{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T12:11:34Z","timestamp":1783426294434,"version":"3.54.6"},"reference-count":67,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":2,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,3,9]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Transgender and gender-diverse (TGD) individuals experience elevated psychological distress and poorer quality of life (QoL) due to pervasive stigma and discrimination. Minority stress theory posits that distal (e.g., discrimination) and proximal stressors (e.g., internalized stigma) predict adverse mental health outcomes, whereas protective factors such as community connectedness foster resilience. However, empirical data from contexts in the global south, such as Chile, remain scarce.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aim<\/jats:title>\n                    <jats:p>This study assessed the impact of minority stress and healthcare discrimination on psychological distress and QoL among TGD people in Chile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional online survey was administered to 224 TGD adults in Chile in 2024. Participants were recruited through sexual and gender minority organizations. Data were analyzed using descriptive statistics, Pearson correlations, and multiple linear regressions, and one-sample t-tests to compare sample scores to Chilean normative data.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcomes<\/jats:title>\n                    <jats:p>Measures included the LGBT Minority Stress Measure; the Patient Health Questionnaire-4 (PHQ-4) to assess overall psychological distress, with its anxiety (Generalized Anxiety Disorder-2; GAD-2) and depression (Patient Health Questionnaire-2; PHQ-2) subscales; and the four subscales, physical, psychological, social, and environmental, of the WHOQOL-BREF. Healthcare discrimination was measured with ad hoc items. Primary outcomes were levels of psychological distress, anxiety, depression, and QoL across four domains. Predictors included minority stress dimensions and healthcare discrimination.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Nearly half of participants (50.1%) reported moderate to severe psychological distress; 42.9% screened positive for anxiety, and 32.1% for probable depression. QoL scores were significantly lower than population norms across all domains, particularly psychological (d\u2009=\u2009\u20131.46) and physical (d\u2009=\u2009\u20131.09). Discrimination events (\u03b2\u2009=\u20090.29), internalized stigma (\u03b2\u2009=\u20090.23), and victimization (\u03b2\u2009=\u2009\u20130.23) significantly predicted higher distress and lower QoL. Community connectedness was a protective factor (\u03b2\u2009=\u20090.19). Healthcare discrimination uniquely predicted higher psychological distress (\u03b2\u2009=\u20090.16) and poorer overall QoL (\u03b2\u2009=\u2009\u20130.23).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Clinical Implications<\/jats:title>\n                    <jats:p>Findings emphasize the urgent need for gender-affirmative healthcare, anti-discrimination training, and community-based interventions to mitigate the psychological burden associated with minority stress and promote resilience among TGD populations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Strengths and Limitations<\/jats:title>\n                    <jats:p>This is one of the first quantitative studies on TGD minority stress and QoL in Latin America. Strengths include a robust sample size and validated measures. Limitations include non-probabilistic sampling, cross-sectional design, and reliance on self-report data, which preclude causal inference and limit generalizability.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>TGD individuals in Chile experience substantial inequities in psychological well-being and QoL, partially driven by minority stress and healthcare discrimination. Inclusive policies and affirming care practices are essential to reducing these disparities and improving TGD health.