Health Disparities Among Lesbian, Gay, and Bisexual Service Members and Veterans

The Relationship Between a Hospital's Magnet Status and LGBTQ+ Inclusivity in Policies and Practices in US Hospitals

LGBTQ+ individuals face discrimination in healthcare settings. Magnet hospitals have been associated with positive patient outcomes, yet it remains uncertain whether Magnet designation is associated with hospitals' LGBTQ+ inclusivity in policies and practices. This study examined 801 American hospitals across 47 states that participated in the Healthcare Equality Index (HEI) in 2021. Multilevel modeling was utilized to investigate the association between Magnet status and HEI scores, adjusting for hospital type and state-level covariates, including LGBTQ+ inclusiveness in laws, political climate, racial/ethnic minority population, and Medicaid expansion status. Among the 801 hospitals, 32.1% (257 hospitals) held Magnet status. Magnet hospitals demonstrated higher HEI scores compared to non-Magnet hospitals (γ = 2.13, p = 0.022), despite significant variations across states (intraclass correlation = 0.22). No significant cross-level interactions were found. Overall, Magnet designation is independently associated with improved LGBTQ+ inclusivity in hospitals regardless of the state in which the hospital is located. Policymakers and healthcare leaders should consider leveraging the Magnet Recognition Program as a benchmark for promoting LGBTQ+ inclusivity within hospitals. Additionally, all healthcare institutions should prioritize comprehensive evaluations and improvements to their policies and practices to ensure inclusivity for LGBTQ+ patients.

Sleep health among sexual and gender minority people in the United States: A scoping review

Sleep has been found to be essential to physical and mental health. Sexual and gender minority (SGM; e.g., lesbian, gay, bisexual, transgender, nonbinary) individuals experience significant health disparities, and emerging research indicates that this includes disparities in sleep health. However, the current literature on sleep health in this population has not previously been rigorously reviewed. This scoping review provides a comprehensive overview and synthesis of the current literature on SGM sleep health in the United States. Following established scoping review methodology, we systematically searched PubMed, CINAHL, PsycINFO, LGBTQ + Source, and Scopus; 76 studies met inclusion criteria. Included studies indicated significant sleep disparities exist for SGM people, particularly sexual minority women and gender minority people. Social determinants of health, including bullying and discrimination, were associated with worse sleep health. Included studies were heterogeneous and had methodological weaknesses, leaving opportunities for future research. Overall, findings point to the need for more rigorous research to advance understanding of sleep health across SGM subgroups and inform interventions to improve sleep health among SGM people, given the known negative impact of poor sleep on overall health.

LGBTQ+ status and sex of record in Veterans with post-traumatic stress disorder: demographics, comorbidities, and outpatient encounters

Objectives

This study aims to analyze differences between lesbian, gay, bisexual, transgender, and queer (LGBTQ+) and non-LGBTQ+ Veterans with post-traumatic stress disorder (PTSD) in terms of demographics, comorbidities, and medical care usage, including differences by sex of record, including separate analyses for transgender and non-transgender Veterans.

Methods

Chi-square, t-test, ANOVA Welch one-way testing, and absolute standardized difference analyses were conducted on a cohort of 277,539 Veterans diagnosed with PTSD.

Results

The study found significant differences, particularly concerning positive LGBTQ+ status and sex of record. There were significant differences found in age, marital status, and medical care usage, as well as pain, mental health, and substance use disorder diagnoses. Differences in having experienced military sexual trauma, crime, or maltreatment were especially significant, with increased percentages among LGBTQ+ individuals, and sex of record females. In separate analyses, there were similar differences among transgender and non-transgender Veterans, with similar increased risks for sex of record females.

Conclusion

Our findings suggest an intersectionality of LGBTQ+ status and sex of record in the context of PTSD. These findings may help guide future research, policy, and interventions.

