Suicidal Ideations and Behavior among Transgender (Systematic Review)

In the last decade, the number of researches focused on the mental health of sexual minorities has increased. In this study, sexual minority refers to people who have problems with their sexual identity. Gender identity means the internal perception of oneself as male or female or bisexual: this concept should not be considered as a binary; Gender identity can cover a spectrum from masculinity to femininity. In addition, a person may not identify himself as a woman or a man. The development of sexual identity in this minority is a complex process, people in this group experience many discriminations, restrictions and hostility in the society. People in this minority are exposed to isolation, violence, sometimes from the family and sometimes from peers, sometimes from the society, they are exposed to many stigmas and they are exposed to annoying behaviors from the society.Transgender people often face various manifestations of discrimination, including violence and harassment, occupational and job discrimination and even discrimination in receiving health care services, therefore, it is not surprising that transgender people experience a high level of psychological distress. Minority stress theory, which is a social theory, states that stress that is rooted in the experience of discrimination and social stigmas can endanger mental well-being, according to this theory, inequality that sexual minority people experience has many unpleasant psychological consequences, one of which is suicide attempt. Research confirms that these people are more likely to commit suicide, have clinical conditions such as depression and anxiety, or tend to use drugs more than normal sex groups.Suicide, suicidal thoughts, suicide planning, self-harm and attempted suicide are among the main issues in public health that can be prevented. Suicide is a complex phenomenon. A phenomenon that is influenced by various personal, social, and environmental factors at different stages of a person's life. Psychiatric disorders, history of abuse in childhood have a significant impact on suicide attempts. The findings show that the possibility of committing suicide among sexual minority people is more than other groups of society. According to the World Health Organization, belonging to a sexual minority group is itself a cause of suicide. Statistics show that people in the sexual minority group are 1.5 to 2 times more prone to suicide, self-mutilation and depression than other people.

In order to access studies related to the purpose of the study, in domestic databases (SID, ISC, Noormags, Magiran, IranMedex and Irandoc) and international databases (Google-Scholar, Medline, PubMed, Elsevier, ProQuest, Springer) using related keywords. , was searched between 2012 and 2022. Finally, after applying the inclusion and exclusion criteria, 15 studies were finally selected. The following keywords were used to search for articles: a term that refers to trans people (trans-sexual, transgender, gender dissatisfaction, disorder gender identity, trans), terms that examine self-injurious behavior (self-mutilation, self-mutilation, non-suicidal self-mutilation) and to examine suicide from the keywords (suicide, suicide, suicidal thoughts, attempted suicide and mortality) has been used. Transgender terms along with the prepositions "and" and "or" were searched with the words suicide and self-mutilation. The articles used included researches that investigated the prevalence of suicide and self-harming behaviors in the transgender community. In addition, researches that investigated the potential factors that could lead to suicide and self-mutilation in transgender people are included in this research. Among the inclusion criteria, it is possible to mention the selection of only original research studies that were published in English. Also, only studies were selected where the diagnosis of gender phobia was made by a mental health specialist (psychiatrist-clinical psychologist). Published studies were selected only if their journals were double-blind peer review. Also, only studies published after 2012 were selected. Also, the exclusion of other articles such as reviews, case studies, and books, exclusion of studies before 2012, and non-use of an expert in transgender diagnosis were among the most important exclusion criteria. A total of 80 articles on this topic were found and duplicates were removed. The remaining abstracts were reviewed considering the inclusion and exclusion criteria and irrelevant ones were removed. The full text of the articles was reviewed by two authors separately. Finally, 15 studies were found to be eligible for inclusion in the review.

In the studies that were reviewed in this research, a high prevalence of self-harming behavior among sexually bored people is confirmed. This behavior has been more in transgender men compared to people of the same gender. This finding can be assumed that the gender they were born with at birth, i.e. the female phenotype, plays a role in the way people face their feelings and resolve them. This finding is in line with researches that have shown that the possibility of self-harming behavior is higher in same-gender women than in transgender women. Despite gender differences, the rate of engaging in self-harming behavior is higher among transgender people than people of the same gender. This issue itself indicates an inconsistent way of coping in transgender people. According to the reviewed researches, this is also the case in suicide. Studies have shown that the rate of suicide attempts, suicidal thoughts and the prevalence of suicide in transgender people even after gender reassignment surgery is higher compared to people of the same gender. Researches that have been reviewed show that the amount of self-harming behavior decreases after the process of gender adjustment. The findings of this research confirm a strong correlation between being transgender and committing suicide and self-mutilation. Most of these people, rather than committing self-harm and suicide with the intention of dying, use it as an incompatible coping method in response to problems, but it exposes them to death. The findings can indicate the vulnerability of transgender people to mental health problems. The increase in the suicide rate in the trans population with increasing age can be related to the lack of social support, feelings of loneliness, being a victim of violence and discrimination. These factors also lead to a decrease in the quality of life of transgender people.

From this research review, it can be concluded that transgender people are at a higher risk of committing suicide and self-harmful behavior than people of the same gender. It seems necessary that in the future researches, this issue should be addressed more on how effective treatment measures can be taken to reduce risk behaviors and improve social support in these people. Therefore, mental health professionals who are in contact with these people need the necessary training to prevent suicide. For this reason, it seems that interventions that lead to an increase in social support and teach interpersonal skills to these people can be effective in reducing self-injurious behavior. For example, among trans people, families understand their child's gender identity less and accept the gender adjustment process. For some trans people, the desire to transition can lead to a complete disconnection with the family. On the other hand, the family's non-acceptance can prevent transgender people from exploring their identity. These things can lead to the experience of depression. It seems that therapeutic actions on the family of transgender people can increase the social support that people need. This process itself can lead to the improvement of the mental health of transgender people. Some interventions can also lead transgender people to learn more adaptive ways of coping.