When the Screening Question Isn't Enough: A Study of Black Transgender Women

Most suicide risk screening starts with a direct question about suicidal thoughts. It is a reasonable place to begin, but it depends on a person feeling able to answer openly. When someone does not say it out loud, what else might a clinician notice?

A new study in Research in Nursing & Health takes up that question. "A Comparison of Post-Traumatic Stress and Depressive Symptoms by Suicidal Ideation Among Black Transgender Women" (Sherman et al., 2026) was led by Athena D. F. Sherman of Emory University. Its co-authors include Brenice Duroseau of the Johns Hopkins School of Nursing, Andrea N. Cimino, PhD, LMSW, who is affiliated with the Center, and the Together We Thrive Community Advisory Board.

This is not a Center study. The Center is highlighting it because its findings speak directly to how screening can work better for everyone.

Why this question matters

The authors note that Black transgender women in the United States carry a significant burden of minority stress. They also point to research suggesting that Black Americans are less likely than White peers to report suicidal ideation, but more likely to have attempted suicide in the past year. If screening depends on disclosure, and disclosure is uneven, some people who need support may not be identified.

What the study found

The team analyzed an online survey of 153 Black transgender women, using standard checklists for post-traumatic stress and depressive symptoms. Just under a quarter of participants (22.9%) reported suicidal ideation.

For the most part, post-traumatic stress symptoms did not set apart the participants who reported suicidal thoughts from those who did not. Depressive symptoms did. Feelings of worthlessness, changes in appetite and overall depressive symptom severity were consistently higher among participants who reported suicidal thoughts. After statistical adjustment, worthlessness was the most consistent of these signals.

Practical takeaways

The authors suggest these symptoms may give providers reason to assess further, and to consider safety planning, even when someone does not disclose suicidal thoughts. For clinicians, that points to a few habits:

• Treat worthlessness as a signal. When it comes up, it deserves a follow-up question.
• Let a "no" be information, not a conclusion. A single screening item does not close an assessment.
• Look beyond the trauma screen. In this study, trauma symptoms mostly did not distinguish who reported suicidal thoughts.

What the study cannot tell us

This was a cross-sectional survey of a convenience sample, so it describes associations at one point in time. It cannot show whether worthlessness comes before suicidal thoughts, follows them or shares a common root, and it may not reflect the experiences of all Black transgender women. The authors call for more research with larger samples of gender-expansive people.

Why it matters

Prevention depends on reaching people early, and that means detection tools have to work for everyone. This study does not solve that problem, but it names a concrete symptom to listen for, and it shows the value of research shaped with the community it is about.