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Амстердамская клиника, 1972–2017: уровень самоубийств в 3–4 раза выше общего, смерти на каждом этапе перехода

Тенденции риска смерти от самоубийства у трансгендерных людей: результаты амстердамского когортного исследования гендерной дисфории (1972–2017)

Когортные и регистровые исследованияПсихическое здоровье и суицид
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

  • Из 8 263 человек, обращавшихся в амстердамскую клинику с 1972 по 2017 год (типично наблюдавшихся 7,5 года), 49 умерли от самоубийства (0,6%).
  • Ежегодно от самоубийства умирали около 64 из 100 000 транс-женщин (41 смерть, 0,8%) и 29 из 100 000 транс-мужчин (8 смертей, 0,3%); у транс-женщин риск был примерно вдвое выше.
  • С 2013 по 2017 год ежегодный уровень самоубийств среди пациентов клиники составлял 40 на 100 000 против 11 в общей популяции Нидерландов.
  • Риск самоубийства слегка снижался с годами у транс-женщин и не показывал явных изменений у транс-мужчин.
  • Из 49 умерших 17 проходили оценку или принимали гормоны, 2 проходили операцию, 16 завершили операции и приходили лишь на осмотры, а 14 уже не поддерживали связь с клиникой.
  • Среди впервые направленных до 18 лет доля самоубийств была ниже (0,2%, 4 смерти), чем среди направленных во взрослом возрасте (0,7%).
  • Авторы заключают, что риск самоубийства сохраняется на каждом этапе транзиции, и рекомендуют уделять ему внимание на протяжении всей помощи.

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.