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

• 연구에는 1996~2019년 핀란드 성 정체성 서비스에 의뢰된 23세 미만 2,083명 전원과 짝지은 또래 16,643명이 포함되었습니다. 의뢰 시 평균 연령은 18.5세였고 평균 6.5년 동안 추적했습니다.
• 사망은 총 55건이었고 그중 20건이 자살이었습니다. 성별로 의뢰된 집단에서 7건(0.3%), 또래에서 13건(0.1%)이었습니다.
• 성별과 출생 연도만 고려하면 성별로 의뢰된 집단의 자살률은 또래의 약 4배였습니다.
• 전문 정신과 진료의 양도 고려하면 자살 차이는 2배 미만으로 줄어 우연일 가능성이 충분했고, 모든 원인의 사망은 차이가 없었습니다.
• 성별로 의뢰된 청소년의 71%가 정신과 전문의를 만났고(26%는 100회 넘게) 또래는 26%였습니다. 매우 많은 정신과 진료는 약 11배의 자살 위험과 관련이 있었습니다.
• 38%가 호르몬이나 수술을 받았고 이들의 자살 위험은 또래보다 높지 않았지만, 치료를 받지 않은 사람은 약 3배의 위험이 있었는데, 저자들은 이것이 엄격한 검정 아래에서는 우연일 수 있다고 판단했습니다.
• 저자들은 전환이 자살 사망을 줄이지 않았으며 정신질환을 찾아 치료하는 것이 우선이라고 결론지었습니다.

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.