Transgender people are often referred to as mentally ill. People who do that will no doubt point to the suicide attempt rate in support of their assertion.

New research out of the University of Texas finds that transgender adolescents are twice as likely to have suicidal thoughts than the general population and four times as likely to engage in substance abuse.

But what causes these differences?

It turns out that being picked on is a major contributor. Who would have guessed?

Depression and school-based victimization factored heavily into the disparities in both cases. The papers are the first set of studies using representative, population-based data to examine whether bias against transgender youths is associated with higher levels of suicidal thoughts and greater alcohol, cigarette, and drug use.

The new research, published this month in the Journal of the American Academy of Child and Adolescent Psychiatry and today in the Journal of Adolescent Health, involves researchers from the Mailman School of Public Health at Columbia University. Previous studies have used what is known as community convenience samples to document risks to transgender youths, but the new study uses representative data that can be generalized to a statewide population.

Like all students, transgender youth deserve to be safe and supported at school. We have the first population-based, representative data to document the high risk for suicide and substance abuse among transgender youth. These results show that reducing depression and victimization for transgender students should significantly reduce their suicide-related risk.

--Stephen Russell, professor of human development and family sciences at Austin

Studies based on representative and population-based data sets are important because results can be extrapolated to the general population. The current papers used the Biennial California Student Survey of middle and high school students from 2013 to 2015. This data set resulted in analysis of more than 25,000 students, including 335 transgender adolescents representing more than 1 percent of the student population.

While 19% of the adolescents reported suicidal thoughts, 34% of the transgender youths experienced suicidal ideation.

Transgender youths also had markedly higher levels of substance abuse, even when controlling for other risk factors.

When the analyses looked at factors that may account for disparities in substance abuse and suicidal thoughts among transgender youths, both depression and school-based victimization were linked to the disparities seen for transgender youths. Victimization was linked both to suicidal thoughts and to students being younger the first time they tried a variety of substances, such as alcohol, cigarettes and illegal drugs. It also led to higher reports of substance use over the lifetime.

Findings across multiple studies underscore that transgender youth are at far greater risk of victimization at school than their non-transgender peers. This study highlights that heightened substance use is a likely consequence of these negative school experiences. School-based interventions that address victimization are needed, along with efforts to train faculty and staff on the unique needs of transgender youth, and provide access to gender-affirming health services.

--Jack Day, postdoctoral fellow

Many studies have shown that transgender youth are among the most vulnerable students in schools. If we can reduce depression and victimization among transgender youth, we could make a dent in suicide and other risks like high substance use among these children.

--Russell