Lethal Means and Precipitating Circumstances in Transgender Youth Suicide Mortality

Abstract

Purpose: Transgender youth experience disproportionately high rates of suicidality, yet little is known about suicide mortality in this population. We characterized suicide lethal methods and precipitating circumstances among transgender youth and compared these factors with matched youth decedents not identified as transgender. Methods: This secondary analysis used National Violent Death Reporting System data from 2003 to 2021. The sample included suicide decedents aged 10–24 years identified as transgender ( n = 384) and matched decedents not identified as transgender ( n = 1119). Multinomial and logistic regression models examined differences in lethal means and precipitating circumstances by transgender status. Results: The sample included 1503 decedents (mean [standard deviation] age, 18.97 [3.40] years; 78.3% White). Among transgender youth, the most common suicide methods were hanging, strangulation, or suffocation (49.2%), firearm (24.0%), and drug or poison ingestion (18.2%). Compared with decedents not identified as transgender, transgender youth had higher odds of suicide by drug or poison ingestion, hanging, strangulation, or suffocation, and other methods relative to firearm suicide. Transgender youth also had higher odds of multiple mental health diagnoses, prior suicide attempts, child abuse, and disclosure of suicidal intent to a health care worker. Conclusion: Transgender youth who died by suicide had distinct patterns of lethal methods and precipitating circumstances, including greater mental health burden and lower likelihood of firearm suicide. These findings highlight the need for tailored suicide prevention strategies and improved gender identity ascertainment in mortality surveillance systems.