Abstracts
Résumé
Les personnes lesbiennes, gaies, bisexuelles, trans, queers ou appartenant à d’autres minorités associées à l’orientation sexuelle ou l’identité de genre (LGBTQ+) sont surreprésentées parmi celles vivant de l’instabilité résidentielle. Si ce phénomène est bien documenté, les variations de cette expérience au sein même de la population LGBTQ+ demeurent peu étudiées. Cette recherche adopte une approche intersectionnelle quantitative pour examiner ces disparités dans un échantillon en ligne de 4275 adultes LGBTQ+ du Québec (Canada) âgées de 18 à 86 ans. Les résultats indiquent qu’un taux global de 8,6 % masque d’importantes variations entre sous-groupes. L’arbre d’inférence conditionnelle, qui permet l’analyse d’interactions complexes entre plusieurs prédicteurs, a mis en évidence neuf profils intersectionnels dont la prévalence d’instabilité résidentielle varie de 3,3 % à 35,1 %. Les prévalences les plus élevées ont été observées chez les personnes trans ou non binaires, en particulier celles s’identifiant comme Autochtones, ainsi que chez les personnes cisgenres pansexuelles ou queers âgées de plus de 24 ans et ayant un statut de migrant. À l’inverse, la prévalence la plus faible a été observée chez les personnes cisgenres LGB sans handicap et disposant d’un revenu annuel d’au moins 60 000$. En montrant que les expériences d’instabilité résidentielle chez les personnes LGBTQ+ ne sont pas homogènes, ces résultats soulignent l’importance de concevoir des stratégies de prévention ciblées et adaptées aux réalités des personnes situées à l’intersection de multiples positions sociales marginalisées.
Mots-clés :
- Instabilité résidentielle,
- Intersectionnalité,
- cissexisme,
- hétérosexisme,
- personnes LGBTQ+
Abstract
Lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+)individuals are overrepresented among those experiencing housing instability. Although thisphenomenon is well documented, variations in these experiences within the LGBTQ+population itself remain insufficiently examined. This study adopts a quantitativeintersectional approach to analyze these disparities using an online sample of 4,275 LGBTQ+adults in Quebec (Canada), aged 18 to 86 years. The findings indicate that an overallprevalence rate of 8.6% obscures substantial variation across subgroups. A conditionalinference tree—enabling the analysis of complex interactions among multiple predictors—identified nine intersectional profiles, with the prevalence of housing instability ranging from3.3% to 35.1%. The highest prevalence rates were observed among transgender or non-binaryindividuals, particularly those identifying as Indigenous, as well as among cisgenderpansexual or queer individuals over the age of 24 with migrant status. Conversely, the lowestprevalence was found among cisgender lesbian, gay, and bisexual individuals withoutdisabilities and with an annual income of at least $60,000. By demonstrating that experiencesof housing instability among LGBTQ+ populations are not homogeneous, these findingsunderscore the importance of developing targeted prevention strategies that are responsive tothe realities of individuals situated at the intersection of multiple marginalized socialpositions, in line with an intersectional and human rights–based approach to housing.
