Experts analyze the connection between gender dysphoria-related diagnostic coding and suicidality

Experts analyze the connection between gender dysphoria-related diagnostic coding and suicidality

According to a study published in The Lancet Child & Adolescent Health, among hospitalized young people in the United States in 2019, 66% of those with gender dysphoria were admitted for suicide attempts or self-harm, compared to 5% without gender dysphoria.

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

Transgender and non-binary young people experience discrimination, which has been linked to suicidal thoughts or attempts and self-harm in previous studies examining outpatients, 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 attempted suicide and self-harm.

Unfortunately, our study confirms existing evidence that suicide and self-harm attempts are more common among transgender or non-binary young people. To help this vulnerable group and prevent negative consequences, we must reduce discrimination. As healthcare providers, we have a unique opportunity to do this by providing more gender-appropriate care to these children when hospitalized. This includes addressing patients with their affirmative names and pronouns, linking them to gender-affirming medical and social support services, and implementing targeted aftercare offers for self-harm.”

Dr. Nadir Yehya, Children's Hospital of Philadelphia

The study used the nationally representative Kids' Inpatient Database (KID) in the most recent two years available, 2016 and 2019. It included 80% of all pediatric discharges in the U.S., representing over 3 million patients in both years. To identify transgender or non-binary youth, the authors looked for patients who had been diagnosed with gender dysphoria or another label that referred to gender dysphoria. They then estimated the number of children hospitalized for suicide attempts, self-harm, and a combination of suicide attempts and self-harm, and compared the rates among young people with and without gender dysphoria. In addition, they examined differences in the prevalence of gender dysphoria by certain characteristics, including race, type of health insurance, and median income in the patient's area of ​​residence.

In both 2016 (36% vs. 5%) and 2019 (55% vs. 4%), young people hospitalized with gender dysphoria had a higher prevalence of suicide attempts than those without gender dysphoria. Similarly, the prevalence of self-harm among hospitalized young people with gender dysphoria was higher in both years (13% versus 1% in 2016 and 15% versus 1% in 2019).

Looking at the two together, young people with gender dysphoria were four to five times more likely to self-harm or attempt suicide in hospital than young people without gender dysphoria. In 2016, 41% of young people hospitalized with gender dysphoria experienced suicide attempts or self-harm, compared to 6% without; In 2019, this rose to 66%, up from 5%. See Table 1 for the number of people.

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

Young people who were black, Hispanic, Latino, or other ethnic and racial minorities, had public insurance, or came from low-income households were less likely to be diagnosed with gender dysphoria. The authors say this doesn't necessarily mean gender dysphoria is less common among these groups. This may reflect inequities in access to gender-affirming care or increased discrimination in certain settings, making young people from economically disadvantaged or ethnic minority backgrounds less likely to be diagnosed.

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

The authors point out some limitations to their study. It relied on formal diagnoses of gender dysphoria to identify transgender and non-binary youth, which may have biased the estimates in various ways. For example, not all transgender and non-binary young people experience gender dysphoria, which may have led to an underestimation of the size of this group. Additionally, some transgender and non-binary youth may not receive a formal diagnosis of gender dysphoria due to a lack of access to a provider who would make the diagnosis. Nonetheless, 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 previously reported high rates of suicidal ideation among transgender and non-binary young people.

Source:

The lancet

Reference:

Mitchell, H.K., et al. (2022) Prevalence of gender dysphoria and suicidality and self-harm in a national database of US pediatric inpatients: a population-based, serial, cross-sectional study. The Lancet Child and Adolescent Health. doi.org/10.1016/S2352-4642(22)00280-2.

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