By David McFadden
Research Writer
The warning signs are abundantly clear: We’re in the midst of a youth mental health crisis. And new research suggests that transgender and gender non-conforming adolescents are particularly in harm’s way, with an alarmingly high risk of suicidal thoughts and attempts.
An ambitious new study examining data from the 2019 Canadian Health Survey on Children and Youth illustrates the staggering scope of the problem in this country. The research team led by uOttawa Faculty of Medicine investigators found that transgender and gender non-conforming adolescents are over five times more likely to be suicidal than their peers whose gender identity matches the sex they were assigned at birth.
In the conversation below, research team leader Dr. Ian Colman, professor at the uOttawa Faculty of Medicine’s School of Epidemiology and Public Health, shares his thoughts on the findings and the scope of this urgent societal problem.
This collaborative paper is very timely since spotlighting the critical importance of mental health, particularly for vulnerable LGBTQ+ youngsters, is a priority for many during Pride Month in June. What does the study suggest about the pressures shouldered by transgender and gender non-conforming adolescents in Canada?
The transition from adolescence to young adulthood is a stressful time for all youth. However, it is particularly difficult for those who do not conform to mainstream societal expectations around gender and sexuality. These youth are often marginalized by their peers and their communities, and this often has negative effects on their mental health.
Our new study shows just how dramatic those effects can be. The finding that transgender and gender non-conforming youth are more than five times more likely to be suicidal underlines just how distressing this time can be for gender minorities. While Pride Month is a time of celebration, it is also a time to raise awareness related to the mental health of LGBTQ+ populations, particularly youth. I hope that research like this can support these initiatives.
The findings suggesting that more than half of all transgender youth reported that they seriously considered suicide in the previous 12 months before the survey is deeply alarming, to say the least. Should these findings be a wake-up call for those trying to address suicidality among Canada’s youth?
Such findings should be a wake-up call for all Canadians. To be fair, I believe that suicide prevention advocates in Canada are well aware that suicidality among transgender or gender non-confirming teens is an important issue. Nevertheless, to see that more than half have seriously considered suicide in the last year is still shocking. We hope that the strength of this research can provide more evidence for those pushing decision makers to prioritize suicide prevention in a more meaningful way.
You and your collaborators examined a big survey of Canadian youth done in 2019. It included 6,800 adolescents. Can you talk a bit about how the large population-based sample acted as a catalyst for the research?
There have been several previous studies highlighting high rates of poor mental health and suicidality in gender and sexual minorities. However, the majority of those studies have focused on targeted self-selected populations of youth. For example, many studies recruited participants through local LGBTQ+ support groups. While such research can teach us a lot, a major limitation is that it’s not clear how representative the study participants are of all gender and/or sexual minority youth. By using data from a population-based study, we can be much more confident that our results represent all minority groups. This provides much stronger evidence.
The Statistics Canada survey asked questions about the participants’ sex at birth, their gender identity, and sexual attraction. How did the nuances of the survey questions impact the study? And there is a high proportion of adolescents in the sample – nearly 15 percent – expressing attraction to more than one gender. Was this proportion surprising?
One of the differences in this study was the nuances in the questions about sexual attraction. Most previous studies about sexual attraction simply ask for respondents to self-report their sexual orientation. Such studies have reported that approximately 5% of the population identify as bisexual. However, in the Statistics Canada questionnaire used for our study, youth were instead asked about level of attractions. While the majority responded that they were “ONLY attracted” to the opposite gender, there were other response options such as “I am MOSTLY attracted” to the opposite gender.
When we looked at these responses, we found that almost 15% of the population reports some level of attraction to more than one gender, which is almost three times higher than previously reported. This has important implications given that these youth were 2.5 times more likely to be suicidal compared to cisgender heterosexual youth.
Your research team says the paper’s findings highlight the need for “inclusive prevention approaches” to address suicidality among Canada’s diverse youth population. What might be the most important approach? And is it likely that early support for gender identification may ameliorate serious mental health issues such as suicidality?
We need to make sure the prevention efforts are attractive to and accessible by transgender and sexual minority youth, and we believe that one way to accomplish this would be to have representation of these groups at every level. One aspect of such efforts should be ensuring that there are safe places that provide support for youth as they explore their gender and sexuality.
Can you talk a little about how “minority stress” is likely experienced by many transgender and gender-nonconforming adolescents in Canada?
Minority stress refers to pressures that are felt by marginalized and stigmatized groups and it can be damaging for mental health. Gender minorities, particularly during adolescence when peer pressure is high, are frequently victims of peer behaviours that are aimed at diminishing them. For example, transgender youth are often victims of bullying and cyber-bullying by their peers. In our study, we showed that such behaviour partially explains the link between being a gender minority and increased suicidality. We strongly support anti-bullying initiatives.
The research team for the study included a transgender woman. How did having someone with lived experience as a trans woman impact this collaborative work?
Honestly, I’m not sure we could have done this project without our collaborator with lived experience, Fae Johnstone. We certainly couldn’t have done it as well as we did! Fae’s input was essential throughout the process, from the first baby steps of the idea right through to getting the results out to both an academic audience and a more general audience, including the public and policymakers. Fae helped in figuring out what were the important gaps where we could make an important contribution with new research, and then how to make best use of the data we had to ensure that we were being respectful to gender and sexual minority populations. She also made a big contribution in helping us interpret our results and focus our discussion of the implications in the right areas.
Without her involvement, it’s easy to see how we could have made decisions that would have made sense for researchers but would have been less meaningful for those who are the focus of this research. We hope that our research will shine a spotlight on a critical public health issue, and Fae made sure that the spotlight was aimed at the right spot.
