Monday, 9 February 2015

Suicide, lies and statistics

Heya everybody,

it is so easy to spread falsehoods and rumours – and so time-consuming to diligently set the facts straight. A friend of mine has pointed out an issue mentioned by Walt Heyer (see also my 2015-01-11 blog entry) in one of his YouTube videos. Just as a a reminder, Walt was apparently falsely diagnosed with gender dysphoria, changed gender roles and had sex reassignment surgery only to be later reverting back to his old male gender role, being diagnosed with dissociative identity disorder.[1]

In his video, Walt talked about that infamously high suicide attempt rate of 41 % for transgender people continuing after transition. At the same time this was pointed out to me, I was also made aware of an article on the website “RenewAmerica”[2], called “An appeal to Bruce Jenner”. In the article, author J. Matt Barber writes “There is a reason that after ’sex reassignment’ surgery, so-called ’transgender’ people commit suicide at a rate 20 times higher than normal, and, despite rationalizations to the contrary, imaginary ’transphobia’ is not that reason.”[3] The 20-times-higher claim is linked to an article by Paul McHugh, already discussed in my 2014-06-25 and 2014-07-05 blog posts.

I believe the source for these claims is two statements from page 82 of the US national transgender discrimination survey from 2011[4]:[5]

  • “When asked ‘have you ever attempted suicide?’ 41 % of respondents answered yes. According to government health estimates, five million, or 1.6 % of currently living Americans have attempted suicide in the course of their lives.”

  • “However, there are a number of attributes that align with an increased rate of attempted suicide. High risk groups include visual non-conformers (44 %) and those who are generally out about their transgender status (44 %). Those who have medically transitioned (45 %) and surgically transitioned (43 %) have higher rates of attempted suicide than those who have not (34 % and 39 % respectively).”

On the face of it, it would appear that the transgender respondents of the study were at a risk of suicide attempts that’s a staggering 25-times higher than that of the general population. In addition, it seems that people who are accepting and open about their transgender status or transitoned medically or surgically have a higher suicide risk than closeted transgender persons before transition.

Okay, that’s two quotes in isolation. Now to the context:

First of all, the study asked “if respondents had ever attempted suicide”. This is vital for the interpretation of the data. Immediately, this poses a problem of comparing numbers, as is stated in the report directly on page 82: “most federal studies refer to suicide attempts within the last year; accordingly it is difficult to compare our numbers with other studies.” So, all we know is that 41 % of transgender people have attempted suicide at some point in their lifes prior to responding in the study. This figure is “shockingly high”, of course, but it’s hard to quantify the difference to the average population.

I think three main points are relevant when interpreting the data:

  • A full 25 % of people in the study are not transsexual; these 25 % are gender-queer or crossdressers (some used non-standard terms for self-description such as “princess” or “bender”). People of the transgender spectrum who do not meet the definition of transsexualism are typically not going for transition or for medical treatment. If this group of people is less prone to suicide than full transsexuals, the figures showing suicidal tendencies for pre-transition individuals would be skewed, i.e. too low. The study is not comparing apples with apples here. One group (post-transition) has only full transsexuals in it, the other group (pre-transition) is a mix of full transsexuals, crossdressers and gender-queer people – it’s fair to assume these people suffer less psychological strain.

  • The study doesn’t mention the average ages of the pre- and the post-transition groups. My guess is that the post-transition group is older. This is relevant, because if you ask the question ‘have you ever attempted suicide’, you will get, all other things being the same, more yes answers in the older group.

  • People forced to take the drastic step of medical transition probably suffer, on average, from more severe gender dysphoria. Often, the biography of transsexuals includes a tipping point when the gender dysphoria becomes so unbearable that help must be sought. If having experienced high psychological strain correlates positively with transition, we would naturally expect this group also to have the most ‘yes’ answer when asked whether have ever attempted suicide.

This is what the authors of the study say themselves:

  • “Our questionnaire did not ask at what age the respondents made suicide attempts and therefore it is difficult to draw conclusions about the risk of suicide over their life spans.”

