Methods: Secondary analyses were conducted on the United States Transgender Survey (N = 27,204). Gender was a categorical variable consisting of five categories: crossdresser (2.73%), transgender woman (33.21%), transgender man (28.69%), genderqueer/nonbinary assigned female at birth (28.44%), and genderqueer/nonbinary assigned male at birth (6.93%). Race was a categorical variable consisting of six categories: Alaska Native/American Indian alone (1.15%), Asian/Native Hawaiian/Pacific Islander (2.83%), Biracial/Multiracial/Not listed (5.27%), Black/African American alone (2.85%), Latino/a/Hispanic alone (5.28%), white/Middle Eastern/North African) alone (82.61%). The dependent variable, SI, was measured as a dichotomous variable in response to the question, “In the past 12 months, have you thought about killing yourself?” The independent variables were gender, race, employment status, trading sex for food, trading sex for a place to sleep, exposure to violence, and age. Bivariate, multivariable, and nested models were used to examine the association between the independent and dependent measures.
Results: The weighted full main effects model is significant. With transgender women as the reference group, all other gender categories are significantly less likely to have SI. While transgender men are significantly less likely (aOR=.676) than transgender women to have SI, transgender women are 1.48 times more likely (1/.676) to have SI than transgender men. In the race variable, Biracial/Multiracial (aOR=2.0) and white (aOR=1.54) participants were significantly more likely than Black/African-American participants to have SI. Every year of increased age is associated with a reduced likelihood (aOR=.960) of SI. Being employed part-time (aOR=.77) or fulltime (aOR=.68) compared to unemployed is associated with reduced SI. Trading sex for food or a place to sleep was not significant. Lastly, increasing exposure to violence is significantly associated with increased odds of having SI. The only significant nested effect is gender nested in white. When comparing transgender women to all of the other gender categories, within the six self-identified racial/ethnic groups, transgender women are significantly more likely (OR 1.84-1.89) to have SI than those who identified as transgender men, AFAB and AMAB, within those who identified as white.
Conclusions and Implications: This study builds upon prior research by examining the links between violence exposure and SI based on gender identity and race/ethnicity. Several factors impact SI among the diverse members of nonbinary subpopulations. Identities including race, gender, age, and experiences regarding employment, exposure to violence, and transactional sex result in various associations with SI. Approaches to mental health and suicide prevention for these groups must consider the various factors facing transgender and gender expansive individuals when developing potential interventions.