.jpg "Hannah Mitchell, BMBS MSc photo")
Hannah Mitchell, BMBS MSc
Critical Care Fellow
Evelina Children's Hospital
Philadelphia, Pennsylvania
Disclosure information not submitted.
Danielle Apple, BS
Clinical Research Coordinator
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Elle Lett, MA PhD
Junior Fellow, Center for Applied Transgender Studies
University Of Pennsylvania, United States
Disclosure information not submitted.
Nadia Dowshen, MD MSHP
Attending Physician - Adolescent Medicine
Children's Hospital of Philadelphia, United States
Disclosure information not submitted.
Nadir Yehya, MD, MSCE
Children's Hospital of Philadelphia
Cherry Hill, NJ
Disclosure information not submitted.
Title: Attempted suicide, suicidal ideation and self-harm in pediatric patients with gender dysphoria
Introduction: Many patients are cared for in the intensive care unit (ICU) following self-harm and attempted suicide. Transgender and gender non-conforming (TGNC) youth are at increased risk for suicide due to discrimination they face, with few epidemiological studies examining this relationship. We examined the relationship between hospitalization for suicidality, self-harm and gender dysphoria in a large, nationally representative database.
Methods: We used the 2016 Kids’ Inpatient Database to identify a subset of the TGNC youth < 21 years of age captured by the database (using ICD-10 gender dysphoria-related codes). We identified suicidal ideation or suicide attempt using either explicit “suicidality” codes, or one of 355 distinct self-harm codes. Using descriptive statistics, prevalence of suicidality and self-harm was compared between youth with and without gender dysphoria. A multivariable logistic regression model adjusting for individual, admission and hospital-level variables was constructed looking for association between gender dysphoria and suicidality.
Results: The cohort included 3,115,589 subjects < 21 years of age, of whom 1,980 (64 per 100,000 admissions) had gender dysphoria. Prevalence of suicidal ideation and suicide attempt in the entire cohort was 2%, compared to 35.3% in young people with gender dysphoria. Using the expanded definition of self-harm and attempted suicide, prevalence increased to 44.1%. After adjusting for individual, admission and hospital-level variables, subjects with gender dysphoria had 7.89 increased odds of attempted suicide or suicidal ideation (95% CI: 7.09-8.79).
Conclusions: Using a large and representative database we found significantly higher prevalence of suicide attempt and self-harm in a population of presumed TGNC youth. This suggests an association between the transphobic discrimination and stigma that TGNC youth experience and negative health outcomes. Concurrent with structural interventions to support gender affirming care and reduce discrimination on a societal level, inclusive and affirming care and language in the ICU is essential to reduce psychological stress secondary to physician-mediated interpersonal discrimination. ICU physicians caring for these vulnerable young people should strive to create an environment where youth feel safe and supported.