Transgender Older Adults: The Association Between Military Service and Mental Health

Background and Purpose: Transgender older adults are a highly underserved population at significant risk for poor mental health outcomes due to stigma rooted in gendered cultural norms. Transgender women (assigned male at birth, identify as female) and men (assigned female at birth, identify as male) have significantly higher rates of military service, which has been shown to have long-term positive and negative effects on mental health, than do women and men in the general population. Given that gender identity and expression are central features of the “hypermasculinity” of military culture, this study sought to answer (1) whether prior military service and identity stigma are associated with depressive symptomatology and perceived stress among transgender older adults, and (2) whether these associations differ between older transgender women and men? We hypothesized that prior military service and identity stigma would be positively associated with depressive symptomatology and perceived stress among older transgender adults, and that these relationships would differ between transgender women and men.

Methods: Data came from Wave 1 of Aging with Pride: National Health, Aging, Sexuality and Gender study, a national longitudinal survey of 2,450 LGBT adults aged 50 and older. Participants were recruited through community agencies and their own social networks. In this study, we focused on the subsample of transgender participants (n = 186; 47% transgender women, 27% transgender men, 26% other). Participants indicated whether they had prior military service (yes/no). Identity stigma was assessed as the mean of 4 items on a 6-point Likert scale regarding negative feelings about one’s sexual or gender identity. Depressive symptomatology was assessed via the 10-item Center for Epidemiological Studies Depression Scale (CES-D 10). Perceived stress was assessed with the 4-item Perceived Stress Scale (PSS4). Controlling for sociodemographic variables, multiple regression models were computed to examine whether prior military service and identity stigma significantly predicted depressive symptomatology and perceived stress. Separate models were computed for transgender women and men.

Results: Among transgender men, prior military service was significantly related to lower depressive symptomatology and lower perceived stress; identity stigma did not predict depressive symptomatology or perceived stress. Among transgender women, prior military service was not significantly related to depressive symptomatology or perceived stress; identity stigma did predict both depressive symptomatology and perceived stress.

Conclusions and Implications: Prior military service appears to be a protective factor in the mental health of older transgender men but not transgender women. Identity stigma appears to be a risk factor for poor mental health outcomes among transgender women but not transgender men. With the likely imminent repeal of the ban on transgender people serving openly in the military, it is critical that social workers understand the differential role of gender identity in the mental health of military service members. It is also crucial that military policy implementation be informed by the best available research to support the mental health of today’s transgender service members and tomorrow’s transgender veterans. Further research on the effects of military service on the mental health of transgender women and men is critical.