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Review
. 2025 Jun 20;22(7):977.
doi: 10.3390/ijerph22070977.

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  1   2 , Ana Luiza N Ferreira  3 , Willians Fernando Vieira  4   5 , Alex S Keuroghlian  1   6   7   8 , Sari L Reisner  6   9   10
Affiliations
Review

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 et al. Int J Environ Res Public Health. .

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: Brazil; mental health; public policies; transgender women; travesti.

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Conflict of interest statement

A.S.K. declares royalties as editor of a McGraw Hill textbook on transgender and gender diverse health care, and editor of an American Psychiatric Association textbook on gender-affirming psychiatric care. All other authors declare no competing interests.

Figures

Figure 1
Figure 1
Geographic distribution of studies on mental health and social determinants among travestis and transgender women across Brazilian cities and states.
Figure 2
Figure 2
Key policy areas to improve health equity for travestis and transgender women in Brazil.
See this image and copyright information in PMC

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