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Rachael Zimlich is a freelance writer in Cleveland, Ohio. She writes regularly for Contemporary Pediatrics, Managed Healthcare Executive, and Medical Economics.
The teenaged years are difficult across the board, but a report highlights the additional challenges for lesbian, gay, bisexual, transgender (LGBT) adolescents and calls to attention their increased risk for suicide attempts.
Suicide is already a leading cause of death among all teenagers, but a recent study reveals just how much higher the risk is for those in the sexual minorities. The new report, published in JAMA Pediatrics, reveals that lesbian, gay, bisexual, transgender (LGBT) youth in general are 3 times more likely to make a suicide attempt than other teenagers, and the rate is highest among transgender adolescents-6 times that of their heterosexual peers.1
Ester di Giacomo, MD, a researcher in the Forensic Psychiatry Department at the University of Milano-Bicocca, Monza, Italy, and lead author of the report, says the problem is rooted in issues with self-acceptance because of how these young persons are seen by their peers.
Suicide is the second-leading cause of death among individuals aged 10 to 34 years-claiming more than 13,000 lives in this age group each year, according to the Centers for Disease Control and Prevention (CDC).2 Di Giacomo’s study sought to investigate whether sexual minority adolescents make up a larger piece of this population. The research team reviewed 35 studies involving more than 2 million heterosexual and 113,000 sexual minority youth aged 12 to 20 years from 10 countries and found a significantly higher risk of life-threatening behaviors in the sexual minority youth compared with their peers.
Sexual minority teenagers were found overall to be 3.5 times more likely to attempt suicide when compared with heterosexual teenagers, followed by bisexual youth, and 3.69 more likely to attempt suicide. Gay and lesbian adolescents were 3.71 more likely to try to take their own lives, and transgender teenagers carried the greatest risk at 5.87 times more likely to attempt suicide than heterosexual peers, according to the report.
Di Giacomo says these figures are not surprising to those in clinical practice but adds that this is one of the first unbiased evaluations of data that shows the real context of this phenomenon. The hope is that the report will help increase awareness of the problem and promote meaningful intervention.
How pediatricians can help
“Support toward self-acceptance and inclusion could be the key to help these youths,” di Giacomo says. “I think pediatricians can offer support and a timely referral to a child psychiatrist in cases of difficulty in self-acceptance or bullying.” She says increased education and intervention could help reduce the stigma for these teenagers and promote acceptance and inclusion.
The American Academy of Pediatrics (AAP) is working to do its part in promoting care for gender-diverse patients, releasing a policy statement with best practices for this population earlier this year.3 The policy statement includes a number of recommendations concerning medical care, psychosocial considerations, and family and community support for gender-diverse teenagers.
The AAP’s guidance, developed in part by Jason Rafferty, MD, MPH, EdM, a pediatrician and child psychiatrist who practices at the gender and sexuality clinic and at the adolescent health center at Hasbro Children’s Hospital, Providence, Rhode Island, revealed that gender diversity is more common than previously thought, with 0.7% of young persons aged 13 to 17 years identifying as transgender.
Similar to di Giacomo’s report, the policy statement also suggests higher rates of suicide attempts and ideation in this population, with 56% of transgender youth endorsing suicidal ideation and 31% reporting suicide attempts. Rafferty says that although mental illness is not directly related to gender diversity, these teenagers face a lot of internal conflict and limited access to healthcare providers who are able to support the problems faced by adolescents with gender differences.
The policy statement recommends comprehensive, gender-affirming, and developmentally appropriate healthcare for gender-diverse teenagers; family therapy; respect for gender identity in health records; appropriate insurance coverage for gender-diverse patients; provider education and training; and community support to promote acceptance of these teenagers. The policy was crafted to reflect recommendations made by the American Psychological Association.4
1. Di Giacomo E, Krausz M, Colmegna F, et al. Estimating the risk of attempted suicide among sexual minority youths: a systematic review and meta-analysis. JAMA Pediatr. 2018;172(12):1145-1152.
2. Centers for Disease Control and Prevention. 10 leading causes of death by age group, United States_2016. Available at: https://www.cdc.gov/injury/wisqars/pdf/leading_causes_of_death_by_age_group_2016-508.pdf. Accessed December 4, 2018.
3. Rafferty J; Committee on Psychosocial Aspects of Child and Family Health; Committee on Adolescence; Section on Lesbian, Gay, Bisexual, and Transgender Health and Wellness. Ensuring comprehensive care and support for transgender and gender-diverse children and adolescents. Pediatrics. 2018; 142(4):e20182162.
4. American Psychological Association. Guidelines for psychological practice with transgender and gender nonconforming people. Available at: https://www.apa.org/practice/guidelines/transgender.pdf. Accessed December 4, 2018.