Emergency department screening identifies suicide risk in nearly 80% of transgender and gender diverse youth

Transgender and gender diverse (TGD) youth are more than five times more likely to test positive for suicide risk compared to cisgender women, who tend to test positive at higher rates than cisgender men, according to a study from Ann & Robert H. Lurie Children’s Hospital of Chicago published in the journal Academic pediatricsIn 78% of TGD youth screened at the Emergency Department (ED) between November 2019 and August 2022, suicide risk was identified. One in four TGD youth had active suicidal thoughts.

“Our study found an increased risk of suicide among transgender and gender-diverse youth, even among patients who presented to the ED for reasons other than mental health concerns,” said lead author Amanda Burnside, Ph.D., a child psychologist at Lurie Children’s and assistant professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. “Our findings underscore the importance of suicide screening for all youth coming to the hospital so we can intervene and connect them with appropriate services.”

Dr. Burnside and colleagues found that among TGD youth presenting to the ED for reasons unrelated to mental health, one in three patients tested positive for suicide risk and one in fifty had active suicidal ideation.

Suicide is a leading cause of death among young people aged 10 to 24, and the suicide rate in this age group has increased by 62% from 2007 to 2021, according to facts from the Centers for Disease Control and Prevention (CDC). A recent nationally representative survey of U.S. high school students (the Youth Risk Behavior Survey) also found that in 2021, LGBTQ+ high school students were nearly four times more likely than their heterosexual peers to have attempted suicide in the past year, with more than one in five reporting having attempted suicide.

“Since 2019, when Lurie Children’s ED began suicide screening of all patients 10 years and older, we have identified suicide risk in one in four visits,” said lead author Jennifer Hoffmann, MD, MS, medical director of behavioral health in the ED at Lurie Children’s and assistant professor of pediatrics at Northwestern University Feinberg School of Medicine. “Universal suicide screening is still new to children’s hospitals, but it is a growing trend.”

For the study, researchers analyzed electronic medical record data from ED visits for youth ages 8-25 who received a suicide risk screening. Of the 12,112 ED visits included in the study, 565 were by TGD youth. Although TGD youth comprised 5% of the sample, they accounted for 15% of all positive suicide screenings.

“The disproportionately high suicide risks we found among transgender and gender diverse youth may be due to multiple reasons, including stigma, discrimination, bullying, and lack of family support,” said co-author Aron Janssen, MD, Vice Chair of Clinical Affairs in the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children’s and Associate Professor of Psychiatry and Behavioral Sciences at Northwestern University Feinberg School of Medicine. “To save lives, pediatricians must also screen these youth for depression and suicide risk.”