Gender identity strongly influences the likelihood a teen will attempt suicide, a new study finds.

Nearly 14% of teens who participated in a survey reported trying to kill themselves, with transgender teens reporting the highest rates of suicide attempts. Among female to male teens, the language the study uses for transgender male teens, more than half (50.8%) said they'd tried to take their lives, according to the study, published Tuesday in the journal Pediatrics.
 
"Gender identity is one's own understanding of being male, female, neither, or both," Russell B. Toomey, lead author of the study and an associate professor of family studies and human development at the University of Arizona, wrote in an email.
 
For most people, their sense of being male or female aligns with what's listed on their birth certificate, he said. However, "a smaller proportion of the population identifies as transgender, which includes people whose internal sense of gender identity" is not consistent with their gender at birth.
 

'Discrimination, victimization, and rejection'

The new study is based on data from the Profiles of Student Life: Attitudes and Behaviors survey produced by Search Institute, a Minneapolis-based nonprofit focused on youth issues. The survey includes self-reported responses from 120,617 people between the ages of 11 and 19, beginning in June 2012 and ending in May 2015.
The sample included 202 teens (0.2%) who identified as male-to-female transgender, 175 (0.1%) who were female-to-male transgender and 344 (0.3%) not exclusively male or female transgender, also called nonbinary. About 0.9% of the surveyed teens (1,052) reported questioning or not being sure of their gender identity. Additionally, 50.6% (60,973) of females identified as female, and 48% (57,871) of males identified as male. (The researchers rounded up the percentages for publication.)
Asking for help

The suicide rate in the United States has seen sharp increases in recent years. Studies have shown that the risk of suicide declines sharply when people call the national suicide hotline: 1-800-273-TALK.

There is also a crisis text line. For crisis support in Spanish, call 1-888-628-9454.

The lines are staffed by a mix of paid professionals and unpaid volunteers trained in crisis and suicide intervention. The confidential environment, the 24-hour accessibility, a caller's ability to hang up at any time and the person-centered care have helped its success, advocates say.

The International Association for Suicide Prevention and Befrienders Worldwide also provide contact information for crisis centers around the world.

Among the survey questions: "Have you ever tried to kill yourself?"
More than 14% (17,007 respondents) said they had, which is in line with other research, Toomey and his colleagues wrote.
In addition to high rates of suicide attempts among female-to-male transgender respondents, 41.8% of adolescents who identified as neither male nor female said they'd attempted suicide; 29.9% of male-to-female transgender respondents, 27.9% of questioning adolescents, 17.6% of females identifying as female and 9.8% of males identifying as male responded the same, the study found.
 
Toomey believes that "research is critically needed" to understand why suicide attempts are highest among transmasculine (female-to-male youth) and nonbinary youth (neither male nor female).
 
What is known is that transgender teens are more likely "to experience discrimination, victimization, and rejection, which are all associated with increased risk for suicidal behaviors," he said. "Other research suggests that the lack of connection and belonging, as well as feeling like a burden to society, are key predictors of suicidal behavior."
Family support is a game-changer, Toomey said: When transgender youth feel that support, "they are more likely to thrive and exhibit similar levels of psychological functioning" as their peers.
 
Heather Huszti, chief psychologist at Children's Hospital of Orange County in California, said the numbers are generally higher in all populations that "have increased stigma attached to them -- or a lack of understanding."
 
Feeling marginalized, stigmatized and isolated also "leads a lot of kids to that level of hopelessness and helplessness, which is one of the things that can fuel depression and substance use," said Huszti, who was not involved in the new study. She added that "substance use and depression together can also make you more at risk for suicide."
 
Huszti said suicide is "the second leading cause of death" among teens.
Why are teens so vulnerable?
 
"That's the million-dollar question, because we're seeing those rates rise," Huszti said.
"They're very impulsive," she said. "For adolescents, in particular, a large percentage -- I think it's like 50% to 60% -- make an attempt within 30 minutes of having the idea. Their brain isn't developed enough."
Substance users "might be a little more inclined to be disinhibited," she said. Lacking the ability to access resources is another key factor. Although adults can simply choose to see a counselor, "as a teen, you might have to say to your parents, 'I need to go and see a therapist.' "
 
"It's probably also somewhat hormonal," Huszti said, explaining that a leap in the numbers of females experiencing depression occurs "around the time they hit puberty, and they have a lifetime greater risk of depression than do males."
Carl Tishler, an adjunct associate professor of psychology and psychiatry at The Ohio State University, said the study's finding of a comparatively higher rate of attempted suicide among transgender youth "speaks to confusion."
"These are young people who are not clear who they are on the outside versus who they are on the inside," said Tishler, who was not involved in the research. "We, as professionals and parents and teachers and coaches, have to pay close attention to these young people."

