Publication year
2013
Citation Title
Veterans Administration health care utilization among sexual minority veterans.
Journal Name
Psychological Services
Journal Volume
10
Issue Number
2
Page Numbers
223-232
DOI
10.1037/a0031281
Summary
Gay, lesbian and bisexual (GLB) Veterans were assessed via an online survey to examine the relationships among Veterans Health Administration (VHA) utilization, clinical needs, demographic variables, and trauma. GLB Veterans in this sample use the VHA at similar rates as other Veterans. Utilization of VHA services was related to positive service connection, positive screens for mental health issues, and a history of a GLB-related interpersonal trauma while in the military.
Key Findings
Forty-six percent of the GLB Veterans reported VHA utilization, including 29% in the past year; these rates are similar to overall Veterans’ utilization rates of VHA.
VHA utilization was associated with positive service connection (disability), positive posttraumatic stress disorder (PTSD) and depression screens, and history of at least one GLB-related interpersonal trauma while in the military.
GLB Veterans who had at least one stressful military experience involving command investigation or punishment of their GLB status (e.g., being interrogated about their sexual orientation, forced to leave the military) were significantly less likely to have utilized the VHA in the past year.
GLB Veterans’ concerns about how they might be treated at the VHA did not add significantly to the models.
Implications for Program Leaders
Educate staff about the unique experiences of GLB military personnel to enhance the cultural competency of personnel who work with and on behalf of families
Include an assessment of possible discriminatory experiences (both military and non-military) that GLB Service members may have experienced
Disseminate information regarding community-based programs that work with LGB Service members
Implications for Policy Makers
Recommend training for program staff regarding the assessment of sexual orientation and any GLB-related health issues could help improve access and culturally-competent care for these Service members
Continue to support open communication about sexual orientation and the elimination of discriminatory treatment could help GLB Veterans receive respectful, sensitive services
Continue to support programs and service that offer resources to LGB Service members and their families
Methods
From May 2004-January 2005, participants were recruited via national online sources and print periodicals that serve the GLB community.
Veterans answered demographics questions, questions about VHA utilization, GLB-adapted health beliefs, enabling resource factors, need factors and GLB military experiences.
Surveys were completed online.
Participants
Three hundred fifty six gay, lesbian, and bisexual (GLB) Veterans participated.
The majority of participants were male (70%), with a mean age of 45.4 years (SD = 13.3 years).
Eighty-eight percent White; 94% identified as lesbian or gay.
Limitations
These data are cross-sectional and causality cannot be assumed.
There was no comparison of heterosexual Veterans; one cannot draw conclusions about the similarities and differences between these groups.
The sample was largely White, gay, and male, and may not be representative.
Avenues for Future Research
Explore the similarities and differences with heterosexual Service members
Conduct longitudinal research to allow for more causal explanations to be drawn from the data
Continue to explore the needs of gay, lesbian, and bisexual Service members
Focus
Multiple Branches
Target Population
Population Focus
Military Branch
Military Component
Abstract
According to recent census reports, nearly a million veterans have a same-sex partner, yet little is known about them or their use of Veterans Health Care Administration (VHA) services. Gay, lesbian, and bisexual (GLB) veterans recruited from the community (N = 356) completed an on-line survey to assess their rates of VHA utilization and whether they experience specific barriers to accessing VHA services. Andersen’s model of health care utilization was adapted to provide an analytic and conceptual framework. Overall, 45.5% reported lifetime VHA utilization and 28.7% reported past-year VHA utilization. Lifetime VHA health care utilization was predicted by positive service connection, positive screen for both posttraumatic stress disorder (PTSD) and depression, and history of at least one interpersonal trauma during military service related to respondent’s GLB status. Past-year VHA health care utilization was predicted by female gender, positive service connection, positive screen for both PTSD and depression, lower physical functioning, a history of military interpersonal trauma related to GLB status, and no history of stressful experiences initiated by the military to investigate or punish GLB status. Rates of VHA utilization by GLB veterans in this sample are comparable to those reported by VHA Central Office for all veterans. Of those who utilized VHA services, 33% reported open communication about their sexual orientation with VHA providers. Twenty-five percent of all participants reported avoiding at least one VHA service because of concerns about stigma. Stigma and lack of communication between GLB veterans and their providers about sexual orientation are areas of concern for VHA.
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