Transgender individuals in Pakistan face physical and mental health challenges due to marginalization, discrimination, and victimization, which may increase their vulnerability to depression, anxiety, negative body image, and suicidal behaviors. This study aimed to examine the relationship between demographic factors, depression, anxiety, and low body appreciation with suicidal ideation, suicide attempts, and suicide risk among transgender individuals in Pakistan. Demographic variables included age, gender assigned at birth, gender identity, profession, education, and socioeconomic status, assessed through a self-developed semistructured questionnaire. Psychological constructs were measured using the Center for Epidemiological Studies Depression Scale, Generalized Anxiety Disorder-7, Body Appreciation Scale-2, and Suicide Behaviors Questionnaire-Revised. Reliability of instruments was evaluated through Cronbach’s alpha. Data were collected from 135 participants through respondent-driven sampling using both online and in-person interviews after informed consent, ensuring anonymity and privacy. Analyses included questionnaire validation, frequencies, descriptive statistics, mean comparisons, bivariate correlations, and logistic regressions. Results indicated that demographic factors significantly influenced suicidal ideation and attempts. Correlation analyses showed significant associations between depression (r = 0.071), anxiety (r = 0.147), low body appreciation (r = 0.110), and suicidal behaviors (r = 0.008). Depression, anxiety, and low body appreciation were significantly related to past suicidal ideation (R² = 0.395), attempts (R² = 0.376), and future suicide risk (R² = 0.415). Regression analysis further revealed that depression (adjusted odds ratio (AOR) = 1.024, p = 0.001) and low body appreciation (AOR = 1.071, p = 0.044) were associated with a higher number of past suicide attempts. These findings highlight the need for culturally sensitive mental health interventions for transgender individuals in Pakistan.
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