Transgender, nonbinary and gender-diverse people attempt suicide more often than the cisgender population, and research often stops at recording that fact. A team from the Fenway Institute (Boston), the University of Michigan, Harvard, the University of California San Francisco and the Callen-Lorde centre in New York asked the next question: which specific circumstances accompany that risk, and which of them can be changed? Their answer, published in Psychiatry Research with 2,131 primary care patients, points to the intensity of gender dysphoria, to violence suffered in childhood and to structural factors — health insurance, housing — ahead of any trait of identity itself.
Two urban clinics and 2,131 surveys
The study is cross-sectional: an electronic survey was offered to transgender, nonbinary and gender-diverse patients receiving care at two urban health centres in the United States, one in Boston and one in New York. A total of 2,131 people responded, with a median age of 28 years; 29.2% reported a non-White racial identity and 30.8% identified as nonbinary. The questionnaire covered demographics, gendered context, social determinants, interpersonal violence, mental health and protective factors.
The authors analysed two outcomes separately: ever having attempted suicide in one’s lifetime, and having attempted it in the past six months. Associations were estimated with log-Poisson models using generalised estimating equations, which yield adjusted risk ratios rather than simple comparisons.
30.8% had attempted suicide at some point
Three in ten participants (30.8%) reported at least one suicide attempt over their lifetime, and 2.5% had attempted it in the six months before the survey. Those figures are far above those of the general population, and the work does not stop there: it looks for what is associated with each of the two outcomes.
Lifetime suicide attempt was associated with higher gender dysphoria, childhood physical and sexual violence, lifetime intimate partner violence, and mild or severe depression and anxiety symptoms, with adjusted risk ratios ranging from 1.19 to 2.12. In the analysis of the past six months the emphasis shifts: high gender dysphoria, lack of health insurance, recent homelessness, childhood sexual violence and severe depression or anxiety symptoms emerge, with adjusted risk ratios of 2.12 to 4.22. Structural factors therefore weigh more heavily in recent risk.
What protects
The study found two factors associated with lower lifetime attempt risk: being between 31 and 40 years old and holding a university degree. The authors read the whole picture as a mix of situated vulnerabilities — what surrounds a person and what they have lived through — and resources, and conclude that reducing suicide risk in this population requires addressing childhood trauma and current structural deprivation, not only the psychological distress of the moment.
What this study cannot say
The design is cross-sectional, so it describes associations rather than causes: it cannot establish what came first. The data are self-reported, with the recall bias that implies, and suicide attempt is asked about rather than clinically recorded. The sample comes from two urban centres with a population largely connected to the health system, which leaves out those who never reach a clinic and much of rural America. One third of participants were nonbinary, a profile under-represented in other studies, but the sample size does not allow precise breakdown of every subgroup. Nor are there data on suicide mortality, which is a different outcome from an attempt.
Why it matters in gender dysphoria
Gender dysphoria emerges as a strong correlate of risk, which reinforces a simple clinical idea: easing distress linked to identity is part of prevention. But the study also shifts the focus outside the consulting room. Lack of health insurance and loss of housing are variables that concrete policies can modify, and childhood violence will appear in the clinical history of many of these patients. For those caring for transgender patients, the operational message is to ask about previous attempts, about housing and about health coverage, and not only about depression symptoms.
Source: Situated vulnerabilities and resiliencies associated with lifetime and past 6-month suicide attempt among transgender and gender diverse primary care patients. Pletta DR, Quint M, Keuroghlian AS, Radix AE, Deutsch MB, Mayer KH, Potter J, Pardee DJ, Campbell J, Hughto JMW, Reisner SL. Psychiatry Research 2026;364:117350. DOI: 10.1016/j.psychres.2026.117350.
Article published in dosier.es. Image generated with artificial intelligence (marta ai → marta.syf.es).
