Engaging Transgender Veterans with Communication Technology

项目总结 背景：变性人退伍军人的自杀率是顺性(非变性人)退伍军人的两倍。 抑郁是自杀的一个危险因素。变性人的精神卫生保健利用模式 患有抑郁症的退伍军人，以及这些退伍军人所经历的护理障碍，都是很好的理解。 意义/影响：2018年退伍军人管理局为变性退伍军人提供医疗保健的指令肯定了退伍军人管理局的 致力于解决变性退伍军人之间的健康差距。因为变性人的数量 退伍军人也增加了这一承诺的重要性。解决老年人的心理健康需求 考虑到这一人群中抑郁症和自杀的高流行率，跨性别退伍军人是及时的。这个 这一试点的结果将为实现指令目标的努力提供参考。 创新：这项先导性研究将是第一个描述精神卫生保健利用模式的研究 使用退伍军人中的变性抑郁症数据。它的创新之处在于它关注边缘人群 对他们来说，精神卫生保健的障碍和利用还没有被很好地理解。此外，它还 在审查通信技术解决护理障碍的潜力方面具有创新性。 具体目标拟议的工作有以下三个具体目标。 目的1：研究变性人退伍军人心理健康利用模式 抑郁症。我们将确定和比较变性退伍军人的精神卫生保健使用率与 抑郁症和匹配的患有抑郁症的顺性退伍军人队列。 目标2：确定并描述变性人退伍军人在获得 抑郁症的治疗，以及使用通信技术访问或协调的经验 相关护理。我们将对变性人患者进行深入的半结构化采访，以了解 他们的护理经历，以及通信技术在这些经历中发挥的作用(如果有的话)。 目标3：设计和计划一项干预措施，以克服跨性别者心理健康方面的障碍 患有抑郁症的退伍军人。我们将从关键的利益相关者小组获得迭代反馈，以便为设计提供信息 制定一项战略，以解决目标2中确定的障碍。 方法：本项目采用混合方法设计。在目标1中，精神卫生保健的利用模式 被诊断为抑郁症的变性人和顺性人将被比较。在目标2中，我们将引出 变性退伍军人抑郁症的观点和经历，以告知我们观察到的模式 目标1，并进行深入访谈，以了解变性人退伍军人的求医经历 对于抑郁症患者，识别和了解他们的促进者和护理障碍。在目标3中，量化 目标1的结果和目标2的定性结果将被整合并纳入到一个 对这一人群的需求敏感的干预战略。 实施/下一步：这一试点的预期结果将是制定干预措施 解决变性退伍军人抑郁症护理的重要障碍的战略。以下是成功的 完成目标3，我们预计将寻求资金来测试并扩大干预措施，并评估其 功效。

PROJECT SUMMARY Background: Transgender Veterans die by suicide at twice the rate of cisgender (non-transgender) Veterans. Depression is a risk factor for suicide. Neither the mental healthcare utilization patterns of transgender Veterans with depression, nor the barriers to care experienced by these Veterans, are well understood. Significance/Impact: A 2018 VA directive, Providing Health Care for Transgender Veterans, affirmed the VA’s commitment to addressing health disparities among transgender Veterans. As the number of transgender Veterans increases, so too, does the importance of this commitment. Addressing the mental health needs of transgender Veterans is timely, given the high prevalence of depression and suicidality in this population. The results of this pilot will inform efforts to meet the goals of the directive. Innovation: This pilot study will be the first study to describe the mental healthcare utilization patterns of transgender Veterans with depression using VA data. It is innovative in its focus on a marginalized population for whom the barriers to, and utilization of, mental healthcare, have not been well understood. Furthermore, it is innovative in its examination of potential of communication technology to address barriers to care. Specific Aims The proposed work has the following three specific aims. Aim 1: Characterize mental health utilization patterns of transgender Veterans diagnosed with depression. We will identify and compare the mental healthcare utilization rates of transgender Veterans with depression and a matched cohort of cisgender Veterans with depression. Aim 2: Identify and describe the facilitators and barriers for transgender Veterans in accessing depression treatment, and their experiences using communication technology to access or coordinate related care. We will conduct in-depth, semi-structured interviews with transgender patients to understand their care experiences, and the role that communication technology plays, if any, in those experiences. Aim 3: Design and plan an intervention to overcome barriers to mental healthcare for transgender Veterans with depression. We will elicit iterative feedback from key stakeholder groups to inform the design of a strategy to address barriers identified in Aim 2. Methodology: This project has a mixed-methods design. In Aim 1, the mental healthcare utilization patterns of transgender and cisgender patients diagnosed with depression will be compared. In Aim 2, we will elicit the perspectives and experiences of transgender Veterans with depression, to inform the patterns we observe in Aim 1, and conduct in-depth interviews to contextualize the care-seeking experiences of transgender Veterans with depression, to identify and understand their facilitators and barriers to care. In Aim 3, the quantitative results of Aim 1 and the qualitative results of Aim 2 will be integrated and incorporated into the design of an intervention strategy sensitive to the needs of this population. Implementation/next steps: The expected outcome of this pilot will be the formulation of an intervention strategy to address an important barrier to depression care for transgender Veterans. Following successful completion of Aim 3, we expect to pursue funding to test and then expand the intervention, and evaluate its efficacy.