Examining the Relation Between Negative Healthcare Experiences and Suicide Ideation in Transgender and Non-binary Adults

Suicidal thoughts and behaviours (STBs) are more common among transgender and non-binary (TGNB) people relative to the general population. Nonetheless, research on correlates and predictors of STBs among TGNB people is lacking. This study used a mixed-methods design to examine whether negative healthcare experiences (NHEs) concurrently and prospectively predicted suicide ideation (SI) among 182 TGNB adults aged 18-55 (M=25.64, SD=6.63). Participants could complete the study online worldwide, although 84% resided in North America. At baseline, participants completed questionnaire measures of NHEs, SI, depression symptoms, social support and TGNB community connectedness. The NHE questionnaire included open textboxes and responses were analyzed in a reflexive thematic analysis. Participants were recontacted four months later, and STBs experienced since baseline were recorded. Participants frequently experienced NHEs; 169 (93%) reported at least one. Further, experiencing more NHEs was significantly associated with more frequent SI concurrently (𝜌=.61, p<.01) and prospectively (𝜌=.56, p<.01), but not when depression was included as a covariate. Community connectedness was associated with SI at baseline, even when controlling for social support and NHEs (p=.007), but not when controlling for depression. Contrary hypotheses, social support and community connectedness generally did not moderate the relationship between NHEs and SI. In qualitative analyses, we identified five themes that added context regarding participants’ adverse experiences in healthcare settings. Our results highlight contributors to suicide risk among TGNB people. Systematically improving healthcare experiences (access; care received) for these groups may ultimately contribute to suicide prevention efforts.