Factors associated with suicide attempts among Australian transgender adults.

BACKGROUND: Transgender, including gender diverse and non-binary people, henceforth referred to collectively as trans people, are a highly marginalised population with alarming rates of suicidal ideation, attempted suicide and self-harm. We aimed to understand the risk and protective factors of a lifetime history of attempted suicide in a community sample of Australian trans adults to guide better mental health support and suicide prevention strategies. METHODS: Using a non-probability snowball sampling approach, a total of 928 trans adults completed a cross-sectional online survey between September 2017 and January 2018. The survey assessed demographic data, mental health morbidity, a lifetime history of intentional self-harm and attempted suicide, experiences of discrimination, experiences of assault, access to gender affirming healthcare and access to trans peer support groups. Logistic regression was used to examine the risk or protective effect of participant characteristics on the odds of suicide. RESULTS: Of 928 participants, 85% self-reported a lifetime diagnosis of depression, 63% reported previous self-harm, and 43% had attempted suicide. Higher odds of reporting a lifetime history of suicide attempts were found in people who were; unemployed (adjusted odds ratio (aOR) 1.55 (1.05, 2.29), p = 0.03), had a diagnosis of depression (aOR 3.70 (2.51, 5.45), p < 0.001), desired gender affirming surgery in the future (aOR 1.73 (1.14, 2.61), p = 0.01), had experienced physical assault (aOR 2.01 (1.37, 2.95), p < 0.001) or experienced institutional discrimination related to their trans status (aOR 1.59 (1.14, 2.23), p = 0.007). CONCLUSION: Suicidality is associated with barriers to gender affirming care, gender based victimisation and institutionalised cissexism. Interventions to increase social inclusion, reduce transphobia and enable timely access to gender affirming care, particularly surgical interventions, are potential areas of intervention.

Virtually Trans: an Australian Facebook group supporting gender diverse adults' health and wellbeing.

Social networking sites are the primary means by which trans and gender diverse people meet, enabling both community contact and information exchange. This study considers the meaning of participation in a secret Facebook group for trans and gender diverse adults in Melbourne (Australia). A peer ethnographic methodology was used to study the Melbourne-based group listed under the pseudonym 'Virtually Trans'. Qualitative semi-structured interviews were conducted with 12 Virtually Trans group members. Interviews were transcribed and thematically analysed. Interview data were supplemented with field notes written throughout online participation over an 8-month period to add richness and provide context to the data. Three major themes were developed from this analysis. First, experiences outside of Virtually Trans, most notably within health care settings, were perceived to be unsafe. Second, practices of care in Virtually Trans conferred a sense of kinship and identity affirmation. Finally, Virtually Trans enabled localized information exchange between peers. Virtually Trans is not a neutral platform of self-performance but a safe(r) environment for expanding the gendered possibilities of who and how people may become. This study highlights the importance of a secret Facebook group in filling care, information and resource gaps experienced by trans and gender diverse people within a major metropolitan setting. The findings have implications for practitioners working with trans and gender diverse adults and peer health navigation.

The impact of the first three months of the COVID-19 pandemic on the Australian trans community.

Background: Trans and gender diverse individuals (people who identify with a gender different to what was presumed for them at birth) are one of the most medically and socially marginalized groups in our community. The COVID-19 pandemic may compound preexisting depression and thoughts of self-harm or suicide. Aim: We aimed to explore the impact of the COVID-19 pandemic on the Australian trans community. Methods: An online cross-sectional survey was conducted between 1st May 2020 and 30th June 2020, amidst strict Australia-wide social restrictions. Australian trans people aged ≥16 years were eligible to participate. Survey questions explored the impact of the COVID-19 pandemic on living situation, employment, financial situation, and healthcare. Logistic regression to assess negative impacts due to COVID-19 on depression and thoughts of self-harm or suicide (measured by Patient Health Questionnaire-9 (PHQ-9) are presented as odds ratios (95% confidence interval)). Results: Of 1019 participants, 49.6% reported experiencing financial strain, 22% had reduced working hours, and 22.4% were unemployed (three times the national rate). Concerningly, 61.1% experienced clinically significant symptoms of depression (Patient Health Questionnaire-9 score ≥10), considerably higher than pre-COVID rates for the trans community and over twice the national rate. Moreover, 49% reported thoughts of self-harm or suicide (over three times the national rate) which was more likely if a person experienced cancelation or postponement of gender-affirming surgery (OR 1.56 (1.04, 2.35)), financial strain (OR 1.80 (1.36, 2.38)), or felt unsafe or afraid in their household (OR 1.96 (1.23, 3.08)). Discussion: Given rates of clinically significant depression and thoughts of self-harm or suicide are far higher in trans people than the general population, specific strategies to improve mental health in the trans community during the COVID-19 pandemic must be made a priority for policymakers, researchers, and health service providers to prevent suicide.Supplemental data for this article is available online at https://doi.org/10.1080/26895269.2021.1890659.

Subjective Experiences of a Cisgender/Transgender Dichotomy: Implications for Occupation-Focused Research.

The subjectivity of researchers has received little attention in occupational research of trans and/or gender diverse (TGD) lives. Secondary thematic analysis of a peer ethnography was conducted to explore the meaning and epistemological significance of a cisgender/transgender dichotomy for TGD adults. The primary research comprised an occupational analysis of participation in a secret Facebook group ("Virtually Trans") for TGD adults who were assigned female at birth and live in Melbourne, Australia. Three themes were developed from this secondary analysis of the experiences of 12 group members. First, an oppositional cisgender/transgender dichotomy was salient and significant to all participants. Second, belonging norms, while profoundly felt, also obscured intragroup differences and opportunity for outgroup contact. Finally, participants recognized the need for self-reflexive allies to document the varied occupational experiences and priorities of this cohort. A cisgender/transgender dichotomy is a significant ontological distinction that must be attended to in TGD occupation-focused research.

Trans, gender diverse and non-binary adult experiences of social support: A systematic quantitative literature review.

Background: Trans, gender diverse and non-binary (TGDNB) adults experience significant health disparities relative to their cisgender peers. While social support is a known health-protective factor within the general population, no systematic reviews of TGDNB experiences of social support exist. Aim: To systematically review prior research of social support for TGDNB adults. We sought to assess the defining characteristics of the research, the participants and the research findings, mapping emerging trends across disciplines. Methods: Six electronic databases (PubMed, MEDLINE, CINAHL, Web of Science, LGBT Life and PsycNet) were searched for literature pertaining to TGDNB adults, social support, and health or well-being published in the past decade. Results: The findings illustrate a predominance of USA-based quantitative research that measures social support of friends, family and a singular intimate partner. The majority of participants were white, binary-identified transgender women and TGDNB people living in metropolitan settings. Social support was commonly reported as a protective factor, with TGDNB peer support the most frequently reported correlate of health and well-being for TGDNB adults. Discussion: The results suggest standardized inventories do not capture the emic nature of social support for TGDNB adults. A key opportunity lies in an inductive, hypothesis-forming approach to the study of what is socially supportive for TGDNB adults. In turn, this knowledge will enable the appropriate measurement, implementation and interpretation of social support studies.