Transgender and nonbinary teens are at much higher risk of suicidal thoughts and suicide attempts than their cisgender peers, according to new research published in CMAJ (Canadian Medical Association Journal).

Suicide is the second leading cause of death in adolescents and young adults aged 15–24 years in Canada. Sexual minority youth—those attracted to the same gender or multiple genders or who identify as lesbian, gay, bisexual or queer—are also at increased risk of mental health issues, suicidal ideation (thoughts) and suicide attempts.

“The transition from adolescence to adulthood is a very stressful time for all young people, but particularly for gender and sexual minority teens. These findings, showing dramatic increases in suicide risk, should sound a clarion call that additional support is needed,” says Dr. Ian Colman, a professor at the University of Ottawa and the Norwegian Institute of Public Health, Oslo, Norway, with coauthors.

As the risk of thoughts of suicide and attempts is not well studied in transgender and nonbinary youth, researchers analyzed data from the national 2019 Canadian Health Survey on Children and Youth to expand the evidence base. The sample included 6800 adolescents aged 15–17 years, most of whom (99.4%) were cisgender, meaning they identify as the gender they were assigned at birth, and 0.6% were transgender, meaning they identify as a gender different from that assigned at birth. The majority (78.6%) of respondents were heterosexual, 14.7% were attracted to multiple genders, 4.3% were unsure of their attraction, 1.6% were girls attracted to girls, and 0.8% were boys attracted to boys.

Overall, 14% of teens experienced suicidal ideation within the previous year, and 6.8% had previously attempted suicide. Transgender youth were 5 times more likely to think about suicide and 7.6 times more likely to have ever attempted suicide than cisgender youth.

“A really concerning finding is that more than half of all transgender youth reported seriously considering suicide in the previous 12 months. This is a crisis, and it shows just how much more needs to be done to support transgender young people,” says coauthor Fae Johnstone, executive director, Wisdom2Action, who is a trans woman herself.

The researchers also found that the proportion of teens who reported some level of attraction to more than one gender was much higher than reported in previous studies. This may be because this survey assessed attraction to different genders rather than self-reported sexual identity, or it may reflect lessening stigma around bisexuality. Notably, this group was more than twice as likely to have thought about suicide.

Overall, 4.3% of adolescents reported being uncertain of their sexual attraction, known as “questioning.”

“Given that the exploration of romantic and sexual relationships is a major developmental task of adolescence, it is perhaps unsurprising that many begin to question sexual attraction and orientation during this time,” says lead author Dr. Mila Kingsbury, University of Ottawa.

The association between suicidality and being a sexual or gender minority was partially explained by bullying or cyberbullying experienced by those teens.

The study’s findings are similar to those from the only other nationally representative study on the topic, which reported a fivefold increased risk of suicide attempts among transgender adolescents in New Zealand.

“Suicide prevention programs specifically targeted to transgender, nonbinary and sexual minority adolescents, as well as gender-affirming care for transgender adolescents, may help reduce the burden of suicidality among this group. Given that these associations were partially mediated through the experience of bullying, systemic change in the form of primary prevention programs aimed at public awareness and promoting inclusivity may lead to a reduction of the experience of minority stress among sexual minority and transgender youth, reducing their risk of poor mental health and suicidality,” says Johnstone.