Mental Health Outcomes Among Travestis and Transgender Women in Brazil: A Literature Review and a Call to Action for Public Health Policies

David R. A. Coelho (), Ana Luiza N. Ferreira, Willians Fernando Vieira, Alex S. Keuroghlian and Sari L. Reisner
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David R. A. Coelho: Division of Public and Community Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
Ana Luiza N. Ferreira: Instituto Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro 22250-020, RJ, Brazil
Willians Fernando Vieira: Instituto e Centro de Pesquisas São Leopoldo Mandic, Faculdade São Leopoldo Mandic, Campinas 13045-755, SP, Brazil
Alex S. Keuroghlian: Division of Public and Community Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
Sari L. Reisner: The Fenway Institute, Fenway Health, Boston, MA 02215, USA

IJERPH, 2025, vol. 22, issue 7, 1-18

Abstract: Travestis and transgender women in Brazil face a disproportionate burden of mental health conditions, exacerbated by structural discrimination, violence, and social exclusion. This narrative review synthesizes evidence on the prevalence of depression, anxiety, suicidality, and substance use among travestis and transgender women in Brazil, and examines intersecting social and health disparities. We searched PubMed, Embase, and PsycINFO in April 2025, identifying peer-reviewed studies in English or Portuguese reporting mental health outcomes or associated social determinants of health in this population. Thirty-one studies across twelve different cities ( n = 7683) were included and grouped into two thematic domains. Reported prevalence ranged from 16–70.1% for depression, 24.8–26.5% for anxiety, and 25–47.3% for suicidality. Substance use was also highly prevalent, with studies reporting high rates of alcohol (21.5–72.7%), tobacco (56.6–61.6%), cannabis (19–68.9%), and cocaine/crack (6–59.8%) use. Discrimination, violence, economic hardship, and HIV were consistently associated with psychological distress and barriers to care. These findings underscore the urgent need to integrate mental health, gender-affirming care, and HIV services into Brazil’s Unified Health System ( Sistema Único de Saúde–SUS ), strengthen anti-discrimination and violence-prevention policies, and adopt inclusive public health strategies that prioritize the leadership and lived experiences of transgender, nonbinary, and gender diverse people, particularly amid rising political threats to gender-affirming care.

Keywords: travesti; transgender women; mental health; public policies; Brazil (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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