Keywords:
- Residential instability,
- LGBTQ+,
- Intersectionality,
- cissexism,
- heterosexism
Appendices
Bibliographie
- Abramovich, A., Marshall, M., Webb, C., Elkington, N., Stark, R. K., Pang, N., & Wood, L. (2024). Identifying 2SLGBTQ+ individuals experiencing homelessness using Point-in-Time counts: Evidence from the 2021 Toronto Street Needs Assessment survey. PLoS ONE 19(4): e0298252. https://doi.org/10.1371/journal.pone.0298252
- Abramovich, I. A. (2012). No safe place to go – LGBTQ youth homelessness in Canada: Reviewing the literature. Canadian Journal of Family and Youth, 4(1), 29–51. https://doi.org/10.29173/cjfy16579
- Allio, L., Clay, C., & Glatze, K. (2015). Homelessness survey: City of Livermore. Hatchuel Tabernik and Associates. https://www.livermoreca.gov/home/showpublisheddocument/6983/637587601728370000
- Baskin, C. (2019). Aboriginal youth talk about structural determinants as the causes of their homelessness. First Peoples Child and Family Review, 14(1), 94–108. https://doi.org/10.7202/1071289ar
- Bauer, G. R. (2014). Incorporating intersectionality theory into population health research methodology: Challenges and the potential to advance health equity. Social Science and Medicine, 110, 10–17. https://doi.org/10.1016/j.socscimed.2014.03.022
- Bauer, G. R., & Scheim, A. I. (2019). Methods for analytic intercategorical intersectionality in quantitative research: Discrimination as a mediator of health inequalities. Social Science and Medicine, 226, 236-245. https://doi.org/10.1016/j.socscimed.2018.12.015
- Bauer, G. R., Braimoh, J., Scheim A. I., & Dharma, C. (2017). Transgender-inclusive measures of sex/gender for population surveys: Mixed-methods evaluation and recommendations. PLoSONE, 12(5): e0178043. https://doi.org/10.1371/journal.pone.0178043
- Bellows, Z., Kim, C., Bai, Y., Cao, P., & Chum, A. (2025). Disparities in self-reported mental health, physical health, and substance use across sexual orientations in Canada. PLoS ONE 20(3): e0305019. https://doi.org/10.1371/journal.pone.0305019
- Bidell, M. P. (2014). Is there an emotional cost of completing high school? Ecological factors and psychological distress among LGBT homeless youth. Journal of Homosexuality, 61(3), 366 381. https://doi.org/10.1080/00918369.2013.842426
- Bowleg, L. (2021). Evolving intersectionality within public health: From analysis to action. American Journal of Public Health, 111(1), 88–90. https://doi.org/10.2105/AJPH.2020.306031
- Bowleg, L. (2012). The problem with the phrase women and minorities: Intersectionality—An important theoretical framework for public health. American Journal of Public Health, 102(7), 1267–1273. https://doi.org/10.2105/AJPH.2012.300750
- Camirand, H., Conus, F., Davison, A., Dupont, K., Gonzalez-Sicilia, D., Joubert, K., & Niyibizi, J. (2023). Enquête québécoise sur la santé de la population 2020-2021. Institut de la statistique du Québec. https://statistique.quebec.ca/fr/fichier/enquete-quebecoise-sante-population-2020-2021.pdf
- Chamberland, L., Bernier, M., Lebreton, C., Richard, G., & Théroux Séguin, J. (2007). Gais et lesbiennes en milieu de travail : rapport synthèse de recherche (122 p.). Collège de Maisonneuve – Institut de recherches et d’études féministes (IREF), Université du Québec à Montréal. https://tablehomophobietransphobie.org/wp-content/uploads/2012/12/55-gais-et-lesbienne-en-milieu-de-travail.pdf
- Chbat, M., Pagé, G., Côté, I., Blais, M. (2023). Resistance strategies and identity reappropriation of LGBTQ+ migrants in Québec. Journal of International Migration and Integration, 24, 1751-1771. https://doi.org/10.1007/s12134-023-01039-3
- Cho, S., Crenshaw, K. W., & McCall, L. (2013). Toward a field of intersectionality studies: Theory, applications, and praxis. Signs: Journal of Women in Culture and Society, 38(4), 785–810. https://doi.org/10.1086/669608
- Collins, P. H. (2000). Black feminist thought: Knowledge, consciousness, and the politics of empowerment (2nd ed.). Routledge. https://doi.org/10.4324/9780203900055
- Collins, P. H., & Bilge, S. (2016). Intersectionality. Polity Press.
