Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jun 2;15:525.
doi: 10.1186/s12889-015-1867-2.

Intervenable Factors Associated With Suicide Risk in Transgender Persons: A Respondent Driven Sampling Study in Ontario, Canada

Free PMC article

Intervenable Factors Associated With Suicide Risk in Transgender Persons: A Respondent Driven Sampling Study in Ontario, Canada

Greta R Bauer et al. BMC Public Health. .
Free PMC article


Background: Across Europe, Canada, and the United States, 22-43 % of transgender (trans) people report a history of suicide attempts. We aimed to identify intervenable factors (related to social inclusion, transphobia, or sex/gender transition) associated with reduced risk of past-year suicide ideation or attempt, and to quantify the potential population health impact.

Methods: The Trans PULSE respondent-driven sampling (RDS) survey collected data from trans people age 16+ in Ontario, Canada, including 380 who reported on suicide outcomes. Descriptive statistics and multivariable logistic regression models were weighted using RDS II methods. Counterfactual risk ratios and population attributable risks were estimated using model-standardized risks.

Results: Among trans Ontarians, 35.1 % (95 % CI: 27.6, 42.5) seriously considered, and 11.2 % (95 % CI: 6.0, 16.4) attempted, suicide in the past year. Social support, reduced transphobia, and having any personal identification documents changed to an appropriate sex designation were associated with large relative and absolute reductions in suicide risk, as was completing a medical transition through hormones and/or surgeries (when needed). Parental support for gender identity was associated with reduced ideation. Lower self-reported transphobia (10(th) versus 90(th) percentile) was associated with a 66 % reduction in ideation (RR = 0.34, 95 % CI: 0.17, 0.67), and an additional 76 % reduction in attempts among those with ideation (RR = 0.24; 95 % CI: 0.07, 0.82). This corresponds to potential prevention of 160 ideations per 1000 trans persons, and 200 attempts per 1,000 with ideation, based on a hypothetical reduction of transphobia from current levels to the 10(th) percentile.

Conclusions: Large effect sizes were observed for this controlled analysis of intervenable factors, suggesting that interventions to increase social inclusion and access to medical transition, and to reduce transphobia, have the potential to contribute to substantial reductions in the extremely high prevalences of suicide ideation and attempts within trans populations. Such interventions at the population level may require policy change.


Fig. 1
Fig. 1
Conceptual model of intervenable social inclusion, transphobia and transition-related factors for suicide prevention among transgender people in Ontario, Canada
Fig. 2
Fig. 2
Network diagram of sample of trans people in Ontario, Canada (n = 433). Circles = male-to-female (MTF) spectrum, including genderqueer individuals. Triangles = female-to-male (FTM) spectrum, including genderqueer individuals. Grey = no past-year serious consideration of suicide. Blue = past-year serious consideration of suicide, but no attempt. Red = past-year suicide attempt(s)

Similar articles

See all similar articles

Cited by 36 articles

See all "Cited by" articles


    1. Conron KJ, Scott G, Stowell GS, Landers SJ. Transgender health in Massachusetts: results from a household probability sample of adults. Am J Public Health. 2012;102:118–22. doi: 10.2105/AJPH.2011.300315. - DOI - PMC - PubMed
    1. Bauer GR, Pyne J, Francino MC, Hammond R. Suicidality among trans people in Ontario: implications for social work and social justice/La suicidabilité parmi les personnes trans en Ontario: implications en travail social et en justice sociale. Serv Soc. 2013;59:35–62. doi: 10.7202/1017478ar. - DOI
    1. Motmans J, de Biolley I, Debunne S. Being Transgender in Belgium: Mapping the Social and Legal Situation of Transgender People. Brussels: Institute for the Equality of Women and Men; 2010. Accessed 15 Sept 2014.
    1. Whittle S, Turner L, Combs R, Rhodes S. Transgender EuroStudy: Legal Survey and Focus on the Transgender Experience of Health Care. Brussels, Belgium: ILGA Europe; 2008. Accessed 15 Sept 2014.
    1. McNeil J, Bailey L, Ellis S, Morton J, Regan M. Trans Mental Health Study 2012. Edinburgh: Equality Network; 2012. Accessed 15 Sept 2014.

Publication types

MeSH terms