Suicide Risk Identified among Transgender and Gender Diverse Youth in the Emergency Department (2019-2022).

Background and objectives: Suicide risk identified via universal screening in healthcare settings is associated with subsequent suicidal behavior and is an important prevention strategy. The prevalence of positive suicide risk screening among transgender and gender diverse (TGD) youth in the emergency department (ED) has not been described. The current study examined the association between gender identity and suicide risk screening results, adjusted for other demographic and clinical characteristics.

Methods: Retrospective cross-sectional study of electronic medical record data from ED visits November 2019-August 2022 in an urban academic children's hospital. Participants were youth ages 8-25 who received the Ask Suicide-Screening Questions suicide risk screening tool.

Results: Of 12,112 ED visits with suicide risk screening performed (42% male, median age 14 [12, 16]), 24% had positive screens. Of 565 visits by TGD youth, 78.1% had positive screens and 9.5% had active suicidal ideation. Compared to visits by cisgender females, the adjusted odds of positive screens was 5.35 times higher (95% CI 3.99, 7.18) among visits by TGD youth and 0.45 times lower (95% CI 0.40, 0.52) among visits by cisgender males. Compared to visits by cisgender females, the adjusted odds of active suicidal ideation was higher for cisgender males (aOR 1.34, 95% CI 1.07, 1.68) but did not significantly differ for TGD youth.

Conclusions: TGD youth have high rates of positive suicide risk screening in the ED, demonstrating substantial mental health needs. Opportunities may be available to improve detection, evidence-based brief interventions, and linkage to mental health services for this population.