Intervenable factors associated with suicide risk in transgender persons: a respondent driven sampling study in Ontario, Canada.

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.

Reducing the risk of sexual abuse for people who use augmentative and alternative communication.

To date little attention has been focused on the sexual abuse experiences of people who use augmentative and alternative communication (AAC) and on addressing ways to reduce their risk for this type of abuse. This paper describes the results of a 3-year project that aimed to: (a) learn about the sexual abuse experiences of people who use AAC; (b) provide educational forums and resources on topics relating to sexual abuse for adults who use AAC; (c) define implications in risk reduction for various community service workers who support people who use AAC (e.g., attendant service providers, abuse counselors, sexual health educators, police, victim assistance services, legal professionals, and health care professionals); and (d) make recommendations to parents, educators, service providers, and consumer advocacy organizations about their roles in reducing the risk of abuse for youth and adults who use AAC. The findings suggest that the majority of participants in this project have experienced a range of abuses including sexual abuse, lack information about healthy and abusive relationships, have no way of communicating about sexuality and abuse, and lack supports in their personal lives and from within the community-at-large that are necessary to cope with relationship difficulties and specifically problems associated with abuse and justice system services. These findings and implications are shared with the intent of highlighting the need for more research and attention to the issue of abuse prevention for people who use AAC.