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Objective: To study the prevalence of suicide-related behaviors in individuals with gender dysphoria and to study the associations among gender affirmation, parental attachment, and suicide-related behaviors. Materials and Methods: The present study was a cross-sectional survey study involved individuals with gender dysphoria attending the Gender-Variation (Gen-V) Clinic at Ramathibodi Hospital between August 2020 and February 2021. An online questionnaire was administered, including demographic data, history of gender affirmation, the Impulse, Self-harm, and Suicide Ideation Questionnaire for Adolescents (ISSIQ-A), and the Inventory of Parent and Peer Attachment-Revised (IPPA-R; parental part only). Descriptive statistics, chi-square tests, and adjusted logistic regression analyses were performed using SPSS v.18.0. Results: The present study included 105 participants with a mean age of 29.2 years (range 18 to 53). Of these participants, 86.7% (n=91) identified as trans men, 36.2% (n=38) reported a history of lifetime non-suicidal self-injury (NSSI), 78.1% (n=82) reported engaging in other self-harm behaviors, and 52.4% (n=55) reported suicidal ideation, respectively. Higher scores on the parental attachment scale were associated with a decreased likelihood of suicidal ideation (adjusted odds ratio aOR 0.90, 95% CI 0.86 to 0.95, p<0.001). Additionally, participants who had undergone gender-affirming surgery were less likely to engage in NSSI (aOR 0.33, 95% CI 0.12 to 0.95, p=0.039). Conclusion: The present study demonstrates the overwhelming prevalence of NSSI, other self-harm behaviors, and suicidal ideation among individuals with gender dysphoria. Gender-affirming surgery and secure attachment with parents may contribute to lower rates of NSSI and suicidal ideation among them. Keywords: Gender dysphoria; Non-suicidal self-injury; Suicidal ideation; Gender affirmation; Attachment
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