Gender Identity and Autism Status Increase Rates of Suicidal Thoughts and Behaviors in College Students

Compared with their cisgender and non-autistic peers, autistic transgender or gender-nonconforming (TGNC) college students experience significantly higher rates of suicidal thoughts and behaviors (STBs), according to a secondary analysis of cross-sectional data published in JAMA Network Open.

College students, particularly TGNC students, are especially vulnerable to STBs due to elevated mental health issues and identity-specific stressors that increase their risk. The current study explored the relationship between autism, TGNC status, and STBs, seeking to enhance their understanding of the intersectionality of these identities and its effects on mental health.

Researchers analyzed wave 3 data from the American College Health Association National College Health Assessment, collected between 2019 and 2023. Participants reported demographics, autism status, and past-year STBs.

A total of 41507 students (mean [SD] age, 23.35 [6.83] years), were included in the analysis. Of the participants, 2,410 (5.81%) identified as TGNC, and 326 (13.53%) of these TGNC students also reported being autistic. In contrast, only 625 (1.58%) cisgender participants identified as autistic.

Both gender identity and autism were independently associated with higher odds of STBs. TGNC students had an odds ratio (OR) of 3.34 (95% CI, 2.99 to 3.73) for suicidal ideation and 2.74 (95% CI, 2.13 to 3.52) for suicide attempts. Students with autism had an OR of 2.06 (95% CI, 1.76 to 2.42) for suicidal ideation and 2.39 (95% CI, 1.62 to 3.52) for suicide attempts.

The interaction between being TGNC and autism was significantly associated with higher suicide attempt rates (OR, 0.51; 95% CI, 0.27 to 0.97, P=.04), although there was no interaction effect on suicidal ideation.

Based on the current findings, students who identify as both TGNC and autistic are at particularly high risk of suicide attempts. Among TGNC students, autistic individuals showed the highest rates of suicide attempts, although their risk did not significantly exceed that of autistic cisgender students or non-autistic TGNC students.

“These findings underscore the need for interventions to support autistic TGNC college students, who may be more likely to experience and report STBs.” the researchers concluded.

Limitations include an inability to remove potential duplicate participants, assessment of both outcomes with single-item questions, and a reliance on self-reports of an autism diagnosis.

One study author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures.

This article originally appeared on Psychiatry Advisor