- Collins, S. B., & Schormans, A. F. (2021). Making visible the prevalence of self-identified disability among youth experiencing homelessness. Journal of Social Distress and Homelessness, 32(1), 16–24. https://doi.org/10.1080/10530789.2021.1940719
- Côté, P. B., & Blais, M. (2021). “The least loved, that’s what I was”: A qualitative analysis of the pathways to homelessness by LGBTQ+ youth. Journal of Gay and Lesbian Social Services, 33(2), 137–156. https://doi.org/10.1080/10538720.2020.1850388
- Crenshaw, K. W. (1989). Demarginalizing the intersection of race and sex: A Black feminist critique of antidiscrimination doctrine, feminist theory and antiracist politics. University of Chicago Legal Forum, 1(8), 139–167. https://chicagounbound.uchicago.edu/uclf/vol1989/iss1/8
- Crenshaw, K.W. (1991). Mapping the margins: Intersectionality, identity politics, and violence against women of color. Stanford Law Review, 43(6), 1241–1299. https://doi.org/10.2307/1229039
- Daley, A., Phipps, S., & Branscombe, N. R. (2018). The social complexities of disability: Discrimination, belonging and life satisfaction among Canadian youth. SSM - Population Health, 5, 55–63. https://doi.org/10.1016/j.ssmph.2018.05.003
- Décary-Secours, B. (2017). Jeunes et itinérance : dévoiler une réalité peu visible. Avis sur la prévention de l’itinérance jeunesse à Montréal. Conseil jeunesse de Montréal. https://ville.montreal.qc.ca/pls/portal/docs/PAGE/CONS_JEUNESSE_FR/MEDIA/DOCUMENTS/CJM_ITIN%C9RANCE_IMP.PDF
- DeChants, J. P., Green, A. E., Price, M. N., & Davis, C. K. (2021). Homelessness and housing instability among LGBTQ youth. The Trevor Project. https://www.thetrevorproject.org/wp-content/uploads/2022/02/Trevor-Project-Homelessness-Report.pdf
- del Río-González, A. M., Holt, S. L., & Bowleg, L. (2012). Powering and structuring intersectionality: Beyond main and interactive associations. Research on Child and Adolescent Psychopathology, 49, 33–37. https://doi.org/10.1007/s10802-020-00720-w
- Ducharme, D., Fournier, É., Bance, E., & Durand, S. (2025). Les obstacles à l’embauche, à l’intégration et au maintien en emploi des personnes en situation de handicap (Étude adoptée à la 732ᵉ séance de la Commission tenue le 11 avril 2025). Commission des droits de la personne et des droits de la jeunesse. https://cdpdj.qc.ca/storage/app/media/publications/Etude-obstacles-emploi-personnes-handicapees-2025-05-20.pdf
- Duford, J., & Blais, M. (2025). Le rôle du cishétérosexisme dans l’itinérance des jeunes de minorités sexuelles et de genre : une métasynthèse qualitative. International Journal on Homelessness, 5(3). https://doi.org/10.5206/ijoh.2023.3.22358
- Duford, J., Blais, M., & Gervais, J. (2024). L’instabilité résidentielle chez les jeunes LGBTQ2+ : une exploration intersectionnelle quantitative. International Journal on Homelessness, 4(2), 126-170. https://doi.org/10.5206/ijoh.2023.3.16794
- Duford, J., Blais, M., Smith, K., & Hébert, M. (2023). La polyvictimisation et la détresse psychologique comme médiateurs de la fugue chez les jeunes de minorités sexuelles. Canadian Journal of Behavioural Science / Revue canadienne des sciences du comportement, 55(4), 273-284. https://doi.org/10.1037/cbs0000351
- Ecker, J., Aubry, T., & Sylvestre, J. (2019): A review of the literature on LGBTQ adults who experience homelessness. Journal of Homosexuality, 66(3), 297-323. https://doi.org/10.1080/00918369.2017.1413277
- Ecker, J. (2016). Queer, young, and homeless: A review of the literature. Child and Youth Services, 37(4), 325-361. https://doi.org/10.1080/0145935X.2016.1151781
- Evans, C. R., Williams, D. R., Onnela, J.-P., & Subramanian, S. V. (2018). A multilevel approach to modeling health inequalities at the intersection of multiple social identities. Social Science and Medicine, 203, 64–73. https://doi.org/10.1016/j.socscimed.2017.11.011
- Gaetz, S., & Dej., E. (2017). A new direction: A framework for homelessness prevention. Canadian Observatory on Homelessness Press. https://www.homelesshub.ca/sites/default/files/attachments/COHPreventionFramework_1.pdf
