Risk of Suicide and Self-Harm Following Gender-Affirmation Surgery

Area of Science:

• Medical Research
• Public Health
• Psychiatry

Background:

• Transgender individuals experience higher rates of depression and suicide ideation.
• The increasing number of gender affirmation surgeries necessitates an evaluation of associated risks.
• This study addresses the critical need to understand mental health outcomes post-gender-affirming procedures.

Purpose of the Study:

• To evaluate the risk of suicide or self-harm associated with gender affirmation procedures.
• To compare suicide attempt rates between individuals who have undergone gender-affirming surgery and control groups.
• To identify the need for enhanced psychiatric support in transgender healthcare.

Main Methods:

• Retrospective analysis of de-identified patient data from the TriNetX database (over 90 million patients).
• Four cohorts were analyzed: gender-affirmation surgery patients, general emergency visit controls, tubal ligation/vasectomy controls, and pharyngitis controls.
• Propensity matching and statistical analysis were used to examine suicide attempts, self-harm, and PTSD within five years of the index event.

Main Results:

• Individuals undergoing gender-affirming surgery showed a 12.12-fold higher risk of suicide attempts compared to non-surgical controls.
• Even after propensity matching with tubal ligation/vasectomy controls, the suicide attempt risk remained significantly elevated (4.71-fold higher).
• Similar significant increases in suicide attempt risk were observed when compared to pharyngitis controls.

Conclusions:

• Gender-affirming surgery is significantly associated with an increased risk of suicide attempts.
• The findings underscore the urgent need for comprehensive psychiatric care and support systems for individuals post-gender-affirming surgery.
• Further research into long-term mental health outcomes is warranted to inform clinical practice and policy.