Engaging Transgender Veterans with Communication Technology

项目摘要 背景：跨性别退伍军人自杀死亡率是顺性别（非跨性别）退伍军人的两倍。 抑郁症是自杀的危险因素。无论是跨性别者的心理健康利用模式， 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，都得到了很好的理解。 意义/影响：2018年VA指令，为变性退伍军人提供医疗保健，肯定了VA的 致力于解决跨性别退伍军人之间的健康差距。随着变性人的数量 退伍军人人数增加，这一承诺的重要性也增加。满足以下群体的心理健康需求 变性退伍军人是及时的，鉴于抑郁症和自杀在这一人群中的高患病率。的 这一试点的结果将为实现该指令目标的努力提供参考。 创新：这项试点研究将是第一项描述精神卫生保健利用模式的研究， 变性退伍军人抑郁症使用VA数据。它在关注边缘化人口方面具有创新性 对他们来说，心理保健的障碍和利用还没有得到很好的理解。而且 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：描述被诊断患有以下疾病的跨性别退伍军人的心理健康利用模式 萧条我们将确定并比较跨性别退伍军人的精神保健利用率， 抑郁症和匹配的顺性别退伍军人抑郁症队列。 目标2：识别和描述跨性别退伍军人在访问中的促进者和障碍 抑郁症治疗，以及他们使用通信技术的经验，以访问或协调 相关护理我们将对跨性别患者进行深入的半结构化访谈， 他们的护理经历，以及通信技术在这些经历中所扮演的角色。 目标3：设计和计划一项干预措施，以克服跨性别者获得精神保健的障碍 患有抑郁症的退伍军人。我们将从关键的利益相关者群体中获得反复的反馈，以告知设计 制定一项战略，以消除目标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， 将对诊断为抑郁症的变性人和顺性人患者进行比较。在目标2中，我们将引出 患有抑郁症的跨性别退伍军人的观点和经历，以告知我们观察到的模式， 目标1，进行深入采访，以了解跨性别退伍军人寻求护理的经历 与抑郁症，以确定和了解他们的促进者和障碍的照顾。在目标3中， 目标1的结果和目标2的定性结果将被整合并纳入一个 对这一群体的需求敏感的干预战略。 实施/下一步：这一试点的预期成果将是制定干预措施 战略，以解决一个重要的障碍，抑郁症护理变性退伍军人。成功后 目标3完成后，我们希望寻求资金来测试，然后扩大干预，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.