(PS2-A15) Suicide and Non-suicidal Self-injury in a National Sample of Gender-diverse Preadolescents

Several studies have shown increased rates of self-injurious thoughts and behaviors in transgender and gender-nonconforming youth. However, these studies have typically focused on adolescents and have assessed gender minority status using language that may be less accessible to a preadolescent population.  The Adolescent Brain and Cognitive Development Study (release version 3.0) provides a uniquely ideal, national dataset to assess gender diversity and self-injury in preadolescents (ages 10-11) , since the size of the sample allows for statistically powered analyses of self-injury in preadolescent youth, and the study also incorporates questions on gender diversity experiences more broadly rather than only transgender identity. Logistic regression analyses were performed on the full sample (n = 11,235) and stratified by biological sex (n_males = 5,879, n_females = 5,356) to evaluate felt-gender incongruence (i.e., feeling like a gender not aligned with one’s biological sex and/or not feeling like the gender aligned with one’s biological sex ) and gender-non-contentedness (i.e., having a wish to be a gender not aligned with one’s biological sex), respectively, as predictors of non-suicidal self-injury (NSSI), suicidal ideation and suicide attempts. Although only 99 youth (0.88%) self-identified as non-cisgender, 2,125 youth (18.91%) endorsed at lease some felt-gender incongruence. Similarly, 1,169 youth (10.40%) endorsed having at least some gender non-contentedness. Felt-gender incongruence was a significant predictor of lifetime presence of NSSI, suicidal ideation and suicide attempts in the full sample and for males and females separately (NSSI ORs = 1.36-1.36, ps < .001; suicidal ideation ORs = 1.38 – 1.46, ps < .001; suicide attempts ORs = 1.29 – 1.44, ps < .01). Gender non-contentedness was also significantly predictive of all outcomes (NSSI ORs = 1.74 – 2.04, ps < .001, suicidal ideation ORs = 1.91 – 1.92, ps < .001, and suicide attempts ORs = 1.74 – 1.87, ps < .01).  These results suggest that felt-gender incongruence and gender non-contentedness are significant predictors for NSSI, suicidal ideation, and suicide attempts in preadolescent children and these findings were largely consistent across biological sex. Assessing these factors may help clinicians identify potential risk for self-injurious behaviors in a wider range of youth than would be captured if focusing exclusively on those who identify as transgender.  While gender diversity is a significant predictor of NSSI, suicidal ideation and suicide attempts, a large portion of gender-diverse preadolescents do not exhibit any of these thoughts or behaviors. It would therefore be important for future research to identify potential moderators of risk in the population. The results of this study also open further possibilities to study the role of family acceptance for preadolescent gender-diverse youth as a potential moderator. Parental acceptance plays a positive role for transgender adolescents and it is important to understand if parental acceptance could be a protective moderator against self injury in gender-diverse preadolescents.