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

• Spośród 8263 osób widzianych w amsterdamskiej poradni w latach 1972–2017 (typowo obserwowanych przez 7,5 roku) 49 zmarło przez samobójstwo (0,6%).
• Rocznie około 64 na 100 000 kobiet transpłciowych (41 zgonów, 0,8%) i 29 na 100 000 mężczyzn transpłciowych (8 zgonów, 0,3%) zmarło przez samobójstwo; kobiety transpłciowe miały około dwukrotnie większe ryzyko.
• W latach 2013–2017 roczny wskaźnik samobójstw wśród pacjentów poradni wynosił 40 na 100 000, w porównaniu z 11 w ogólnej populacji holenderskiej.
• Ryzyko samobójstwa nieznacznie malało z biegiem lat u kobiet transpłciowych, a u mężczyzn transpłciowych nie wykazywało wyraźnej zmiany.
• Spośród 49 osób, które zmarły, 17 było w trakcie oceny lub przyjmowało hormony, 2 miały operację, 16 ukończyło operacje i przychodziło tylko na badania kontrolne, a 14 nie miało już kontaktu z poradnią.
• Osoby po raz pierwszy skierowane przed 18. rokiem życia miały niższy odsetek samobójstw (0,2%, 4 zgony) niż skierowane jako dorosłe (0,7%).
• Autorzy wnioskują, że ryzyko samobójstwa utrzymuje się na każdym etapie tranzycji, i zalecają zwracanie na nie uwagi w trakcie całej opieki.

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.