Summary

Finnish researchers used national records to follow every young person (under 23) who came to Finland's two gender identity services between 1996 and 2019, comparing them with matched peers from the general population. Suicide was rare but more common in the gender-referred group (7 of 2,083, or 0.3%, versus 0.1%). Once the researchers accounted for how much specialist psychiatric care each person had received, the difference could easily have been chance, and those who did or did not have hormones or surgery did not clearly differ from controls. The authors conclude that mental illness, not gender dysphoria itself, drives suicide risk, and that transition has not been shown to prevent suicide. Because the result rests on a handful of deaths, and psychiatric care may partly result from gender distress, it is suggestive rather than proof.

Key findings

• 研究納入 1996 至 2019 年間被轉介到芬蘭性別認同服務的全部 2,083 名 23 歲以下者，以及 16,643 名配對同儕；轉介時的平均年齡為 18.5 歲，平均追蹤 6.5 年。
• 總共有 55 人死亡，其中 20 例是自殺；7 例自殺（0.3%）在因性別問題被轉介的組別，13 例（0.1%）在同儕中。
• 只考慮性別和出生年份時，因性別問題被轉介的組別的自殺率約為同儕的 4 倍。
• 在還考慮專科精神科照護的量之後，自殺差異縮小到不到 2 倍，很可能只是偶然；所有原因的死亡沒有差異。
• 71% 因性別問題被轉介的青少年看過精神科專科醫師（26% 超過 100 次），而同儕為 26%；非常大量的精神科照護與約 11 倍的自殺風險有關。
• 38% 接受了荷爾蒙或手術；他們的自殺風險並沒有比同儕高，而未接受治療者的風險約為 3 倍，作者判斷在其嚴格的檢定下，這可能只是偶然。
• 作者的結論是，過渡並沒有減少自殺死亡，而找出並治療精神疾病是首要之務。

Abstract

BACKGROUND: All-cause and suicide mortalities of gender-referred adolescents compared with matched controls have not been studied, and particularly the role of psychiatric morbidity in mortality is unknown. OBJECTIVE: To examine all-cause and suicide mortalities in gender-referred adolescents and the impact of psychiatric morbidity on mortality. METHODS: Finnish nationwide cohort of all <23 year-old gender-referred adolescents in 1996-2019 (n=2083) and 16 643 matched controls. Cox regression models with HRs and 95% CIs were used to analyse all-cause and suicide mortalities. FINDINGS: Of the 55 deaths in the study population, 20 (36%) were suicides. In bivariate analyses, all-cause mortality did not statistically significantly differ between gender-referred adolescents and controls (0.5% vs 0.3%); however, the proportion of suicides was higher in the gender-referred group (0.3% vs 0.1%). The all-cause mortality rate among gender-referred adolescents (controls) was 0.81 per 1000 person-years (0.40 per 1000 person-years), and the suicide mortality rate was 0.51 per 1000 person-years (0.12 per 1000 person-years). However, when specialist-level psychiatric treatment was controlled for, neither all-cause nor suicide mortality differed between the two groups: HR for all-cause mortality among gender-referred adolescents was 1.0 (95% CI 0.5 to 2.0) and for suicide mortality was 1.8 (95% CI 0.6 to 4.8). CONCLUSIONS: Clinical gender dysphoria does not appear to be predictive of all-cause nor suicide mortality when psychiatric treatment history is accounted for. CLINICAL IMPLICATIONS: It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide.

Conclusion

Clinical gender dysphoria does not appear to be predictive of all-cause or suicide mortality when psychiatric treatment history is accounted for. The authors state that suicide in this population appears to be explained by psychiatric morbidity, that medical gender reassignment did not show an impact on suicide risk, and that the risk of suicide attributed to transgender identity or gender dysphoria per se may have been overestimated. It is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing gender dysphoria to prevent suicide, and health policies should ensure professionals receive accurate information along these lines.