Study establishes first causal link between anti-trans laws and suicide attempts

State laws targeting transgender people made trans and non-binary young people more likely to attempt suicide last year, according to a first-of-its-kind study.

The study, published last week in the journal Nature Human Behavior and conducted by the Trevor Project, an LGBTQ youth suicide prevention and crisis intervention organization, is the first to show that such laws directly led to an increase in suicide attempts .

The Trevor Project surveyed more than 60,000 trans and non-binary young people (aged 13 to 24) about their mental health between 2018 and 2022. During this period, 19 state governments passed 48 laws targeting transgender people, particularly youth. These included restrictions on transition-related care for minors and laws prohibiting trans student-athletes from participating on school sports teams that match their gender identity.

The study compared suicide-related outcomes for trans and non-binary youth in these 19 states with the outcomes for trans and non-binary youth in states that had not enacted such laws.

These laws were found to result in an estimated 7 to 72% increase in suicide attempts among trans and non-binary youth. The range of estimates is wide because it includes the percentage increase for five time periods from 2018 to 2022, and the estimated percentage increase varies depending on the time period and age group of participants.

“This causality is the key aspect,” said Ronita Nath, one of the study’s co-authors and vice president of research at the Trevor Project. “Anti-transgender laws at the state level have led to – so we can safely say – they have led to an increase in suicide attempts among trans and non-binary young people by up to 72% in the past year,” as well as a 49 -percent increase in the proportion of trans and non-binary young people who have made at least one attempt in the past year.

She said previous research has found that laws targeting trans people are linked to worse mental health outcomes for trans and non-binary people, including youth.

Dr. Jack Turban, a child psychiatrist and director of the gender psychiatry program at the University of California, San Francisco, said this study is significant because its design, known as a causal inference technique, provides strong evidence that the laws reduce suicide attempts compared to just Suicide attempts show a link between the laws and an increase in suicides.

He added that causality is important as the Supreme Court prepares to hear U.S. v. Skrmetti, the first case involving a ban on transition-related care for transgender minors.

“One of the questions that comes into play in these legal analyzes is whether states have a legitimate interest in banning these treatments or passing these laws,” said Turban, who is also the author of “Free to Be: Understanding Kids and Gender.” Identity.”

He added: “Since we have evidence that these laws drive suicide attempts, it would be really difficult to argue that states are justified or have a compelling reason to enact such laws.”

Understand the data

During the study’s first measured period, in early 2018, suicide attempt rates increased 7% among trans and non-binary young people ages 13 to 17 living in the 19 states with anti-trans laws, Nath surprised who wasn’t necessarily expecting it. I see such an immediate increase. After periods two and three, which fell between December 2019 and December 2020, suicide attempts last year increased by 72% and 52%, respectively, in the same age group.

For the entire sample of trans and non-binary young people ages 13 to 24, there was no statistically significant increase in past-year suicide attempts after the first period, but after periods two and three, past-year suicide attempts increased by 38 % and 44%, compared to youth in states without anti-trans laws.

The study controlled for a variety of variables to determine causality, including the Covid pandemic, cultural factors in the state, pre-existing suicide rates, national suicide prevention efforts and federal policy.

There were some limitations within the study. First, it was a cross-sectional rather than a longitudinal survey, meaning that young people were interviewed only once and not multiple times over months or years. So if a study participant moves to Wyoming, which has anti-transsexual laws, after living in a state that has not passed such laws, such as California, for the past year, their response to questions about suicide attempts in the past year can only be reflective her experiences in California, Nath said. She added that researchers expected this type of misclassification would underestimate the percentage increase in suicide attempts.

The study also did not use a randomized sample as participants were recruited via social media. Researchers also couldn’t randomly sample trans and non-binary young people to live in states with anti-trans laws and states without them, because such a study design would be unethical, Nath said. This means the sample used may not accurately reflect the entire population of trans and non-binary young people, although Nath noted that the results correspond to at least a 95% confidence level.

Turban also noted that the study does not break down laws by type, so research is still needed into which laws might have more or less impact on young people’s mental health. The study also doesn’t consider the laws’ indirect effects on trans youth who live in states where there are no laws, such as his patients in California, Turban noted. He said they still hear messages like “trans people are mentally ill” or that they will harm their peers if they play on sports teams that match their gender identity.

“I’m seeing more of my patients withdrawing, more of them just avoiding exercise altogether,” Turban said. “So I really don’t think we can overstate the negative impact of rhetoric, even when we’re in places where the laws don’t have a direct impact on us.”

Trans and non-binary youth are not inherently vulnerable to increased risk of suicide, Nath said, but are often at increased risk due to mistreatment and stigma, “including through the implementation of these discriminatory policies.” She pointed to a 2019 study by the Trevor Project that found LGBTQ youth with an accepting adult in their lives were 40% less likely to report a suicide attempt in the past year.

If you or someone you know is in crisis, call or text 988 to reach the Suicide and Crisis Lifeline or chat live on 988lifeline.org. You can also visit SpeakingOfSuicide.com/resources for additional support.

If you are a young LGBTQ person in crisis, having suicidal thoughts, or needing a safe and judgment-free place to talk, call TrevorLifeline now at 1-866-488-7386 or the Rainbow Youth Project at 1-317- 643. 4888.