Milan Sherry knows what it feels like to recite her final prayers while staring down the barrel of a gun.

But as a black transgender woman and a former sex worker, she faces discrimination based on her gender identity on a daily basis.

It's why she identifies closely with Shantee Tucker, a transgender woman who was fatally shot in Hunting Park early Wednesday morning.

Sherry's now an advocate who works with the North Philadelphia-based Trans Equity Project and hopes the program that's organizing an October march to remember victims of violence can make a difference in the lives of transgender women who face disproportionately high rates of violence and discrimination. But she's not naive.

"Our sisters' lives are worth more when they become hashtags than when they are alive," she said. "Unfortunately, Shantee is not going to be the last girl who is murdered."

Tucker, 30, whose killer police had not identified as of Thursday, is one of three black transgender women killed this week in the United States and one of at least five transgender women of color killed in Philadelphia since 2013. There has been a documented uptick in homicides reported against transgender women over the last five years, and 2018 could be the "deadliest" on record for the group, according to Mara Keisling, executive director of the National Center for Transgender Equality, which has counted 21 such homicides this year.

The killing is particularly chilling for advocates in Philadelphia, where a robust network of activists has successfully lobbied the city to implement progressive policies meant to better protect transgender individuals from discrimination in employment and housing.

Nationally, the New York City Anti-Violence Project counted 27 "hate-violence related" homicides of transgender and gender-nonconforming people in 2017, up from 19 reports in 2016. Of those 27 homicides, 22 were of trans women of color. Beverly Tillery, executive director of the nonprofit, said those figures are incomplete — there is little nationwide accounting of violence against the LGBTQ community, and the group relies largely on media reports and its partner organizations to gather data.

Deja Lynn Alvarez, a health system navigator in the city's Department of Public Health and an advocate for transgender people in Philadelphia, said violence against transgender individuals has always been disproportionately high — but one reason it looks as if homicides have increased is that "it's being reported correctly."

She explained that in the past, police or media may have incorrectly identified a transgender person by the gender they were assigned at birth. Today, Philadelphia police operate under a five-year-old directive that requires that they use pronouns and titles consistent with that person's gender identity.

But that slow change in reporting procedures likely doesn't encapsulate all the reasons why there's an increase nationally in these numbers, said Sarah McBride, a spokesperson for the Human Rights Campaign, the country's largest civil rights organization working on issues related to LGBTQ equality. She said there's been a large increase in overall hate crimes in America over the last two years, including anti-trans hate crimes.

Added Tillery: "This is still a crisis of homicides and violence against trans women and, particularly, trans women of color. No amount of increased reporting can take that away."

In the case of Tucker, who was killed in the 4300 block of Old York Road, Homicide Capt. John Ryan said during a news conference Wednesday that she "wasn't targeted because of her gender affiliation or lifestyle." But activists and advocates say there's no way to be sure that's the case.

"A crime might not qualify as technically a hate crime," McBride said, "but you look at the circumstances and you raise the question of: Was the violence emboldened or enhanced or escalated, even in some way, by the devaluation of trans lives that exists in our society?"

That discrimination can manifest itself in assault and harassment. The NCTE released a report in 2015 showing the results of a national poll of 28,000 transgender people. Nearly one in 10 respondents said they were physically attacked in the last year because of being transgender, and transgender women of color were four times as likely as other transgender people to have been attacked with a gun.

McBride blamed the violence in part on what she sees as "vitriol and cruelty" in rhetoric used by politicians, both in the federal government and in places like North Carolina, where lawmakers in 2016 passed a controversial "bathroom bill," which required people to use the facilities that match their gender assigned at birth. (That bill has since been replaced, but advocates say it still discriminates against LGBTQ people.)

"If society communicates that trans lives are less important and lesser than others," she said, "then the implicit consequence is that people will be more likely to commit harm, discrimination, and even violence."

The mother of a former Missouri high school student is suing the school board and three current and former district administrators, alleging discrimination against her transgender child.

Natalie Murray alleges in the lawsuit that the district denied her child the right to use the boys restroom and locker rooms at Joplin High School. She says her 16-year-old was born female but has lived as a male since the age of 12.

The Joplin Globe reports that the student was told to use the girls restroom, or to use gender-neutral bathrooms designated for faculty. The lawsuit says this embarrassed and humiliated the student.

School board president Sharrock Dermott said Tuesday that the district doesn't have a specific policy for accommodating transgender students but that its anti-bullying policy covers all students

Charleston police on Tuesday night arrested a man who they said attacked a transgender woman in the city’s bar and restaurant district, a crime that authorities classified as bias-motivated.

And on the same evening, members of the LGBTQ community told police that they too have feared for their safety and have been accosted on the city’s streets.

