Association of Updating Identification Documents with Suicidal Ideation and Attempts among Transgender and Nonbinary Youth
Abstract
:1. Introduction
2. Materials and Methods
2.1. Procedure
2.2. Measures
2.2.1. Identification Documents
2.2.2. Suicide Risk
2.2.3. Sociodemographic Covariates
2.2.4. Gender Identity Related Covariates
2.3. Analyses
3. Results
3.1. Sample Description
3.2. Bivariate Analysis
3.3. Multivariate Logistic Regression Analysis
4. Discussion
Limitations
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Byrne, J. License to Be Yourself: Laws and Advocacy for Legal Gender Recognition of Trans People; Open Society Foundation: Washington, DC, USA, 2014. [Google Scholar]
- Grant, J.M.; Mottet, L.A.; Tanis, J.; Harrison, J.; Herman, J.L.; Keisling, M. Injustice at Every Turn: A Report of the National Transgender Discrimination Survey; National Center for Transgender Equality and National Gay and Lesbian Task Force: Washington, DC, USA, 2011. [Google Scholar]
- Meyer, I.H. Resilience in the study of minority stress and health of sexual and gender minorities. Psychol. Sex. Orient. Gend. Divers. 2015, 3, 209–213. [Google Scholar] [CrossRef] [Green Version]
- Chodzen, G.; Hidalgo, M.A.; Chen, D.; Garofalo, R. Minority stress factors associated with depression and anxiety among transgender and gender-nonconforming youth. J. Adolesc. Health 2019, 64, 467–471. [Google Scholar] [CrossRef] [PubMed]
- Price-Feeney, M.; Green, A.E.; Dorison, S. Understanding the mental health of transgender and nonbinary youth. J. Adolesc. Health 2020, 66, 684–690. [Google Scholar] [CrossRef] [PubMed]
- Open Society Foundation. License to Be Yourself: Trans Children and Youth; Open Society Foundation: Washington, DC, USA, 2014; pp. 1–22. [Google Scholar]
- Movement Advancement Project. Equality Maps: Identity Document Laws and Policies. 2021. Available online: https://www.lgbtmap.org/equality-maps/identity_document_laws (accessed on 15 December 2021).
- JUSTIA. Name Change Forms: 50-State Resources (18 October 2021). Retrieved 14 January 2022. Available online: https://www.justia.com/estate-planning/estate-planning-probate-forms-50-state-resources/name-change-forms/ (accessed on 14 January 2022).
- Hill, B.J.; Crosby, R.; Bouris, A.; Brown, R.; Bak, T.; Rosentel, K.; VandeVusse, A.; Silverman, M.; Salazar, L. Exploring transgender legal name change as a potential structural intervention for mitigating social determinants of health among transgender women of color. Sex. Res. Soc. Policy 2018, 15, 25–33. [Google Scholar] [CrossRef] [PubMed]
- Scheim, A.I.; Perez-Brumer, A.G.; Bauer, G.R. Gender-concordant identity documents and mental health among transgender adults in the USA: A cross-sectional study. Lancet Public Health 2020, 5, e196–e203. [Google Scholar] [CrossRef]
- Restar, A.; Jin, H.; Breslow, A.; Reisner, S.L.; Mimiaga, M.; Cahill, S.; Hughto, J.M. Legal gender marker and name change is associated with lower negative emotional response to gender-based mistreatment and improve mental health outcomes among trans populations. SSM Popul. Health 2020, 11, 100595. [Google Scholar] [CrossRef] [PubMed]
- World Health Organization. Adolescent Health. World Health Organization. Available online: https://www.who.int/southeastasia/health-topics/adolescent-health (accessed on 22 March 2022).
- Children’s Online Privacy Protection Rule, 15 U.S.C. 6501–6508. 312.2 Code of Federal Regulations. 2013. Available online: https://www.ecfr.gov/current/title-16/chapter-I/subchapter-C/part-312 (accessed on 18 January 2022).
- Centers for Disease Control and Prevention: YRBSS. Youth Risk Behavior Surveillance System (YRBSS). 2021. Available online: https://www.cdc.gov/healthyyouth/data/yrbs/index.htm (accessed on 1 October 2021).