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/jsxmed\/qdag055","type":"journal-article","created":{"date-parts":[[2026,2,17]],"date-time":"2026-02-17T12:30:49Z","timestamp":1771331449000},"source":"Crossref","is-referenced-by-count":3,"title":["Healthcare discrimination, minority stress, psychological distress, and quality of life among transgender and gender diverse people in Chile"],"prefix":"10.1093","volume":"23","author":[{"given":"Maximiliano Arancibia","family":"Torrej\u00f3n","sequence":"first","affiliation":[{"name":"Sexological Studies Unit, CIBIS Research Center, University of Almer\u00eda , Almer\u00eda 04120 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Estibaliz","family":"Cepa-Rodr\u00edguez","sequence":"additional","affiliation":[{"name":"Department of Educational Sciences, University of the Basque Country , San Sebastian 20018 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Inmaculada Fern\u00e1ndez","family":"Agis","sequence":"additional","affiliation":[{"name":"Sexological Studies Unit, CIBIS Research Center, University of Almer\u00eda , Almer\u00eda 04120 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0232-8897","authenticated-orcid":false,"given":"Jenna Marie","family":"Strizzi","sequence":"additional","affiliation":[{"name":"Sexological Studies Unit, CIBIS Research Center, University of Almer\u00eda , Almer\u00eda 04120 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"issue":"4","key":"2026031405570259300_ref1","first-page":"571","article-title":"The institutionalization of heteronormativity and cisnormativity in educational institutes: a review","volume":"2","author":"Roy","year":"2024","journal-title":"Int J Interdiscip Approaches Psychol"},{"issue":"2-3","key":"2026031405570259300_ref2","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1080\/15532739.2019.1640654","article-title":"The terminology of identities between, outside and beyond the gender binary \u2013 a systematic review","volume":"20","author":"Thorne","year":"2019","journal-title":"Int J Transgend"},{"issue":"4","key":"2026031405570259300_ref3","doi-asserted-by":"publisher","first-page":"1182","DOI":"10.1177\/13591045211033187","article-title":"Gender minority stress in trans and gender diverse adolescents and young people","volume":"26","author":"Hunter","year":"2021","journal-title":"Clin Child Psychol Psychiatry"},{"issue":"3","key":"2026031405570259300_ref4","doi-asserted-by":"publisher","first-page":"222","DOI":"10.1080\/19012276.2021.1989708","article-title":"Transgender and gender non-conforming people\u2019s adaptive coping responses to minority stress: a framework synthesis","volume":"74","author":"Smith","year":"2022","journal-title":"Nord Psychol"},{"issue":"9","key":"2026031405570259300_ref5","doi-asserted-by":"publisher","first-page":"1537","DOI":"10.1007\/s00127-021-02036-6","article-title":"Country-level structural stigma, identity concealment, and day-to-day discrimination as determinants of transgender people\u2019s life satisfaction","volume":"56","author":"Br\u00e4nstr\u00f6m","year":"2021","journal-title":"Soc Psychiatry Psychiatr Epidemiol"},{"issue":"1","key":"2026031405570259300_ref6","doi-asserted-by":"publisher","first-page":"7","DOI":"10.1089\/trgh.2023.0025","article-title":"Transgender and gender-diverse minority stress and substance use frequency and problems: systematic review and meta-analysis","volume":"10","author":"Pellicane","year":"2025","journal-title":"Transgend Health"},{"key":"2026031405570259300_ref7","doi-asserted-by":"publisher","first-page":"102358","DOI":"10.1016\/j.cpr.2023.102358","article-title":"Minority stress and mental health in European transgender and gender diverse people: a systematic review of quantitative studies","volume":"107","author":"Mezza","year":"2024","journal-title":"Clin Psychol