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Transgender individuals had significantly higher rates of suicide attempts and suicide mortality compared with non-transgender individuals, according to a population-based retrospective cohort study from Denmark.

Among over 6.6 million individuals, standardized suicide attempt rates per 100,000 person-years were 498 for those who were transgender compared with 71 per 100,000 person-years for those who were not transgender (adjusted incidence rate ratio [aIRR] 7.7, 95% CI 5.9-10.2), reported Annette Erlangsen, PhD, of the Danish Research Institute for Suicide Prevention at the Mental Health Centre Copenhagen, and co-authors.

Standardized suicide mortality rates per 100,000 person-years were 75 versus 21, respectively (aIRR 3.5, 95% CI 2.0-6.3), they noted in .

Transgender individuals also had higher rates of mortality not related to suicide (aIRR 1.9, 95% CI 1.6-2.2) and higher rates of all-cause mortality (aIRR 2.0, 95% CI 1.7-2.4) compared with non-transgender individuals.

Notably, rates of suicide attempts and mortality decreased over the study period (1980-2021), but rates of suicide attempts (aIRR 6.6, 95% CI 4.5-9.5) and suicide mortality (aIRR 2.8, 95% CI 1.3-5.9) remained significantly high between 2000 and 2021.

Erlangsen said that this is the first study to investigate rates of suicide attempts and mortality among transgender individuals on a national level in any country. "It's unfortunately not surprising that there is a higher frequency of suicide behavior among transgender individuals," she told MedPage Today. "We were already worried that was what we were going to find based on what has been conducted [in] other studies, but this was the first study where we could examine this in an entire nation."

These data will be crucial to moving the conversation about suicide and mental health for transgender individuals forward, she noted.

"We think that the data quality and the lack of selection bias make these findings a little bit more convincing than where we were beforehand," she said. "It's very important to have convincing evidence that transgender individuals are a high-risk group, because then we can take the next step and think about how we can try to prevent this."

Erlangsen emphasized that these findings are unique to Denmark and the data can't be generalized to other countries, but acknowledged there is enough research to suggest these rates would be similar in countries like the U.S.

"All the indications that we have point in that direction," she said.

The researchers analyzed data from a cohort of 6,657,456 Danish-born individuals who were at least 15 years old and lived in Denmark from January 1980 through December 2021. Half were assigned male sex at birth. They were followed over 171,023,873 person-years.

Of these individuals, 3,759 (52.5% assigned male at birth) were identified as transgender at a median age of 22. This was determined by national hospital records and administrative records of legal change of gender. Over 21,404 person-years, there were 92 suicide attempts, 12 suicides, and 245 suicide-unrelated deaths among this group.

Limitations included that the study results may not apply to individuals who have never received hospital care for gender identity-related issues or applied for a legal change of gender. Also, hospital codes used to identify transgender individuals carry descriptions that may be seen as stigmatizing, which may have reduced their use. Suicide attempts also tend to be under-recorded in Danish hospital records.

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