- May, A.; Klonsky, E.D. Validity of suicidality items from the Youth Risk Behavior Survey in a high school sample. Assessment 2011, 18, 379–381. [Google Scholar] [CrossRef] [PubMed]
- DeChants, J.; Green, A.E.; Price, M.N.; Davis, C. Measuring Youth Sexual Orientation and Gender Identity; The Trevor Project: West Hollywood, CA, USA, 2021. [Google Scholar]
- IBM Corporation. IBM SPSS Statistics; Version 28.0; IBM Corporation: Armonk, NY, USA, 2021. [Google Scholar]
- Toomey, R.B.; Syvertsen, A.K.; Shramko, M. Transgender Adolescent Suicide Behavior. Pediatrics 2018, 142, e20174218. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- De La Cretaz, B. American Medical Association Recommends Removing Sex from Birth Certificates. 2021. Available online: https://www.them.us/story/american-medical-association-recommends-removing-sex-from-birth-certificates (accessed on 14 March 2022).
- Green, A.E.; DeChants, J.P.; Price, M.N.; Davis, C.K. Association of gender-affirming hormone therapy with depression, thoughts of suicide, and attempted suicide among transgender and nonbinary youth. J. Adolesc. Health 2021, 70, 1–7. [Google Scholar] [CrossRef] [PubMed]
- Malta, M.; LeGrand, S.; Turban, J.; Poteat, T.; Whetten, K. Gender-congruent government identification is crucial for gender affirmation. Lancet Public Health 2020, 5, e178–e179. [Google Scholar] [CrossRef]
Not Able to, but Would Like to Change Them (%) | Yes, and Want to Change Them When Am Able (%) | Yes, and Has Changed Them (%) | X2 (df) p-Value | |
---|---|---|---|---|
Age (n = 6581) | X2(2) = 449.07, p < 0.001 | |||
13–17 | 248 (66.1) | 1163 (31.0) | 109 (2.9) | |
18–24 | 1209 (42.8) | 1265 (44.8) | 351 (12.4) | |
Gender Identity (n = 6581) | X2(6) = 342.11, p < 0.001 | |||
Transgender boy/man | 227 (37.3) | 313 (51.5) | 68 (11.2) | |
Transgender girl/woman | 1100 (46.9) | 992 (42.3) | 245 (10.8) | |
Nonbinary assigned male at birth | 231 (58.2) | 145 (36.5) | 21 (5.2) | |
Nonbinary assigned female at birth | 2135 (66.1) | 978 (30.3) | 117 (3.6) | |
Sexual Identity (n = 6528) | X2(10) = 87.35, p < 0.001 | |||
Gay or lesbian | 698 (53.1) | 492 (37.4) | 124 (9.4) | |
Straight | 45 (35.3) | 59 (46.1) | 24 (18.8) | |
Bisexual | 1074 (56.4) | 713 (37.4) | 117 (6.1) | |
Queer | 677 (53.8) | 476 (37.4) | 106 (8.4) | |
Pansexual | 1000 (59.8) | 594 (35.5) | 77 (4.6) | |
I am not sure | 164 (65.5) | 77 (30.6) | 10 (4.0) | |
Race/Ethnicity (n = 6347) | X2(10) = 71.04, p < 0.001 | |||
African American/Black | 169 (68.4) | 73 (29.6) | 5 (2.0) | |
Asian Pacific Islander | 190 (62.3) | 99 (32.5) | 16 (5.2) | |
Latinx | 497 (62.9) | 248 (31.4) | 45 (5.7) | |
Native/Indigenous | 82 (63.6) | 42 (32.6) | 5 (3.9) | |
Multiracial | 762 (56.8) | 504 (37.6) | 75 (5.6) | |
White | 1851 (52.4) | 1386 (39.2) | 298 (8.4) | |
Income (n = 5901) | X2(2) = 1.67, p = 1.67 | |||
Just meeting basic needs | 2288 (54.1) | 1610 (38.1) | 330 (7.8) | |
More than meets basic needs | 932 (55.7) | 623 (37.2) | 118 (7.1) | |
U.S. Region (n = 6581) | X2(6) = 162.09, p < 0.001 | |||
Northeast | 464 (47.6) | 401 (41.2) | 109 (11.2) | |
South | 1508 (64.4) | 724 (30.9) | 108 (4.6) | |
Midwest | 856 (58.3) | 518 (35.4) | 93 (6.3) | |
West | 867 (48.1) | 785 (43.6) | 150 (8.3) | |
Immigrant Status (n = 6562) | X2(2) = 2.65, p = 0.27 | |||
Born in the U.S. | 3499 (56.0) | 2319 (37.1) | 432 (6.9) | |
Born outside of the U.S. | 178 (57.1) | 106 (34.0) | 28 (9.0) | |
