According to a study by Georgia State University’s Kristie L. Seelman, being denied bathroom access is correlated with an increased risk of suicide attempts among trans people.

Transgender people have said bathroom access is one of their “most pressing challenges,” Seelman writes in the study, which was published in February in the Journal of Homosexuality. Trans people have reported getting stared at or being asked to leave, something that causes them “great stress,” according to researchers. Seelman highlights an earlier study of 93 trans people that found 68 percent had been verbally harassed in bathrooms, and 9 percent were physically assaulted.

For her study, Seelman examined a sample of 2,325 transgender college graduates who responded to the National Transgender Discrimination Survey in 2009. A quarter had been denied access to bathrooms in some way or another. Their suicide-attempt rate was also much higher than that of the general U.S. population—47 percent, compared to about 4 percent for all Americans. Those who had been denied access to bathrooms were 45 percent more likely to have tried to kill themselves, even when controlling for other types of victimization.

“This suggests that there may be a distinct relationship between the stress of not being able to use bathrooms or gender-appropriate campus housing and one’s mental health,” Seelman writes.

Seelman connects the suicide risk to “minority stress,” or the chronically high levels of stress from discrimination that stigmatized groups face.

Last week the Obama administration told school districts across the country to allow transgender students to use the restrooms that match their gender identity, so this is already less of an issue for public-school students in North Carolina. But the broader debate over bathroom access has sparked a series of bizarre incidents involving people who were perceived to be transgender. Last week a short-haired woman in Danbury, Connecticut, said she was washing her hands in a Walmart when a stranger told her, “You’re disgusting! You don’t belong here!” After a transgender boy attempted to use the boy’s bathroom in Vermont, someone complained, then students launched a “straight pride” campaign.

But perhaps nothing compares to the stress of hearing yourself compared to a “pervert” or devil-rapist—words used by the Bible-toting mother—on your weekend shopping trip. As another protester marched, railing against “pedophiles,” through a San Francisco Target recently, a trans person approached him and said, “there’s a trans person right here in front of you.”

“You’re gonna go to hell,” the man yelled.