• Norik Kirakosian, Amelia M Stanton, Samantha M McKetchnie, Dana King, Brett Dolotina, Conall O'Cleirigh, Chris Grasso, Jennifer Potter, Kenneth H Mayer, and Abigail W Batchelder.
• Department of Psychology, University of Miami, Coral Gables, FL, USA.
• J Gen Intern Med. 2023 May 1; 38 (6): 135713651357-1365.

BackgroundTransgender and gender diverse (TGD) individuals experience more severe psychological distress and may be at higher risk for suicide compared to cisgender individuals. The existing literature largely consists of small-sample studies that do not assess subgroup differences.ObjectiveTo examine rates of self-reported suicidal ideation among four TGD groups compared to cisgender individuals.DesignData were extracted from the electronic health records of patients receiving primary care at a community health center specializing in sexual and gender minority health. A logistic regression was used to examine the relationship between sociodemographic variables and the presence of current suicidal ideation.Participants29,988 patients receiving care at a community health center in Northeastern US between 2015 and 2018.Main MeasuresDemographic questionnaire, 9-item Patient Health Questionnaire KEY RESULTS: Younger age, sexual and gender minority identity, and public/grants-based insurance were associated with significantly higher odds of suicidal ideation. Relative to cisgender men, transgender men (OR=2.08; 95% CI=1.29-3.36; p=.003), transgender women (OR=3.08; 95% CI=2.05-4.63; p<.001), nonbinary (NB) individuals assigned male at birth (AMAB; OR=3.55; 95% CI=1.86-6.77; p<001), and NB individuals assigned female at birth (AFAB; OR=2.49; 95% CI=1.52-4.07; p<001) all endorsed significantly higher odds of current suicidal ideation, controlling for age, race, ethnicity, sexual orientation, and insurance status. Larger proportions of transgender women (23.6%) and NB AMAB individuals (26.7%) reported suicidal ideation not only compared to cisgender men (6.1%) and women (6.6%), but also compared to transgender men (17.4%; χ2[5, n=25,959]=906.454, p<0.001).ConclusionsTGD patients were at significantly increased risk of suicidal ideation, even after accounting for age, race, ethnicity, sexual orientation, and insurance status. Findings suggest distinct risk profiles by assigned sex at birth. Consistent assessment of and intervention for suicidal ideation should be prioritized in settings that serve TGD patients.© 2023. The Author(s), under exclusive licence to Society of General Internal Medicine.

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