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Danimarka kaydı: 42 yılda transseksüel kişilerde intihar girişimleri 7,7 kat, intihar ölümleri 3,5 kat daha yüksek

Danimarka'da transseksüel kimlik, intihar girişimleri ve mortalite

Kohort & kayıt çalışmalarıRuh sağlığı & intihar
Authors
Annette Erlangsen, Anna Lund Jacobsen, Anne Ranning, Alex Lauridsen Delamare, Merete Nordentoft, Morten Frisch
Journal
JAMA
Year
2023
Source
https://doi.org/10.1001/jama.2023.8627

Summary

Danish researchers linked national records covering 6.7 million people over 42 years. They found 3,759 transgender people from hospital diagnoses or legal gender changes and compared their suicide attempts and deaths with everyone else's. Taking only age, birth sex and time period into account, transgender people had about 7.7 times the rate of hospital-treated suicide attempts, 3.5 times the suicide rate (12 deaths) and about twice the death rate from any cause. The gaps shrank over time but were still there in the latest decade, when transition care was widely available. The authors partly blame the stress of being a minority. But the study did not account for the much higher rates of mental illness in the transgender group, had no data on hormones or surgery, and found people mostly through hospital diagnoses. It shows higher risk, not its cause.

Key findings

  • 42 yıl boyunca izlenen 6,66 milyon Danimarka doğumlu kişiden 3.759'u (%0,06) tipik olarak 22 yaşında transgender olarak belirlendi.
  • Hastanede tedavi edilen intihar girişimleri yılda 100.000 kişide 498'e karşı 71 oranında, yaklaşık 7,7 kat daha sık gerçekleşti; girişimde bulunan 92 transgender kişiye dayanıyor.
  • İntihar ölümleri yılda 100.000 kişide 75'e karşı 21, yaklaşık 3,5 kat daha sıktı; hepsi erkek doğumlu olan transgender kişiler arasındaki 12 ölüme dayanıyor.
  • Herhangi bir nedenden ölümler yaklaşık iki kat daha yaygındı; bunun çoğu intiharla ilgili olmayan 245 ölümden kaynaklanıyordu (yaklaşık 1,9 kat daha yaygın).
  • 2010-2021'de oranlar hâlâ daha yüksekti: intihar girişimleri yaklaşık 6,6 kat, intihar ölümleri yaklaşık 2,8 kat (2000-2021) ve tüm ölümler yaklaşık 1,7 kat daha yaygındı.
  • Yalnızca yasal cinsiyet değişikliği yoluyla belirlenen kişilerde daha fazla intihar girişimi (yaklaşık 5 kat) vardı ancak hastane kayıtları yoluyla bulunanların aksine diğer nedenlerden ya da genel olarak fazladan ölüm yoktu.
  • Ruhsal ve fiziksel hastalık kasıtlı olarak hesaba katılmadı; bu yüzden rakamlar transgender olmanın kendisinin etkisini değil, genel bağlantıları gösteriyor.

Abstract

IMPORTANCE: Prior studies have suggested that transgender individuals may be a high-risk group with respect to suicide attempt and mortality, but large-scale, population-based investigations are lacking. OBJECTIVE: To examine in a national setting whether transgender individuals have higher rates of suicide attempt and mortality than nontransgender individuals. DESIGN, SETTING, AND PARTICIPANTS: Nationwide, register-based, retrospective cohort study on all 6 657 456 Danish-born individuals aged 15 years or older who lived in Denmark between January 1, 1980, and December 31, 2021. EXPOSURE: Transgender identity was determined through national hospital records and administrative records of legal change of gender. MAIN OUTCOMES AND MEASURES: Suicide attempts, suicide deaths, nonsuicidal deaths, and deaths by any cause during 1980 through 2021 were identified in national hospitalization and causes of death registers. Adjusted incidence rate ratios (aIRRs) with 95% CIs controlling for calendar period, sex assigned at birth, and age were calculated. RESULTS: The 6 657 456 study participants (50.0% assigned male sex at birth) were followed up during 171 023 873 person-years. Overall, 3759 individuals (0.06%; 52.5% assigned male sex at birth) were identified as transgender at a median age of 22 years (IQR, 18-31 years) and followed up during 21 404 person-years, during which 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths occurred. Standardized suicide attempt rates per 100 000 person-years were 498 for transgender vs 71 for nontransgender individuals (aIRR, 7.7; 95% CI, 5.9-10.2). Standardized suicide mortality rates per 100 000 person-years were 75 for transgender vs 21 for nontransgender individuals (aIRR, 3.5; 95% CI, 2.0-6.3). Standardized suicide-unrelated mortality rates per 100 000 person-years were 2380 for transgender vs 1310 for nontransgender individuals (aIRR, 1.9; 95% CI, 1.6-2.2), and standardized all-cause mortality rates per 100 000 person-years were 2559 for transgender vs 1331 for nontransgender individuals (aIRR, 2.0; 95% CI, 1.7-2.4). Despite declining rates of suicide attempts and mortality during the 42 years covered, aIRRs remained significantly elevated in recent calendar periods up to and including 2021 for suicide attempts (aIRR, 6.6; 95% CI, 4.5-9.5), suicide mortality (aIRR, 2.8; 95% CI, 1.3-5.9), suicide-unrelated mortality (aIRR, 1.7; 95% CI, 1.5-2.1), and all-cause mortality (aIRR, 1.7; 95% CI, 1.4-2.1). CONCLUSIONS AND RELEVANCE: In this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population.

Conclusion

In this Danish population-based, retrospective cohort study, results suggest that transgender individuals had significantly higher rates of suicide attempt, suicide mortality, suicide-unrelated mortality, and all-cause mortality compared with the nontransgender population. Despite declining rates over 42 years, adjusted rate ratios remained elevated through 2021. The authors suggest the excess may partly reflect minority stress, and recommend suicide-prevention efforts including encouraging help-seeking and reducing structural discrimination.