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

• 在1972至2017年间于阿姆斯特丹诊所就诊的8,263人中（通常随访7.5年），49人死于自杀（0.6%）。
• 每年，每10万名跨性别女性中约有64人（41例死亡，0.8%）、每10万名跨性别男性中约有29人（8例死亡，0.3%）死于自杀；跨性别女性的风险约为两倍。
• 2013至2017年，诊所患者的年自杀率为每10万人40例，而荷兰普通人群为11例。
• 跨性别女性的自杀风险多年来略有下降，跨性别男性则没有明显变化。
• 在死亡的49人中，17人正在接受评估或使用激素，2人正在做手术，16人已完成手术且只是来做检查，14人已不再与诊所联系。
• 18岁之前首次被转介的人，自杀所占比例（0.2%，4例死亡）低于成年后被转介的人（0.7%）。
• 作者的结论是，自杀风险在过渡的每个阶段都持续存在，并建议在整个护理过程中予以关注。

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.