Abstract
IMPORTANCE: Transgender and gender diverse (TGD) youth face adversities that increase risks for suicidality and nonsuicidal self-injury (NSSI). However, substantial variability in prevalence rates have been reported across the literature. OBJECTIVE: To provide meta-analytic syntheses of research investigating the prevalence of suicidal ideation, suicide attempts, and NSSI in TGD youth and to examine the moderating effects of sample characteristics and study methods on estimates. DESIGN, SETTING, AND PARTICIPANTS: MEDLINE, Embase, CINAHL, Web of Science, Social Work Abstracts, Scopus, PsycINFO, Cochrane Central Register of Controlled Trials, and ProQuest Dissertations & Theses Global databases were searched in January 2025. This meta-analysis included studies of TGD youth aged 25 years and younger measuring suicidal ideation, suicide attempts, and/or NSSI published in English. These data were analyzed from June 2025 to September 2025. DATA EXTRACTION AND SYNTHESIS: Data extraction followed the PRISMA guidelines. Random-effects meta-analyses were used to derive the pooled prevalence estimates. MAIN OUTCOMES AND MEASURES: Outcomes included prevalence rates of suicidal ideation, suicide attempts, and NSSI. Sample characteristics (ie, race and ethnicity and gender identity group) and study methods (ie, assessment modality, timeframe, geographical region, and study quality) acted as moderator variables. RESULTS: From 137 studies, 262 nonoverlapping samples with a total of 131 429 TGD youth (mean age, 17.0 [range, 7.5-23.4] years) were included. Pooled prevalence estimates of suicidal ideation, suicide attempts, and NSSI were 48.8% (95% CI, 45.6%-52.0%), 26.2% (95% CI, 23.9%-28.6%), and 46.6% (95% CI, 40.5%-52.7%), respectively. Survey studies yielded higher prevalence rates across all outcomes compared with interview and medical record reviews. Significant moderating effects for ethnicity, gender identity group, timeframe, geographical region, and study quality varied across outcomes. CONCLUSIONS AND RELEVANCE: In this meta-analyis, pooled estimates suggested that 1 in 2 TGD youth globally are experiencing suicidal ideation and/or NSSI, and 1 in 4 have experienced a suicide attempt. These pooled estimates are 2 to 3.5 times greater in TGD youth compared with those established for cisgender peers. There is a critical need for improved prevention and intervention efforts to address TGD mental health concerns.