Rev"},{"key":"2026031405570259300_ref8","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1007\/978-3-319-57365-6_33-1","volume-title":"Handbook of Labor Human Resources and Population Economics","author":"Drydakis","year":"2020"},{"issue":"5","key":"2026031405570259300_ref9","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1037\/a0029597","article-title":"A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model","volume":"43","author":"Hendricks","year":"2012","journal-title":"Prof Psychol Res Pr"},{"issue":"1","key":"2026031405570259300_ref10","doi-asserted-by":"publisher","first-page":"65","DOI":"10.1037\/sgd0000081","article-title":"Development of the gender minority stress and resilience measure","volume":"2","author":"Testa","year":"2015","journal-title":"Psychol Sex Orientat Gend Divers"},{"issue":"1","key":"2026031405570259300_ref11","doi-asserted-by":"publisher","first-page":"38","DOI":"10.2307\/2137286","article-title":"Minority stress and mental health in gay men","volume":"36","author":"Meyer","year":"1995","journal-title":"J Health Soc Behav"},{"issue":"5","key":"2026031405570259300_ref12","doi-asserted-by":"publisher","first-page":"674","DOI":"10.1037\/0033-2909.129.5.674","article-title":"Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence","volume":"129","author":"Meyer","year":"2003","journal-title":"Psychol Bull"},{"key":"2026031405570259300_ref13","doi-asserted-by":"publisher","DOI":"10.1007\/s13178-025-01131-6","article-title":"Out of sight but on my mind: distal stressors, identity concealment, proximal stress, and mental health among sexual or gender minorities","author":"Dennis","year":"2025","journal-title":"Sex Res Soc Policy"},{"issue":"10","key":"2026031405570259300_ref14","doi-asserted-by":"publisher","first-page":"1471","DOI":"10.1080\/00918369.2019.1591789","article-title":"Gender minority stress: a critical review","volume":"67","author":"Tan","year":"2020","journal-title":"J Homosex"},{"issue":"5","key":"2026031405570259300_ref15","doi-asserted-by":"publisher","first-page":"943","DOI":"10.2105\/AJPH.2013.301241","article-title":"Stigma, mental health, and resilience in an online sample of the US transgender population","volume":"103","author":"Bockting","year":"2013","journal-title":"Am J Public Health"},{"issue":"3","key":"2026031405570259300_ref16","doi-asserted-by":"publisher","first-page":"67","DOI":"10.15585\/mmwr.mm6803a3","article-title":"Transgender identity and experiences of violence victimization, substance use, suicide risk, and sexual risk behaviors among high school students 19 states and large urban school districts, 2017","volume":"68","author":"Johns","year":"2019","journal-title":"MMWR Morb Mortal Wkly Rep"},{"issue":"5","key":"2026031405570259300_ref17","doi-asserted-by":"publisher","first-page":"389","DOI":"10.1037\/ccp0000487","article-title":"Longitudinal associations between minority stress, internalizing symptoms, and substance use among sexual and gender minority individuals assigned female at birth","volume":"88","author":"Dyar","year":"2020","journal-title":"J Consult Clin Psychol"},{"issue":"8","key":"2026031405570259300_ref18","doi-asserted-by":"publisher","first-page":"984","DOI":"10.1001\/jamainternmed.2024.2544","article-title":"Health status and mental health of transgender and gender-diverse adults","volume":"184","author":"Liu","year":"2024","journal-title":"JAMA Intern Med"},{"issue":"7","key":"2026031405570259300_ref19","doi-asserted-by":"publisher","DOI":"10.1098\/rsos.221230","article-title":"The influence of minority stress-related experiences on mental wellbeing for trans\/gender-diverse and cisgender youth: a comparative longitudinal analysis","volume":"10","author":"Black","year":"2023","journal-title":"R Soc Open Sci"},{"key":"2026031405570259300_ref20","doi-asserted-by":"publisher","first-page":"1142","DOI":"10.1001\/jamapsychiatry.2025.1850","article-title":"Mental health outcomes in transgender and nonbinary