Intersectionality and PTSD: Race, Sexual Orientation, Gender Identity, and Veteran Health

Research suggests that veterans who identify as members of marginalized populations (e.g., women and racial/ethnic minority groups) carry far greater risk for developing PTSD. Recent research on veterans who identify as sexual minorities points to similar findings. Minority stress theory posits that experiences of social stigma in the form of harassment, hate crimes, and felt stigma in the form of awareness of discrimination and prejudice have a cumulative effect. These distal forms of stigma combine with internalized stigma to form cumulative stress. This cumulative stress, known as minority stress, creates an expectation of homophobic events, which when combined with the events themselves and every day stress, creates damaging effects. Several studies have suggested this group may be at greater risk for development of PTSD such that Veterans who identify as lesbian, gay, or bisexual (LGB) are more likely than heterosexual veterans to report symptoms of PTSD; suggesting confirmation of minority stress theory. The current study examined PTSD symptoms, combat exposure, military sexual trauma (MST), and experiences of violence and harassment related to lesbian, gay, bisexual, and/or transgender (LGBT) identity in a sample of veterans who identified as sexual minorities (i.e., LGBT; N=243).

This study tested the contributions of minority stress to PTSD symptoms independent of occupational stress (i.e., combat exposure and MST) using a four generalized linear models predicting (1) PTSD symptoms, (2) re-experiencing, (3) avoidance, and (4) hypervigilance. In the first generalized linear model predicting PTSD symptoms; identification with a non-white racial or ethnic group was the strongest contributor in the model. In the second model, combat exposure is statistically significantly predictive of re-experiencing symptoms associated with PTSD as is identification with a non-white race. When predicting avoidance associated with PTSD, violence and harassment related to sexual minority identity was the most significant predictor. In the final model, predicting hypervigilance associated with PTSD, identification with a non-white racial or ethnic group is the most significant predictor. 

The findings of the current study support the need to address intersectionality of identities in working with sexual minority populations, especially as they relate to race and ethnicity. We found that identification with a non-white race/ethnicity was the strongest predictor of PTSD symptomatology. There has been some criticism of theories explaining disproportionality among marginalized communities that do not take into account the intersection of different identities. This study suggests that in work with veterans intersectionality may be a key factor.