- Gaetz, S., Barr, C., Friesen, A., Harris, B., Hill, C., Kovacs-Burns, K., Pauly, B., Pearce, B., Turner, A., & Marsolais, A. (2012) La définition canadienne de l’itinérance. Observatoire canadien sur l’itinérance. https://homelesshub.ca/sites/default/files/COHhomelessdefinitionFR.pdf
- Garcia, V., Boucher, N., & Schmouth, M.-È. (2018). Vocabulaire et terminologies dans les domaines de l’intégration et du maintien en emploi dans le champ du handicap. Comité consultatif Personnes handicapées. Centre interdisciplinaire de recherche en réadaptation et intégration sociale. https://ccpersonneshandicapees.com/wp-content/uploads/2024/01/LEXIQUE-VFF.pdf
- Gattis, M. N. (2013). An ecological systems comparison between homeless sexual minority youths and homeless heterosexual youths. Journal of Social Science Research, 39(1), 38-49. https://doi.org/10.1080/01488376.2011.633814
- Goyette, M., Bellot, C., Blanchet, A., & Silva-Ramirez, R. (2019). Stabilité résidentielle, instabilité résidentielle et itinérance des jeunes quittant un placement substitut pour la transition à la vie adulte. Étude sur le devenir des jeunes placés. http://edjep.ca/wp-content/uploads/2019/11/Consultez-le-rapport-en-cliquant-ici.pdf
- Hallett, R. E., & Crutchfield, R. M. (2017). Homelessness and housing insecurity in higher education: A trauma‐informed approach to research, policy, and practice. Ashe Higher Education Report, 43, 7-118. https://doi.org/10.1002/aehe.20122
- Held, L., & Bové, D. S. (2020). Likelihood and Bayesian Inference. With applications in biology and medicine (2e éd.). Springer. https://link.springer.com/book/10.1007/978-3-662-60792-3
- Hothorn T, & Zeileis, A. (2015). “partykit: A modular toolkit for recursive partytioning in R.” Journal of Machine Learning Research, 16(118), 3905-3909. https://jmlr.org/papers/v16/hothorn15a.html
- Houghtaling, L. M., Simon, K., Gower, A. L., McCurdy, A., Rider, G. N., Russell, S. T., & Eisenberg, M. E. (2024). Unaccompanied unstable housing among racially, ethnically, sexually, and gender diverse youth: Intersecting identities bearing the greatest burden. American Journal of Orthopsychiatry, 94(3), 311–321. https://doi.org/10.1037/ort0000725
- Hunt, S. (2016). Une introduction à la santé des personnes bispirituelles : questions historiques, contemporaines et émergentes. Centre de collaboration national de la santé autochtone. https://nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/156/2016-05-10-RPT-HealthTwoSpirit-Hunt-FR-Web.pdf
- Hunter, P. (2019). Tout le monde compte 2018 : faits saillants — résultats préliminaires du deuxième dénombrement ponctuel de l’itinérance dans les communautés canadiennes coordonné à l’échelle nationale. Gouvernement du Canada. https://publications.gc.ca/collections/collection_2019/edsc-esdc/Em12-25-2018-fra.pdf
- Institut de la statistique du Québec. (2024). Vitrine statistique sur l’égalité entre les femmes et les hommes : personnes de minorités sexuelles et de genre. Gouvernement du Québec. https://statistique.quebec.ca/vitrine/egalite/dimensions-egalite/demographie/personnes-minorites-sexuelles-et-genre
- Kattari, S. K., Whitfield, D. L., Walls, N. E., Langenderfer-Magruder, L., & Ramos, D. (2016). Policing gender through housing and employment discrimination: Comparison of discrimination experiences of transgender and cisgender LGBQ individuals. Journal of the Society for Social Work and Research, 7(3), 427–447. https://doi.org/10.1086/686920
- Kia, H., Robinson, M., MacKay, J., & Ross, L. E. (2020). Poverty in lesbian, gay, bisexual, transgender, queer, and two-spirit (LGBTQ2S+) populations in Canada: An intersectional review of the literature. Journal of Poverty and Social Justice, 28(1), 21-54. https://doi.org/10.1332/175982719X15687180682342