Psychometric Properties and Cultural Adaptation of the Polish Version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL)

People from the LGBT+ community often face unique healthcare disparities, including barriers to accessing appropriate and respectful care. The purpose of this study was to test the psychometric properties of the Polish-language version of the Lesbian, Gay, Bisexual, and Transgender Development of Clinical Skills Scale (LGBT- DOCSS-PL). Before testing its psychometric properties, the LGBT-DOCSS was translated and adapted from the original English version into Polish. Subsequently, we tested the instrument's psychometric properties on a sample of 415 participants. In addition, internal consistency of the questionnaire was checked with confirmatory factor analysis (CFA). Cronbach's alpha together with discriminative power index were uses as internal consistency measures. There were more female than male participants (58%). More than 57% of the participants were heterosexual and the average age of the respondents was approximately 30 years. The internal consistency of the Polish version and its domains was strong with an overall Cronbach's alpha of 0.789. The alpha ranges for each subscale domains were between 0.780-0.824. The McDonald's omega coefficient was 0.86. The Polish version of the LGBT-DOCSS-PL has good properties of factorial validity.

Sexual orientation and sexual functioning in midlife women veterans

OBJECTIVE

Midlife women experience menopause- and aging-related health changes that may impact sexual functioning. Research has historically relied on heteronormative constructs of sexuality, and little is known about the experiences of sexual minority women (SMW) during menopause. We therefore examined whether indices of sexual function differed between SMW and heterosexual midlife women Veterans.

METHODS

Data were drawn from a cross-sectional survey designed to examine midlife women Veterans' experiences of menopause and aging. Participants self-reported sexual orientation, sociodemographic characteristics, vaginal symptoms, past-month engagement in sexual activity, and pain with sexual activity with structured-item responses. Sexual function was assessed with validated questionnaires. Logistic and linear regression models examined group differences adjusted for age, education, race, menopause status, and body mass index.

RESULTS

In this sample (n = 232, mean age = 56.0, SD = 5.14), 25% self-identified as SMW. Relative to heterosexual women, SMW were more likely to endorse recent sexual activity (odds ratio [OR], 2.20; 95% confidence interval [CI], 11.13-4.30), less likely to report pain during sex (OR, 0.07; 95% CI, 0.16-0.32), less likely to report past-month vaginal symptoms (OR, 0.33; 95% CI, 0.17-0.66), and endorsed lower impact of vaginal symptoms on sexual function (β = -0.24; 95% CI, -0.97 to -0.26). Both groups reported high levels of distress related to sexual dysfunction (sample mean = 19.9, SD = 8.0).

CONCLUSIONS

Midlife SMW Veterans reported better sexual functioning and less impact of vaginal symptoms compared with heterosexual peers. Despite this, both groups reported high levels of distress related to sexual function.

Food Insecurity Among LGBQ+ Veterans

Importance

Food insecurity is associated with numerous adverse health outcomes. Little is known about the prevalence of and risks for food insecurity among veterans identifying as lesbian, gay, bisexual, queer, and similar (LGBQ+), a population facing unique social barriers and medical comorbidities.

Objective

To examine food insecurity and potential risk factors among LGBQ+ veterans.

Design, Setting, and Participants

This retrospective, cross-sectional study used administrative data from all US Veterans Health Administration (VHA) facilities nationally. Participants included veterans screened for food insecurity between March 1, 2021, and August 31, 2023.

Exposure

Positive response to food insecurity screening administered in VHA facilities as part of routine clinical care.

Main Outcomes and Measures

Prevalence of and sociodemographic, clinical, and psychosocial factors associated with food insecurity among veterans identifying as LGBQ+ or heterosexual and those with "don't know" responses regarding their sexual orientation.

