“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

Objective: This qualitative study aims to describe themes related to suicide risk among autistic transgender and gender diverse adults and to identify potential intervention approaches to reduce suicide risk among autistic TGD adults, with an emphasis on healthcare experiences.  Method: Qualitative interviews were performed with 30 autistic TGD adults. Participants responded to questions about suicide risk, their identities, and healthcare experiences. Reflexive 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 factors for STBs related both to being autistic and TGD. Autistic burnout and financial, work, and school stressors were STB factors for autistic individuals. Puberty, dysphoria, and legislation concerns were STB factors specific to TGD individuals. Participants highlighted the impact of negative healthcare experiences on STB risk and recommendations to improve suicide prevention for this intersectional population. Conclusions: Using a qualitative design, results revealed several factors influencing STB 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 STB risk in this population.