Understanding Mental Health Problems and Health Risk Behaviors among LGBT Veterans

背景：女同性恋、男同性恋、双性恋和变性人（LGBT）已被确定为处于危险之中 医学研究所的健康差异。与异性恋和非变性人相比， 与同龄人相比，他们患抑郁症和创伤后应激障碍的几率更高， （PTSD），自杀意念和企图，酒精滥用和吸烟。LGBT人群在美国的比例也过高， 退伍军人人口与一般人口相比，特别是妇女和变性人 个体认识到这一弱势群体是一个独特的和相当大的少数民族，弗吉尼亚州已作出 通过咨询和工作人员培训，做出重大努力，改善对LGBT退伍军人的照顾。虽然 对LGBT退伍军人的研究也有所增加，但它已经落后，只有少数研究 LGBT退伍军人至今现有数据表明，LGBT退伍军人经历了很高的精神负担， 健康问题和健康风险行为，尽管研究往往未能通过以下方式来检查差异： 性别（男女结合）或性身份（男女同性恋和双性恋结合），以及 一些子群体（例如，男同性恋和双性恋男子）极为有限。此外，很少有研究 研究了可能解释这些差异的风险和保护因素，或LGBT退伍军人的经历 以及对治疗的偏好。 目的：本研究的目的是：1）确定性取向和性别认同的程度 心理健康问题（抑郁、创伤后应激障碍、焦虑、自杀意念/企图）和健康风险的差异 行为（酒精滥用，吸烟）在退伍军人随着时间的推移和跨地理区域; 2）检查 与这些结果相关的风险和保护因素，由一个概念模型指导， 少数民族压力理论和自我药疗假设;和3）评估LGBT退伍军人的经验， 治疗偏好，包括VA利用，护理障碍，以及对定制干预措施的偏好。 方法：这是一项有1,600名退伍军人参加的前瞻性队列研究，将解决三个研究目标 每个小组200人：异性恋女性，女同性恋女性，双性恋女性， 异性恋男性、同性恋男性、双性恋男性、变性女性和变性男性。所有退伍军人将 通过在线社交网站和在线团体的广告招募。目标广告 将用于从性取向和性别认同亚组中招募退伍军人。研究评估将 也可以在网上进行，以增加研究的覆盖面和保留率，每九个月收集一次， 27个月（4次评估）。 这项研究的目标是HSR&D的平等和健康差距优先事项，以及改善心理和 行为健康干预。这些发现应该大大提高我们对现有的 健康差异，与之相关的风险和保护因素，以及LGBT的治疗偏好 老兵它们还将为今后的预防和干预工作提供重要信息。 被污名化和高度脆弱的群体。

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.