Results

Of 3 580 148 veterans screened, the mean (SD) age was 61.6 (0.4) years; 3 192 507 (89.2%) were assigned male sex at birth. A total of 83 292 veterans (2.3%) identified as LGBQ+, and 10 183 (0.3%) had "don't know" responses. LGBQ+ veterans (5352 [6.4%]) and veterans with "don't know" responses (635 [6.2%]) were more than twice as likely as heterosexual veterans (90 426 [2.6%]) to have positive screen results for food insecurity. While risk factors for food insecurity were similar for veterans across sexual orientation groups, LGBQ+ veterans had higher rates of several risk factors compared with heterosexual veterans, including age younger than 45 years (45.3% vs 19.5%), female sex assigned at birth (44.1% vs 10.0%), being in a minoritized racial or ethnic group (34.7% vs 29.8%), unmarried or unpartnered status (69.1% vs 39.7%), low income (16.4% vs 14.9%), homelessness or housing instability (10.3% vs 5.4%), anxiety (7.7% vs 4.3%), depression (31.1% vs 19.3%), suicidality (3.6% vs 1.4%), posttraumatic stress disorder (42.2% vs 30.2%), substance use disorder (13.1% vs 9.0%), military sexual trauma (24.0% vs 5.4%), and recent intimate partner violence (2.6% vs 1.4%).

Conclusions and Relevance

In this cohort study of veterans screened for food insecurity, LGBQ+ veterans and those with "don't know" responses for sexual orientation experienced food insecurity at nearly 2.5 times the rate of heterosexual veterans. While risk factors for food insecurity were similar across groups, LGBQ+ veterans faced a higher prevalence of particular risks, including homelessness and several mental health and trauma-related comorbidities. Future work should examine targeted screening and interventions tailored to identifying and addressing food insecurity in this population, given their increased vulnerability and burden of food insecurity.

Equity and Inclusion for LGBTQ+ Residents: Lessons Learned from the Initial Long-Term Care Equality Index (LEI)

OBJECTIVES

Most older adults with lesbian, gay, bisexual, queer, questioning, transgender, and related identities (LGBTQ+) are concerned about receiving lower-quality care and/or being mistreated in nursing homes. Older LGBTQ+ veterans may have additional reservations about care in Department of Veterans Affairs (VA) nursing homes (Community Living Centers [CLCs]) because of experience with past discriminatory military policies (eg, bans on participating in military service, Don't Ask Don't Tell). This article describes one of the first VA CLCs to participate in the Human Rights Campaign-developed Long-Term Care Equality Index (LEI).

DESIGN

A single-site formative evaluation was completed to support quality improvement and identify opportunities for growth using the LEI. The LEI is a facility benchmarking tool to support more inclusive environments for LGBTQ+ residents and employees. The LEI offers 4 evaluation criteria: (1) Non-Discrimination and Staff Training; (2) LGBTQ+ Resident Services and Support; (3) Employee Benefits and Policies; and (4) Resident and Community Engagement. Facilities receive ratings based on the number of requirements achieved in each category.

PARTICIPANTS AND METHODS

Older LGBTQ+ veterans, current CLC residents, interdisciplinary CLC providers and leadership, and national Geriatrics and Extended Care program managers collaborated to pilot the LEI and develop tools and materials to support other VA facilities' participation in the LEI.

RESULTS

Qualitative interviews with veterans and CLC residents supported inclusion of gender identity and sexual orientation in resident handbooks, discussions about person-centered care, and opportunities for additional staff training and community engagement (eg, observing Pride Month in June). Resources to support VA long-term care facilities' participation in the LEI were developed.

CONCLUSIONS AND IMPLICATIONS

The LEI offers a structured approach to identifying areas for improvement in providing high-quality and equitable care in long-term care settings. Practical suggestions for CLCs and other nursing home settings considering the LEI for the first time are discussed.

Sexual Orientation Concealment, Hope, and Depressive Symptoms Among Sexual Minority Women: The Moderating Role of Sexual Orientation

Sexual minority women (SMW) experience higher levels of depression compared to heterosexual women, and bisexual women show higher levels than lesbian women. Sexual orientation concealment is a risk factor for depressive symptoms among SMW. Hope is protective against depressive symptoms in diverse samples, but limited research in this area has centered on SMW. This study examined the role of hope and its components, agency and pathways, as moderators of the relation between sexual orientation concealment and depressive symptoms, and whether the moderating effects were conditional on sexual orientation. An international sample of 218 lesbian women aged 18 to 69 (M = 32.93 years, SD = 12.75) and 230 bisexual women aged 18 to 67 (M = 27.83 years, SD = 7.52) completed an online survey. Hope, agency, and pathways did not moderate the relation between sexual orientation concealment and depressive symptoms. The significant negative relations between hope and depressive symptoms, and between agency and depressive symptoms, were moderated by sexual orientation: the relations were stronger among lesbian women than bisexual women. Results suggest that increasing levels of hope and agency through clinical intervention may reduce depressive symptoms for both groups of women, with more pronounced effects among lesbian women.

