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Mon, April 1, 2013
Suicide Prevention in our Transgendered Kids
Suicide is the third leading cause of death for adolescents (aged 15-24 years) in the United States, accounting for 20 percent of all deaths annually among that age group. (1)

Research into the etiology of suicidal behavior among our youth has found that childhood exposure to victimization appears to be an important determinant of suicidal ideation.  Several studies have specifically found significant effects of victimization in the form of peer bullying on suicidal ideation and many studies have found that both victims and perpetrators of bullying are at higher risk of suicide than their peers, with children who are both victims and perpetrators of bullying having the highest risk of all (2),(3),(4)

It is well documented that as a group, lesbian, gay, bisexual, and transgender (LGBT) youth experience more bullying (including physical violence and injury) at school than their heterosexual peers (5),(6),(7) Unlike their LGB counterparts who can hide their affectional orientation, children that are gender-nonconforming in their appearance or interests, whether they identify as transgender or not, experience a tremendous amount of ridicule and shame for being “different.”  This harassment will in turn produce or reinforce characteristics known to be associated with an increased risk of victimization: the tendency to internalize problems; low self-esteem; and low assertiveness. (8)

There is research which documents that transgender youth in particular do experience a disproportionate amount of harassment and statistics which indicate that transgender youth do account for a disproportionate amount of suicides.  For instance, though data suggests that though 6.9 percent of adolescents have attempted suicide, nearly one third (33.2%) of transgender youth have done so. (9),(10)

It is almost surprising that the rate isn’t higher when one considers the findings of a large scale published by the Gay Lesbian Straight Education Network (GLSEN);  nearly nine in ten transgender students had been verbally harassed in the prior year due to their gender expression (87%), and more than half had also been physically assaulted (53%).  In addition, most (54%) transgender students did not feel that they could report incidents of victimization to school authorities, noting that school staff failed to intervene when incidents of harassment were reported or witnessed.  Worst of all, more than a third of transgender students reported that they had heard school staff make homophobic statements, sexist remarks, or negative remarks about someone’s gender expression. (11)

Aspects of the school environment known to promote or perpetrate victimization include: lack of adequate adult supervision (which may be a result of the physical layout of a school, the sheer size of a school, or inadequate staffing); a school climate characterized by conflict; and a general lack of consistent and effective discipline. (12)   In contrast, school environments with LGBT support groups (such as gay-straight alliances) result in fewer threats of violence and a reduced incidence of suicide attempts (13) and recent research indicates that a school environment which is specifically supportive of LGBT youth results in less suicidality among all students, not just those that identify as LGBT.(14) 

For transgender youth the victimization at school is just a microcosm of the stress they experience within the hostile, homophobic culture.  There is evidence that even without specific instances of victimization, the chronic stress of being a sexual minority has a measurable negative impact on mental and physical health and wellbeing.  In addition to harassment, maltreatment, discrimination and victimization there are a multitude of other internalized stressors which are the result of chronic expectations of rejection, hiding, concealing, and internalized homophobia. (15)

While sexual minority status is a key risk factor for life-threatening behaviors among transgender youth, research has identified specific factors significantly related to having made a suicide attempt.  As expected, these include lower body esteem, and concerns about how others evaluate the youths' bodies.  Sadly, the factor which has been identified as having the most profound impact on suicidality among transgender and gender non-conforming youth is their experiences of past parental verbal and physical abuse and rejection. (16)
 
The Family Acceptance Project found that the way that parents and caregivers respond to their child’s gender variance is the most significant marker of long-term health and well-being. (17)  The research found that young LGBT adults who had experienced high levels of family rejection as adolescents were more than eight times as likely to have attempted suicide than their LGBT peers who had not experienced family rejection.  (In addition to suicidality, family rejection was also found to greatly increase minority youth’s risk for other potentially life threatening behaviors; making them more than three times as likely to use illegal drugs; and more than three times as likely to engage in unprotected sexual behaviors that put them at increased risk for HIV and other sexually transmitted infections.)

