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Blosnich JR, Center for Health Equity Research and Promotion; Marsiglio MC, Portland VA Medical Center; Gao S, Center for Health Equity Research and Promotion; Gordon AJ, Center for Health Equity Research and Promotion; Shipherd JC, VA Office of Patient Care Services; Kauth M, VA Office of Patient Care Services; Brown GR, Mountain Home VA Medical Center; Fine MJ, Center for Health Equity Research and Promotion;
Objectives:
Recent evidence suggests that sociopolitical factors (e.g., laws allowing same-sex marriage) are associated with better mental health among LGB individuals. No studies have explored whether laws affording protections to transgender individuals may be associated with better mental health. This study examined how sociopolitical factors were associated with mental health conditions among transgender Veterans.
Methods:
We extracted VA administrative data for 1,640 patients who (1) had ever been diagnosed with Gender Identity Disorder, which defined transgender status in this study, (2) had at least one visit in FY2013, and (3) lived in a zip code with a Municipality Equality Index (MEI) score. Along with MEI score (ranging from 0-100), two other key independent variables were whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws. Dependent variables included ICD-9 diagnoses for mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder, and suicidal ideation or attempt. Statistically non-significant intra-class correlations supported use of single-level logistic regression models to examine the associations of LGBT sociopolitical indicators with each dependent variable, adjusting for age, sex, race/ethnicity, and marital status.
Results:
Most patients in this sample were white (81.2%), identified as male (69.3%), and never married (49.6%); the mean age was 54.8 years. The mean MEI score was 74.1, 47.3% lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Transgender patients who lived in states with employment nondiscrimination protection had 26% decreased odds of mood disorders (aOR = 0.74, 95%CI = 0.59-0.93) and 43% decreased odds of self-directed violence (aOR = 0.57, 95%CI = 0.34-0.95) compared with transgender patients in states without such protections. Hate crimes laws and MEI score did not have significant associations.
Implications:
The protective associations of employment nondiscrimination align with previous findings for other stigmatized groups. Providers and health care systems should be cognizant that social factors, such as laws affected LGBT populations, may play roles in the mental health of transgender Veterans.
Impacts:
Understanding social stressors could improve systems' and providers' knowledge about the complex etiology of health disparities among transgender Veterans and inform the treatment processes and coordination of care for this vulnerable Veteran population.
