Rejection by family members may increase the risk of substance abuse and suicide attempts in transgender and gender non-conforming individuals, a new study suggests.

“People should understand that families matter,” researcher Sarit Golub of Hunter College and the Graduate Center of City University of New York told Reuters. “When people are rejected by their loved ones, it can have serious emotional and social consequences.”

Past research has suggested that transgender people have increased risks for health problems, including substance abuse, suicide, depression and HIV, the article notes. Transgender individuals also face challenges including poverty, violence, incarceration and discrimination in employment, healthcare and housing, the researchers write in the journal LGBT Health.

The new study analyzed data from 6,456 adults who participated in the National Transgender Discrimination Survey in 2008 and 2009. They were asked if they had ever abused drugs or alcohol to cope with transgender-related discrimination, or had ever attempted suicide.

Participants were also asked how their families reacted to learning they were transgender or gender nonconforming. The survey found 54 percent of participants experienced a low amount of family rejection, while 31 percent experienced a moderate amount and 14 percent experienced a high amount.

The researchers found 42 percent of participants said they had attempted suicide at some point in their lives, and about 26 percent said they had abused drugs or alcohol. Those who faced a moderate amount of family rejection were about twice as likely to say they had attempted suicide as those with a low amount of family rejection.

People who experienced a high amount of family rejection were more than three times as likely to report attempting suicide. The more family rejection a person experienced, the higher their odds of substance misuse, the study found.