people","volume":"82","author":"Hainey","year":"2025","journal-title":"JAMA Psychiatry"},{"issue":"1","key":"2026031405570259300_ref21","doi-asserted-by":"publisher","first-page":"27","DOI":"10.1080\/15532739.2016.1258353","article-title":"Prevalence of anxiety symptoms and disorders in the transgender population: a systematic review of the literature","volume":"18","author":"Millet","year":"2017","journal-title":"Int J Transgend"},{"issue":"4","key":"2026031405570259300_ref22","doi-asserted-by":"publisher","first-page":"433","DOI":"10.1080\/15532739.2017.1365034","article-title":"Relationship among gender-related stress, resilience factors, and mental health in a midwestern U.S. transgender and gender-nonconforming population","volume":"18","author":"Brennan","year":"2017","journal-title":"Int J Transgend"},{"issue":"16","key":"2026031405570259300_ref23","doi-asserted-by":"publisher","first-page":"8843","DOI":"10.3390\/ijerph18168843","article-title":"Review: prevalence of addictions among transgender and gender diverse subgroups","volume":"18","author":"Ruppert","year":"2021","journal-title":"Int J Environ Res Public Health"},{"key":"2026031405570259300_ref24","doi-asserted-by":"publisher","first-page":"9","DOI":"10.3389\/fpubh.2021.598455","article-title":"A qualitative scoping review of transgender and gender non-conforming people\u2019s physical healthcare experiences and needs","volume":"9","author":"Teti","year":"2021","journal-title":"Front Public Health"},{"issue":"23-24","key":"2026031405570259300_ref25","doi-asserted-by":"publisher","first-page":"4080","DOI":"10.1111\/jocn.13913","article-title":"Discrimination and resilience and the needs of people who identify as transgender: a narrative review of quantitative research studies","volume":"26","author":"McCann","year":"2017","journal-title":"J Clin Nurs"},{"issue":"5","key":"2026031405570259300_ref26","doi-asserted-by":"publisher","first-page":"705","DOI":"10.3390\/healthcare11050705","article-title":"Prevalence and determinants of depressive and anxiety symptoms among transgender people: results of a survey","volume":"11","author":"Hajek","year":"2023","journal-title":"Healthcare"},{"issue":"6","key":"2026031405570259300_ref27","doi-asserted-by":"publisher","first-page":"1357","DOI":"10.1007\/s11606-022-07996-2","article-title":"Suicidal ideation disparities among transgender and gender diverse compared to cisgender community health patients","volume":"38","author":"Kirakosian","year":"2023","journal-title":"J Gen Intern Med"},{"key":"2026031405570259300_ref28","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpain.2024.104681","article-title":"Understanding risk of chronic pain development and related mental health disparities among transgender people: a review of current literature and future directions","volume":"37S","author":"Stocking","year":"2024","journal-title":"J Pain"},{"key":"2026031405570259300_ref29","volume-title":"TRans and Non-Binary Suicidality (TRANS): Microaggressions and Mental Health","author":"Wright","year":"2024"},{"issue":"6","key":"2026031405570259300_ref30","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1037\/cou0000759","article-title":"Associations between misgendering, invalidation, pride, community connectedness, and trauma among nonbinary adults","volume":"71","author":"Colson","year":"2024","journal-title":"J Couns Psychol"},{"issue":"6","key":"2026031405570259300_ref31","doi-asserted-by":"publisher","first-page":"825","DOI":"10.1080\/00918369.2016.1236587","article-title":"The impact of social connectedness and internalized transphobic stigma on self-esteem among transgender and gender non-conforming adults","volume":"64","author":"Austin","year":"2017","journal-title":"J Homosex"},{"issue":"4","key":"2026031405570259300_ref32","doi-asserted-by":"publisher","DOI":"10.1037\/sgd0000691","article-title":"Internalized transphobia and self-concept clarity among transgender and gender-nonconforming young