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암스테르담 클리닉, 1972~2017: 자살률은 인구 수준의 3~4배, 전환의 모든 단계에서 사망

트랜스젠더 사람들의 자살 사망 위험 추세: 성별 불쾌감의 암스테르담 코호트 연구(1972~2017) 결과

코호트 및 등록 연구정신 건강과 자살
Authors
C.M. Wiepjes, M. den Heijer, M.A. Bremmer, N.M. Nota, C.J.M. de Blok, B.J.G. Coumou, T.D. Steensma
Journal
Acta Psychiatrica Scandinavica
Year
2020
Source
https://doi.org/10.1111/acps.13164

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

  • 1972년부터 2017년까지 암스테르담 클리닉을 찾은 8,263명(통상 7.5년 추적) 중 49명(0.6%)이 자살로 사망했습니다.
  • 매년 트랜스 여성 10만 명당 약 64명(41명 사망, 0.8%)과 트랜스 남성 10만 명당 29명(8명 사망, 0.3%)이 자살로 사망했으며, 트랜스 여성의 위험이 약 두 배였습니다.
  • 2013년부터 2017년까지 클리닉 환자의 연간 자살률은 10만 명당 40명으로, 일반 네덜란드 인구의 11명과 비교됩니다.
  • 자살 위험은 해가 갈수록 트랜스 여성에서는 약간 줄었고, 트랜스 남성에서는 뚜렷한 변화가 없었습니다.
  • 사망한 49명 중 17명은 평가 중이거나 호르몬을 쓰고 있었고, 2명은 수술 중이었으며, 16명은 수술을 마치고 점검만 받으러 왔고, 14명은 더 이상 클리닉과 연락이 닿지 않았습니다.
  • 18세 이전에 처음 의뢰된 사람들은 자살 비율이 성인으로 의뢰된 사람들(0.7%)보다 낮았습니다(0.2%, 4명 사망).
  • 저자들은 자살 위험이 전환의 모든 단계에서 지속된다고 결론짓고 진료 내내 이에 주의할 것을 권고합니다.

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.