Risk and protective factors of suicidal ideation in transgender people in the gender-affirming medical care context—An ENIGI follow-up study

Background Transgender and gender-diverse (TGD) individuals are highly vulnerable to suicidality which can persist throughout gender-affirming medical care (GAMC). Factors affecting the persistence or development of suicidal ideation (SI) during GAMC have not been studied previously. Young adults might be at particular risk and present with different risk and protective factors.Methods We aimed to identify risk and protective factors associated with SI, with a focus on social and TGD-specific factors, in the European Network for the Investigation of Gender Incongruence. Questionnaire data from 3 gender clinics, collected at clinical intake (baseline) and 4–6 years later (follow-up) was examined (N = 477). χ2-tests compared the prevalence of risk and protective factors between 4 groups with persisting, absent, decreasing, and developing SI determined by the SI item of the symptom checklist-90-R at the two time points. Logistic regression analyzed the relationship between these factors and SI at follow-up, with age group (<25/≥25) as covariate.Results At the group level 16/22 factors were significant. Group 1 (persisting) scored worst on both risk and protective factors, while group 4 (developing) was mainly characterized at follow-up by poor scoring on social and TGD-specific correlates, such as perceived barriers to receiving care and body dissatisfaction.Regression models were significant (Nagelkerke RBL2=.127 and RFU2 =.412); factors significantly associated with follow-up SI were baseline loneliness, parent mental disorder and uncertainty about abuse during childhood, and follow-up psychiatric hospitalization, barriers to receiving care, loneliness and body dissatisfaction; contact with TGD peers (baseline) and social support (follow-up) were associated with lower odds of SI. No age effect was found.Conclusion To our knowledge, this is the first study that examined risk and protective factors of SI in TGD individuals before and 4–6 years into GAMC. Social factors seemed to play a crucial role and present suitable targets for interventions.This study was preregistered on OSF (Voetterl et al., Citation2025).