The themes of family acceptance, harassment at school and a culture which is unaccepting are highlighted in the Human Rights Campaign (HRC) report “Growing Up LGBT in America”; When LGBT youth were asked to describe the most important problem facing their lives right now, 26% identified lack of family acceptance, 21% identified school bullying problems and 18% identified a generalized fear of being honest about their identity. (18)  The primacy of these variables is reinforced by research which has identified that the three factors which provide the most resilience to suicidality are overall safety within the school setting, positive family connections, and involvement with other caring adults. (19)

The message is loud and clear:  Schools and other organizations which serve youth must do a better job of prohibiting bullying, harassment, and violence and adults in those setting who are expected to be allies must be the first to stop the hurtful and hateful comments.  Those in the community who are potential allies need to step-up.

Leaders of community organizations, parents, and peers all have a role to play in building positive, supportive, and healthy environments for youth which promote acceptance and respect and help all youth feel valued.  Any comprehensive effort to reduce the incidence of suicide among gender variant youth must not only address peer bullying but must stress the failure of the adults across settings within the community.  In order to reduce the incidence of suicide among transgender youth there must be prevention strategies in the school environment, family outreach, and the identification and provision of appropriate services to youth with personal characteristics that increase their risk of being bullied or bullying others.

Intervention in school settings needs to occur at all grade levels.  All schools should have library materials which address the topic of gender diversity.  School administration and staff should attend trainings on how to create safe and supportive school environments for all students and should implement educational programs to raise student awareness about gender stereotyping and name calling.  The HRC offers tools, lessons and resources through a project called “Welcoming Schools”. (20)  Though this program was designed for K-5 elementary schools, the program can be adapted for middle school grades as well.  GLSEN also has resources for educators including lesson plans and a “Safe Schools Improvement Act Action Kit”. (21)

In addition to actively identifying providers who already have experience meeting the educational, medical, social and psychological needs of transgender youth, allies must create safe and affirming settings for transgender and gender non-conforming youth by making existing programs more welcoming and by initiating the development of programs where the need exists.  Allies must expect and advocate for measures to improve the cultural competence of community institutions, including youth serving organizations, healthcare providers, and faith based groups. 

All agencies which serve youth should seek diversity training which addresses the topic of gender expression and should have resources for youth and their families.  The Safe Schools Coalition has one such list of resources for parents/guardians, family members, educators and allies. (22)

Even community members with no direct involvement with schools or institutions which serve youth can advocate for safe schools legislation which includes enumeration of perceived gender identity and gender expression as a protected category.  Caring individuals can also advocate for the legitimization of gay relationships and should openly acknowledge gender and sexual diversity.  One could hope that a groundswell of acceptance within the community would prompt the least accepting of families to re-evaluate their own prejudices. 

Though there is no one program or exclusive approach to eradicate the problem of suicide among transgender youth, open dialogue and factual information are our best weapons in the battle against the layers of victimization which lead to this tragedy.  Those steps can, and should be, part of everyone’s agenda.

For more information and support:
 
Organizations:
  • GLSEN (Gay, Lesbian and Straight Education Network) www.glsen.org - An organization for students, parents, and teachers that tries to affect positive change in schools.
  • Safe Schools Coalition - www.safeschoolscoalition.org - An International Public-Private Partnership in Support of Gay, Lesbian, Bisexual and Transgender Youth.
  • HRC/Welcoming Schools Project - www.welcomingschools.org - An HRC project welcoming tools, lessons and resources on embracing family diversity, avoiding gender stereotyping and ending bullying and name-calling.
  • PFLAG.org - Parents, Families and Friends of Lesbians and Gays - A non-profit ally organization committed to advancing equality through its mission of support, education and advocacy.
  • Trans Youth Family Allies - TYFA empowers children and families by partnering with educators, service providers and communities, to develop supportive environments in which gender may be expressed and respected.
 
Book:
The Transgender Child, by Stephanie Brill and Rachel Pepper
 
Local:
  • Gender Rainbow Support Group (ages 4-12)
  • Parents of Trans Kids Support Group - Meets every 6-8 weeks with attendees from Michigan and Ohio to support families and their children who have non-conforming gender identities. All family members and allies welcome. Email Dr.Caretto@BeTreatedWell.com to be added to the list for upcoming events. All information held confidential and there is no cost. For ages 4-18.

