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Данський реєстр: спроби суїциду в 7,7 раза, а самогубства в 3,5 раза частіші серед трансгендерних людей за 42 роки

Трансгендерна ідентичність, спроби самогубства та смертність у Данії

Когортні та реєстрові дослідженняПсихічне здоров'я та самогубство
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

  • Із 6,66 мільйона народжених у Данії людей, яких спостерігали 42 роки, 3 759 (0,06%) були ідентифіковані як трансгендерні, типово у віці 22 років.
  • Спроби самогубства, пролікувані в лікарні, відбувалися з частотою 498 проти 71 на 100 000 осіб на рік, приблизно в 7,7 раза частіше, на основі 92 трансгендерних людей, які здійснили спробу.
  • Смерті від самогубства становили 75 проти 21 на 100 000 осіб на рік, приблизно в 3,5 раза частіше, на основі 12 смертей серед трансгендерних людей, усі чоловічої статі при народженні.
  • Смерті від будь-якої причини були приблизно вдвічі частішими, переважно через 245 смертей, не пов'язаних із самогубством (приблизно в 1,9 раза частіше).
  • У 2010–2021 роках показники все ще були вищими: спроби самогубства приблизно в 6,6 раза, смерті від самогубства приблизно в 2,8 раза (2000–2021) і всі смерті приблизно в 1,7 раза частіше.
  • Люди, ідентифіковані лише через юридичну зміну статі, мали більше спроб самогубства (приблизно в 5 разів), але не мали додаткових смертей від інших причин чи загалом, на відміну від тих, кого знайшли через лікарняні записи.
  • Психічну та фізичну хворобу свідомо не враховували, тож цифри показують загальні зв'язки, а не вплив самої трансгендерності.

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.