Literature on the protective factors to transgender youth suicidality, current gaps in research, and implications for social work practice in healthcare.
Author: SOWK 551 Student
Date: December 10, 2022
Transgender folks (an umbrella term for people whose gender identify differs from their sex assigned at birth) often face unique stressors compared to their cisgender counterparts, including increased experiences of sexism, heterosexism, and transphobia, which result in poorer mental health outcomes. Research has consistently found transgender identity to be associated with heightened risk for suicidal ideation and higher suicide attempt rates than either the general population or lesbian, gay, or bisexual populations (Hunt et al., 2020). This risk is especially high for youth, and “many transgender youths report discrimination, bullying, and violence as a result of their gender identity” (Veale, 2017, p. 44). In a 2019 Canadian survey, almost two-thirds of trans youth had considered attempting suicide within the past year, and over 20% made an attempt (Taylor et al., 2020). Given an increase in awareness of the unique and complex challenges related to transgender youth and suicidality, there has been a growing body of research dedicated to better understanding what protective factors exist that are associated with decreased rates of suicidality and the promotion of the mental wellbeing for this population. Upon review of recent literature, the primary themes identified that will be touched in this paper include: 1) peer and parental support, 2) positive school support, and 3) use of chosen name and pronouns. Along with a mention on current gaps in the literature, a discussion of some of the implications for social workers in healthcare as it relates to this issue will be provided.
To capture current and relevant literature, only information published within the past ten years in a North American context has been included. To gather such information, the following search terms were used: “trans(gender)”, “youth”, “suicide”, and “protective factors”. The scholarly and peer-reviewed journal articles chosen for this review were found through the University of British Columbia Library search engine and Google Scholar.
Peer & Parental Support
Adequate social support is vital to the mental wellbeing of trans youth. Research suggests that support from young people’s peers and family members is not only associated with greater life satisfaction and fewer depressive symptoms, but can ultimately be lifesaving (Hunt et al., 2020). Having long-term, caring relationships with both family and friend groups provides trans youth with a source of resiliency when navigating challenging events in their lives. Parental support specifically can play a crucial role in offsetting the “mental health impact of societal harassment and discrimination their children receive” (Simons et al., 2013, p. 3). Parents or family members can contribute to their child’s wellbeing by advocating for them in ways which young people may find themselves powerless to do independently, such as championing for school policy reform (Gorse, 2020). In addition, Taylor et al. (2022) found that gender, role, and relationship differences can influence a youth’s willingness to seek support from parents, and that further research should address these dynamics as it relates to mothers, fathers, single, and two-parent families.
Imperative to note is that the need for support through a specific source/person (peer versus parental support) may differ given the young person’s ethnic, racial, and other intersecting identities. Ito et al. (2018) suggests that Asian trans youth may have increased internalized negative attitudes and are less likely to look to family for support whatsoever compared to other ethnic groups. Lawlace et al. (2022) found that support from a significant other (a person’s intimate partner) was particularly important for Black trans youth compared to their White and Latinx counterparts. Additionally, a strong connection with friends rather than family members was seen as significant for Latinx vs White or Black trans youth (Lawlace et al., 2022). In agreeance with this theme is Taylor et al. (2020), who found that Canadian trans youth reported their friends as being most helpful when in need of support.
Positive School Support
School is a place where youth spend a substantial amount of their time, yet the occurrence of school-based anti-transgender harassment, victimization, bullying, as well as the “corresponding mental health and behavioral health risks” is well documented (Austin et al., 2022, p. NP2071). Several studies propose that a trans youth’s sense of safety, belonging, and connectedness in school are all protective factors linked to a decrease in suicidal thoughts (Austin et al., 2022; Gorse, 2020; Taylor et al., 2020). Parodi et al. (2022) suggests one strategy to bolster student’s experience of school-connectedness is ensuring that sexual orientation and gender identity (SOGI) information and curriculum is provided to youth and educators alike. To further this, Austin et al. (2022) found that trans youth were half as likely to have attempted suicide if they felt they belonged at school and suggested that incorporating gender affirming and inclusive policies in schools “may be critical to staving off and/or mitigating the risk of suicidality among transgender young people” (p. NP2710). This includes taking a firm stance against interpersonal microaggressions through education and supporting gender diversity through environmental changes (e.g. inclusive washrooms or locker rooms) (Austin et al., 2022).
Apart from peer support, caring, supportive relationships with trusted adults within the school context appear to be a protective factor for trans youth and their mental wellbeing. Support from teachers, school counsellors, youth and/or social workers, and well as coaches can be provide helpful for trans youth in feeling connected to school as well as assist them in navigating other interpersonal relationship challenges with peers or family (Austin et al. 2022; Taylor et al., 2020). Moreover, Taliaferro et al. (2019) found that connection with non-familial adults in the school setting can support trans youth with increased feelings of safety in this environment.