Still "Don't Ask" more than a decade later: The impact of research barriers for LGB+ military couples

Despite the repeal of "Don't Ask, Don't Tell" (DADT) over a decade ago, military processes and policies continue to function as significant structural and institutional barriers to research aimed at optimizing resources for military couples and families with marginalized sexual identities. Such research is essential given the apparent mental health and related disparities among lesbian, gay, bisexual, and those with other marginalized sexual identities (LGB+) active-duty service members (SMs), as well as the absence of appropriately tailored resources to support these members of the military community. In this paper, we review the empirical literature on the experiences and psychological health of LGB+ military couples, revealing severe limitations in our understanding of these diverse military romantic partnerships. We illuminate process-related barriers to conducting this essential research through an illustrative case example. Our review concludes with specific recommendations for reform and advocacy distinguished by coordinated efforts inclusive of all five military branches, policymakers, military leaders, researchers, and LGB+ stakeholders.

Associations of Sexual Orientation-Related Minority and Military Stressors With Past-Year Cigarette Use Among Lesbian, Gay, and Bisexual Veterans

INTRODUCTION

Lesbian, gay, and bisexual (LGB) individuals and Veterans are more likely to report current smoking than the general adult population in the United States. The Minority Stress Model may explain the high prevalence of cigarette smoking among LGB individuals, who experience unique interpersonal (e.g., discrimination) and intrapersonal (e.g., identity concealment) stressors related to their minoritized sexual orientation.

AIMS AND METHODS

This study assessed whether three types of stressors (interpersonal, intrapersonal, and LGB-specific military) were associated with past-year smoking among LGB Veterans. Veterans were recruited online for a prospective cohort study. We conducted secondary data analysis of baseline surveys collected from 2019 to 2020. The study sample included cisgender, LGB Veterans (n = 463). Adjusted nested multivariable logistic regression models were used to estimate the association of each stressor with past-year cigarette smoking.

RESULTS

Participants were mostly male (54.0%), non-Hispanic white (82.1%), and at least a college graduate (58.5%). LGB Veterans who were younger, had lower levels of education, income, and healthcare coverage, higher general stressors, and post-traumatic stress disorder and depression symptoms were more likely to smoke in the past year (n = 98, 21.2%). The adjusted odds of past-year smoking were higher among those who reported higher levels of harassment (aOR = 1.13, 95% confidence interval [CI]: 1.01 to 1.26), victimization (aOR = 1.13, 95% CI: 1.02 to 1.43), and family rejection (aOR = 1.13, 95% CI: 1.08 to 1.36).

CONCLUSIONS

Multiple interpersonal stressors were associated with past-year smoking, highlighting the need to intervene on these stressors. Future interventions should aim to address policies that reduce prejudice against LGB Veterans, while helping those who smoke identify and develop positive coping skills that support cessation.

IMPLICATIONS

Our findings contribute to the growing body of literature on tobacco use disparities among LGB individuals, particularly LGB Veterans. Results of this analysis provide some evidence for the Minority Stress Model as a conceptual model for understanding and intervening in disparities in smoking prevalence among LGB Veterans.

Perpetuating and protective factors in insomnia across racial/ethnic groups of veterans

