19 july 2024
By Professor Louis Appleby, University of ManchesterDepartment of Health and Social Care adviser on suicide prevention
Aim of this review
I have reviewed data provided by NHS England (NHSE) on suicides by young patients of the gender services at the Tavistock and Portman NHS Foundation Trust, based on an audit at the trust. The specific aim is to examine evidence for a large rise in suicides claimed by campaigners.
Summary of conclusions
The data do not support the claim that there has been a large rise in suicide in young gender dysphoria patients at the Tavistock.
The way that this issue has been discussed on social media has been insensitive, distressing and dangerous, and goes against guidance on safe reporting of suicide.
The claims that have been placed in the public domain do not meet basic standards for statistical evidence.
There is a need to move away from the perception that puberty-blocking drugs are the main marker of non-judgemental acceptance in this area of health care.
We need to ensure high quality data in which everyone has confidence, as the basis of improved safety for this at risk group of young people.
Suicide risk in gender dysphoria
The evidence on suicide risk in children and young people with gender dysphoria is generally poor. Most studies are methodologically weak, being based on online surveys and self-selected samples and coming from biased sources. However, there are good reasons to believe that their risk is high compared to other young people. They have often experienced prejudice and intimidation, isolation and family conflict. They may have mental health conditions such as depression and anxiety. There are high rates of autism. These are known risk factors - suicide in any group is usually the result of multiple risks acting in combination.
It therefore seems reasonable to assume that services offering non-judgemental support may contribute to lower risk. However, the evidence for “gender-affirming care” in the form of puberty-blocking drugs is unreliable. In contrast, a robust study from Finland published earlier this year (Ruuska et al, BMJ Mental Health 2024) reported that suicide risk was reduced after gender reassignment but that the improvement was explained by the treatment of co-existing mental ill-health.
Public discussion of suicide
Responsible reporting of suicide in the media is an important strand of suicide prevention, and a central feature of the national suicide prevention strategy in England. Guidance has been developed by Samaritans, originally for the news media but with wider applicability to any public discussion of suicide, and increasingly relevant to social media.
The risks include:
alarming stories about suicide causing distress to people who are themselves at risk
identification - when someone sees in themselves a connection with a person who has died by suicide; leading to:
imitation and suicide clusters in people with similar characteristics
As a result, the media - and users of social media - are asked to:
ensure that any claims about suicide are evidence-based and from a reliable source
avoid alarming and dramatic language
avoid the impression that suicide is the expected or likely outcome in certain situations
avoid oversimplifying suicide by attributing it to a single cause which could be the basis of identification
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