Purpose: Transgender youth experience disproportionately high rates of suicidality, yet little is known about suicide mortality in this population. We characterized suicide lethal methods and precipitating circumstances among transgender youth and compared these factors with matched youth decedents not identified as transgender. Methods: This secondary analysis used National Violent Death Reporting System data from 2003 to 2021. The sample included suicide decedents aged 10–24 years identified as transgender ( n = 384) and matched decedents not identified as transgender ( n = 1119). Multinomial and logistic regression models examined differences in lethal means and precipitating circumstances by transgender status. Results: The sample included 1503 decedents (mean [standard deviation] age, 18.97 [3.40] years; 78.3% White). Among transgender youth, the most common suicide methods were hanging, strangulation, or suffocation (49.2%), firearm (24.0%), and drug or poison ingestion (18.2%). Compared with decedents not identified as transgender, transgender youth had higher odds of suicide by drug or poison ingestion, hanging, strangulation, or suffocation, and other methods relative to firearm suicide. Transgender youth also had higher odds of multiple mental health diagnoses, prior suicide attempts, child abuse, and disclosure of suicidal intent to a health care worker. Conclusion: Transgender youth who died by suicide had distinct patterns of lethal methods and precipitating circumstances, including greater mental health burden and lower likelihood of firearm suicide. These findings highlight the need for tailored suicide prevention strategies and improved gender identity ascertainment in mortality surveillance systems.
Purpose: This review aimed to determine how autism spectrum disorder (ASD) and autistic traits are assessed in gender-diverse populations. Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines, we conducted a systematic review and meta-analysis of studies published from January 2013 in English or French that focused on gender-diverse individuals and reported diagnostic procedures and/or tools used to assess ASD. Only studies involving human participants were included. Reviews, meta-analyses, case reports, editorials, posters, and conference abstracts were excluded. Two independent reviewers screened records and extracted data using a standardized form, including study design, sample characteristics, diagnostic instruments, and assessment procedures. Data were synthesized qualitatively, and pooled prevalence estimates were calculated using random-effects meta-analysis when appropriate. Methodological quality and risk of bias were assessed using the Joanna Briggs Institute tools for analytical cross-sectional studies and for case-control studies. Results: Twenty-eight studies met the inclusion criteria. Eighteen assessed ASD diagnoses; only six (33%) used robust diagnostic criteria, identifying 100 participants with a confirmed ASD diagnosis (5.4%) among 1855 participants. Other studies relied mainly on self-report or screening instruments. Twenty-three studies examined the broader autism phenotype using 13 different tools. The pooled prevalence of robust ASD diagnosis was 12% (95% confidence interval [CI] = 7%–19%), and broader autism phenotype prevalence was 24% (95% CI = 17%–33%). Conclusions: Few studies met clinical gold standards. Elevated prevalence estimates may reflect methodological variability and barriers to appropriate evaluation. Training in both ASD and gender diversity is essential for inclusive and accurate diagnostic practices.
Purpose: Lesbian, gay, bisexual, transgender, queer, intersex, asexual, or another sexual or gender minority (LGBTQIA+) people face health inequities and commonly report health care avoidance. We examined how multidisciplinary subspecialist providers care for LGBTQIA+ people with pediatric-onset chronic conditions, using cystic fibrosis (CF) as a model. Methods: We conducted a survey of United States and Canadian CF providers regarding their LGBTQIA+ health knowledge, attitudes, comfort, and practices from January-September 2024. We analyzed results descriptively and compared responses by key variables using chi-square tests. Results: Among 389 participants, 15% felt that there are only two genders and 6% reported discomfort working with LGBTQIA+ people based on personal beliefs. Nearly all (87%) agreed that asking about gender identity and sexual orientation is important to health care. Thirty percent felt unprepared to discuss concerns related to sexual orientation or gender identity, and 86% felt that they would be a better clinician if they had more training on supporting LGBTQIA+ people. Fifty-one percent reported asking their CF patients about their sexual orientation, 57% about their gender identity, and 73% about their affirmed name/pronouns. Forty-three percent of U.S. and 20% of Canadian respondents reported receiving training on supporting LGBTQIA+ people. Conclusion: CF providers valued addressing LGBTQIA+ health but lacked expertise, training, and resources to routinely do so. Future research should explore the experiences and health outcomes of LGBTQIA+ people with CF and develop needed provider education.
