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

• Van 8.263 mensen die van 1972 tot 2017 bij de kliniek in Amsterdam werden gezien (gemiddeld 7,5 jaar gevolgd), overleden er 49 door suïcide (0,6%).
• Elk jaar overleed ongeveer 64 op 100.000 transvrouwen (41 sterfgevallen, 0,8%) en 29 op 100.000 transmannen (8 sterfgevallen, 0,3%) door suïcide; transvrouwen hadden ongeveer twee keer het risico.
• Van 2013 tot 2017 was het jaarlijkse suïcidecijfer onder kliniekpatiënten 40 per 100.000, tegenover 11 in de algemene Nederlandse bevolking.
• Het suïciderisico daalde in de loop der jaren licht bij transvrouwen, en liet geen duidelijke verandering zien bij transmannen.
• Van de 49 overledenen werden er 17 beoordeeld of gebruikten hormonen, ondergingen er 2 een operatie, hadden er 16 de operaties voltooid en kwamen alleen voor controles, en hadden er 14 geen contact meer met de kliniek.
• Mensen die vóór hun 18e voor het eerst werden verwezen hadden een lager aandeel suïcides (0,2%, 4 sterfgevallen) dan wie als volwassene werd verwezen (0,7%).
• De auteurs concluderen dat het suïciderisico in elke fase van de transitie blijft bestaan en bevelen aan er gedurende de hele zorg aandacht aan te besteden.

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.