Occupational Risk and Health Outcomes Among Transgender Veterans

Background:

Research shows that the prevalence of transgender identity among veterans is higher than that of the general population. Given that the general veteran population experiences a higher prevalence of chronic pain, PTSD, and other chronic health problems than the general population, it is likely that transgender veterans also experience elevated occupational health risks.  However, transgender people typically experience minority stressors while in the military, suggesting that disproportional risk may exist for veterans who also identify as transgender. To date, no studies have investigated occupational stress and subsequent health outcomes among transgender veterans.

Methods:

This study examined the military experiences of US veterans who identify as transgender (n=151), male-to-female transgender (76.8%), female-to-male transgender (6.0%), other gender (6.6%), or were not sure of their gender (1.3%). Veterans responded to an anonymous survey that assessed for PTSD—using the PTSD Clinical Checklist—and health outcomes, including depression and chronic pain using the Health Questionnaire Short Form-12 (SF12).  Experiences of heterosexism while in the military were assessed using the Workplace Heterosexism Questionnaire as well as experiences of LGBT-related violence (e.g., physical or sexual assault they felt was related to their sexual orientation or gender identity). The survey also assessed military sexual trauma (MST) and combat exposure. 

The study sought to describe participants’ occupational stress and how it related to certain health outcomes (i.e., PTSD, depression, and chronic pain). Relationships between stressors and health outcomes were examined through bivariate correlations. Linear and binary logistic regressions were conducted to determine which measures were most predictive of negative health outcomes.

Results: 

Transgender veterans reported high rates of occupational stress while in the military, including LGBT-related violence (24.3%), some form of heterosexism (85.5%), MST (45.3%), and combat exposure (34.4%). The rates of MST appeared to be higher than those found in previous studies on military populations. The prevalence of PTSD in this population was 33.1%. A total of 41.1% of respondents indicated symptoms of depression, while 19.2% reported chronic pain.  The rates of depression and PTSD are consistent with deployed populations.

PTSD symptoms were moderately correlated with MST, experiences of heterosexism, and LGBT-related violence while in the military, but not combat exposure. Depression was moderately correlated with MST and experiences of heterosexism but not with combat exposure or LGBT-related violence. Chronic pain and occupational stress were not correlated.

Regression results demonstrated that experiences of LGBT-related violence and heterosexism in the military, but not MST or combat, were predictive of PTSD symptoms. None of the occupational stressors in the model contributed to depression. Combat exposure predicted chronic pain, but not MST, LGBT-related violence, or heterosexism.

Conclusion and Implications:

Findings from this study provide unique insight into the health and occupational risks facing transgender populations in the military. These results further suggest that care must be taken to examine how individual veterans or specific subgroups experience occupational stress. Implications for clinical practice with transgender veterans will be discussed.