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Gender-affirming IDs linked to lower suicidal thoughts, study finds

Transgender people who have IDs that match their gender identity are 25 percent less likely to experience psychological distress or consider suicide.
Image: A transgender flag during a rally to mark the 50th anniversary of the Stonewall Riots in New York
A person holds a transgender pride flag during a rally to mark the 50th anniversary of the Stonewall Riots in New York on June 28, 2019.Angela Weiss / AFP - Getty Images file

A report published in the medical journal Lancet Public Health has found that access to identity documents that align with an individual's gender identity correlate with lower rates of suicidal thoughts.

The research highlights the significance of such gender-congruent IDs, even as Idaho enacts a first-of-its-kind law preventing transgender people from updating their birth certificates.

Those who had the ability to change their name and gender marker on birth certificates, driver’s licenses or other forms of identification were 25 percent less likely to experience psychological distress or consider taking their own lives.

The research, led by Drexel University’s Dr. Ayden Scheim and published in mid-March, came to its conclusions by analyzing 2015 data collected by the National Center for Trans Equality, which surveyed more than 27,000 trans individuals at the time.

Dr. Jack Turban, a resident physician in psychiatry at Massachusetts General Hospital, where he researches the mental health of transgender youth, wrote an editorial in Lancet Public Health to accompany Dr. Scheim's study. Turban said the study's findings indicate that having documents affirming a trans person’s gender identity “sends a powerful message that transgender people are accepted and valued by society.”

“Gender-congruent identification is a vital aspect of gender affirmation,” Turban told NBC News, while noting that the National Center for Transgender Equality’s survey found that just 11 percent of trans respondents “had fully congruent government identification.”

The study is prescient given the enactment of the new law in Idaho that blocks the state from issuing birth certificates to trans people reflecting their lived gender. House Bill 509 was one of two anti-transgender bills signed by Gov. Brad Little on Monday. The other, House Bill 500, prevents trans girls from playing on school sports teams in alignment with their gender identity.

Jen Moore, a licensed professional counselor practicing in the state of Idaho, said they have “lost sleep” over how these bills will impact the local trans community.

“The Idaho Counseling Association came out in opposition to the bills that the governor just signed,” Moore said. “These are folks who already lack essential support or who are more vulnerable because the system has historically worked against them. The Idaho government is making my job that much harder.”

According to Moore, having access to an updated birth certificate is incredibly important for the transgender patients that they work with because it “validates a person and the core part of who they are.”

“To hold up a mirror and say, ‘Yes, who you are is right,’ is so important from a mental health standpoint,” she said.

Critics of the Idaho law said refusing trans people the ability to have their lives reflected on their identity documents also opens them up to greater discrimination and abuse. The National Center for Transgender Equality’s survey showed that a third of individuals who showed a birth certificate or ID that did not align with their gender presentation reported experiencing verbal harassment or physical violence as a result.

Kathy Griesmyer, policy director for the American Civil Liberties Union of Idaho, said laws like HB 509 prevent trans people from “maneuvering through daily life without fear of people questioning you and your existence.” When HB 509 was being debated in the Idaho Legislature, she recalled that a trans man testified that he was once refused service at an Office Depot because he didn’t have a driver’s license that reflected his physical appearance.

“Those are small things most of us take for granted that become much bigger hurdles for trans people when their documents don't match,” Griesmyer said. “This legislation is an attempt to legislate away trans people by not allowing them to have identity documents that match who they are.”

Although HB 509 is set to take effect July 1, it remains to be seen whether it will stand. After it was signed into law Monday, Lambda Legal accused Idaho of “explicitly flouting a binding federal court order.” Magistrate Judge Candy W. Dale, of the U.S. District Court for the District of Idaho, ruled in 2018 that the state’s standing policy of “automatically and categorically” refusing corrected birth certificates to trans people violates the U.S. Constitution.

“This policy was unconstitutional two years ago, and it is still unconstitutional today,” Peter Renn, an attorney for the LGBTQ advocacy group, said in a statement. “Idaho has deliberately set itself on a collision course with the federal courts. It is in open rebellion against the rule of law.”

Just two other states, Ohio and Tennessee, do not allow trans people to update their birth certificates, and both of those policies are currently facing legal challenges. No other state has introduced a bill like HB 509 this year.

But while the U.S. court system debates the future of trans rights, experts say greater support is needed for the community. Although access to gender-congruent identity documents lowered the likelihood of suicidal thoughts, it did not eliminate such feelings. According to the Lancet study, 30 percent of respondents who had their name and gender marker updated on all forms of ID still reported thoughts of suicide.

That figure is significantly higher than members of the general population. A 2009 study of 17 countries published in the British Journal of Medicine found that the lifetime prevalence of suicidal thoughts and attempts among all individuals is 9.2 percent.

Turban said that more research is needed but hopes the Lancet report is a call to action for lawmakers and medical professionals in how they interact with vulnerable communities.

“We also need to work on other determinants of mental health,” he said, “including lack of access to gender-affirming medical care, widespread gender identity conversion therapy and alarmingly high rates of violent victimization.”

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