Situated vulnerabilities and resiliencies associated with lifetime and past 6-month suicide attempt among transgender and gender diverse primary care patients.

Transgender, nonbinary, and gender diverse (TGD) adults experience elevated suicide attempt (SA) risk relative to cisgender adults, yet modifiable vulnerabilities and resiliencies remain understudied. This cross-sectional study examined correlates of lifetime and past 6-month SA among TGD adults receiving primary care. Electronic surveys were completed by 2131 TGD patients at two urban health centers, assessing demographics, gendered contexts, social determinants, interpersonal violence, mental health, and protective factors. Bivariate and multivariable log-Poisson generalized estimating equation models estimated associations with lifetime and past 6-month SA risk. The median age was 28 years; 29.2% had a non-White racial identity and 30.8% were nonbinary. Overall, 30.8% reported a lifetime SA and 2.5% a past 6-month SA. Higher gender dysphoria, childhood physical and sexual violence, lifetime intimate partner violence, and mild or severe depression/anxiety symptoms were associated with increased lifetime SA risk (adjusted risk ratios [aRRs]=1.19-2.12, p < 0.05). Past 6-month SA was associated with high gender dysphoria, lack of health insurance, recent homelessness, childhood sexual violence, and severe depression/anxiety symptoms (aRRs=2.12-4.22, p < 0.05). Ages 31-40 years and college degree attainment were protective against lifetime SA. Findings underscore the importance of addressing early-life trauma and current structural vulnerabilities to reduce suicide risk among TGD adults.