adults: characteristics, associations, and the mediating role of self-esteem","volume":"12","author":"Gao","year":"2025","journal-title":"Psychol Sex Orientat Gend Divers"},{"key":"2026031405570259300_ref33","doi-asserted-by":"publisher","DOI":"10.2139\/ssrn.3475801","volume-title":"Trans People, Transitioning, Mental Health, Life, and Job Satisfaction","author":"Drydakis","year":"2019"},{"issue":"2","key":"2026031405570259300_ref34","doi-asserted-by":"publisher","first-page":"123","DOI":"10.1097\/ANS.0000000000000256","article-title":"Health care experiences of transgender adults","volume":"42","author":"Cicero","year":"2019","journal-title":"Adv Nurs Sci"},{"issue":"6","key":"2026031405570259300_ref35","doi-asserted-by":"publisher","first-page":"113","DOI":"10.3390\/ejihpe15060113","article-title":"Perceived stigma and quality of life in binary and nonbinary\/queer transgender individuals in Italy: the mediating roles of patient\u2013provider relationship quality and barriers to care","volume":"15","author":"Mezzalira","year":"2025","journal-title":"Eur J Investig Health Psychol Educ"},{"issue":"4","key":"2026031405570259300_ref36","doi-asserted-by":"publisher","first-page":"359","DOI":"10.1080\/15532739.2018.1502711","article-title":"Transgender peoples\u2019 experiences and perspectives about general healthcare: a systematic review","volume":"19","author":"Heng","year":"2018","journal-title":"Int J Transgend"},{"issue":"1","key":"2026031405570259300_ref37","doi-asserted-by":"publisher","first-page":"e14362","DOI":"10.1111\/1475-6773.14362","article-title":"Barriers to quality healthcare among transgender and gender nonconforming adults","volume":"60","author":"Berrian","year":"2025","journal-title":"Health Serv Res"},{"issue":"1","key":"2026031405570259300_ref38","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1186\/s12889-023-15856-9","article-title":"The significance of structural stigma towards transgender people in health care encounters across Europe: health care access, gender identity disclosure, and discrimination in health care as a function of national legislation and public attitudes","volume":"23","author":"Falck","year":"2023","journal-title":"BMC Public Health"},{"key":"2026031405570259300_ref39","first-page":"2016","volume-title":"The Report of the 2015 US Transgender Survey","author":"James"},{"issue":"4","key":"2026031405570259300_ref40","doi-asserted-by":"publisher","DOI":"10.1002\/ajhb.70044","article-title":"Rethinking gender\/sex identity","volume":"37","author":"Fausto-Sterling","year":"2025","journal-title":"Am J Hum Biol"},{"key":"2026031405570259300_ref41","volume-title":"Law 20.609 which Establishes Measures against Discrimination","author":"Library of the National Congress of Chile","year":"2012"},{"key":"2026031405570259300_ref42","volume-title":"Law 20.845 School Inclusion Law","author":"Library of the National Congress of Chile","year":"2015"},{"key":"2026031405570259300_ref43","volume-title":"Law 21.120 Recognizes and Protects the Right to Gender Identity","author":"Library of the National Congress of Chile","year":"2018"},{"key":"2026031405570259300_ref44","article-title":"Circular N 21: Reitera Instrucci\u00f3n sobre La Atenci\u00f3n de personas trans En La red Asistencial","author":"Ministry of Health of Chile","year":"2012"},{"key":"2026031405570259300_ref45","article-title":"V\u00eda Cl\u00ednica Para La Adecuaci\u00f3n corporal En personas con Incongruencia entre Sexo F\u00edsico e Identidades de G\u00e9nero (Ord. B22\/2988).","author":"Ministry of Health of Chile","year":"2010"},{"key":"2026031405570259300_ref46","article-title":"Circular No 34: Instruye sobre La Atenci\u00f3n de personas trans y Fortalecimiento de La Estrategia de Hospital amigo a personas de La Diversidad sexual.","author":"Ministry of Health of Chile","year":"2011"},{"issue":"3","key":"2026031405570259300_ref47","doi-asserted-by":"publisher","first-page":"181","DOI":"10.4067\/S0718-48082019000300181","article-title":"Efectos