Prevalence of suicidal thoughts and attempts in the transgender population of the world: a systematic review and meta-analysis

Transgender is an umbrella term encompassing individuals whose gender identity or expression differs from sex assigned at birth, including trans women (male to female, MTF), trans men (female to male, FTM), and gender nonconforming individuals. Transgender people, as a minority group, face elevated risks for negative mental health outcomes, including depression, anxiety, substance use disorders, suicidal thoughts, and attempts. WHO data indicate suicide as a significant public health problem globally and a leading cause of death among youth. Prior estimates suggest 5.6–14.4% of people in general populations experience suicidal thoughts and 1.9–8.7% attempt suicide, while among transgender people suicide attempts have been estimated at 16–42%. Studies report markedly elevated suicide risks among transgender people (e.g., 19-fold higher suicide death risk vs controls in Sweden). Factors contributing to heightened risk include prejudice, discrimination, violence, rejection, mental health problems, and substance use, while protective factors include social support and access to mental healthcare. This study aimed to systematically review and meta-analyze the global pooled prevalence (point, period, lifetime) of suicidal thoughts and attempts among transgender individuals worldwide and to estimate prevalence by subgroup (gender identity and region).

Prior research indicates substantially higher suicidality among transgender populations than general or other sexual minority groups. Reported figures include suicide attempts among transgender people ranging from 16–42%, 19-fold higher suicide mortality risk in Sweden, prevalence estimates in India of 32–50%, lifetime suicidality around 33% in Argentina, and among U.S. transgender students 15% reported attempts in the past 12 months and 41% lifetime. Risk factors repeatedly identified include stigma, discrimination, violence, rejection, mental health disorders (depression, anxiety), substance use, and socioeconomic stressors. Protective factors include family and peer support, social participation, and access to mental health services. Prior studies often combined LGBT subgroups, obscuring differences, and focused on risk/tendency rather than precise prevalence figures, underscoring the need for a focused prevalence meta-analysis in transgender populations.

Protocol and reporting: Registered in PROSPERO (CRD42022376073) and followed PRISMA 2020 guidelines. Eligibility: Included cross-sectional (descriptive or analytical) studies reporting frequency/percentage of suicidal ideation and/or suicide attempts among transgender populations. Excluded non–cross-sectional designs (case-control, cohort, clinical trials), letters, case reports, reviews; studies not in English; studies reporting suicide measures only as mean scores or other non-frequency metrics; and studies on other sexual/gender minorities without separate transgender data. Information sources and search: Searched PubMed (Medline), Scopus, Embase, Web of Science, PsycINFO, and CINAHL from January 1990 to December 2022. Complemented with manual reference checks and the first ten pages of Google Scholar. Duplicates were removed via EndNote X9, with title/abstract/full-text screening by two independent reviewers (PK, MN) and adjudication by a supervisor when needed. Data extraction: Standardized checklist captured authors, study design, year, sample size, country/continent, population type (FTM, MTF, both), age, and frequencies of suicidal ideation and attempts. Risk of bias: Newcastle–Ottawa Scale (NOS) adapted for cross-sectional studies (max score 9), rated independently by two reviewers (PK, MCH) with third reviewer (YM) resolving discrepancies. Statistical analysis: Extracted counts of events and sample sizes. Used metaprop in STATA 17 to compute pooled prevalence estimates with corresponding 95% CIs. Heterogeneity assessed with Cochran’s Q and I2, significance at p<0.05. Publication bias evaluated by funnel plots and Egger’s test, with trim-and-fill sensitivity analyses. Meta-regression examined age effects. Prespecified subgroup analyses by gender identity (FTM, MTF, both), prevalence timeframe (point=past month, period=past year, lifetime), and continent/region.

