by Debra Baty
Photo by Pixabay
A study entitled “All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study”1 was posted online on February 17, 2024. It revealed, thankfully, that suicide rates among those who report gender dysphoria are low, and, according to the Society for Evidence Based Gender Medicine (SEGM), there was “no evidence of benefits of gender reassignment” among this population.2
The study covered a 25 year span, focusing on those under the age of 23:
The study found that suicide among young people <23 ("youth") seeking gender services in Finland is an unusual event (0.3%, or 0.51 per 1,000 person-years). Further, in comparing gender-referred youth to a cohort of matched controls (n=16,643), the study found no convincing evidence that gender-referred youth have statistically significantly higher suicide rates as compared to the general population, after controlling for psychiatric needs. The study also did not detect a statistically significant association between gender reassignment and the risk of suicide. The study did, however, find a statistically significant relationship between a high rate of co-occurring mental health difficulties and increased suicide. The authors concluded that "it is of utmost importance to identify and appropriately treat mental disorders in adolescents experiencing GD [gender dysphoria] to prevent suicide, while also noting that "the risk of suicide-related to transgender identity and/or GD per se may have been overestimated."
SEGM does a good job of outlining the strengths and weaknesses of this particular study, and shared the following in their summary:3
The results of the study should be interpreted in the context of the unique characteristics of Finland's transgender-identifying population (e.g., the reportedly low rates of substance use in Finland, in contrast to the high reported rate in the US), Finland's recent strides in having significantly reduced suicide rates in the country overall, and Finland's unique, high-quality healthcare system, which contributes to superior health outcomes for the Finnish population. At the same time, several important aspects of the Finnish results are nonetheless likely generalizable to other Western countries, as the trend of high numbers of young people presenting to specialty services with a wish to medicalize their recent-onset transgender identity appears to be ubiquitous in the West.
The recent Finnish study confirms the earlier finding from the UK that suicides remain uncommon events in gender-dysphoric youth, regardless of gender transition status. It also confirms the finding from an earlier international study on suicidality (a related concept) that while the frequency of such events is elevated in gender-dysphoric young people compared with the general population of youth, it is comparable to youth referred for other mental health problems but not gender dysphoria. The Finnish study's results suggest that the clinical management of gender-dysphoric young people should focus on the management of comorbid psychiatric conditions, which are a well-known risk factor for suicides. This conclusion is consistent with prior research, which consistently shows that psychiatric comorbidities are highly prevalent in gender-dysphoric youth, typically predating the diagnosis of gender dysphoria.
The UK study linked to above revealed that even those whose care was delayed by lengthy wait times were not at higher risk of suicide. Once again, the co-morbidities of depression, anxiety, etc. which commonly are noted before being diagnosed (or self-assessed) with gender dysphoria, should be addressed.
Professor Louis Appleby is a psychiatrist who leads the National Suicide Prevention Strategy for England.
In March of this year he posted on X:
Children with gender distress may face bullying, isolation & family conflict, reasons to be alert to suicide risk. Empathic support is vital but evidence that puberty blockers reduce risk is weak & unreliable. Invoking suicide in this debate is mistaken & potentially harmful. (March 12)
We need to see an end to that line about choosing a living daughter or dead son. It is not based on evidence. May add to distress in young people & mislead worried parents. Deeply insensitive to 200 families/yr to whom the suicide of a teenager is more than a slogan. (March 13)4
This is good news, and hopefully will help those in need find the right care, addressing their core needs without being pressured into introducing medications, cross-sex hormones, or undergoing surgery that results in permanent changes to their bodies.
[1] Ruuska S, Tuisku K, Holttinen T, et al, All-cause and suicide mortalities among adolescents and young adults who contacted specialised gender identity services in Finland in 1996–2019: a register study BMJ Ment Health 2024;27:e300940. https://mentalhealth.bmj.com/content/27/1/e300940
[2] https://segm.org/Suicide-Gender-Dysphoric-Adolescent-Young-Adult-Finland-2024
[3] Ibid.
[4] louis Appleby @ProfLAppleby
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