Vol.:(0123456789) 1 3 European Child & Adolescent Psychiatry https://doi.org/10.1007/s00787-020-01508-5 REVIEW Lifetime prevalence of suicidal ideation and suicidal behaviors in gender non‑conforming youths: a meta‑analysis Teresa Surace 1  · Laura Fusar‑Poli 1  · Lucia Vozza 1  · Vito Cavone 1  · Chiara Arcidiacono 1  · Rossella Mammano 1  · Lucia Basile 2  · Alessandro Rodolico 1  · Pablo Bisicchia 1  · Pasquale Caponnetto 3  · Maria Salvina Signorelli 1  · Eugenio Aguglia 1 Received: 15 September 2019 / Accepted: 5 March 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020 Abstract Gender identity represents a topic of growing interest in mental health research. People with non-conforming gender identity are prone to sufer from stigmatization and bullying and often present psychiatric issues, which may in turn lead to a high prevalence of suicidal ideation and behaviors. The present meta-analysis aimed to estimate the prevalence of suicidal ideation and suicidal behaviors in gender non-conforming children, adolescents and young adults. A systematic search was performed in Web of Science and PsycINFO from inception to December 2018. We selected cross-sectional and cohort studies including youths (up to 25 years) with a diagnosis confrmed by a clinician according to international classifcations, or after a direct interview with a peer. A random-efects meta-analysis was computed for the following outcomes: non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts. Overall, we found a mean prevalence of NSSI of 28.2% (9 studies, 3057 par- ticipants, 95% CI 14.8–47.1). A similar prevalence (28%) was found for suicidal ideation (6 studies, 2249 participants, 95% CI 15–46.3), while the prevalence of suicide attempts was 14.8% (5 studies, 1039 participants, 95% CI 7.8–26.3). Subgroup analyses revealed no signifcant diferences according to biological sex. Given the prevalence of suicidal behaviors in gender non-conforming youths, it appears desirable to implement therapeutic and support strategies for this population. Moreover, educational interventions directed to parents, teachers, mental health professionals and general community should be pro- moted to struggle against stigma and social isolation, factors that may contribute to increasing the risk of suicidal behaviors. Keywords Gender identity · Gender dysphoria · Gender incongruence · Children · Adolescents · Suicide · Self-injury · Minority stress Introduction Gender identity can be defned as the personal sense of one’s own gender [1]. Disorders related to gender identity repre- sent a topic of growing interest for mental health profes- sionals, particularly considering the number of diagnostic refnements occurred over the last years [2]. After abandon- ing the expressions of transsexualism and gender identity disorder (GID), adopted in previous editions of the Diag- nostic and Statistical Manual of Mental Disorders (DSM), the DSM-5 has fnally introduced the concept of gender dysphoria. Gender dysphoria refers to the distress felt by a person due to a mismatch between their gender identity and their biological sex [3]. Moreover, while gender identity was previously considered to be dichotomous (male/female), in DSM-5, this concept is better described as a multi-category or a spectrum [4, 5]. More recently, the International Classifcation of Diseases (ICD-11) has proposed the notion of gender incongruence, which corresponds to a marked and persistent incongruence between an individual’s experienced gender and the assigned sex [6]. A remarkable diference from DSM-5 gender dys- phoria is that gender incongruence does not require to cause signifcant distress or impairment. Additionally, in ICD-11, gender incongruence has been moved from the “Mental and behavioral disorders” chapter to the new section “Condi- tions related to sexual health” [6]. Another umbrella term, frequently used in scientifc literature and among the general Teresa Surace and Laura Fusar-Poli are joint-frst authors. * Teresa Surace teresa.surace70@gmail.com Extended author information available on the last page of the article