Summary

Researchers at Amsterdam's gender clinic, the largest in the Netherlands, went through the records of everyone referred there over 45 years and checked who had died by suicide. Of 8,263 people, 49 died by suicide, mostly trans women. In recent years the suicide rate was three to four times that of the Dutch population. The rate among trans women fell slightly over the decades, while among trans men it did not change. Suicides happened before, during and after medical transition: 16 were people who had finished genital surgery and only came in for check-ups. The authors conclude that suicide risk stays high at every stage and needs attention throughout care. The study has no matched comparison group and no mental-health data, so it shows the risk but cannot show whether treatment helps or harms.

Key findings

• Delle 8.263 persone viste presso la clinica di Amsterdam dal 1972 al 2017 (seguite in genere per 7,5 anni), 49 sono morte per suicidio (0,6%).
• Ogni anno, circa 64 su 100.000 donne trans (41 decessi, 0,8%) e 29 su 100.000 uomini trans (8 decessi, 0,3%) sono morte per suicidio; le donne trans avevano un rischio circa doppio.
• Dal 2013 al 2017, il tasso annuo di suicidio tra i pazienti della clinica era 40 ogni 100.000, contro 11 nella popolazione generale olandese.
• Il rischio di suicidio è diminuito leggermente nel corso degli anni nelle donne trans e non ha mostrato un chiaro cambiamento negli uomini trans.
• Delle 49 persone decedute, 17 erano in valutazione o in terapia ormonale, 2 erano in corso di intervento chirurgico, 16 avevano concluso la chirurgia e si presentavano solo per i controlli e 14 non erano più in contatto con la clinica.
• Le persone inviate per la prima volta prima dei 18 anni avevano una quota di suicidi inferiore (0,2%, 4 decessi) rispetto a quelle inviate da adulte (0,7%).
• Gli autori concludono che il rischio di suicidio persiste in ogni fase della transizione e raccomandano attenzione ad esso durante tutta l'assistenza.

Abstract

OBJECTIVE: This study explored the overall suicide death rate, the incidence over time, and the stage in transition where suicide deaths were observed in transgender people. METHODS: A chart study, including all 8263 referrals to our clinic since 1972. Information on death occurrence, time, and cause of death was obtained from multiple sources. RESULTS: Out of 5107 trans women (median age at first visit 28 years, median follow-up time 10 years) and 3156 trans men (median age at first visit 20 years, median follow-up time 5 years), 41 trans women and 8 trans men died by suicide. In trans women, suicide deaths decreased over time, while it did not change in trans men. Of all suicide deaths, 14 people were no longer in treatment, 35 were in treatment in the previous two years. The mean number of suicides in the years 2013-2017 was higher in the trans population compared with the Dutch population. CONCLUSIONS: We observed no increase in suicide death risk over time and even a decrease in suicide death risk in trans women. However, the suicide risk in transgender people is higher than in the general population and seems to occur during every stage of transitioning. It is important to have specific attention for suicide risk in the counseling of this population and in providing suicide prevention programs.

Conclusion

We observed no increase in suicide death risk over time and even a decrease in suicide death risk in trans women. However, the suicide risk in transgender people is higher than in the general population and seems to occur during every stage of transitioning. It is important to have specific attention for suicide risk in the counseling of this population and in providing suicide prevention programs, and to create a safe environment in which these feelings can be discussed at all stages of treatment. Further research is needed into the motives behind suicides to develop adequate prevention programmes.