Suicide is the second leading cause of death among adolescents, and transgender adolescents (TGAs; adolescents who identify with a gender identity which is different from their sex assigned at birth) exhibit higher rates of suicidal behavior compared to non-TGAs. Over half of TGAs reported a lifetime history of suicide attempts in preliminary data collected by the PI. Initial evidence from cross-sectional studies indicates TGAs experience higher levels of peer victimization than non-TGAs, and victimization is associated with suicidal ideation among adolescents. Furthermore, unique psychosocial factors could contribute to suicidality among TGAs, including perceived stress related to their social gender transition and progress within their transition (including disclosing their gender identity to others, asking others to use their chosen name and pronouns, and making alterations to their hairstyle or clothing to express their gender in ways that align with their true gender identity). Thus, TGAs experience higher rates of stressors known to be associated with suicidal ideation among all adolescents, and unique TGA-specific stressors within this population could further contribute to their risk for suicidal behavior. Additionally, experiences of psychosocial stressors during childhood are associated with blunted hypothalamic-pituitary-adrenal (HPA) axis activity and increased inflammatory markers, two forms of biological dysregulation which differentiate suicide attempters. Prior research indicates inflammation could be positively associated with impulsivity and impaired decision-making. It is possible that multiple psychosocial stressors could precipitate both biological dysregulation and higher neurocognitive risk for suicidal behavior among TGAs. The specific aims of this pilot study are to:
Aim 1: Recruit TGAs (n = 50) aged 14-18 years who are engaging in their social gender transition but have not yet begun medical transition steps (including hormone replacement therapy) and follow them at 6 and 12 months.
Aim 2: Collect biological measures of chronic HPA axis activity (hair cortisol concentrations [HCC], a novel biological marker which provides historical recording of cortisol levels over the past months), inflammatory markers (interluekin-6, C-reactive protein), behavioral measures of neurocognitive functioning (impulsivity and decision-making), and interview and self-report questionnaires (peer victimization, perceived stress, social transition progress, childhood abuse, impulsivity, suicidal ideation and behavior, psychopathology, aggression, hopelessness) at each time point.
We will compare TGAs to non-transgender heterosexual and lesbian, gay, and bisexual adolescents in the PI's concurrent K01 study which uses similar methods. The proposed study would be the first longitudinal study to examine how clinical, biological, psychosocial, and neurocognitive factors contribute to risk for suicidal behavior over time within this vulnerable population. We hypothesize that increased peer victimization and perceived stress related to social gender transition among TGAs will be associated with increased biological dysregulation in these pathways, thus increasing their risk for suicidal behavior over time. Results from this pilot study will produce initial empirical evidence to launch a larger program of research with the potential to improve identification of TGAs at highest risk for suicidal behavior and identify novel intervention targets to reduce suicidality among TGAs.