August 2019

In This Issue: Improving Care and Access for LGBTQ Veterans
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Understanding Suicide Risks among LGBT Veterans in VA Care

Feature Article

The causes of suicidal behaviors may consist of a combination of factors, which vary over time, and between individuals and groups. Despite literature on suicidality among lesbian, gay, bisexual, and transgender (LGBT) persons, little research has examined suicide among LGBT Veterans. With the 2011 repeal of the ‘Don't Ask, Don't Tell’ (DADT) policy, LGB personnel are currently able to openly serve in the US military, while the status of T (transgender) personnel remains uncertain. While LGBT Veterans, especially those who served prior to the repeal of DADT, may suffer similar discrimination, stigma, and stress, they may each have dissimilar suicide risks. For example, one study in the VA healthcare system found that the prevalence of gender identity disorder diagnosis was >5 times higher than in the general US population—and that the rate of suicide-related events was >20 times higher than the VA population (Blosnich et al., 2013). However, the engagement of LGBT Veterans in VA care is difficult to estimate because sexual orientation and gender identity data are not collected in a structured manner. In addition, HSR&D’s ESP Evidence Review: Social Determinants of Health for Veterans found “only two articles that examined sexual orientation for Veterans and non-Veterans and included only women. No articles addressed gender identity for Veterans and non-Veterans.” In addition to LGBT status, there is less research on other suicide risk factors such as pain and opioid prescriptions, as well as potential protective factors such as receipt of complementary and integrative health services, which may treat both pain and PTSD. Also, little is known about how race/ethnicity, gender, morbidity, and treatment intersect with sexual orientation/gender identity to impact suicidality risk.

Therefore, the main objectives of this ongoing prospective HSR&D study (2019–2023) are to:

• Develop informatics tools to identify LGBT Veterans and suicide attempts and events;
• Characterize suicide risk factors in a national sample of Veterans; and
• Examine the differential effect of risk factors on suicide by LGBT status.

Using VA electronic health record data, study investigators will assess both risk and protective factors related to LGBT individuals in all gender, age, and racial and ethnic groups.

Investigators hypothesize that LGBT status is a pre-disposing factor that increases risk of suicide due to minority stress, the stress of prior and potentially ongoing discrimination, including military sexual trauma. This risk may be further increased due to factors such as comorbid mental health and medical conditions, a lack of engagement in care, system and providers’ lack of awareness or insensitivity to the unique needs of LGBT Veterans, and pain, among other factors.

Findings:

There are no findings to report at this time.

Impact:

Future research might include an examination of VA healthcare use after policy changes and VA directives such as the repeal of DADT (2010) and the Defense of Marriage Act (DOMA), in addition to VHA Directives 1340(1) (Health Care for Veterans who Identify as Lesbian, Gay or Bisexual) and 1341(1) (Providing Health Care for Transgender and Intersex Veterans).

Principal Investigator: Joseph Goulet, PhD, MS, is a Core Investigator with the VA Connecticut Healthcare System in West Haven.

View project abstract.