Increased risk of suicidality in treatment-seeking transgender adults and adolescents with autism traits and anxiety/depression

<i>Background:</i> Transgender adolescents and adults appear to be at increased risk of suicidality, but the risk factors are unclear.<i>Aim:</i> This study aimed to examine suicidality in treatment-seeking adolescents and adults. We examined whether autism traits, anxiety/depression, access to gender affirming treatments, or self-identification category affected suicidality in this group.<i>Methods:</i> We conducted a cross-sectional study of 123 patients (16 years and older) currently attending, or previously attended, specialist gender services in Northern Ireland. Main outcome measures included a demographic information questionnaire, the Suicide Behaviour Questionnaire Revised, the Childhood Trauma Questionnaire or the Recent Trauma Questionnaire, and the Hospital Anxiety and Depression Scale. Autism traits were measured using the Autism Quotient, the Ritvo Autism and Asperger Diagnostic Scale-Revised, and the Cambridge Behaviour Scale (Empathy Quotient).<i>Results:</i> Only autism traits and anxiety/depression were independently associated with higher levels of suicidality. Self-reported future risk of suicidality was markedly lower than self-reported past suicidality for the patients who were attending the specialist gender service. This apparent reduction in suicidality is possibly attributable to the impact of being able to access the specialist service. <i>Conclusion:</i> This study highlights increased vulnerability in this population for suicidality, particularly those with autism traits and anxiety/depression. These findings are important in the context of the reclassification of gender incongruence to conditions of sexual health. While a move away from mental health services reduces stigma for individuals seeking gender-affirming interventions, the treatment of co-existing mental health needs requires close involvement with mental health services.