- Kohn, M., & Reddy, K. (2023). Colonialism. Dans E. N. Zalta & U. Nodelman (dir.), The Stanford Encyclopedia of Philosophy (Spring 2023 Edition). https://doi.org/10.1146/annurev-publhealth-040119-094017
- Kuhn, M., & Johnson, K. (2013). Applied predictive modeling. Springer New York. https://doi.org/10.1007/978-1-4614-6849-3
- la Roi, C., Frost, D. M., Mallory, A., Lin, A., & Meyer, I. H. (2022). Sexual identity and birth cohort differences in social support and its link with well-being among sexual minority individuals. Archives of Sexual Behavior (2022). https://doi.org/10.1007/s10508-022-02366-9
- Lessard, C. (2023). Les titulaires d’un grade universitaire au Québec : portrait sommaire tiré du Recensement de 2021. Science technologie et innovation, 14. Institut de la statistique du Québec. https://statistique.quebec.ca/fr/fichier/titulaires-grade-universitaire-quebec-2021.pdf
- Mahendran, M., Lizotte, D., & Bauer, G. R. (2022). Quantitative methods for descriptive intersectional analysis with binary health outcomes. SSM – Population Health, 17, Article 101032 https://doi.org/10.1016/j.ssmph.2022.101032
- McCormick, A., Schmidt, K., & Terrazas, S. (2017). LGBTQ youth in the child welfare system: An overview of research, practice, and policy. Journal of Public Child Welfare, 11(1), 27-39. https://doi.org/10.1080/15548732.2016.1221368
- McKenzie K. (2019). Improving mental health services for immigrant, racialized, ethno-cultural and refugee groups. HealthcarePapers, 18(2), 4–9. https://doi.org/10.12927/hcpap.2019.25926
- Ministère de la Santé et des Services sociaux. (2021). Plan d’action interministériel en itinérance 2021-2026 : S’allier devant l’itinérance. Gouvernement du Québec. https://publications.msss.gouv.qc.ca/msss/fichiers/2021/21-846-01W.pdf
- Ministère de la Santé et des Services sociaux. (2023). Dénombrement des personnes en situation d’itinérance visible au Québec. Rapport de l’exercice du 11 octobre 2022. Gouvernement du Québec. https://publications.msss.gouv.qc.ca/msss/fichiers/2023/23-846-05W.pdf
- Nadal, K. L., Whitman, C. N., Davis, L. S., Erazo, T., & Davidoff, K. C. (2016). Microaggressions toward lesbian, gay, bisexual, transgender, queer, and genderqueer people: A review of the literature. Journal of Sex Research, 53(4-5), 488–508. https://doi.org/10.1080/00224499.2016.1142495
- O'Grady, B., Kidd, S., & Gaetz, S. (2020). Youth homelessness and self identity: A view from Canada. Journal of Youth Studies, 23(4), 499-510. https://doi.org/10.1080/13676261.2019.1621997
- O’Neill, L., Fraser, T., Kitchenham, A., & McDonald, V. (2018). Hidden burdens: A review of intergenerational, historical and complex trauma, implications for indigenous families. Journal of Child and Adolescent Trauma, 11(2), 173-186. https://doi.org/10.1007/s40653-016-0117-9
- Pitt, R.S., Sherman, J. & Macdonald, M.E. Low-income working immigrant families in Quebec: Exploring their challenges to well-being. Canadian Journal Public Health 106, e539–e545 (2015). https://doi.org/10.17269/CJPH.106.5028
- Polillo, A., & Sylvestre, J. (2019). An exploratory study of the pathways into homelessness among of foreign-born and Canadian-born families: A timeline mapping approach. Journal of Social Distress and Homelessness, 30(1), 6–19. https://doi.org/10.1080/10530789.2019.1705518
- Purdie-Vaughns, V., & Eibach, R. P. (2008). Intersectional invisibility: The distinctive advantages and disadvantages of multiple subordinate-group identities. Sex Roles, 59(5–6), 377–391. https://doi.org/10.1007/s11199-008-9424-4
- Quayum, S., Love, C., & Hunter, P. (2024). Tout le monde compte 2020-2022 – Résultats du troisième dénombrement ponctuel coordonné de l’itinérance au Canada à l’échelle pancanadienne. Infrastructure Canada. Ministre du Logement, de l’Infrastructure et des Collectivités. https://logement-infrastructure.canada.ca/alt-format/pdf/homelessness-sans-abri/reports-rapports/pit-counts-dp-2020-2022-results-resultats-fr.pdf
- R Core Team. (2025). R: A language and environment for statistical computing. R Foundation for Statistical Computing. http://www.r-project.org/index.html
