Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

IIR 17-089 – HSR Study

IIR 17-089
Understanding Mental Health Problems and Health Risk Behaviors among LGBT Veterans
Tracy L Simpson, PhD
VA Puget Sound Health Care System Seattle Division, Seattle, WA
Seattle, WA
Funding Period: April 2019 - June 2024


Background: 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, posttraumatic stress disorder (PTSD), suicide ideation and attempt, alcohol misuse, and smoking. LGBT people are also overrepresented in the Veteran population compared to the general population, especially among women and transgender individuals. Recognizing this vulnerable population as a unique and sizable minority, the VA has made significant efforts to improve care for LGBT Veterans through consultation and staff trainings. Although research on LGBT Veterans has also increased, it has lagged behind, with only a small number of studies on LGBT Veterans to date. The available data 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. Objectives: The objectives of this study are to: 1) 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; 2) 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 3) assess LGBT Veterans’ experiences with and preferences for treatment, including VA utilization, barriers to care, and preferences for tailored interventions. Methods: This is a prospective cohort study with 1,600 Veterans that will address the three study objectives with 200 individuals in each of the following groups: 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). This study targets HSR&D Priorities of Equity and Health Disparities as well as Improving Mental and Behavioral Health Interventions. Findings should greatly improve our knowledge about the extent of existing health disparities, the risk and protective factors associated with them, and treatment preferences of LGBT Veterans. They will also provide critical information for future prevention and intervention efforts for this stigmatized and highly vulnerable group.

External Links for this Project

NIH Reporter

Grant Number: I01HX002423-01A1

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project


Journal Articles

  1. Simpson TL, Rise P, Browne KC, Lehavot K, Kaysen D. Clinical presentations, social functioning, and treatment receipt among individuals with comorbid life-time PTSD and alcohol use disorders versus drug use disorders: findings from NESARC-III. Addiction (Abingdon, England). 2019 Jun 1; 114(6):983-993. [view]
  2. Carter SP, Allred KM, Tucker RP, Simpson TL, Shipherd JC, Lehavot K. Discrimination and Suicidal Ideation Among Transgender Veterans: The Role of Social Support and Connection. LGBT health. 2019 Feb 4; 6(2):43-50. [view]
  3. Goldberg SB, Simpson TL, Lehavot K, Katon JG, Chen JA, Glass JE, Schnurr PP, Sayer NA, Fortney JC. Mental Health Treatment Delay: A Comparison Among Civilians and Veterans of Different Service Eras. Psychiatric services (Washington, D.C.). 2019 May 1; 70(5):358-366. [view]
  4. Lehavot K, Beckman KL, Chen JA, Simpson TL, Williams EC. Race/Ethnicity and Sexual Orientation Disparities in Mental Health, Sexism, and Social Support among Women Veterans. Psychology of sexual orientation and gender diversity. 2019 Jan 1; 6(3):347-358. [view]

DRA: Mental, Cognitive and Behavioral Disorders
DRE: Epidemiology, Prevention
Keywords: Disparities, Utilization
MeSH Terms: None at this time.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.