Abstract Background Access to transition-related medical interventions (TRMIs) for transgender veterans has been the subject of substantial public interest and debate. To better inform these important conversations, the current study investigated whether undergoing hormone or surgical transition intervention(s) relates to the frequency of recent suicidal ideation (SI) and symptoms of depression in transgender veterans. Methods This study included a cross-sectional, national sample of 206 self-identified transgender veterans. They self-reported basic demographics, TRMI history, recent SI, and symptoms of depression through an online survey. Results Significantly lower levels of SI experienced in the past year and 2-weeks were seen in veterans with a history of both hormone intervention and surgery on both the chest and genitals in comparison with those who endorsed a history of no medical intervention, history of hormone therapy but no surgical intervention, and those with a history of hormone therapy and surgery on either (but not both) the chest or genitals when controlling for sample demographics (e.g., gender identity and annual income). Indirect effect analyses indicated that lower depressive symptoms experienced in the last 2-weeks mediated the relationship between the history of surgery on both chest and genitals and SI in the last 2-weeks. Conclusions Results indicate the potential protective effect that TRMI may have on symptoms of depression and SI in transgender veterans, particularly when both genitals and chest are affirmed with one's gender identity. Implications for policymakers, providers, and researchers are discussed.
In the United States, the Affordable Care Act and marriage equality may have eased sexual orientation-based differences in access to healthcare coverage, but limited research has investigated sexual orientation-based differences in healthcare satisfaction. The purpose of this study was to examine whether satisfaction with healthcare varied by sexual orientation in a large population-based sample of adults.Data are from the 2014 Behavioral Risk Factor Surveillance System, including items about sexual orientation and healthcare (n = 113,317). Healthcare coverage included employer-based insurance; individually purchased insurance; Medicare; Medicaid; or TRICARE, VA, or military care. Respondents indicated whether they were "very satisfied, somewhat satisfied, or not at all satisfied" with healthcare.After adjusting for several sociodemographic covariates, lesbian, gay, and bisexual status was associated with lower satisfaction with healthcare with individually purchased insurance (adjusted odds ratio = 1.49, 95% confidence interval = 1.24-1.80).Efforts are needed to examine and reduce sexual orientation differences in satisfaction with healthcare.
Women veterans represent a vulnerable population with unique health needs and disparities in access to care. One constellation of exposures related to subsequent poor health includes adverse childhood experiences (ACEs; e.g., physical and sexual child abuse), though research on impacts of ACEs among women veterans is limited.Data were drawn from the 2010 Behavioral Risk Factor Surveillance System for the 11 states that included the ACE module (n=36,485). Weighted chi-squared tests and multivariable logistic regression were used to assess the prevalence of ACEs among women veterans compared with women non-veterans and differences in the following outcomes, controlling for ACEs: social support, inadequate sleep, life satisfaction, mental distress, smoking, heavy alcohol use, obesity, diabetes, cardiovascular disease symptoms, asthma, and disability.Women veterans (1.6% of the total sample) reported a higher prevalence of 7 out of 11 childhood adversities and higher mean ACE score than women non-veterans. Women veterans were more likely to be current smokers and report a disability, associations which were attenuated when controlling for ACE.Despite women veterans' higher prevalence of ACE, their health outcomes did not differ substantially from non-veterans. Further research is needed to understand the intersections of traumatic experiences and sources of resilience over the lifecourse among women veterans.
The present study sought to investigate whether gender moderates the relationship between military sexual trauma (MST) and posttraumatic stress disorder (PTSD) treatment utilization, among veterans with clinically significant PTSD symptoms. Participants were 2,664 veterans with probable PTSD from a nationwide, population-based survey. Participants reported sociodemographic information, history of MST (including military sexual harassment and military sexual assault), and lifetime receipt of PTSD psychotherapy and medication treatment. We found that gender significantly moderated relationships between (a) military sexual harassment and PTSD psychotherapy, (b) military sexual assault and PTSD psychotherapy, and (c) military sexual harassment and PTSD medication. For women, MST was associated with a greater likelihood of receiving treatment, but for men, MST was not associated with PTSD treatment. Future research is needed to better understand gender differences in how experiences of MST may affect engagement in PTSD treatment. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
We have reached a 30-year high in the rate of suicide in the United States, with a notable increase in the suicide rate among women.1 Suicide prevention among women has become especially important within the US Departments of Defense (DoD) and Veterans Affairs (VA), as higher rates of suicide among women veterans has been observed compared with women nonveterans.2 Further, in this issue, Hoffmire and colleagues report that women veterans are 35% more likely to report a nonfatal suicide attempt during their lifetime than nonveteran women.3 Such trends have spawned a growing focus on the need to understand suicide risk and prevention among women—toward tailoring prevention approaches to match women's experiences and finding new ways to reduce their risk. However, little research currently exists in this area. The VA Health Services Research and Development Service (HSR&D), with the VA Women's Health Research Network (WHRN), sponsored this special supplement with the hope of accelerating the knowledge base on women and suicide as well as increasing national awareness of suicide among women, which may further increase the resources available to tackle this growing concern. The articles in this supplement highlight the value of a wide range of data sources, from the macro-level surveillance data available through the DoD, VA, and the US National Violent Death Reporting System to the depth of qualitative data of individual experiences with suicide attempts. They also illustrate the complexities of studying gender and suicide, while generating new understanding of important areas for suicide prevention among women. CHALLENGES AND BREAKING BARRIERS IN GENDER AND SUICIDE PREVENTION Research on suicide among women and studies of gender differences in suicide prevention has historically been limited because of a number of challenges. Despite suicide being the 10th leading cause of death in the United States,1 it is actually a