The Alliance For Full Acceptance, an advocacy group, partnered with the Charleston Police Department to host a town hall discussion to encourage people to voice their concerns after the Aug. 19 attack on Ann Street. 

A 34-year-old Goose Creek woman was leaving King Street bars around 2 a.m. when a man kicked her sister in the stomach near an elevator of the Charleston Visitor Center parking garage, police said. When the woman came to her sister’s aid, the attacker then punched her in the head, knocking her out. The man used slurs about the woman’s gender identity before punching her, investigators said.

The victim was hospitalized, but she is recovering.

Officers have arrested 30-year-old Christopher Lamar Price in connection with the attack. He faces a charge of second-degree assault and battery, according to jail records. Police initially denied that the attack was a potential hate crime but later corrected the statement while social media posts circulated.

On Tuesday, a diverse crowd filled a room at the Arthur W. Christopher Community Center and addressed a panel that included Police Chief Luther Reynolds, Deputy Chief Naomi Broughton, two officers and several LGBTQ advocates.

Reynolds brought up the “offensive” wording of a statement that his department initially issued about the Ann Street assault, which had said the victim “wasn’t assaulted because she’s a transgender.” The chief encouraged members of the crowd to speak their minds and said that “a level of humility” is necessary for the department to improve. 

“In my mind, there should be no space between us. Zero,” he said. “We should be in this together. I know that’s not where we’re at today, but that’s where we need to be.”

The agency plans to train patrol officers and investigators on how to treat LGBTQ victims, suspects and fellow employees. Part of that conversation will center around pronoun use and how to respond to transgender individuals.

One man in the crowd told the panel that Charleston officers have assumed he is a woman and called him the name he was assigned at birth, even after he had corrected them. 

“I hate hearing that my co-workers and fellow officers don’t call you by the right pronoun or the right name after you’ve repeatedly told them, or they’re condescending,” said Officer Jessica Hans, a member of the LGBTQ community who along with another officer spoke of the need for better education. “We are trying to change that, but we can’t do it without y’all.”

 

Vanity Reid Deterville, a 24-year-old College of Charleston student, pushed back against the Police Department for initially making a definitive statement that the Ann Street assault wasn’t bias-motivated as opposed to saying that aspect of the crime remained under investigation.

“It was like a slap in the face to me because I knew as a transgender woman that that was the exact reason she was attacked,” she said after the forum. 

Reid Deterville said she has endured catcalls and hostility on campus and downtown. She said she’s suffered two assaults, one of which she didn’t report to police out of fear of not being taken seriously by authorities. 

But on Tuesday, Reid Deterville said she walked away feeling heard by police after a conversation that she said “scratched a little deeper than surface level.”

“We still have a long way to go when it comes to eradicating this issue,” she said. 

The 12-year transgender girl who was bullied online by local parents says she’s trying hard not to be bothered by the negativity.

Maddison Kleeman Rose spoke to VICE News, her first on-camera interview since her story caught national attention. Said she does not understand the fuss around her using the girls’ restroom.

“I don’t care for it. I think it’s all stupid, except supporters. But the threats and that, is stupid. Who would do that to a 12-year-old?” she said.

“Heads up parents of 5th through 7th grade,” parent Jamie Crenshaw said in a now-deleted post. “The transgender is already using the girls bathroom. We have been told how the school has gone above and beyond to make sure he has his own restroom yet he is still using the girls. REALLY… Looks like its going to be a long year.”

Another parent weighed in and said a “sharp knife” could take care Maddie using the girls’ bathroom. Other parents said their children should beat up Maddie until she left school.

Maddie and her family had moved to Achille from Sherman, Texas, where they said Maddie was bullied during her transition. Maddie’s mother, Brandy Rose, told TIME that in Sherman students had forced her daughter into the boys’ bathroom and taunted her to commit suicide. The family moved to Achille in 2017 hoping for a more accepting environment for their daughter, but after the controversy the family has decided to move out of Achille for fear of Maddie’s safety.

Maddie said she would not allow the negativity of certain parents affect her.

“Some adults out there do get it but they don’t support it and thats their choice, they can be hateful and rude about it but they ain’t dragging me down.” she said.

“Everyone’s different, no one’s the same,” Maddie added. “We’re all different, unique and special in our own way.”

Maddie’s mother said she plans to move her family to Houston, Texas, where Maddie will have more support and is likely not to be the only transgender student in her school.

Bathrooms have long been a flashpoint in the fight for LGBTQ rights – and recently became a hot-button political issue as several states debated bills restricting transgender people from using the bathroom of their gender identity. Transgender teen Gavin Grimm’s battle to use the boy’s bathroom at his Virginia school gained national attention.

In January, an Oklahoma state lawmaker introduced a “bathroom bill” that critics said would have restricted the rights of transgender people to use the bathroom of their gender identity, but the bill never came up for a vote.

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