“The world is really not built for everyone”: a qualitative investigation of suicide risk among autistic transgender and gender diverse adults and the essential role of health care providers

Aim This qualitative study aims to identify themes related to suicide risk among autistic transgender and gender diverse (TGD) adults and to identify potential intervention approaches to reduce suicide risk among autistic TGD adults, with an emphasis on healthcare experiences.Methods Qualitative interviews were performed with 30 autistic TGD adults. Participants responded to questions about suicide risk, their identities, and healthcare experiences. Applied thematic analysis was used to identify themes and subthemes and describe the data.Results Social challenges and barriers as well as access to services were relevant drivers of suicide risk. Autistic burnout and financial, work, and school stressors were autism-related suicide risk factors. Puberty, dysphoria, and legislation concerns were suicide risk factors related to gender identity. Participants highlighted the impact of negative healthcare experiences on suicide risk and recommendations to improve suicide prevention for this population.Discussion Using a qualitative design, results revealed several factors influencing suicide risk for autistic TGD individuals. Findings highlight that autistic TGD individuals face considerable barriers when trying to access healthcare. Such barriers and inability to receive needed services appear to considerably impact suicide risk in this population.