del prejuicio sexual en la salud mental de personas transg\u00e9nero chilenas desde el Modelo de Estr\u00e9s de las Minor\u00edas: una aproximaci\u00f3n cualitativa [effects of sexual prejudice on the mental health of Chilean transgender people from the minority stress model: a qualitative approach]","volume":"37","author":"Barrientos Delgado","year":"2019","journal-title":"Terapia psicol\u00f3gica"},{"issue":"8","key":"2026031405570259300_ref48","doi-asserted-by":"publisher","first-page":"1113","DOI":"10.4067\/S0034-98872020000801113","article-title":"Salud mental en poblaci\u00f3n transg\u00e9nero y g\u00e9nero no conforme en Chile[mental health in the transgender and gender non-conforming population in Chile]","volume":"148","author":"Guzm\u00e1n-Gonz\u00e1lez","year":"2020","journal-title":"Rev Med Chile"},{"issue":"2","key":"2026031405570259300_ref49","first-page":"49","article-title":"Evaluaci\u00f3n con enfoque de salud de la situaci\u00f3n de personas trans en Chile: una realidad invisibilizada [mental health in the transgender and gender non-conforming population in Chile]","volume":"58","author":"Gonz\u00e1lez D\u00edaz","year":"2018","journal-title":"Cuadernos M\u00e9dico Sociales"},{"issue":"3","key":"2026031405570259300_ref50","doi-asserted-by":"publisher","first-page":"e3767","DOI":"10.15649\/cuidarte.3767","article-title":"Nursing care as perceived by trans persons: a phenomenological approach","volume":"15","author":"\u00c1lvarez-Mu\u00f1oz","year":"2024","journal-title":"Revista Cuidarte"},{"key":"2026031405570259300_ref51","article-title":"Informe Estad\u00edstico Del Sistema Educacional con An\u00e1lisis de G\u00e9nero 2024 (con Datos Del A\u00f1o 2023) (Evidencias 64)","author":"Ministry of Education of Chile","year":"2024"},{"key":"2026031405570259300_ref52","volume-title":"Developing the LGBT Minority Stress Measure","author":"Outland","year":"2016"},{"key":"2026031405570259300_ref53","article-title":"Adaptaci\u00f3n de La Escala de Estr\u00e9s de las Minor\u00edas LGTBI En poblaci\u00f3n Espa\u00f1ola: Datos Preliminares","author":"Nebot-Garc\u00eda"},{"issue":"1","key":"2026031405570259300_ref54","doi-asserted-by":"publisher","DOI":"10.17060\/ijodaep.2021.n1.v3.2035","article-title":"Proyecto SAFO: La diversidad sexual a lo largo del ciclo vital en Espa\u00f1a [SAFO project: sexual diversity throughout the life cycle in Spain]","volume":"3","author":"Nebot-Garc\u00eda","year":"2021","journal-title":"Revista INFAD de Psicolog\u00eda Int J Dev Educ Psychol"},{"issue":"11","key":"2026031405570259300_ref55","doi-asserted-by":"publisher","first-page":"994","DOI":"10.1093\/jsxmed\/qdae098","article-title":"Sex talks\u2014experiences with and barriers to communication about sexuality with healthcare staff among patients with anxiety disorder in Denmark","volume":"21","author":"Hald","year":"2024","journal-title":"J Sex Med"},{"issue":"11","key":"2026031405570259300_ref56","doi-asserted-by":"publisher","first-page":"2099","DOI":"10.1093\/jsxmed\/qdaf235","article-title":"Experiences of discrimination among BDSM and kink practitioners","volume":"22","author":"Catal\u00e1n \u00c1guila","year":"2025","journal-title":"J Sex Med"},{"issue":"6","key":"2026031405570259300_ref57","doi-asserted-by":"publisher","first-page":"613","DOI":"10.1176\/appi.psy.50.6.613","article-title":"An ultra-brief screening scale for anxiety and depression: the PHQ-4","volume":"50","author":"Kroenke","year":"2009","journal-title":"Psychosomatics"},{"issue":"5","key":"2026031405570259300_ref58","doi-asserted-by":"publisher","first-page":"e0304623","DOI":"10.1371\/journal.pone.0304623","article-title":"Factor structure and measurement invariance of the patient health Questionnaire-4 among the Chilean population","volume":"19","author":"Moreno","year":"2024","journal-title":"PLoS