Michael Marshal noticed an alarming trend while working with adolescents dealing with substance abuse and mental health problems at the University of Pittsburgh Services for Teens at Risk Center: A growing number identified as gay, lesbian, bisexual and transgender.
It was alarming because there “wasn’t much” literature to work off of when treating these particular adolescents.
“I was less familiar about it and wanted to learn more about the risk factors these particular youth might experience,” said Marshal, formerly an associate professor of psychiatry and pediatrics at Pitt, who now operates his own private practice. “There was nothing out there in research that could help me understand how to help them in therapy with their struggles.”
Since 2004, Marshal has focused his research efforts on studying adolescents in the LGBTQIA+ community to get a more accurate measure of how big this problem was, including co-authoring a recent study that measures suicidality disparities between transgender and cisgender adolescents.
The survey study comprised of over 2,000 adolescent participants across the United States ages 14 to 18, including 1,148 who identified as transgender. The researchers’ findings confirmed Marshal’s hypothesis: Transgender adolescents have higher odds of suicidality than cisgender adolescents. More specifically, about 85% of transgender adolescents reported “seriously considering suicide,” while over half of transgender adolescents attempted suicide, according to the study.
“One of the key problems they face is this notion that everyone else in the world can essentially invalidate their identity by just telling them it’s not OK to identify as transgender,” Marshal said. “Their identities are hidden, and when they’re hidden, it’s easy for other people to discriminate against them. This causes a lot of pain and suffering.”
The large sample size gave researchers the opportunity to split the transgender study participants into subgroups, something that couldn’t be done well before.
Going deeper, transgender boys were at the highest risk of a suicide attempt requiring medical attention, followed by non-binary teens assigned male at birth. Transgender girls meanwhile were six times more likely than cisgender boys to have suicidal thoughts.
“Unfortunately, this is the norm for transgender adolescents in the U.S. right now,” said Brian Thoma, the study’s lead author and assistant professor of psychiatry at Pitt. “It’s really important that we examine some of the psychosocial stressors that could be underlying these suicidality disparities between transgender and cisgender youth. Once we look at that more, we’ll have more information about how to develop prevention and intervention efforts to reduce these rates.”
Marshal said one tactic the team implemented in its study to obtain a large sample size was the questions researchers used.
“We wanted to make sure our questionnaire asked the types of questions that were appropriate for transgender youth, and wanted to ask questions that were respectful of how they were identified,” he said. “We didn’t just say ‘Do you identify as transgender or not?’ We asked them to list different types of identities they identified with. Many studies in this area don’t ask teenagers about their sexual orientation or their gender identity.”
The team is also preparing to study eating behavior and body image in transgender youth.
While information is still being gathered for better treatment, Thoma says companies and organizations can take steps in the meantime to relieve some of the stress youth and adults in the transgender community face by validating their identities.
“This can include things like using their chosen names or correct pronouns that align with their current gender identities,” he said. “These simple steps help foster an environment where transgender individuals feel included.”