Study selection and quality: 2,907 records identified; after screening, 65 cross-sectional studies included. NOS quality scores: 21 studies scored 6, 35 scored 7, and 9 scored 8. Suicidal ideation (71 prevalence estimates): • Overall pooled prevalence: 48% (95% CI 42–54%; I2=88.53%; p<0.0001). • Point (past month): 39% (95% CI 35–43%). • Period (past year): 45% (95% CI 35–54%). • Lifetime: 50% (95% CI 42–57%). Subgroups—ideation: • FTM overall: 51% (95% CI 43–59%); period 40% (95% CI 35–45%); lifetime 53% (95% CI 44–62%). • MTF overall: 44% (95% CI 35–53%); period 47% (95% CI 33–61%); lifetime 43% (95% CI 33–53%). • By continent (ideation): period prevalence—America 50% (95% CI 37–63%), Europe 38% (95% CI 35–40%), Asia 23% (reported as 23%; CI presentation in text). Lifetime ideation in Asia: 54% (95% CI 48–61%). Publication bias (ideation): Egger’s test B=−0.38 (SE 0.174), p=0.0477; trim-and-fill suggested minimal impact on pooled estimates. Meta-regression (ideation): Age effect not significant (B=0.0001; SE 0.0033; p=0.969). Suicide attempts (82 prevalence estimates): • Overall pooled prevalence: 26% (95% CI 22–31%; I2=95.51%; p<0.0001). • Point (past month): 16% (95% CI 13–19%). • Period (past year): 11% (95% CI 5–19%). • Lifetime: 29% (95% CI 25–34%). Subgroups—attempts: • FTM lifetime: 22% (95% CI 13–31%). • MTF overall: 25% (95% CI 21–30%); period 13% (95% CI 10–17%); lifetime 26% (95% CI 22–34%). • By continent (attempts, lifetime): Europe 33% (95% CI 29–36%), America 29% (95% CI 24–35%), Asia 23% (95% CI 18–28%). Australia/Oceania overall attempts: 38% (95% CI 26–52%). Publication bias (attempts): Egger’s test B=2.18 (SE 0.974), p=0.0214; trim-and-fill indicated limited effect on pooled results. Meta-regression (attempts): Age effect not significant (B=0.010; SE 0.002; p=0.666).

This meta-analysis demonstrates a high global burden of suicidal ideation and attempts among transgender populations, with lifetime ideation at 50% and lifetime attempts at 29%. These magnitudes imply that a substantial proportion of those with ideation proceed to attempts, underscoring critical gaps in prevention and care. Differences across gender identity and regions were notable: ideation tended to be higher among FTM individuals in some regions, while attempts were often elevated among MTF individuals in several analyses; regional variation showed higher ideation in Asia and higher attempts in Australia/Oceania and Europe compared with Asia. The findings align with literature indicating that stigma, discrimination, violence, social rejection, and limited access to gender-affirming care (including hormone therapy) contribute to mental health burdens and suicidality. Economic barriers, lack of family support, and healthcare discrimination can impede access to needed treatments, exacerbating depression and anxiety. Elevated substance use and earlier high-risk sexual experiences further compound risk. Internalized transphobia and negative self-concept are additional pathways to suicidality. Although publication bias was detected, sensitivity analyses suggested minimal impact on overall estimates. Age did not significantly modify prevalence. These results highlight the urgent need for culturally sensitive, gender-affirming, and accessible interventions, as well as policy actions aimed at reducing structural stigma and improving mental healthcare for transgender communities globally.

The meta-analysis reveals high prevalence of suicidal thoughts (lifetime 50%) and suicide attempts (lifetime 29%) among transgender individuals worldwide, indicating that about half of those with suicidal ideation engage in attempts. Immediate implementation of patient-centered and community-centered, evidence-based, and culturally sensitive interventions is needed, including social and economic support programs and accessible counseling and mental health services for transgender people and their families. Training healthcare providers to deliver inclusive, comprehensive care and to identify and manage suicide risk is essential.

The study notes an uneven geographic distribution and a small number of studies from certain regions (e.g., Australia), which may contribute to imprecision or overestimation in some pooled results. The analysis detected publication bias by Egger’s test for both ideation and attempts, though trim-and-fill suggested limited influence on pooled estimates. As only English-language cross-sectional studies reporting frequency/percentage were included, selection and reporting biases are possible.