Australian study finds rate of trans young people who have ever attempted suicide of 48%

[CaptainWarbeck]

I've seen on here discussions of the trans attempted suicide rate being over estimated and from dodgy statistics.

This study (Australian research) has found a rate of 48% ever having attempted suicide, n=739, so a large study.

Pic of relevant page in report and link here.

They also found ASD over represented in the trans population they looked at.

Thoughts? Any academically minded MNetters take a look?

[IWearPurple]

This was an online survey of "Australian trans people" aged 14-25 years. The definition of trans used appears to be quite wide: "Trans is an umbrella term that includes specific gender identities, such as trans woman, trans man, genderqueer, non-binary, genderfluid or simply male or female." So it is not clear what "trans" actually means in the context of this research.

The survey selected its participants through the following methods: " The Trans Pathways online questionnaire was promoted widely through social media (namely Facebook, Twitter and Tumblr), queer departments at universities, trans and LGBTIQ support groups, parent support groups, peer-led safe spaces, various trans rights organisations in Australia, medical and mental health services, radio and by word of mouth." This means that the survey participants are a self-selected and therefore biased sample. It is not stated how the researchers prevented participants from answering the questionnaire more than once.

The report says that 859 "trans" (by the definition used in the survey) responded. The Australian Bureau of Statistics estimates that there are almost 3.82 million people aged between 14 and 25 years. The participants therefore represent 859/3815581 = 0.02% of that age range.

The participants were not balanced with respect to sex, 74% were female and 26% were male. Interestingly, while only 1.6% identified as intersex, 21% were "not sure if they are intersex".

70% reported a current diagnosis of depression, 55% reported a current diagnosis of anxiety, 11% were currently diagnosed with PTSD, 9% were currently diagnosed with a personality disorder (an interesting finding given that 20% had ever been diagnosed with a personality disorder and personality disorders don't tend to disappear), 3% had a current diagnosis of psychosis, 6% had a current eating disorder, and 23% had a current diagnosis of an autism spectrum disorder. 48% had ever been diagnosed with gender dysphoria.

48% had tried suicide, 82% reported ever having suicidal thoughts, and 91% had wanted to self harm. These results are not surprising given their negative life experiences. Suicide attempts were particularly associated with issues with accommodation (such as homelessness), experiencing school, university, or TAFE issues (not specified), experiencing bullying, experiencing neglect or been verbally or emotionally abused by a family member, physical abuse by a family member, physical abuse by someone outside of the family, sexual abuse by someone outside of the family.

With the parent respondents (separate sample) this finding is striking: "The mean age at which parents realised their young person was trans was 11 years of age. The minimum youngest age was 18 months and the maximum oldest age was 24 years old."

[ItsAllGoingToBeFine]

[WhatWouldGenghisDo]

These rates of self-reported past suicide attempts are consistent with those found by other studies using a similar methodology. The main problem with all these studies is that the methodology is weak.

There's no control group, so it's impossible to say whether these rates are really different to rates among young people generally. It's worth noting that there's no evidence of elevated rates of completed suicide among gnc and trans youth, in the uk at least.

The study is cross-sectional, which means the direction of causality can't be established. This means we can't tell the difference between 3 broad possibilities:

1. being trans causes people to be suicidal (this is the transactivist narrative, I.e. that a hostile environment drives trans people to suicidality)
   
   
2. being distressed and suicidal causes people to become trans. E.g. transitioning might appear to be a way of becoming a completely new person and leaving all your existing problems behind at a time when you are feeling as though you can't live with your existing self
   
   
3. suicidality and being trans are independently caused by some other factor. E.g. a sexual abuse history might cause you to feel repulsed by your body as well as depressed and suicidal
   
   Or most likely there are a mixture of things going on which require completely different approaches and interventions. Cross-sectional retrospective studies of this type won't help us to tease these apart.
   
   Finally, these samples tend to include a mix of people at different stages of social and/or medical transition. Lumping them all in together means we actually have no idea whether either form of transition helps, makes no difference, or makes things worse.
   
   This is important. We need much, much higher quality research.

[WhatWouldGenghisDo]

Sorry, I meant to say that's all in addition to the problems identified by IWearPurple

[CaptainWarbeck]

I knew MN would be good for this.

Thank you both for looking at it and explaining your thoughts.

At one point in the report the authors compare rates of mental health issues to a big study of young people generally (and not surprisingly, trans rates of suicide attempts are much much higher, as with many other issues) - but if the participants are self selected for the LGBTQI study and a different method of recruitment used for the other, that makes comparison less valid, doesn't it? As in, likely to be higher but possibly not actually quite that high?

[LangCleg]

I agree that the methodology is so flawed as to make the statistics unreliable - self-selection, no account taken of co-morbidities or other social pressures.

It should be noted that reported rates are pretty much the same when similar studies with similar methodologies are done for lesbian and gay youth. And the Telegraph recently reported on youth suicide being related to exam stresses here:

www.telegraph.co.uk/education/2017/07/13/youth-suicide-surges-run-up-exam-season-report-finds/

And, as ever, the usual caveats about valorising suicide and suicidal ideation possibly causing contagion, as per Samaritans reporting guidelines.

That said, suicide among the under-25s is rising and we have to take into account all possible causes, very much including transgender identification.

[pisacake]

I think we would need to see the actual suicide rate, not just attempts.

Also if these figures are accurate, it doesn't give us too much information about how we should respond. E.g., with hormones and castration, or with counselling.

