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Health Services Research & Development

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2023 HSR&D/QUERI National Conference Abstract

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1089 — Uneven VA Mental Healthcare Experiences among Transgender Veterans with Depression

Lead/Presenter: Joy Lee,  COIN - Indianapolis
All Authors: Lee JL (Center for Health Information and Communication, Indianapolis, IN), Fuqua M (Center for Health Information and Communication, Indianapolis, IN) Weiner M (Center for Health Information and Communication, Indianapolis, IN)

Objectives:
To identify and describe the facilitators and barriers for transgender Veterans accessing depression treatment. Transgender Veterans experience higher rates of depression than cisgender Veterans, yet transgender Veterans often report delaying mental healthcare in the prior year, citing fear of discrimination among the reasons for the delay.

Methods:
We conducted in-depth, semi-structured interviews with transgender Veterans with depression to understand their mental healthcare experiences both within and outside of the VA. Each interview was audio recorded, transcribed, and coded for themes using an immersion/crystallization approach.

Results:
Twenty-seven Veterans participated in the study, representing a range of experiences. The participants were very knowledgeable about the parameters of VA care for transgender Veterans, often quoting exact VA directives. Health system facilitators cited included the LGBTQ+ program, mental health provider availability (relative to non-VA providers), and ease of accessing care. Barriers included lack of provider knowledge about transgender experiences and lack of provider availability. Interpersonal facilitators included mental health providers who went “above and beyond” to deliver care, while barriers included Veteran experiences with misgendering and misnaming by VA staff. Overall, Veteran experiences in mental healthcare at the VA were not uniform: provider availability and knowledge were cited by participants as both facilitators and barriers to care. Given that study enrollment took place during the COVID-19 pandemic, many participants had experience with receiving care through video visits. Video visits were noted not only for their convenience, but the safe space it created. One patient said, “Being able to do [video visits] in the space where I’m most comfortable, I’ve been able to express myself a lot easier. It makes for a more productive session. When you go somewhere that’s not your personal space, I never felt comfortable just sharing things.”

Implications:
Mental healthcare experiences for transgender Veterans with depression are not uniform. Greater availability of mental healthcare providers and more provider education on caring for transgender Veterans are needed to improve care experiences.

Impacts:
Despite a nationwide VA directive aimed at reducing health disparities for transgender Veterans, uneven experiences and barriers to mental healthcare remain. A health system focus on Veteran safety, provider availability, and provider knowledge could help to improve mental health experiences for transgender Veterans with depression.