Purpose: We examined how sociodemographic, structural, and violence-related factors and disruptions in HIV services and gender-affirming care (GAC: nonmedical supplies, therapy/counseling, medications/hormones, surgeries) were associated with suicidal ideation and moderate/severe anxiety and depression symptoms among South African transgender people. Methods: In September–November 2021, surveyors sampled populations with high HIV risk to understand COVID-19 pandemic experiences. We analyzed sociodemographic, structural (housing, food, financial insecurities), and violence correlates of suicidal ideation and anxiety and depression symptoms. We estimated associations of disruptions in HIV services and GAC with suicidal ideation and anxiety and depression symptoms, adjusting for identified correlates. Additional analyses were stratified by HIV status and age (15–24, 25–30, >30). Results: Among 194 transgender people, 27% ( N = 190) reported suicidal ideation and 37% ( N = 178) reported anxiety and depression symptoms. Factors positively associated with suicidal ideation included living with disabilities, increasing educational attainment, unemployment, financial and housing insecurity, and emotional violence; social and structural vulnerabilities affected nearly all HIV and age strata. Correlates positively associated with moderate/severe anxiety and depression symptoms comprised age, housing insecurity, and economic violence. Disruptions in gender-affirming therapy/counseling, medications/hormones, and/or surgeries were positively associated with moderate/severe anxiety and depression symptoms (overall; people without HIV; aged 15–24, 25–30) and suicidal ideation (aged 15–24). In those reporting HIV service disruptions, suicidal ideation (overall, aged 15–24) and anxiety and depression symptoms (overall, aged 25–30) were higher. Conclusions: Social and structural inequalities were associated with suicidal ideation; GAC and HIV service disruptions were mostly associated with moderate/severe anxiety and depression symptoms. Improving transgender people’s mental health requires reducing inequalities while preserving care linkages and access.
Purpose: This study assessed the prevalence of unmet needs for gender-affirming surgery (GAS) and associated socioeconomic factors among transgender women and nonbinary individuals assigned male at birth in South Korea.Methods: A multicenter cross-sectional study was conducted using initial data from the Korean Initiative for Transgender Health study. It was conducted between January and October 2024 across eight medical institutions providing gender-affirming care in Korea. Transgender women and nonbinary individuals assigned male at birth (undergone or are currently undergoing hormone therapy) were included. Participants desiring but not undergoing GAS were classified as having unmet needs. Demographic and socioeconomic data were collected, and multivariable logistic regression identified factors associated with unmet needs.Results: Among 540 participants (median age 27 years), 81.5% identified as transgender women and 18.5% as nonbinary individuals. Overall, 29.8% had undergone at least one GAS, whereas 90.6% reported unmet surgical needs. The most desired procedures were vulvoplasty with or without vaginoplasty (75.0%), orchiectomy (61.7%), and facial feminization surgery (61.3%). Financial burden (80.3%) and social discrimination (34.1%) were the most common barriers. Participants with diverse sexual orientations had higher odds of unmet needs for orchiectomy (adjusted odds ratio [aOR] 2.77, 95% confidence interval [CI] 1.67-4.60) and genital surgery (aOR 2.41, 95% CI 1.47-3.96) than heterosexual participants.Conclusions: Korea's National Health Insurance, covering the entire population, excludes GAS, forcing patients to pay out-of-pocket and causing high unmet needs. Financial barriers and social discrimination appear to substantially limit access, highlighting the need for structural efforts to improve access to GAS.