[JessicaEccles]

The minimum youngest age was 18 months

I'm sorry - but how could this submission even be taken seriously? This is the trouble with self-reported surveys- no follow up questions, no investigation into what the person means by 'trans' or how this is demonstrated.

[PaintingByNumbers]

Link to asd as always
To my mind, there is a lot of exploitation of a vulnerable group happening here

[MrGHardy]

Causality. Why does no one understand what that means. Even people who use the word often don't.

[cromeyellow0]

As WhatWouldGenghisDo points out, the survey is useless because there's no sample of any defined population.

It's much inferior to the Minnesota survey which allows systematic comparison between trans and others:
www.ncbi.nlm.nih.gov/pubmed/28736148

Of course it still can't identify causation.

The very broad definition of trans reflects the bewildering proliferation of gender identities in recent years. Ideally one would ask girls whether they bind and boys whether they tuck--that would sort our the sheep (those contemplating transition) from the goats (transtrenders).

[FizzyWaterAndElderflower]

48% had tried suicide, 82% reported ever having suicidal thoughts, and 91% had wanted to self harm. These results are not surprising given their negative life experiences. Suicide attempts were particularly associated with issues with accommodation (such as homelessness), experiencing school, university, or TAFE issues (not specified), experiencing bullying, experiencing neglect or been verbally or emotionally abused by a family member, physical abuse by a family member, physical abuse by someone outside of the family, sexual abuse by someone outside of the family.

If they matched non-trans people according to this history, I wonder if results would be significantly different. I also wonder that the correlation between trauma and trans - particularly when it comes to TIFs, and it's certainly not discounted by this survey.

I also note that in the parents portion, only 23% of parents reported a suicide attempt.

[MyVisionsComeFromSoup]

also, there are different "levels" of suicide attempt - there's the ones who do actually want to do it, there's the ones who are very vocal but take three paracetamol, there's the ones who are already self harming with blades and don't really mean it/do really mean it. There's also the "don't care what happens to me" risky behaviour which could be classified as an attempt depending on your viewpoint.

Was there an actual definition of what a suicide attempt was, or was that also self defined? IME of teenagers, their views and definitions can and do change daily, and if you add in mental health issues etc, I'm convinced you could get a totally different result on a different week.

However, that's still a horrendous level of very unhappy young people .

[pilatesofthecaribbean]

::adds to applause for IWearPurple and WhatWouldGenghisDo

[BlindYeo]

Yes Myvisions I was also going to ask how the suicide attempts were counted. Medical/police records or self-report?

I also think a self-selected sample could be very biased. I think of the people on health forums I have frequented, where by the nature of illness, the people most unwell are posting frequently while those doing well are off living their lives.

[Datun]

Are these suicide attempts ever verified? If the person was admitted to hospital, are the records checked, for instance?

Because if not, all it demonstrates is that 48% of people say something.

[cromeyellow0]

Are these suicide attempts ever verified? If the person was admitted to hospital, are the records checked, for instance?

All such surveys are based on self-reports and so will exaggerate the levels. When you ask respondents whether they were hospitalised, far fewer say yes. I've not seen any study of adolescents where they matched self-report in a survey to hospital records; confidentiality would make this almost impossible.

[Datun]

When you ask respondents whether they were hospitalised, far fewer say yes.

Maybe that should always be an included question, in that case.

Otherwise I can’t see how anyone can reliably form a conclusion about suicide at all, in general.

[Gingernaut]

What control did they use?

Did the sample 'normal' 14-25 year olds to determine their rates of self harm and attempted suicide?

Did they look at the average suicide/self harm/attempted suicide rate for that age group?

Studying one group in isolation, with no reference to the rest of the population is very poor science.

[hackmum]

I also applaud Genghis and Purple. It's a dreadful abuse of statistics. I think perhaps the most important of the flaws identified is the lack of a control group. Suppose you conducted the survey in exactly the same way amongst an ordinary group of 14-25 year old Australians. If we don't know how many would claim to have attempted suicide in that group the results are meaningless.

[ArbitraryName]

I agree. Much better research is needed, particularly to explore whether vulnerable young people with mental health and social problems in their lives are particularly drawn to transgender as a means of self-managing, or whether the issues result from being trans. My wager would be on the former but it is something that research needs to be very carefully designed to explore.

There is a huge issue of suicide ideation and the effects of a very dominant narrative that you be trans is to feel suicidal. That will have an effect on participants in a study like this.

[Datun]

In any case they can’t have it both ways. Either trans children have a high risk of suicide and need treatment, or it’s not a treatable illness. Which one is it?

[OneFlewOverTheDodosNest]

I don't understand why reported suicidality is supposed to mean that trans people should get what they demand.

First off, threats of suicide are usually treated with caution because of the known potential for manipulation, but secondly if someone is suicidal then it is quite probable they do not understand what is best for themselves anyway.

[Datun]

Because they cite the non-acceptance of trans-people as the reason for suicidal thoughts.

Frankly, I have never understood the premise.

It’s mostly trans who are prostitutes who are abused and harmed.

I can’t see how, even if the entire world says they are women, it would make any difference.

Punters are going to kill. Finding out someone is a man at the last minute might induce rage. So I don’t see how it’s helpful to pretend otherwise.

[hackmum]

OneFlew: "First off, threats of suicide are usually treated with caution because of the known potential for manipulation, but secondly if someone is suicidal then it is quite probable they do not understand what is best for themselves anyway."

Yup. This person feels suicidal, and is asking to have surgery to remove their genitalia and receive hormones to change their appearance. Clearly, the best thing to do in this situation is to accede to their request...