Associations between gender discrimination, resilience, social support, and self-harm and suicidality among transgender women in Brazil

Objective: To explore suicidal behavior among transgender women by investigating the associations between resilience, social support, and experiences of gender discrimination and thoughts of self-harm, suicidal ideation, and suicide attempts among transgender women in Brazil. Methods: This study draws on cross-sectional data from the Brazilian Dinamizando a Inclusão e Valorizando as Atividades Saudáveis (DIVAS) study. A respondent-driven sampling method was used to recruit 2,470 participants. Fourteen discrimination domains were used in a latent class analysis model to separate the sample into classes. A multiple logistic regression model was used to assess the association of each outcome (i.e., recent thoughts of self-harm and suicidal ideation, lifetime suicidal ideation, and recent and lifetime suicide attempts) with gender discrimination, resilience, and social support scores. Results: Four classes of discrimination were obtained: low, medium-low, medium-high, and high. Higher levels of discrimination were associated with thoughts of self-harm and suicidal ideation (ORs from 1.26 to 2.39) and suicide attempts (ORs from 1.68 to 3.34), as well as lower levels of resilience (ORs from 1.79 to 4.08). However, higher levels of social support were associated with a lower chance of thoughts of self-harm or suicidal ideation (ORs from 0.66 to 0.43) and suicide attempts (ORs from 0.78 to 0.58). Conclusions: The clear link between discrimination, whether structural or interpersonal, and suicidal ideation found in this study calls for structural changes that address harassment in all forms against gender minorities.