Healthcare Avoidance and Mental Health Problems Among Transgender Veterans: The Role of Minority Stressors

Background and purpose:

The healthcare experiences of transgender veterans are poorly understood. Some evidence suggests that transgender veterans are overrepresented in healthcare settings, and experience higher rates of mental health problems than the general veteran population (Blosnich et al., 2013; Shipherd et al., 2011). However, very little is known about the factors contributing to their healthcare seeking behaviors, and how these behaviors inform their mental health. Building on a few studies examining minority stressors in transgender populations (e.g., Bockting et al., 2013), the current study explores how identity-related minority stressors inform transgender veterans’ mental health and healthcare experiences.

Methods:

The relationships among internalized transphobia, healthcare avoidance, and mental health outcomes in a sample of transgender veterans (N=150) were examined in this study. The study’s following hypotheses were tested through a series of OLS hierarchical regressions: 1) internalized transphobia predicts healthcare avoidance due to one’s gender identity, above and beyond respondents’ demographic characteristics (age, employment, education, relationship status, and income); and 2) avoidance and transphobia predict more negative mental health outcomes above and beyond demographic characteristics. The study also sought to explore whether transphobia would predict more negative mental health outcomes above and beyond avoidance. To test the study’s first hypothesis, the dependent variable, avoidance, was regressed on transphobia, after controlling for the effects of demographic variables entered in the first step. To test the study’s second hypothesis, three dependent variables were examined that measure mental health outcomes: concerns about suicide, depression, and PTSD. For each dependent variable, after controlling for demographic variables in the first step, avoidance was entered in the second step to examine its unique contribution to mental health outcomes. Finally, transphobia was entered into the third step of the equations to examine whether it predicted poorer mental health above and beyond the effects of avoidance.

Findings:

Results indicated that internalized transphobia significantly predicted healthcare avoidance due to one’s gender identity [F(7, 98) = 7.49, p < .001, Adj. R² = .302], and both healthcare avoidance and internalized transphobia predicted greater concerns about suicide [F(9, 95) = 2.44, p < .01, Adj. R² = .11], higher depression [F(9, 95) = 2.29, p < .05, Adj. R² = .10], and more PTSD symptomatology [F(9, 95) = 4.78, p < .001, Adj. R²= .25]. Furthermore, in each of the models testing mental health outcomes, transphobia significantly predicted more negative mental health outcomes above and beyond the effects of healthcare avoidance. Of note, the strength of the contribution of healthcare avoidance on mental health outcomes was diminished in all models when accounting for the effects of internalized transphobia.

Conclusion:

This study has important implications for improving healthcare access for transgender veterans in order to meet their important health and mental health needs. It is crucial that service providers are aware of their own competencies that may affect transgender veterans’ decisions and feelings about healthcare. Healthcare providers should also be prepared to explore and address their transgender veteran clients’ identity status in order to sufficiently address their mental health needs.