This study examines the effect of adverse childhood experiences (ACEs) on lifetime suicide attempts (LSA) across five gender subgroups (i.e., transgender men, transgender women, transgender non-binary, cisgender men and cisgender women). To examine (1) the prevalence of LSA across gender identity subgroups; (2) whether the association between ACEs and LSA is moderated by gender identity subgroup; (3) depressive symptoms, alcohol use disorder, social support, and social well-being as mechanisms linking ACEs with LSA; and (4) the moderating role of gender identity on the four putative mediators. We used nationally representative data from a population-based survey of = 1368 transgender and cisgender individuals collected between 2016 and 2019. Structural equation modeling was used to explore the indirect effect of depressive symptoms on the relation between ACEs and LSA, and the moderating impact of gender identity. LSA was significantly more prevalent among transgender respondents (cisgender man = 5 %; cisgender woman = 9 %; transgender man = 42 %; transgender woman = 33 %; transgender non-binary = 37 %; < 0.001). Individuals with more ACEs had a greater risk of engaging in LSA regardless of gender identity; however, moderation results showed that the impact of each additional ACE on LSA was stronger for individuals with transgender identities: the likelihood of engaging in LSA was statistically similar for transgender men with no ACEs and cisgender men with all 8 ACEs. Indirect effects of ACEs on LSA via depressive symptoms were also observed, and the mediating effect was moderated by gender identity. By examining the mechanisms linking childhood adversity to LSA, this study demonstrates that not all ACEs impact gender minority subgroups equally.

中文翻译：

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性别多样化个体中儿童早期逆境与终生自杀企图之间的关联：有调节的中介

本研究探讨了不良童年经历 (ACE) 对五个性别亚组（即跨性别男性、跨性别女性、跨性别非二元性别、顺性别男性和顺性别女性）的终生自杀未遂 (LSA) 的影响。检查 (1) 不同性别认同亚组中 LSA 的患病率； (2) ACE 和 LSA 之间的关联是否受到性别认同亚组的调节； (3) 抑郁症状、酒精使用障碍、社会支持和社会福祉作为 ACE 与 LSA 的联系机制； (4)性别认同对四个假定中介变量的调节作用。我们使用了 2016 年至 2019 年间收集的 1368 名跨性别和顺性别个体的全国代表性数据。结构方程模型用于探讨抑郁症状对 ACE 和 LSA 之间关系的间接影响，以及性别认同。 LSA 在跨性别受访者中显着更为普遍（顺性别男性 = 5%；顺性别女性 = 9%；跨性别男性 = 42%；跨性别女性 = 33%；跨性别非二元性别 = 37%；< 0.001）。无论性别认同如何，拥有更多 ACE 的个体参与 LSA 的风险更大；然而，调节结果表明，对于具有跨性别身份的个体来说，每增加一个 ACE 对 LSA 的影响更大：没有 ACE 的跨性别男性和拥有所有 8 个 ACE 的顺性别男性进行 LSA 的可能性在统计上相似。还观察到 ACE 通过抑郁症状对 LSA 产生间接影响，并且中介作用受到性别认同的调节。通过研究童年逆境与 LSA 之间的联系机制，本研究表明并非所有 ACE 都会平等地影响性别少数群体。