Young, low-income transgender women with a history of unsafe sexual behavior face a high rate of mental health problems, according to a new study.

The study, led by Sari Reisner, a researcher at Harvard T.H. Chan School of Public Health, Harvard Medical School, and Boston Children’s Hospital, looked at mental health and substance abuse among a group of 300 young, low-income transgender women living in either Chicago or Boston. Researchers found that more than 40% of the women had at least one serious mental health issue or substance abuse problem, and nearly 20% had two or more serious mental health diagnoses.

The study also found that the women were nearly two to four times more likely to have mental health and substance abuse issues than the U.S. population at large.

The findings show that “interventions are urgently needed to address adverse mental health and substance use outcomes for young transgender women,” Reisner said in a March 21, 2016 HealthDay article.

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