Use of Chosen Name & Pronouns
Inclusive and gender-affirming language is a significant protective factor that positively impacts the mental wellbeing of trans youth. “Research has explored the way language often fails young trans people in their attempts to narrate the complexity of their gender, names, and identity” in a multitude of contexts, including the home and institutionalized settings (Sinclair-Palm & Chokly, 2022, p. 3). Respecting and using a young trans person’s name and pronouns is a matter of safety and dignity, and studies have found that transgender youth who are able to use their chosen name in various contexts, including home, school, healthcare, and work settings were associated with lower depressive symptoms, suicidal ideation, and suicidal behaviour (Russell et al., 2018; Sinclair-Palm & Chokly, 2022; Taylor et al., 2020). Going beyond the acknowledgement of chosen name and pronouns is the need for policies that promote the translation of this language to information systems and records (e.g. health records, personal ID cards) to further enhance a young person’s feelings of safety and belonging in society (Russell et al., 2018).
Gaps in the Literature
Although research on this issue is quickly emerging, several limitations and shortcomings exist within the current body of literature. Much of literature does not adequately address the unique needs and experiences of trans youth specifically, and rather focuses on ‘LGBT’ or ‘sexual or gender minority’ populations in their entirety. Directing specific focus on subgroups will likely provide essential and revealing insight that honours the voices and lived experiences of transgender youth struggling with mental illness and suicidality.
Upon analysis of many of the articles included in this review, the samples of participants are predominantly White, which is a critique of LGBTQ2S+ research in general. Whilst some of the research conducted in the United States appears to be more inclusive of Black and Latinx trans youth voices, current findings “may not adequately reflect the lives and experiences of trans and/or non-binary youth who are Black, Indigenous, or from other cultural groups” in Canadian and Western contexts (Taylor et al., 2020). Opara et al. (2020) argues that “the intersection of multiple marginalized identities can increase an individual’s likelihood of experiencing discrimination and the resulting psychological consequences” (p. 617). Furthermore, few studies have solely examined the differences among trans youth of colour and have yet to fully explore how geographic (urban vs. rural), poverty, and/or socioeconomic factors correlate with mental health and suicidality (Opara et al., 2020). Thus, deeper exploration in this area may provide nuance to what is currently understood about protective factors to trans youth suicidality.
Application to Practice
Foundational to the social work discipline is its strengths-based approach to practice that is rooted in social justice. Given this, social workers practicing in healthcare can play a pivotal role in supporting the psychosocial needs of trans youth clients and their families. Through comprehensive screening and assessment processes, social workers have the ability to “assess for and monitor levels of internalized stigma, exposure to microaggressions, and a lack of social support, in addition to general-population risk factors, so that they can intervene in these areas to reduce risk” related to suicidality in transgender youth (Lawlace et al., 2022, p. 7). Given that advocacy is central to the role of healthcare social workers, practitioners or mental health clinicians working with families of transgender youth are uniquely positioned to advocate for the importance of support from various sources, including parents, school staff, and other healthcare providers (Simons et al., 2013). Social workers can provide support to families in a variety of ways, including psychoeducation and other therapeutic interventions, as well as refer clients and/or their families to services that may better serve them in the community. Social workers may also advocate for increased support in the school environment and serve as a link between the young person’s healthcare team and formal support system at their school.
At the organizational and systemic levels of practice, social workers can play a role in advocating for and implementing policy change that seeks to develop and strengthen access to gender-affirming care within healthcare. Social workers provide an integral voice in the policy change process given their use of an intersectional, anti-oppressive lens and profound knowledge of the social determinants of health that directly applies to the multifaceted issues faced by trans youth and their loved ones. Perhaps unsurprisingly, much of the research outlined in this review was undertaken by social workers; therefore, social workers can utilize their skills in research to further advance their practice and invoke change in the organizations they work within as well as through larger institutions.
It should be mentioned that whilst social workers are indeed well positioned to support this population and enact positive change cross various settings and contexts, “opportunities must be developed and implemented to prepare practicing social workers on affirming practices with LGBTQ+ youth who are at risk for suicide” (Gorse, 2022, p. 25). Social workers often receive very minimal education and training through their graduate programs; thus, efforts must be made to better understand the unique needs, risks, and protective factors related to trans youth mental health (Gorse, 2022). Additionally, it is critical that this burden of education be on the social worker (or other healthcare provider) rather than the client or family as this population has historically been and continues to be severely underserved (Hunt, 2020).