low-base-rate phenomenon. This low rate makes it difficult to sufficiently power suicide prevention intervention studies, let alone examine gender effects. In this issue, Hoffmire and colleagues further discuss the challenges associated with studying gender in suicide prevention and outline several key future directions for the field.4 From a health care practice standpoint, Chen and colleagues' findings that gender may be associated with self-directed violence classifications by providers raise awareness of the potential for gender disparities in systems designed to identify and treat Veterans at risk for suicide.5 Among women veterans at risk, health care barriers have remained a significant issue, and Monteith and colleagues present data describing circumstances associated with women veterans' willingness to seek VA and non-VA health care for mental health concerns and suicidal thoughts.6 Their findings suggest that military sexual trauma is associated with a lower willingness to seek care for suicidal ideation. Blosnich and colleagues studied suicides among transgender patients in the VA health care system and found that transgender patients were more likely to use poisoning or firearms to die by suicide than their non–transgender peers.7 This work is one of a few studies seeking to understand suicide risk and suicidal behaviors among transgender patients. IDENTIFYING RISK AND FACILITATING RECOVERY AMONG WOMEN A number of papers in this issue examine whether certain factors confer greater risk for suicide among women than among men, and which factors may cluster together to increase risk among women. Montgomery et al8 studied unstably housed veterans and found that younger age increased risk of suicide among women, but other characteristics studied did not reveal gender differences in risk. Naifeh et al9 examined DoD administrative records of documented suicide attempts among military service members to identify sex differences in risk. Small differences emerged for several predictors, most notably time in service, deployment status, and mental health diagnosis. Zelkowitz et al10 used latent class analysis on survey data from a sample of veterans aged 18–50 to identify symptom clusters that included self-directed violence. Analyses revealed some gender differences, especially regarding substance use. Edgcomb et al11 developed a machine learning algorithm to identify risk for a suicide attempt following medical hospitalization among women. The algorithm, developed in a sample of women with depression, bipolar disorder, or chronic psychosis in California was replicated in a similar sample of women in New York. Finally, Denneson et al's12 findings point to women's needs in recovering from a nonfatal suicide attempt—increasing a sense of self-worth and developing stronger relationships with others. CONSIDERING SUICIDE RISK ACROSS THE LIFESPAN Several papers in this issue delve into the examination of risk, and changes in risk, relative to age or life events. Gibson et al's13 use of longitudinal data from VA health care records of women veterans over 50 years old revealed that menopausal hormone therapy prescription at baseline was associated with a 2-fold increase in risk of suicide at follow-up. This association remained after controlling for mental health conditions and medications. Holliday et al14 examined whether timing of physical and sexual violence affected subsequent suicidal ideation and attempts among female veterans, relative to their time in military service. Sexual violence at any time point was more strongly associated with postmilitary suicide attempts than physical violence. Crosby et al's15 work addressed changes in circumstances associated with suicide death among females in the National Violent Death Reporting System, by age and time period. Changes in leading circumstances by age followed developmental periods, though many circumstances remained consistent throughout the lifespan (ie, mental health problems, depressed mood, recent or impending crisis, and history of suicide attempts). IMPLICATIONS AND CONCLUSIONS We have begun to see a promising impact of focused attention in suicide prevention among women. O'Brien and Tomoyasu discuss the ways prior research has expanded the field and the many ways VA HSR&D has supported the growth of research, dissemination, and collaboration in suicide prevention among women.16 Uptake of new research into practice and policy has also been favorable. Strauss and colleagues describe the important ways VA is translating knowledge into clinical training and practice—for VA and non-VA providers—and disseminating findings within clinic settings so that providers remain at the forefront of emerging science.17 Congressmembers Brownley and Dunn,18 who serve on the House Committee on Veterans' Affairs, have championed suicide prevention among women. Their article describes the Committee's efforts to advance prevention for women veterans, developing the bipartisan Women Veterans Task Force in 2019. Both the Committee and Task Force rely on research findings to support programs, develop partnerships, and advance legislation affecting the health and well-being of women veterans. Furthering our response to the rising suicide rate among women in the United States will require additional understanding of the complex nature of suicide risk and prevention. This special issue addresses a wide range of topics important to women and suicide, contributing to the growing knowledge in this area. Younger age, mental health concerns, experiencing violence, and medical comorbidities may all contribute to suicide risk among women. We look forward to seeing how investigators build upon the work published here; how healthcare operations, community partners, and policy leadership use these new findings to bolster prevention efforts; and how this work will elevate awareness of suicide among women with clinical providers and others.
Primary care services are cornerstones for US health care, assuring preventive screening, maintenance of therapeutics, and access to specialty care. Sexual minority (SM) adults are less likely to have access to primary care services than their heterosexual counterparts. Additionally, access to health services among SM persons can vary by age. One plausible explanation for these disparities are experiences of minority stress. Thus, the purpose of this study was to explore the association between experiences of minority stress and access to primary care services among SM people in the United States across multiple age cohorts. A series of logistic regressions examined associations among multiple experiences of minority stress and access to primary care services. Analyses, stratified by age cohort, examined associations between experiences of minority stress and access to primary care services. Felt stigma, on average, was negatively associated with having a primary care provider among the full sample. The stratified analysis revealed that higher rates of felt stigma were negatively associated with having a primary care provider only among younger SM adults. This study offers novel information suggesting that unique experiences of minority stress are linked with barriers in access to primary care services among SM people.
