % más de probabilidades de morir por cualquier causa, aproximadamente el doble de morir por causas externas como el suicidio o los accidentes, y unas 4 veces más de morir por suicidio (35 muertes frente a 31 en un grupo cuatro veces mayor).
Las muertes por accidentes y por enfermedades no eran mayores que en el grupo de comparación.
En comparación con 4.765 hermanos no trans, las muertes globales y las muertes por causas externas no eran mayores, pero el suicidio seguía siendo unas 2,6 veces mayor.
El riesgo adicional de suicidio fue mayor en las personas cuyo sexo legal era mujer (unas 6 veces) y en los adolescentes (unas 13 veces, pero basado en muy pocas muertes, por lo que esta cifra es muy incierta).
Tener en cuenta la depresión fue lo que más redujo la asociación con el suicidio. Entre las personas con depresión, la diferencia en suicidio podría deberse fácilmente al azar.

Abstract

BACKGROUND: Transgender persons have been reported to experience excess mortality, but evidence is dominated by Western cohorts and seldom addresses familial confounding. METHODS: We conducted a nationwide, retrospective cohort study using two prespecified comparison designs: matched population controls (1:4, matched on legal sex and birth date) and within-family cisgender sibling comparisons. Transgender persons were identified by ≥2 psychiatrist-recorded gender identity disorder diagnoses during 2001-2021; cohort entry required age ≥6 years. Participants were followed until death or December 31, 2022. We compared all-cause, external-cause (suicide and accidents), and internal-cause mortality using Cox regression adjusted for sociodemographics and medical comorbidity. FINDINGS: Among 3906 transgender persons (mean age 24.6 years; 70.6% with a male legal sex) and 15,624 controls (mean follow-up 9.5 years), psychiatric conditions were markedly over-represented in the transgender cohort (e.g., depressive disorders 40.8% vs 5.7%). Adjusted hazard ratios were 1.40 (95% confidence interval 1.06-1.84) for all-cause mortality, 2.03 (1.39-2.96) for external causes, and 4.07 (2.52-6.59) for suicides; accidents (0.56, 0.21-1.45) and internal-cause (0.98, 0.65-1.48) mortality did not differ. In sibling comparisons (4765 siblings), excess all-cause and external-cause mortality were not observed (0.96, 0.67-1.36; and 1.14, 0.70-1.85), suicide risk was higher (2.57, 1.32-5.00), and accident mortality lower (0.19, 0.06-0.67). Relative hazards were greatest in those with a female legal sex and in adolescents. Adjustment for psychiatric clusters attenuated-but did not eliminate-the suicide mortality excess. INTERPRETATION: In Taiwan, transgender persons had higher all-cause and suicide mortality than population controls; in within-family comparisons, the suicide mortality excess persisted, indicating influences beyond shared familial factors. Prevention should prioritize targeted mental-health and safety interventions, with particular attention to adolescents and those with a female legal sex. FUNDING: Taiwan National Science and Technology Council.

Conclusion

In Taiwan, transgender persons had higher all-cause and suicide mortality than population controls; in within-family comparisons, the suicide mortality excess persisted, indicating influences beyond shared familial factors. Adjustment for psychiatric clusters attenuated, but did not eliminate, the suicide excess, with depressive disorders producing the greatest attenuation. Prevention should prioritise targeted mental-health and safety interventions, with particular attention to adolescents and those with a female legal sex, including structured suicide-risk assessment at key points of care.

Methodological limitations

Mental illness only partly accounted for: Each type of mental illness was taken into account one at a time rather than all together, and the timing relative to diagnosis was not checked. So the study cannot say how much of the extra suicide risk is explained by mental illness overall, and the authors admit they cannot tell whether mental illness is a separate cause or part of the pathway.
Trans people were checked more often: In Taiwan a psychiatrist must make the diagnosis, so trans people saw psychiatrists far more, and their mental illnesses were more likely to be recorded than other people's. The authors note this may distort how much the results were adjusted for mental illness.
Sibling comparison timing: Siblings were followed from 2001 or from birth, and the trans group's death rate in this comparison was less than half that in the main comparison. This suggests years before diagnosis were counted, when people could not yet have died as diagnosed trans people. That can make the differences look smaller than they are.
Few deaths: The results rest on 35 suicides and 73 deaths in total. Subgroup figures, especially for teens (about 13 times higher, but anywhere from about 1.5 to 110 times), are very uncertain, and many extra analyses were run.
No treatment data: There was no information on hormones or surgery (national insurance does not cover surgery and covers hormones unevenly). So the study cannot say whether transition affects the risk of death.
Legal sex, not birth sex: Sex came from the earliest insurance record from 2001. Surgery before then could not be seen, so some results split by sex may put people in the wrong group.
Many factors not measured: There was no information on smoking, drug or alcohol use beyond diagnoses, family rejection or being victimised. Explanations offered by the authors (minority stress, family rejection, avoiding sports) were not measured.
A selected group: Needing two psychiatrist diagnoses picks out people who sought formal assessment, often to qualify for surgery. The results may not apply to other trans people or to countries with different health systems.

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Summary

Key findings

Abstract

Conclusion