Transgender individuals, encompassing various gender identities and expressions differing from their assigned sex at birth, experience disproportionately high rates of negative mental health outcomes, including suicidal ideation and attempts. Suicide is a leading cause of death globally, and existing data suggest significantly elevated suicide risk among transgender individuals compared to the general population. Studies from various regions report widely varying prevalence rates of suicidal thoughts and attempts within the transgender community, necessitating a comprehensive meta-analysis to determine a global estimate. This study aims to address this gap by systematically reviewing and meta-analyzing available research to determine the global pooled prevalence of suicidal thoughts and attempts among transgender individuals, considering variations by gender transition type (female-to-male, male-to-female), geographic region, and time frame (point, period, lifetime). Understanding these prevalence rates is crucial for informing public health policies, resource allocation, and the development of targeted interventions aimed at suicide prevention and promoting the mental well-being of transgender individuals.

The existing literature demonstrates a significant disparity in mental health outcomes between transgender individuals and the cisgender population. Studies consistently highlight the increased prevalence of depression, anxiety, and substance use disorders among transgender individuals. The risk of suicide attempts and suicidal ideation is substantially elevated in this population, with some studies reporting suicide rates as much as 19 times higher than in control groups. However, significant variability exists in reported prevalence rates due to differences in study methodologies, sample characteristics, and geographical locations. This lack of consistent global data necessitates a systematic review and meta-analysis to obtain a more accurate and comprehensive understanding of the global prevalence of suicidal thoughts and attempts within the transgender population. This review will analyze the available data to provide a reliable estimate of this prevalence, accounting for potential sources of heterogeneity.

This systematic review and meta-analysis followed the PRISMA guidelines. A comprehensive search was conducted across six international databases (PubMed, Scopus, Embase, Web of Science, PsycINFO, CINAHL) from January 1990 to December 2022 using keywords related to "Suicide Attempt," "Suicide Ideation," and "Transgender." The search also included manual searches and Google Scholar. Cross-sectional studies reporting suicidal thoughts or attempts as frequencies were included, excluding other study designs, qualitative studies, or those reporting mean scores instead of frequencies. Study quality was assessed using the Newcastle-Ottawa Scale. Data extraction included author names, study type, publication year, sample size, country, continent, population type, age, and frequency of suicidal thoughts and attempts. Meta-analysis was performed using STATA version 17 with the Metaprop command, examining heterogeneity using Cochran's Q and I² tests. Publication bias was assessed using funnel plots and Egger's test. Subgroup analyses explored differences based on gender transition type (FTM, MTF), continent, and prevalence type (point, period, lifetime). Meta-regression analyzed the effect of age on suicide prevalence.

The meta-analysis included 65 studies, yielding 71 prevalence measures for suicidal thoughts and 82 for suicide attempts. The pooled prevalence of suicidal thoughts was 48% (95% CI: 42-54%), with point, period, and lifetime prevalences of 39%, 45%, and 50% respectively. The pooled prevalence of suicide attempts was 26% (95% CI: 22-31%), with point, period, and lifetime prevalences of 16%, 11%, and 29% respectively. Subgroup analyses revealed variations across different continents and gender transition types. The prevalence of suicidal thoughts was highest in Asia (lifetime prevalence 54%), while suicide attempts were most prevalent in Australia and Oceania (lifetime prevalence 38%). FTM individuals in Asia and America reported higher suicidal thoughts than MTF individuals. Publication bias was detected, but trim and fill analysis did not substantially alter the overall results. Meta-regression showed a non-significant increase in suicidal thoughts and attempts with age.

The findings confirm the significantly elevated risk of suicidal thoughts and attempts among transgender individuals globally. The lifetime prevalence of suicidal thoughts (50%) underscores the urgent need for comprehensive preventative measures. Variations observed across continents and gender transition types highlight the influence of sociocultural factors and potential differences in experiences of discrimination and marginalization. The higher prevalence of suicidal ideation among FTM individuals in certain regions suggests the need for targeted interventions addressing specific stressors faced by this subpopulation. The study's limitations, including publication bias and the potential for underreporting in some regions, should be considered when interpreting these findings. Future research should focus on understanding the complex interplay of factors contributing to suicide risk among transgender individuals and developing culturally sensitive interventions addressing these factors.

This meta-analysis reveals alarmingly high rates of suicidal thoughts and attempts among transgender individuals worldwide. The approximately 50% lifetime prevalence of suicidal thoughts highlights a critical public health concern. Further research should prioritize investigating protective factors and developing tailored interventions to mitigate suicide risk within specific subgroups and geographical locations. Comprehensive mental health services, social support programs, and policies addressing discrimination are crucial for improving the well-being and reducing suicide risk among transgender individuals.

The study's limitations include potential publication bias, despite the use of trim and fill analysis; variations in study quality; limited data from some regions, potentially affecting the generalizability of findings; and reliance on self-reported data, which could be subject to recall bias. Further research with larger, more representative samples and diverse methodologies is needed to confirm these findings and gain a more comprehensive understanding of the factors contributing to suicide risk within the transgender population.