Tuesday, December 27, 2016

About That 40% Suicide Attempt Rate

Over at a rabidly anti-transgender blog called "4th Wave Now" we find the following article which attempts to debunk the 40% suicide rate that several iterations of the US Transgender Survey have found.  The argument largely seems to be that the US Transgender Survey is "flawed", and therefore we shouldn't consider its findings legitimate.

Let's be clear, measuring suicidality isn't the primary focus of the US Transgender Survey's design.  In fact the question is incidental, primarily intended to give some insight into the consequences of stigma, discrimination and minority stress rather than to evaluate the overall risk of suicidal behaviour within the community.

If the 40% number from the first US Transgender Survey published in 2011 was a onetime result, one might have cause to look at it with a degree of skepticism, but the 2015 survey released in late 2016 shows exactly the same number, from a much larger sample.  So, we aren't talking about a singular aberration.

It is important to understand that the question only asks "have you ever attempted suicide in your lifetime?".  It does not attempt to assess causes of this rate, nor does it tell us anything beyond the fact that 40% of respondents to these surveys said they had considered or attempted suicide in their lives.  Let's put that 40% number in perspective.  The US lifetime suicide risk statistics are down around 4.5%.  Within the transgender population, which is less than 2% of the overall population, we have a suicide attempt rate nearly 9 times that of the general population.  By any statistical measures that is a number to be deeply concerned about.

Further, the 2015 US Transgender Survey was designed to start addressing the questions that the previous survey presented.  It gathered significantly more information (and had a much larger sample), and there are statistically significant correlations between suicide risk and maltreatment at the hands of support networks.

The 4th Wave Now article goes one to attempt to "debunk" the idea that this frighteningly high statistic is correlated with transition.  In many respects, this is something of a straw man argument.  They argue that because the original survey did nothing to confirm or corroborate those claims that they could be just inflated by respondents choosing to respond for "dramatic purposes".  Since the survey didn't delve into respondents' medical records etc., they argue that we have no way of knowing the causality.  It seems, however, somewhat irrelevant in the face of the sample size in the more recent 2015 survey.  Even if you argued that the 2011 publication was subject to error because of its smaller sample size (approximately 2,000 participants), the 2016 survey had some 26,000 participants, and came to a similar number.  (as an aside, for a marginalized population like the Transgender community, even getting a sample of 2,000 is no small feat)

The 2016 report explores a number of significant issues that warrant consideration.  More or less, the 2016 report shows strong correlations between social rejection and suicidality.  Time and again, unsupportive families, social networks and workplaces are correlated with increased suicide risk, and not just a small difference, but the kind of difference that you can't ignore statistically.  In fact, the 2016 survey really highlights the effect of minority stress on transgender people.  Minority Stress is basically a model that gives us a lens through which to understand why seemingly independent sources of negative experience compound in minority populations to create a much stronger effect than is seen in general population.  In this case, the basic analysis is "treat people like crap, and they will come to the point that they will internalize those messages.

But, 4th Wave Now isn't content just trying to attack the statistic itself.  They couldn't be.  No, they have to attempt to attack the idea that transition is necessary to treat gender dysphoria.  Their reasoning (muddled as it is) seems to largely be that the suicide risk is likely correlated with other causes, therefore it is unreasonable to conclude that withholding transition support is a cause.

It almost sounds reasonable, until you realize that the real problem is that attitudes like this fight right smack into the minority stress model.  If you're the kind of parent who would deny their child support while they make an effort to sort out their feelings, YOU ARE THE PROBLEM.  In fact, you set your child up to internalize ever every nasty message about transgender people that they will ever see - because you're their primary example.  If you won't support them, then who will?  If you would kick your transgender child out of the family home because they are transitioning, why would they believe that they will be able to find employment?

Gender Dysphoria is no laughing matter.  If your male-bodied child comes to you and says "I think I'm a girl", or vice versa, take it seriously.  Your child is asking for your help and support as they sort out their feelings.  This doesn't mean that you need to rush out and get them on hormones, or any other medical intervention - it means that they need your support as a parent, whatever path they may need to be on.

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