Self-harm and Suicidality in Gender-Nonconforming Children: A Canadian Community-Based Parent-Report Study.

No study to date has examined self-harm/suicidality in a community sample of children who express gender nonconformity (GNC). This parent-report study (N = 1,923) examined self-harm/suicidality in a nonclinical community sample of 6- to 12-year-old children, including those who express marked GNC but do not have a gender dysphoria (GD) diagnosis. Child Behavior Checklist (CBCL) Items 18 ("Deliberately harms self or attempts suicide") and 91 ("Talks about killing self") measured self-harm/suicidality. The Gender Identity Questionnaire for Children measured GNC, the CBCL measured peer relations and behavioral and emotional challenges, and the Child-Rearing Sex-Role Attitude Scale measured parents' gender-stereotypical attitudes toward child-rearing. Among children who expressed GNC most markedly, 9.1% had attempted suicide and/or self-harmed and 6.8% had suicidal ideation. These rates parallel those reported for children clinic-referred for GD. Across the sample, suicidal ideation, self-harm/suicide attempt, poor peer relations, and behavioral and emotional challenges were significantly positively correlated. Among children assigned female at birth, self-harm/suicide attempt was negatively correlated with gender-liberal parental attitudes. Binary logistic regressions showed some evidence that children who expressed GNC had higher suicidality/self-harm compared to children who were gender-conforming and did not have a mental health diagnosis; however, group effects were mostly accounted for when controlling for poor peer relations and behavioral and emotional challenges, with the latter being the strongest predictor of suicidal ideation and self-harm/suicide attempt. Thus, self-harm/ suicidality among gender-nonconforming children is likely greater in scope than previously recognized, and parental attitudes, peer relations, and behavioral and emotional challenges are important factors to consider.