Addressing the Needs of Transgender and Non-Binary Youth

Among hospitalized youth in the United States, 66% of those with a diagnosis of gender dysphoria were admitted for attempted suicide or self-harm in 2019, compared to 5% without gender dysphoria, according to a study published in The Lancet Child & Adolescent Health .

The study analyzed more than 2 million cases of young people (ages 6 to 20) hospitalized for any reason and determined how many of those hospitalizations were related to suicide attempts or self-harm, for those with and without a diagnosis of gender dysphoria. The authors emphasize that youth who have been hospitalized are likely to be at greater risk of suicidal thoughts and self-harm than youth in general.

Transgender and nonbinary youth experience discrimination that has been linked to suicidal thoughts or attempts and self-harm in previous studies that surveyed outpatient populations, but existing evidence on how many people end up hospitalized is limited. This study is the first to use a large, nationally representative inpatient database to understand the relationship between gender dysphoria and suicide attempts and self-harm.

Dr Nadir Yehya, from Children’s Hospital of Philadelphia (CHOP), USA, says: "Unfortunately, our study confirms existing evidence that suicide attempts and self-harm are more common among transgender or non-binary youth. To help this vulnerable group and prevent adverse outcomes, we must reduce discrimination. As healthcare providers, we have a unique opportunity to do this by providing more gender-affirming care to these children when they are hospitalized. This includes addressing patients using their affirmed names and pronouns, linking them to gender-affirming health care and social support services, and implementing follow-up services specific to self-harm.”

The study used the nationally representative Children’s Inpatient Database (KID) in the two most recent available years, 2016 and 2019. It included 80% of all pediatric discharges in the US, representing more than 3 million patients in both years. To identify transgender or nonbinary youth, the authors looked for patients who had been diagnosed with gender dysphoria or any other label that referred to gender dysphoria. Next, they calculated the number of children who had been hospitalized for suicide attempts, self-harm, and a combination of suicide attempts and self-harm , comparing the rates in youth with and without gender dysphoria. Additionally, they investigated differences in the prevalence of gender dysphoria based on certain characteristics, such as race, type of health insurance, and median income in the patient’s area of ​​residence.

Hospitalized youth with gender dysphoria had a higher prevalence of suicide attempts compared to those without gender dysphoria in both 2016 (36% vs. 5%) and 2019 (55% vs. 4%). Likewise, the prevalence of self-harm was higher in hospitalized youth with gender dysphoria in both years (13% versus 1% in 2016 and 15% versus 1% in 2019).

Looking at both, hospitalized youth with gender dysphoria were four to five times more likely to experience self-harm or suicide attempts compared to those without gender dysphoria. In 2016, 41% of hospitalized youth with gender dysphoria experienced suicide attempts or self-harm compared to 6% without; in 2019 it rose to 66% compared to 5%. See Table 1 for the number of individuals.

Although the overall proportion of youth with gender dysphoria remained low, it increased significantly from 2016 (0.16%) to 2019 (0.48%). The authors say this is likely due to greater understanding and social acceptance of diverse gender identities, as well as greater access to gender-affirming medical and mental health services.

Young people who were black, Hispanic or Latino, or other minority racial and ethnic groups, with public insurance or from low-income households were less likely to be diagnosed with gender dysphoria. The authors say this does not necessarily mean that gender dysphoria is less common among these groups. It may reflect inequalities in access to gender-affirming care, or greater discrimination in certain settings, making youth from economically disadvantaged or racial minority backgrounds less likely to be diagnosed.

Those with a diagnosis of gender dysphoria were also less likely to be from the southern US or from rural hospitals. The authors say these regional inequalities raise concerns about increasing levels of discrimination inside and outside of healthcare settings in certain places, which could be preventing young people from self-identifying. It may also mean that health care providers in rural or southern hospitals are less equipped to provide gender-affirming care. This highlights the impact that culture and policies at the regional and state levels can have in determining health outcomes.

The authors point out some limitations of their study. It relied on formal diagnoses of gender dysphoria to identify transgender and non-binary youth, which could have biased the estimates in several ways. For example, not all transgender and nonbinary youth experience gender dysphoria, which could have led to an underestimation of the size of this group. Additionally, some transgender and nonbinary youth may not receive a formal diagnosis of gender dysphoria due to lack of access to a provider who makes the diagnosis. However, the authors say this was the most effective way to identify transgender and non-binary youth using this large national data set and emphasize that their results are consistent with the previously reported high rates of suicidal ideation among transgender and non-binary youth. non-binary.

This study was funded by the National Institutes of Health (NIH). It was conducted by researchers at the Children’s Hospital of Philadelphia, USA.