Healthcare discrimination, minority stress, psychological distress, and quality of life among transgender and gender diverse people in Chile

BACKGROUND: 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. AIM: This study assessed the impact of minority stress and healthcare discrimination on psychological distress and QoL among TGD people in Chile. METHODS: 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. OUTCOMES: 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. RESULTS: 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 = -1.46) and physical (d = -1.09). Discrimination events (β = 0.29), internalized stigma (β = 0.23), and victimization (β = -0.23) significantly predicted higher distress and lower QoL. Community connectedness was a protective factor (β = 0.19). Healthcare discrimination uniquely predicted higher psychological distress (β = 0.16) and poorer overall QoL (β = -0.23). CLINICAL IMPLICATIONS: 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. STRENGTHS AND LIMITATIONS: 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. CONCLUSION: 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.