Prevalence of gender dysphoria and suicidality and self-harm in a national database of paediatric inpatients in the USA: a population-based, serial cross-sectional study.
Prevalence of gender dysphoria and suicidality and self-harm in a national database of paediatric inpatients in the USA: a population-based, serial cross-sectional study.
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DOI：
10.1016/s2352-4642(22)00280-2
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发表时间：
2022-12
影响因子：
36.4
通讯作者：
Yehya, Nadir
中科院分区：
文献类型：
--
作者：
Mitchell, Hannah K.;Keim, Garrett;Apple, Danielle E.;Lett, Elle;Zisk, Annie;Dowshen, Nadia L.;Yehya, Nadir
Transgender and nonbinary youth (TNBY) experience discrimination which has been linked to suicidal ideation and self-harm. Few studies have examined this relationship systematically. We studied the relationship between gender dysphoria coding and hospitalization for suicidality and/or self-harm in a large representative database from the United States. Using the 2016 and 2019 Kids’ Inpatient Database, we identified TNBY youth with gender dysphoria between 6 and 21 years of age using ICD-10 codes. We identified suicidal ideation using explicit “suicidality” codes, and self-harm using 355 self-harm codes. Prevalence of suicidality and/or self-harm was compared between youth with and without gender dysphoria. Multivariable regression tested for an association between gender dysphoria and suicidality or self-harm. Gender dysphoria had a prevalence of 161 per 100,000 admissions between 6 and 21 years of age in 2016 and 475 per 100,000 admissions in 2019. Subjects with gender dysphoria were disproportionately White, privately insured, and from higher median income than those without dysphoria. Prevalence of suicidality in subjects with gender dysphoria was 36% in 2016 and 55% in 2019, which increased to 41% and 66% for either suicidality or self-harm, compared with 4 to 6% for subjects without gender dysphoria. In multivariable modelling, subjects with a gender dysphoria diagnosis had a 3 to 5-fold greater prevalence of suicidality and/or self-harm relative to those without gender dysphoria codes. In a large representative national sample, TNBY with gender dysphoria were frequently hospitalized for suicidality and/or self-harm. The fewer non-White, publicly insured, and low-income youths with gender dysphoria suggest that underlying inequities may shape the identification and management of gender dysphoria. Structural and provider-level interventions are needed to reduce discrimination and expand gender-affirming competencies to prevent adverse outcomes for hospitalized TNBY with gender dysphoria. NIH K23-HL136688 (NY)
