• Usama Bin Zubair PIMS
  • Muhammad Azeem Khan
  • Aneza Jalil
  • Asif Kamal
  • Asad Nizami
  • Fareed Minhas
  • Shumaila Tasleem


Background: This study was conducted to assess the frequency of suicide attempt among the transgender population and analyse the relationship of depression and other socio-demographic factors with the suicide attempt Cross-sectional study Methods: The sample population comprised of one hundred and forty-eight transgender people of Rawalpindi and Islamabad. Suicidal attempt was assessed by the simple question that “Have you ever performed an action with the intent to take your own life in your life time?” Answer of yes or no was recorded. Hamilton rating scale for Depression (HAM-D) was used to look for the presence of depression among the target population. Relationship of the age, smoking, family income, illicit substance use and depression was studied with the presence of suicidal attempt among these transgender population of twin cities of Pakistan. Results: A total of 148 transgender people were included in the final analysis. Mean age of the study participants was 38.24±3.18. Out of these, 70.9% had no suicidal attempt in their whole life while 29.1% had one or more suicidal attempts during the course of their life. Twelve had more than one suicidal attempt while 19 had attempt in last one year. Fifty-five did not showed depression while 93 had depression on HAM-D. With binary logistic regression we found that presence of depression and low income had significant association with the presence of suicidal attempt among the target population. Conclusion: This study showed a high prevalence of suicidal attempts among the transgender population of twin cities of Pakistan. Routine screening for mental health problems should be performed on this high-risk group and adequate employment resources should be generated in order to enable them to earn their livelihood and prevent them from making attempts to take their own life.Keywords: depression; suicide attempt; trans-genders


Wang J, Wu X, Lai W, Long E, Zhang X, Li W, et al. Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ Open 2017;7(8):e017173.

Godil A, Mallick MSA, Adam AM, Haq A, Khetpal A, Afzal R, et al. Prevalence and Severity of Depression in a Pakistani Population with at least One Major Chronic Disease. Journal of Clinical and Diagnostic Research : J Clin Diagn Res 2017;11(8):OC5–10.

Li H, Luo X, Ke X, Dai Q, Zheng W, Zhang C, et al. Major depressive disorder and suicide risk among adult outpatients at several general hospitals in a Chinese Han population. PLoS One 2017;12(10):e0186143.

Clarke JL, Skoufalos A, Medalia A, Fendrick AM. Improving Health Outcomes for Patients with Depression: A Population Health Imperative. Report on an Expert Panel Meeting. Popul Health Manag 2016;19(Suppl 2):S1–12.

Heslin M, Desai R, Lappin JM, Donoghue K, Lomas B, Reininghaus U, et al. Biological and psychosocial risk factors for psychotic major depression. Soc Psychiatry Psychiatr Epidemiol 2016;51(2):233–45.

Blosnich JR, Brown GR, Shipherd, PhD JC, Kauth M, Piegari RI, Bossarte RM. Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care. Am J Public Health 2013;103(10):e27–32.

Winter, S, Diamond, M, Green, J, Karasic D, Reed T, Whittle S, et al. Transgender people: health at the margins of society. Lancet 2016;388(10042):390–400.

Perez-Brumer AG, Oldenburg CE, Reisner SL, Clark JL, Parker RG. Towards ‘reflexive epidemiology’: conflation of cisgender male and transgender women sex workers and implications for global understandings of HIV prevalence. Glob Public Health 2016;11(7-8):849–65.

Brown GR, Jones KT. Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study. LGBT Health 2016;3(2):122–31.

Virupaksha HG, Muralidhar D, Ramakrishna J. Suicide and Suicidal Behavior among Transgender Persons. Indian J Psychol Med 2016;38(6):505–9.

Oswalt SB, Lederer AM. Beyond Depression and Suicide: The Mental Health of Transgender College Students. Soc Sci 20176;6(1):20.

Alves Vde M, Francisco LC, Belo FM, de-Melo-Neto VL, Barros VG, Nardi AE. Evaluation of the quality of life and risk of suicide. Clinics (Sao Paulo) 2016;71(3):135–9.

Pandey GN. Biological basis of suicide and suicidal behavior. Bipolar Disord 2013;15(5):524–41.

Conejero I, Olié E, Calati R, Ducasse D, Courtet P. Psychological Pain, Depression, and Suicide: Recent Evidences and Future Directions. Curr Psychiatry Rep 2018;20(5):33.

Abdullah MA, Basharat Z, Kamal B, Sattar NY, Hassan ZF, Jan AD, et al. Is social exclusion pushing the Pakistani Hijras (Transgenders) towards commercial sex work? a qualitative study. BMC Int Health Hum Rights 2012;12:32.

Saeed A, Mughal U, Farooq S. It's Complicated: Sociocultural factors and the Disclosure Decision of Transgender Individuals in Pakistan. J Homosex 2018;65(8):1051–70.

Nasrullah M. Concentrated HIV Epidemic in Pakistan: An Opportunity to Prevent Generalized Epidemic. Int J Prev Med 2012;3(12):824–6.

Hashmi AM, Naz S, Asif A, Khawaja IS. Urdu translation of the Hamilton Rating Scale for Depression: Results of a validation study. Pak J Med Sci 2016;32(6):1479–83.

Ahmed B, Enam S, Iqbal Z, Murtaza G, Bashir S. Depression and anxiety: a snapshot of the situation in Pakistan. Int J Neurosci Behav Sci 2016;4(2):32–6.

Yüksel Ş, Aslantaş Ertekin B, Öztürk M, Bikmaz PS, Oğlağu Z. A clinically neglected topic: risk of suicide in transgender individuals. Arch Neuropsychiatr Ars 2017;54(1):28–32.

Clements-Nolle K, Marx R, Katz M. Attempted suicide among transgender persons: The influence of gender-based discrimination and victimization. J Homosex 2006;51(3):53–69.