Suicide Risk Among Transgender Adolescents and Young Adults: A Meta-Analysis of Nearly One Million Participants

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.