- Rech, N. (2019). Homelessness in Canada. The Canadian Encyclopedia. https://www.thecanadianencyclopedia.ca/en/article/homelessness-in-canada
- Santos, H., Bauer, G. R., Joiner, T., Surachman, A., Lê-Scherban, F., & Scheim, A. I. (2025). Intersectional analysis of suicide risk among transgender and non-binary people. Social Science and Medicine – Mental Health, 8, e100496. https://doi.org/10.1016/j.ssmmh.2025.100496
- Sears, B., Castleberry, N. M., Lin, A., & Mallory, C. (2024). LGBTQ people’s experiences of workplace discrimination and harassment 2023. Williams Institute. https://williamsinstitute.law.ucla.edu/wp-content/uploads/Workplace-Discrimination-Aug-2024.pdf
- Sen, G., Iyer, A., & Mukherjee, C. (2009). A methodology to analyse the intersections of social inequalities in health. Journal of Human Development and Capabilities, 10(3), 397–415. https://doi.org/10.1080/19452820903048894
- Shelton, J., & Bond, L. (2017). “It just never worked out”: How transgender and gender expansive youth understand their pathways into homelessness. Families in Society, 98(4), 284 291. https://doi.org/10.1606/1044-3894.2017.98.33
- Stanton, A. M., Trichtinger, L. A., Kirakosian, N., Li, S. M., Kabel, K. E., Irani, K., Bettis, A. H., O’Cleirigh, C., Liu, R. T., & Liu, Q. (2025). Identifying intersecting factors associated with suicidal thoughts and behaviors among transgender and gender diverse adults: Preliminary conditional inference tree analysis. Journal of Medical Internet Research, 27, e65452 https://doi.org/10.2196/65452
- Statistique Canada. (2024). Profil socioéconomique de la population 2ELGBTQ+ âgée de 15 ans et plus, 2019 à 2021. Le Quotidien. https://www150.statcan.gc.ca/n1/fr/daily-quotidien/240125/dq240125b-fra.pdf?st=cd1KMBlD
- Sylvain-Morneau, J., Da Silva, M. A., Gadbois, J., Springmann, V., Rancourt-Vanier, R., Desgagnés-Bolduc, M.-É., & Tessier, M. (2023). Dénombrement des personnes en situation d’itinérance visible au Québec: Rapport de l’exercice Tout le monde compte du 11 octobre 2022. Ministère de la Santé et des Services sociaux du Québec. https://publications.msss.gouv.qc.ca/msss/fichiers/2023/23-846-05W.pdf
- Taylor, C., Peter, T., McMinn, T.L., Elliott, T., Beldom, S., Ferry, A., Gross, Z., Paquin, S., & Schachter, K. (2011). Every class in every school: Final report on the first national climate survey on homophobia, biphobia and transphobia in Canadian schools. Final report. Egale Canada Human Rights Trust. http://egale.ca/wp-content/uploads/2011/05/EgaleFinalReport-web.pdf
- Thomas, M., McCoy, T., Jeffries, I., Haverkate, R., Naswood, E., Leston, J., & Platero, L. (2022). Native American Two Spirit and LGBTQ health: A systematic review of the literature. Journal of Gay and Lesbian Mental Health, 26(4), 367-402. https://doi.org/10.1080/19359705.2021.1913462
- Venkatasubramaniam, A., Wolfson, J., Mitchell, N., Barnes, T., Jaka, M., & French, S. (2017). Decision trees in epidemiological research. Emerging Themes in Epidemiology, 14(11). https://doi.org/10.1186/s12982-017-0064-4
- Worthen, M. G. F. (2020). Queers, bis, and straight lies: An intersectional examination of LGBTQ stigma. Routledge/Taylor & Francis Group. https://doi.org/10.4324/9781315280332
- Worthen, M. G. F. (2022). Heteronormativity and the victimization of bisexual and pansexual women: An empirical test of norm-centered stigma theory. Critical Criminology, 30, 1035–1055. https://doi.org/10.1007/s10612-022-09632-1
- Zahran, A., Dermody, S. S., Berlin, G. W., Palma, P. A., Skakoon-Sparling, S., Noor, S. W., Lachowsky, N. J., Grace, D., Cox, J., Moore, D. M., Lambert, G., Zhang, T. H., Dvorakova, M., Jollimore, J., Lal, A., & Hart, T. A. (2024). Problematic alcohol use among gay, bisexual, and other men who have sex with men in Canada: The role of proximal stressors and anxiety. Substance Abuse Treatment, Prevention, and Policy, 19(16). https://doi.org/10.1186/s13011-024-00597-8