  • “In terms of age group risk, the highest rates of suicide attempts in this study were reported among those in the 18–24 age group (45 %) and 25–44 age group (45 %), with only 16 % of those over 65 reporting a suicide attempt. These rates are inverse to the general population, which shows a higher incidence of attempts among older Americans than youth.”

The authors state themselves, right there on page 82 of the report, that no conclusion can be drawn from their data about the risk of suicide attempts over the course of the life of the respondents. As a result, one cannot draw any conclusions about the effectiveness of interventions during the lifetimes of the participants. If anything, medical intervention seems to help, since the risk of suicide attempts is actually decreasing with age, in contrast to suicide attempts among the general public (assuming that the post-transition group had a higher average age than the pre-transition group).

I believe that any other interpretation of the data presented in the study is either poorly understood or dishonest.

It is notoriously difficult to measure suicide rates. Maybe I’ll do a blog post on that issue in the future. Simple assessments of well-being, quality of life, living standards and mental health are probably magnitudes more reliable. For the “What helps?” section of my website I have collected 141 studies that use varying measures to analyse the effectiveness of medical intervention for transsexualism. Have a read and you can see for yourself why the scientific consensus agrees on the benefits of medical treatment.

To give just one example of a study that looks at suicide in particular, have a read of the British study by Bailey, Ellis and McNeil (2014)[6], using a large sample of 889 transgender individuals:

“The study revealed high rates of suicidal ideation (84 % lifetime prevalence) and attempted suicide (48 % lifetime prevalence) within this sample. A supportive environment for social transition and timely access to gender reassignment, for those who required it, emerged as key protective factors. Subsequently, gender dysphoria, confusion/denial about gender, fears around transitioning, gender reassignment treatment delays and refusals, and social stigma increased suicide risk within this sample.” “The study found that trans people are most at risk prior to social and/or medical transition and that trans people who require access to hormones and surgery can be left, in many cases, unsupported for dangerously long periods of time. The article highlights the devastating impact that delaying or denying gender reassignment treatment can have and urges commissioners and practitioners to prioritise timely intervention and support.”[7]

Peace and light ✨

[1] This post isn’t the place to discuss this, but it should be common knowledge that medical interventions are typically not 100 % effective, and medical diagnoses can not be absolutely error-free. If sex reassignment surgery has, for example, a success rate of 97.8 % (see Dhejne, Öberg, et al., 2014), we still have two people in a hundred whose lifes were not improved by the measure.

[2] The “about” section of the website says: “RenewAmerica is a grassroots organization that supports the self-evident truths found in the Declaration of Independence, and their faithful application through upholding the U.S. Constitution, as written. Its purpose is to thoughtfully and courageously advance the cause of our nation's Founders.” However, the articles seem highly partisan christian to me, in apparent contradiction of the secular values of the US constitution and its founding fathers?

[3] There is so much wrong with this sentence – I won’t have time today to discuss all of it. Just a few points: The word transgender is in scare quotes (I don’t think its meant to be a citation) – I guess this means Mr. Barber doesn’t approve of the word as a description of people who believe they straddle conventional gender divides? What word would he suggest for this phenomenon? Another term in scare quotes is sex reassignment – again, what word would be better or more descriptive for a process that changes the appearance and function of the external genitalia? And finally, transphobia is also in quotes. Again, I’m unsure as to why … does he see an issue with the word or with the concept? To give just one example, the US national transgender discrimination survey from 2011 reports that 51 % of transgender people were harassed/bullied in school, or were the victim of physical assault (61 %) or sexual assault (64 %).

[4] There is another study that Paul McHugh referenced in his original article; I might write about that in a future blog post.

[5] Study listed on the “Other references/Reference list of scientific articles and studies (2013 and older)” section of this website.

[6] Study listed on the “What helps?/Sex reassignment surgery helps” section of this website.

[7] Emphasis mine.