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Health Services Research & Development

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HSR&D In Progress

August 2019

In This Issue: Improving Care and Access for LGBTQ Veterans
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Understanding Mental Health Problems and Health Risk Behaviors among LGBT Veterans

Feature Article

Lesbian, gay, bisexual, and transgender (LGBT) individuals have been identified as being at risk for health disparities by the Institute of Medicine. Compared to their heterosexual and non-transgender counterparts, they are especially likely to have higher rates of depression, PTSD, suicide ideation and attempt, alcohol misuse, and smoking. Although research on LGBT Veterans also has increased, it lags behind, with only a small number of studies on LGBT Veterans to date. However, data that are available suggest that LGBT Veterans experience a high burden of mental health problems and health risk behaviors, though studies have most often failed to examine differences by gender (combining women and men) or sexual identity (combining gay/lesbian and bisexual), and data on some sub-populations (e.g., gay and bisexual men) are extremely limited. Furthermore, few studies have examined the risk and protective factors that may explain these disparities, or LGBT Veterans’ experiences with and preferences for treatment.

The main objectives of this ongoing prospective cohort HSR&D study (2019-2023) are to:

  • Identify the extent of sexual orientation and gender identity disparities in mental health problems (depression, PTSD, anxiety, suicide ideation/attempt) and health risk behaviors (alcohol misuse, smoking) among Veterans over time and across geographic regions;
  • Examine risk and protective factors associated with these outcomes guided by a conceptual model that is informed by minority stress theory and the self-medication hypothesis; and
  • Assess LGBT Veterans’ experiences with and preferences for treatment, including VA utilization, barriers to care, and preferences for tailored interventions.

Investigators will recruit 1,600 Veterans from the following groups (200 individuals per group): heterosexual women, lesbian women, bisexual women, heterosexual men, gay men, bisexual men, transgender women, and transgender men. All Veterans will be recruited through online social networking sites and advertisements to online groups. Targeted advertisements will be used to recruit Veterans from sexual orientation and gender identity subgroups. Study assessments will also be conducted online to increase study reach and retention, with measures collected every nine months for 27 months (four assessments).


There are no findings to report at this time.


Findings should greatly improve knowledge about the extent of existing health disparities, the risk and protective factors associated with them, and treatment preferences of LGBTQ Veterans. They also will provide critical information for future prevention and intervention efforts for this stigmatized and highly vulnerable group.

Principal Investigator: Keren Lehavot, PhD, MS, is a Core Investigator with HSR&D’s Center of Innovation for Veteran-Centered and Value-Driven Care in Seattle, WA.

View project abstract.

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