Risk and Protective Factors Among Transgender and Gender Diverse Youth With Suicidal Thoughts and Behaviors in a Pediatric Emergency Department
Sarah R. Johnson, Allison J. Vachon, Jonathon W. Wanta, Aron Janssen, Claire Coyne, Doug Lorenz, Jennifer A. HoffmannObjectives:
Transgender and gender diverse (TGD) youth attempt suicide at higher rates than cisgender peers. Among TGD youth who received psychiatric consultation in the emergency department (ED) for suicidal thoughts or behaviors (STB), we aimed to describe factors associated with admission and with return ED visits within 6 months.
Methods:
We conducted a retrospective cross-sectional study of TGD youth 11 to 17 years old who presented to an academic children’s hospital ED from January 2021 to June 2024, screened positive on Ask Suicide-Screening Questions, and received psychiatric consultation. Variables of interest were abstracted from clinician notes. Logistic regression models examined the association of sociodemographic and clinical characteristics with (1) admission and (2) a mental health-related ED return visit within 6 months.
Results:
We included 229 TGD youth (53% were 13 to 15 y old, 12% identified as transgender). The adjusted odds of admission were higher among youth with a previously documented mental health diagnosis (aOR: 3.27, 95% CI: 1.46, 7.35) and youth who reported access to lethal means (aOR: 24.0, 95% CI: 5.36, 107) and lower among youth with effective coping skills (aOR: 0.07, 95% CI: 0.03, 0.17). The adjusted odds of returning were lower among 16- to 18-year-olds (aOR: 0.17, 95% CI: 0.04, 0.72) compared with 11- to 12-year-olds.
Conclusions:
Among TGD youth with STB who received ED psychiatric consultation, identification of coping strategies and access to lethal means were associated with admission decisions. Further work is needed to understand how to improve mental health and reduce suicide risk among TGD youth receiving psychiatric consultation in the ED.