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

• この研究には、1996年から2019年にフィンランドの性自認サービスに紹介された23歳未満の2,083人全員と、対応する同年代の16,643人が含まれました。紹介時の平均年齢は18.5歳で、平均6.5年追跡されました。
• 死亡は合計55件、うち20件が自殺でした。7件（0.3%）は性別を理由に紹介されたグループで、13件（0.1%）は同年代の人々の間でした。
• 性別と生年のみを考慮すると、性別を理由に紹介されたグループの自殺率は、同年代の人々の約4倍でした。
• 専門的な精神科ケアの量も考慮すると、自殺の差は2倍未満に縮まり、偶然でも十分に起こりうるものでした。あらゆる原因による死亡には違いはありませんでした。
• 性別を理由に紹介された若者の71%が精神科の専門医にかかっており（26%は100回を超える）、同年代の人々では26%でした。非常に多い精神科ケアは、約11倍の自殺リスクと関連していました。
• 38%がホルモンまたは手術を受けていました。彼らの自殺リスクは同年代の人々より高くありませんでしたが、治療を受けなかった人は約3倍のリスクで、著者らは、厳格な検定の下ではこれは偶然でもありうると判断しました。
• 著者らは、トランジションが自殺による死亡を減らしたわけではないと結論づけ、精神疾患を見つけて治療することが優先事項だと述べています。

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.