Researchers from the UC Irvine Joe C. Wen School of Population & Public Health found that more than 70% of transgender women living with disabilities experience high levels of mental health risk, including psychological stress and suicidal ideation.
People with disabilities are one of the largest marginalized groups in the United States, facing well-documented health inequities and poorer outcomes than nondisabled individuals. Yet, little research has explored disability within the transgender community—a population already disproportionately burdened by mental health challenges compared to their cisgender peers.
To address this gap, corresponding author Sean Arayasirikul, associate professor in-residence of health, society, and behavior at the UC Irvine Joe C. Wen School of Population & Public Health, led a study recently published in Preventive Medicine Reports.
Using data from the San Francisco site of the National HIV Behavioral Surveillance Transgender Study within the years 2019 to 2020, the researchers found that more than 70% of the roughly 200 transgender women surveyed reported living with at least one disability. Those individuals with disabilities had significantly greater odds of experiencing serious psychological distress and suicidal ideation.
The fact that over 70% of transgender women in our study reported living with at least one disability is both striking and deeply concerning.”
– Dr. Sean Arayasirikul, corresponding author
“The fact that over 70% of transgender women in our study reported living with at least one disability is both striking and deeply concerning,” said Arayasirikul who is also the director of The Legacy Center at UC Irvine. “It underscores the urgent need to recognize how disability and gender identity intersect to create compounded barriers to mental health and well-being.”
The most frequently reported disabilities included cognitive difficulties (52.2%), followed by ambulatory (29.9%), independent living (27.9%), vision (17.9%), hearing (13.9%), and self-care difficulties (7.0%). Notably, 22.4% of participants with at least one disability reported suicidal ideation in the past year, compared to only 5.2% of participants with no disabilities.
These findings reinforce the fact that people with disabilities experience higher rates of depression and anxiety, often driven by a lack of social and emotional support. The researchers argue that social and environmental contexts, including discrimination, inaccessible systems, and insufficient support networks, play a central role in perpetuating these disparities.
The study calls for urgent, system-level changes. Researchers emphasize the need for an intersectional approach in both future research and clinical practice—one that acknowledges the overlapping impacts of gender identity, disability, race, and other social positions. They also advocate for:
- Routine screening for social determinants of health, especially among clinicians serving transgender individuals with disabilities;
- Medical education that integrates training on both transgender health and disability justice; and
- Greater provider awareness, as many transgender individuals report having to educate their own physicians due to a lack of knowledgeable care.
Ultimately, the study urges healthcare systems to be reimagined to serve all bodies and identities. As the global population ages and the population of transgender people grows, the prevalence of disabilities will increase, and it will be important to advance strategies, interventions, and clinical practices that address chronic stress at this critical intersection.
Additional authors include Abtin Shafie, recent graduate, University of California, Riverside; Alexis Salvatore, recent graduate, San Diego State University; Riley Shea, recent graduate, University of San Francisco; Eileen Yu, President of Queer & Asian Student Group at UC Irvine; Oyku Ozyucel, recent graduate, UCLA; Ansharan Akbar, recent graduate, University of Maryland; Bow Suprasert, MPH research data analyst, Erin C. Wilson, DrPH, Senior Research Scientist, and Willi McFarland, MD, PhD, founding director, all from Center for Public Health Research at San Francisco Department of Public Health; Kelly D. Taylor, PhD, UC San Francisco.
This work was supported by the Centers for Disease Control and Prevention (CDC)’s National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention under grant [number 6NU62ES005077] and the National Institute of Mental Health (NIMH) under grant [number R25MH119858]. The opinions presented in this article are of Wen Public Health and do not reflect the opinion of the funders.
