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Rates of Suicide Higher among Transgender Veterans


BACKGROUND:
Several studies with community and clinical samples of self-identified transgender individuals found prevalence of lifetime suicidal ideation at about 60% or higher. Self-directed violence also is a major concern among transgender populations, but information about rates of death by suicide is limited. This study sought to document all-cause and suicide mortality among VA healthcare users with an ICD-9-CM diagnosis consistent with transgender status, which included: gender identity disorder, gender identity disorder not otherwise specified, transsexualism, and transvestic fetishism. Using VA data, investigators identified all VA patients who received one of these diagnoses between FY98 and FY13. Cross-referencing with data from the National Death Index (NDI) from FY00 through FY09, the analytic sample for this study included 3,327 Veterans among whom there were 309 deaths.

FINDINGS:

  • The crude suicide rate among Veterans with transgender-related diagnoses across the 10-year study period was approximately 82/100,000 person-years, which approximated the crude suicide death rates for Veterans with serious mental illness (e.g., depression, schizophrenia). However, this rate was higher than in both the general VA and U.S. populations.
  • Comparisons of age at time of death suggest Veterans with transgender-related diagnoses may be dying by suicide at younger ages than Veterans without such diagnoses. The average age of transgender Veterans at the time of death by suicide was 49 years compared with studies that show the average age of death among non-transgender Veterans who die from suicide was between 55 and 60 years.
  • Diseases of the circulatory system and neoplasms were the first and second leading causes of death among transgender Veterans, however, the other ranked causes of death differed somewhat from patterns among the general U.S. population for the same time period. For example, certain infectious and parasitic diseases were the 6th leading cause of death among transgender Veterans, whereas they ranked 9th among the general U.S. population.

LIMITATIONS:

  • Crude estimates were reported, which did not take into account potential confounding by age, sex, or psychiatric comorbidities.
  • The diagnosis-driven methods used to identify Veterans in this cohort may have resulted in mis-identification of transgender Veterans in the VA healthcare system.
  • While the NDI is considered the gold standard for mortality information, classifying suicide as a cause of death can be prone to reporting bias, resulting in a potential underestimate of suicides.

AUTHOR NOTE:
Authors suggest future research is needed to examine how transgender Veterans seek or receive mental health services and that programs aimed at suicide prevention may benefit from clinical education and training about transgender populations.

AUTHOR/FUNDING INFORMATION:
Drs. Blosnich and Brown are co-first authors on this manuscript. Dr. Blosnich is a post-doctoral fellow with HSR&D's Center for Health Equity Research & Promotion, Pittsburgh, PA.


Blosnich J, Brown G, Wojcio S, Jones K, and Bossarte R. Mortality among Veterans with Transgender-related Diagnoses in the Veterans Health Administration, FY2000-2009. LGBT Health. December 2014;1(4):269-76.

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HSR&D requires notification by HSR&D-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR&D and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR&D based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR&D published articles. Visit the HSR&D citations database for a complete listing of HSR&D articles and presentations.