One"},{"issue":"2","key":"2026031405570259300_ref59","doi-asserted-by":"publisher","first-page":"299","DOI":"10.1023\/B:QURE.0000018486.91360.00","article-title":"The World Health Organization\u2019s WHOQOL-BREF quality of life assessment: psychometric properties and results of the international field trial. A report from the WHOQOL group","volume":"13","author":"Skevington","year":"2004","journal-title":"Qual Life Res"},{"key":"2026031405570259300_ref60","doi-asserted-by":"crossref","first-page":"1541","DOI":"10.4067\/S0034-98872013001200008","article-title":"A, Caqueo-Ur\u00edzar a. Estructura factorial y valores de referencia del WHOQoL-Bref en poblaci\u00f3n adulta chilena [factorial structure and reference values \u200b\u200bof the WHOQoL-Bref in the Chilean adult population]","volume":"141","author":"Urz\u00faa","year":"2013","journal-title":"Rev Med Chile"},{"issue":"2-3","key":"2026031405570259300_ref61","doi-asserted-by":"publisher","first-page":"251","DOI":"10.1080\/15532739.2019.1630346","article-title":"Mental health and quality of life in non-binary transgender adults: a case control study","volume":"20","author":"Jones","year":"2019","journal-title":"Int J Transgend"},{"issue":"2","key":"2026031405570259300_ref62","doi-asserted-by":"publisher","first-page":"99","DOI":"10.3138\/cjhs.252-A3","article-title":"Mindfulness, cognitive distraction, and sexual well-being in women","volume":"25","author":"Newcombe","year":"2016","journal-title":"Can J Hum Sex"},{"issue":"3","key":"2026031405570259300_ref63","doi-asserted-by":"publisher","first-page":"409","DOI":"10.1177\/1049732319860265","article-title":"Unmet expectations in health care settings: experiences of transgender and gender diverse adults in the central great plains","volume":"30","author":"Meyer","year":"2020","journal-title":"Qual Health Res"},{"issue":"10","key":"2026031405570259300_ref64","doi-asserted-by":"publisher","first-page":"2133","DOI":"10.3390\/ijerph15102133","article-title":"Health and well-being of cisgender, transgender and non-binary young people","volume":"15","author":"Aparicio-Garc\u00eda","year":"2018","journal-title":"Int J Environ Res Public Health"},{"issue":"1","key":"2026031405570259300_ref65","doi-asserted-by":"publisher","first-page":"87","DOI":"10.1037\/cou0000127","article-title":"Transgender community belongingness as a mediator between strength of transgender identity and well-being","volume":"63","author":"Barr","year":"2016","journal-title":"J Couns Psychol"},{"issue":"02","key":"2026031405570259300_ref66","doi-asserted-by":"publisher","DOI":"10.4172\/2161-0487.1000257","article-title":"Positive aspects of being lesbian, gay or bisexual in Spain: an exploratory study","volume":"06","author":"Strizzi","year":"2016","journal-title":"J Psychol Psychother"},{"issue":"3","key":"2026031405570259300_ref67","doi-asserted-by":"publisher","first-page":"281","DOI":"10.1037\/sgd0000122","article-title":"Social support, trans community connectedness, and mental health symptoms among transgender and gender nonconforming adults","volume":"2","author":"Pflum","year":"2015","journal-title":"Psychol Sex Orientat Gend Divers"}],"container-title":["The Journal of Sexual Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/4\/qdag055\/67302657\/qdag055.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/jsm\/article-pdf\/23\/4\/qdag055\/67302657\/qdag055.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T09:57:11Z","timestamp":1773482231000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/jsm\/article\/doi\/10.1093\/jsxmed\/qdag055\/8514508"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,9]]},"references-count":67,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2026,3,9]]}},"URL":"https:\/\/doi.org\/10.1093\/jsxmed\/qdag055","relation":{},"ISSN":["1743-6095","1743-6109"],"issn-type":[{"value":"1743-6095","type":"print"},{"value":"1743-6109","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[2026,4]]},"published":{"date-parts":[[2026,3,9]]},"article-number":"qdag055"}}