Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection

Abstract

Objectives: To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health.

Methods: We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt.

Results: Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95).

Conclusions: Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations.

FIGURE 1—

Prevalence of ICD-9 Diagnoses Among Transgender Veterans With ≥ 1 Veterans Health Administration Visit, by Living in States With and Without Employment Nondiscrimination Protection: United States, 2013 Note. ICD-9 = International Classification of Diseases, Ninth Revision; PTSD = posttraumatic stress disorder.