To conclude, transgender youth are folks who face unique stressors which can result in poor mental health outcomes and an increased risk for suicidality. This population has inherent strengths, and a better understanding of protective factors is key to promoting the health and wellbeing of trans youth now and into the future. Whilst other protective factors exist, current literature suggests that peer and parental support, positive school support, and the use of chosen names and pronouns are some of these key protective factors – and healthcare social workers are positively situated to contribute to the advancement of these aspects in trans youth’s lives. Ultimately, support for transgender youth needs to be weaved through and integrated across all systems, from the micro to macro. To support these efforts, continued research aimed at informing best practices for supporting transgender youth at risk of suicide is needed (Gorse, 2022). As alluded to earlier, research committed to exploring the needs and experiences of trans youth with multiple, intersecting identities is also highly sought after.
Austin, A., Craig, S. L., D’Souza, S., & McInroy, L. B. (2022). Suicidality among transgender youth: Elucidating the role of interpersonal risk factors. Journal of Interpersonal Violence, 37(5–6), NP2696–NP2718. https://doi.org/10.1177/0886260520915554
Gorse, M. (2022). Risk and protective factors to LGBTQ+ youth suicide: A review of the literature. Child and Adolescent Social Work Journal, 39(1), 17–28. https://doi.org/10.1007/s10560-020-00710-3
Hunt, Q. A., Morrow, Q. J., & McGuire, J. K. (2020). Experiences of suicide in transgender youth: A qualitative, community-based study. Archives of Suicide Research, 24(sup2), S340–S355. https://doi.org/10.1080/13811118.2019.1610677
Ito, B. (2018). Intersectionality: Why race matters in LGBTQ+ youth. Journal of the American Academy of Child & Adolescent Psychiatry, 57(10), S63. https://doi.org/10.1016/j.jaac.2018.07.268
Lawlace, M., Newcomb, M. E., & Whitton, S. W. (2022). Minority stressors and suicidal ideation in sexual and gender minority youth assigned female at birth: Prospective associations and racial differences. Suicide and Life-Threatening Behavior, n/a(n/a). https://doi.org/10.1111/sltb.12912
Opara, I., Assan, M. A., Pierre, K., Gunn, J. F., Metzger, I., Hamilton, J., & Arugu, E. (2020). Suicide among black children: An integrated model of the interpersonal-psychological theory of suicide and intersectionality theory for researchers and clinicians. Journal of Black Studies, 51(6), 611–631. https://doi.org/10.1177/0021934720935641
Parodi, K. B., Holt, M. K., Green, J. G., Katz-Wise, S. L., Shah, T. N., Kraus, A. D., & Xuan, Z. (2022). Associations between school-related factors and mental health among transgender and gender diverse youth. Journal of School Psychology, 90, 135–149. https://doi.org/10.1016/j.jsp.2021.11.004
Russell, S. T., Pollitt, A. M., Li, G., & Grossman, A. H. (2018). Chosen name use is linked to reduced depressive symptoms, suicidal Ideation, and suicidal behavior among transgender youth. Journal of Adolescent Health, 63(4), 503–505. https://doi.org/10.1016/j.jadohealth.2018.02.003
Simons, L., Schrager, S. M., Clark, L. F., Belzer, M., & Olson, J. (2013). Parental support and mental health among transgender adolescents. Journal of Adolescent Health, 53(6), 791–793. https://doi.org/10.1016/j.jadohealth.2013.07.019
Sinclair-Palm, J., & Chokly, K. (2022). ‘It’s a giant faux pas’: Exploring young trans people’s beliefs about deadnaming and the term deadname. Journal of LGBT Youth, 0(0), 1–20. https://doi.org/10.1080/19361653.2022.2076182
Taliaferro, L. A., McMorris, B. J., Rider, G. N., & Eisenberg, M. E. (2019). Risk and protective factors for self-harm in a population-based sample of transgender youth. Archives of Suicide Research, 23(2), 203–221. https://doi.org/10.1080/13811118.2018.1430639
Taylor, A.B., Chan, A., Hall, S.L., Saewyc, E. M., & the Canadian Trans & Non-binary Youth Health Survey Research Group (2020). Being Safe, Being Me 2019: Results of the Canadian Trans and Non-binary Youth Health Survey. Vancouver, Canada: Stigma and Resilience Among Vulnerable Youth Centre, University of British Columbia.
Veale, J. F., Watson, R. J., Peter, T., & Saewyc, E. M. (2017). Mental health disparities among Canadian transgender youth. Journal of Adolescent Health, 60(1), 44–49. https://doi.org/10.1016/j.jadohealth.2016.09.014