ABSTRACT
Background
Mental health disparities among transgender and gender diverse adolescents and young adults represent a critical public health concern. This meta-analysis examined suicidal risk among transgender youth compared to their cisgender peers.
Methods
Following PRISMA guidelines, we analyzed 29 studies published between 2015–2024, comprising nearly one million participants (957,163; 29,041 transgender and 928,122 cisgender). Random effects models were used to calculate risk ratios (RR) and prevalence estimates for suicidal ideation, planning, attempts, and completion.
Results
Transgender youth showed significantly higher prevalence of suicidal ideation (transmale: 52.2%, transfemale: 49.5% vs. cismale: 18.1%, cisfemale: 22.4%; p < 0.001) and attempts (48.0%–51.3% vs. 18.0%–22.0%; p < 0.001). Risk analyses revealed elevated risks for ideation (RR = 2.38, 95% CI: 1.97–2.88), attempts (RR = 2.85, 95% CI: 1.31–6.21), and completed suicide (RR = 4.80, 95% CI: 2.15–10.74). However, substantial heterogeneity was observed across all suicide outcomes (I2 > 90%), indicating that pooled estimates should be interpreted with caution. Publication bias assessment suggested potential overestimation of unadjusted effects, with trim-and-fill adjustment reducing the pooled risk estimate (adjusted RR = 1.25, 95% CI: 1.08–1.45). No significant differences emerged between transmale and transfemale groups (p > 0.05).
Conclusion
Overall, this meta-analysis documents markedly elevated suicidality among transgender adolescents and young adults, while emphasizing the need for cautious interpretation of aggregated effect sizes and further high-quality longitudinal research.