References

(1) Centers for Disease Control and Prevention, National Center for Injury Prevention and Control. Web-based Injury Statistics Query and Reporting System (WISQARS), 2010 from www.cdc.gov/injury/wisqars/index.html.)

(2) Kim Y. & Leventhal, B. (2008). Bullying and suicide: A review. International Journal of Adolescent Medicine and Health, 20(2):133-54.

(3) Hay C. & Meldrum, R. (2010). Bullying victimization and adolescent self-harm: testing hypotheses from general strain theory. Journal of Youth and Adolescence, 39(5):446-59.

(4) Kaminski J. & Fang X. (2009). Victimization by peers and adolescent suicide in three US samples. Journal of Pediatrics, 155(5):683-8.

(5) Garofalo, R., Wolf, R., Kessel, S., Palfrey, J., and DuRant, R. (1998). The association between health risk behaviors and sexual orientation among a school-based sample of adolescents. Pediatrics, 101(5), 895–902.

(6) Bontempo, D. & D’Augelli, A. (2002). Effects of at-school victimization and sexual orientation on lesbian, gay, or bisexual youths’ health risk behavior. Journal of Adolescent Health, 30, 364-374.

(7) Berlan E., Corliss H., Field A., Goodman E, Austin S. (2010). Sexual orientation and bullying among adolescents in the growing up today study. Journal of Adolescent Health, 46(4):366-71.

(8) Arseneault, L., Bowes, L., & Shakoor, S. (2010). Bullying victimization in youths and mental health problems: 'much ado about nothing'? Psychological Medicine, 40(5):717-29.

(9) Youth risk behavior surveillance—United States, 2005. Morbidity and Mortality Weekly Report from www.cdc.gov/mmwr/PDF/SS/SS5505.pdf

(10) Clements-Nolle, K., Marx, R., & Katz, M. (2006). Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. Journal of Homosexuality, 51(3):53-69.

(11) Harsh Realities: The Experiences of Transgender Youth in Our Nation’s Schools. New York: GLSEN. (2009) from www.glsen.org/binary-data/GLSEN_ATTACHMENTS/file/000/001/1375-1.pdf

(12) Bowes, L., Arseneault, L., Maughan, B., Taylor, A., Caspi, A., & Moffitt, T. (2009). School, neighborhood, and family factors are associated with children's bullying involvement: a nationally representative longitudinal study, 48(5):545-53.

(13) Goodenow, C., Szalacha, L., & Westheimer, K. (2006). School support groups, other school factors, and the safety of sexual minority adolescents. Psychology in the Schools, 43:573–89.

(14) Hatzenbuehler, M. (2011). The Social Environment and Suicide Attempts in Lesbian, Gay, and Bisexual Youth. Pediatrics, 127(5):896-903.

(15) Meyer I. (2003). Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychological Bulletin, 129(5):674-97.

(16) Grossman, A. & D'Augelli, A. (2007). Transgender youth and life-threatening behaviors. Suicide and Life-Threatening Behaviors, 37(5):527-37.

(17) Ryan, C., Huebner, H., Diaz, R., et al. (2009). Family Rejection as a Predictor of Negative Health Outcomes in White and Latino Lesbian, Gay, and Bisexual Young Adults. Pediatrics, 123(1):346-352).

(18) Growing Up LGBT in America: HRC Youth Survey Report Key Findings. (2012) www.hrc.org/files/assets/resources/Growing-Up-LGBT-in-America_Report.pdf

(19) Eisenberg, M. & Resnick, M. (2006). Suicidality among gay, lesbian and bisexual youth: The role of protective factors. Journal of Adolescent Health, 39:662-668.

(20) Welcoming Schools: A Project of the Human Rights Campaign Foundation. www.welcomingschools.org

(21) Safe Schools Improvement Act Action Kit.(2010) www.glsen.org/binary-data/GLSEN_ATTACHMENTS/file/000/001/1518-1.PDF

(22) Transgender and Gender Variant Children and Youth: Resources for Parents/Guardians, Family Members, Educators and Allies. (2012) www.safeschoolscoalition.org/RG-gender_nonconforming_trans_youth.html

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