@2024 Afarand., IRAN

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ISSN: 1027-1457    Scientific Journal of Forensic Medicine 2019;25(1):31-36

Background
Gender dysphoria (GD) is a psychological state that reflects a person's inner sense of being a man or a woman … [1-6]. Diagnostic and Statistical Manual of Mental Disorders (DSM-V-TR) describes GD as a group of disorders, whose common feature is the strong and consistent preference for the role of the opposite sex [7].
Previous Studies
… [8]. Hejazi et al.'s research on the epidemiological characteristics of GD patients referring to forensic medicine centers in southwest Iran showed that the mean age of patients was 27.6±2.9 years and the majority of them had diploma and most of them were unemployed [9]. Suicide is one of the social and mental health disorders that is considered as a serious public health problem, as this problem is of particular interest in the first and second levels of health care [10]. … [8-11]. Aghabakhshi et al. found that the family harassment, community harassment, sexual dissatisfaction, lack of social protection, and family breakdown were the most important causes of suicidal tendencies in heterosexuals [19]. A study conducted by Javeheri and Kuchakyan about heterosexuals revealed that abnormal social behaviors such as escape, sexual relations, and suicidal tendencies, and suicide attempts were frequent in these individuals and at least half of them attempted suicide at least once [20]. Macneil et al. in a study titled “Trans Mental Health and Emotional Wellbeing Study”, found that suicidal thoughts and real action after Sex reassignment surgery (SRS) were reduced [21]. In his research, Zucker reported GD patients’ suicide attempts in the United States from 16-37%, of which only 4-3% led to death [22]. Levey and Curfman believe that although SRS may have short-term outcomes in people with GD, these individuals in long-term and after SRS experience problems such as suicidal thoughts, lack of social and interpersonal efficacy, loss of family, work, and family support, negative attitude toward participation in therapeutic and psychotherapy sessions, and sustainable resistance to gender change [23].
Aim(s)
The aim of this study was to compare the suicidal tendency in operated and non-operated men with GD in Fars province during 2011-2013.
Research type
This cross sectional study is a descriptive-analytical research.
Research society, place and time
This study was conducted in Fars province during 2011-2013 among the GD patients operated and non-operated male to female that 3 years have elapsed since they were licensed to SRS.
Sampling method and number
A total of 35 operated male to female GD patients and 35 non-operated male to female GD patients were selected by available sampling method. Due to limited studies regarding suicide among GD patients and difficult access to these patients, 35 were considered for each group; thus, our sample included two groups of GD patients; the first group consisted of patients who had operated a male to female SRS, and the second group was waiting for a SRS authorization. The inclusion criteria included consent for participation in the study, definitive diagnosis of disorder in patients by the Commission for Psychiatry and confirmation of forensic medicine centers, and for those who have undergone SRS, the inclusion criteria included least one year elapse of their surgery. Exclusion criteria included dissatisfaction with participation in the study, people aged less than 20 years and over 40 years and history of admission to psychiatric centers.
Used devices&materials
After obtaining the necessary permissions from the general office of the forensic medicine of Fars province, the research was carried out by Beck Scale for Suicide Ideation, which included demographic characteristics. Beck Scale for Suicide Ideation was developed by Beck in 1979 to measure the susceptibility to suicide. It provides a numerical estimate of the intensity of suicidal thoughts and desires. This scale consists of 19 items that ranked from zero (lowest intensity) to 2 (highest intensity). The overall score of a person is calculated based on the total score, which is from zero to 38. Beck Scale for Suicide Ideation has a high reliability. Coefficients 0.87 to 0.97 were obtained, using Cronbach's alpha and reliability was calculated 0.54, using test-retest method. Also, the validity of the scale was 0.95, using the Cronbach's alpha method and 0.75 was obtained by Split-half method [24]. The findings were analyzed by SPSS 22 software, using ANOVA and Pearson correlation coefficient.
Findings by Text
The mean age of the patients was 27.47±3.30 years in the study population, 27.97±3.28 years in the non-operated group (Male), and 26.97±3.30 years in the operated group (Female; Table 1). The mean score of suicidal tendency was significant between the operated patients group (11.61±04.04) and the non-operated group (14.50±7.43) and the non-operated group was more likely to suicide than the operated group (p<0.05; F=4.09). There was a significant negative correlation between the age of the population of the study and suicide preparedness. In other words, with age, suicide preparedness was reduced (p=0. 3; r=-0.35).
Main comparison to the similar studies
According to the findings of the present study, there was a significant difference between the two groups regarding the level of suicidal tendency, and the non-operated group was more likely to suicide than the operated group; results obtained from this study were consistent with the results of the studies of Javeheri and Kuchakyan [20] and Macneil et al. [21] and were not consistent with the results of the studies by Levey and Curfman [23]. Based on the findings of this study on demographic variables, the findings of the present study were consistent with the results of studies conducted by Hedjazi et al. [9], VasghRahim Parvar et al. [25], Javaheri and Hosseinzade kasmani [26], and Jalali et al. [27]. … [28, 29].
Suggestions
It is suggested that in future studies, other examples should be studied with other tools in order to extract more complete results. It is also suggested to other researchers to look for the authenticity and accuracy of the findings at different times and places. Considering the importance of GD disorder and its impact on people's lives, educational research is recommended for these variables.
Limitations
The limitations of this study include: In this research, due to poor people's trust in researchers and low motivation and inadequate understanding of research goals, the level of participation and cooperation of people with GD disorder was weak. The lack of research on suicidal tendencies was another limitation of research. Also, many people were not willing to interview with the researcher due to problems that the community has for their acceptance. Available sampling and low sample size also reduce the generalization of the results.
Conclusions
Non-operated patients with GD are more likely to suicide than operated ones, and are more exposed to suicide.
Acknowledgments
The authors of this study are very grateful to the staff of Forensic Medicine of Fars province, especially the manager Dr. Saeed Gholamzadeh, who have co-operated with us on this project.
Conflict of interest
There is no conflict of interest.
Ethical Permissions
This research was approved by the Ethics Committee of Islamic Azad University of Shiraz.
Funding Sources
This research was funded by the research committee of Islamic Azad University of Shiraz.

TABLES and CHARTS

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