Engaging Transgender Veterans with Communication Technology

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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.