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Gender identity disorder tied to higher suicide risk

Posted September 13, 2013
(VA Research Currents; online only)

Gender identity disorder is about five times more prevalent among VA patients than among the general population, and the rate of suicidal behavior among Veterans with the disorder is 20-fold that of the general VA population, according to a new study.

The study, say the authors, is the "largest study of a transgender population to date in the United States."

People with GID feel a strong identification with the opposite sex, and often experience discomfort with their actual anatomical gender. They may seek to alter their bodies—for example, through cosmetics, hormones, or surgery—and may assume mannerisms, behavior, or dress characteristic of the opposite sex.

Recently, the official diagnostic term for the condition switched to "gender dysphoria." Lead researcher John Blosnich, PhD, MPH, says future research will have to take into account the varying terms in Veterans' and others' medical records.

The condition is rare overall. Examining data for an 11-year period, from 2000–2011, the researchers found that GID affected about 23 in 100,000 VA patients, versus 4 in 100,000 people in the general U.S. population. Across the 11-year period, there were 3,177 unique VA patients with a GID in their files. That translates into some 246 new cases per year.

Blosnich says the finding supports past studies suggesting higher rates of transgender individuals in the military, relative to the general population. Dating back to the 1980s, Air Force psychiatrist George Brown, MD—now chief of psychiatry at the Mountain Home (Tenn.) VA Medical Center, and director of health care outcomes for VA's Office of Health Equity—advanced the idea that young men struggling with the condition may join the military in an attempt to prove their masculinity. He called the theory "Flight into Hypermasculinity."

Blosnich and colleagues found that the rate of suicidal behavior among VA patients with GID was more than 20 times that of the general VA patient population. Research on other transgender populations has also found higher suicide risk.

The VA study didn't look at completed suicides—only information about suicide-related behaviors that was reported by the suicide prevention coordinators at VA medical centers nationwide.

The authors of the study concluded that "immediate attention may be needed to assess how current [Veterans Health Administration] suicide prevention and intervention strategies reach this population."

The research was supported by VA's Center of Excellence for Suicide Prevention in Canandaigua, N.Y., and by the National Institute of Mental Health.

(American Journal of Public Health, online Aug. 15, 2013)