Pronouns | X2(2) = 364.36, p < 0.001 | |||
Binary | 873 (41.3) | 959 (45.3) | 283 (13.4) | |
Outside of the binary | 2816 (63.2) | 1466 (32.9) | 177 (4.0) | |
GAHT Status (n = 6415) | X2(10) = 1657.41, p < 0.001 | |||
No, and don’t want them | 1108 (69.4) | 443 (27.8) | 45 (2.8) | |
No, but I would like them | 2254 (61.3) | 1383 (37.6) | 42 (1.1) | |
Yes | 217 (19.0) | 559 (49.0) | 364 (31.9) | |
Gender Identity Support (n = 6315) | X2(4) = 693.89, p < 0.001 | |||
No | 1183 (64.3) | 602 (32.7) | 56 (3.0) | |
Yes | 1079 (39.5) | 1265 (46.3) | 479 (27.5) | |
Not out about gender | 56 (3.0) | 388 (14.2) | 8 (0.5) | |
Outcome Variable | ||||
Attempted suicide | 824 (62.9) | 438 (33.4) | 49 (3.7) | X2(2) = 54.01, p < 0.001 |
EXP(B) | 95% C.I. for EXP(B) | |||
---|---|---|---|---|
Lower | Upper | |||
Age | Age dichotomized into minors and above | 2.28 *** | 1.94 | 2.69 |
Gender Identity | Transgender girl/woman (Ref) | |||
Transgender boy/man | 0.98 | 0.75 | 1.28 | |
Nonbinary assigned male at birth | 0.58 * | 0.38 | 0.89 | |
Nonbinary assigned female at birth | 0.81 | 0.59 | 1.11 | |
Sexual Identity | Gay or lesbian (Ref) | |||
Straight or heterosexual | 0.87 | 0.49 | 1.52 | |
Bisexual | 1.10 | 0.89 | 1.35 | |
Queer | 0.93 | 0.73 | 1.18 | |
Pansexual | 1.27 * | 1.03 | 1.57 | |
Questioning | 1.30 | 0.89 | 1.91 | |
Race/Ethnicity | White (Ref) | |||
American Indian/Alaskan Native | 2.32 *** | 1.48 | 3.64 | |
Asian American/Pacific Islander | 1.05 | 0.73 | 1.52 | |
Black | 1.39 | 0.97 | 2.01 | |
Latinx | 1.16 | 0.92 | 1.46 | |
Multiracial | 1.44 *** | 1.21 | 1.72 | |
Income | Just meets basic needs | 1.86 *** | 1.59 | 2.17 |
U.S. Region | Northeast (Ref) | |||
South | 1.09 | 0.87 | 1.36 | |
Midwest | 0.98 | 0.77 | 1.25 | |
West | 1.02 | 0.81 | 1.27 | |
Immigrant Status | Born in the US or US territory | 0.94 | 0.66 | 1.33 |
GAHT Status | Are you currently taking gender affirmation hormones? | 1.16 * | 1.01 | 1.34 |
Gender Identity Support | No supportive parent (Ref) | |||
At least one supportive parent | 0.71 *** | 0.60 | 0.84 | |
Not out to parents about gender identity | 0.60 *** | 0.49 | 0.73 | |
Pronouns | Use of nonbinary pronouns | 1.34 ** | 1.08 | 1.66 |
Identification Document Status | Has changed legal documents (Ref) | |||
Wants to change documents but is not able | 2.04 *** | 1.41 | 2.95 | |
Is able to change documents but has not | 1.74 ** | 1.22 | 2.50 | |
Constant | 0.06 *** |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
DeChants, J.P.; Price, M.N.; Green, A.E.; Davis, C.K.; Pick, C.J. Association of Updating Identification Documents with Suicidal Ideation and Attempts among Transgender and Nonbinary Youth. Int. J. Environ. Res. Public Health 2022, 19, 5016. https://doi.org/10.3390/ijerph19095016
DeChants JP, Price MN, Green AE, Davis CK, Pick CJ. Association of Updating Identification Documents with Suicidal Ideation and Attempts among Transgender and Nonbinary Youth. International Journal of Environmental Research and Public Health. 2022; 19(9):5016. https://doi.org/10.3390/ijerph19095016
Chicago/Turabian StyleDeChants, Jonah P., Myeshia N. Price, Amy E. Green, Carrie K. Davis, and Casey J. Pick. 2022. "Association of Updating Identification Documents with Suicidal Ideation and Attempts among Transgender and Nonbinary Youth" International Journal of Environmental Research and Public Health 19, no. 9: 5016. https://doi.org/10.3390/ijerph19095016