Few studies have examined racial/ethnic differences in rates and correlates of insomnia among veterans. This study compared rates of insomnia and interest in sleep treatment among veterans of diverse racial/ethnic backgrounds. Consistent with the 3P model, we tested racial discrimination as a predictor of insomnia, with post-traumatic stress disorder symptoms and romantic partners as perpetuating and protective moderators of this association, respectively. A total of 325 veterans (N = 236 veterans of colour; 12% Asian, 36% Black, 14% Hispanic/Latine) completed questionnaires online from remote locations. Descriptive statistics were used to compare patterns across racial/ethnic groups. Linear regression was used to test moderators of the association between racial discrimination and insomnia severity. Overall, 68% of participants screened positive for insomnia: 90% of Asian; 79% of Hispanic/Latine; 65% of Black; and 58% of White participants. Of those, 74% reported interest in sleep treatment, and 76% of those with partners reported interest in including their partner in treatment. Racial discrimination and post-traumatic stress disorder were correlated with more severe insomnia, while romantic partners were correlated with less severe insomnia. Only post-traumatic stress disorder moderated the association between racial discrimination and insomnia severity. Rates of insomnia were highest among Asian and Hispanic/Latine participants, yet these groups were among the least likely to express interest in sleep treatment. Racial discrimination may exacerbate insomnia symptoms among veterans, but only among those who do not already have disturbed sleep in the context of post-traumatic stress disorder. Romantic partners may serve as a protective factor in insomnia, but do not seem to mitigate the impact of racial discrimination.

Military service and health-related quality of life among gay and bisexual prostate cancer survivors: Results from the -2 study

INTRODUCTION

There are notable disparities in health-related quality of life (HRQOL) between gay and bisexual men (GBM) and heterosexual patients with prostate cancer (PCa); however, the role of past military service is unclear. This study examines HRQOL differences in GBM PCa survivors based on reported military service history.

METHODS

We used data from the 24-month follow-up survey of the Restore-2 study, a clinical trial which evaluated a rehabilitation programme for GBM PCa survivors. PCa HRQOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC-50) and the Functional Assessment of Cancer Treatment-Prostate (FACT-P). Mental health quality of life was assessed using the Brief Symptom Inventory-18 (BSI-18) scale, while sexual functioning was measured using the Sexual Minorities and Prostate Cancer Scale (SMACS). Multivariable linear regression was used to estimate unadjusted and adjusted mean differences in HRQOL between GBM with and without a reported history of military service.

RESULTS

In this cross-sectional study of 351 GBM PCa survivors, 47 (13.4%) reported a history of US military service. After adjusting for covariates, participants who reported a history of military service (compared with those with no military service) had clinically better scores on the FACT-P physical, social and emotional well-being domains, as well as higher total FACT-General, EPIC urinary bother and hormonal function scores. Additionally, men with a history of military service reported significantly fewer sexual problems, more sexual confidence and less urinary incontinence in sex.

CONCLUSION

This exploratory study provides the first evidence that GBM PCa survivors with a military background may have clinically better outcomes than those without military service. Potential reasons may include the structured support and healthcare access associated with military service, fostering resilience and well-being. These findings underscore the need for further research to elucidate how military service influences PCa HRQOL.

Prevalence of Sexual Violence and Intimate Partner Violence Among US Military Veterans: Findings from Surveys with Two National Samples

BACKGROUND

Sexual violence (SV) and intimate partner violence (IPV) experiences are major social determinants of adverse health. There is limited prevalence data on these experiences for veterans, particularly across sociodemographic groups.

OBJECTIVE

To estimate the prevalence of SV before, during, and after military service and lifetime and past-year IPV for women and men, and explore differences across sociodemographic groups.

DESIGN

Data are from two national cross-sectional surveys conducted in 2020. Weighted prevalence estimates of SV and IPV experiences were computed, and weighted logistic regression models were used for comparisons across gender, race, ethnicity, sexual orientation, and age.

PARTICIPANTS

Study 1 included veterans of all service eras (N = 1187; 50.0% women; 29% response rate). Study 2 included recently separated post-9/11 veterans (N = 1494; 55.2% women; 19.4% response rate).

MAIN MEASURES

SV was assessed with the Deployment Risk and Resilience Inventory-2 (DRRI-2). IPV was assessed with the extended Hurt-Insult-Threaten-Scream Tool.

KEY RESULTS

Women were more likely than men to experience pre-military SV (study 1: 39.9% vs. 8.7%, OR = 6.96, CIs: 4.71-10.28; study 2: 36.2% vs. 8.6%, OR = 6.04, CIs: 4.18-8.71), sexual harassment and/or assault during military service (study 1: 55.0% vs. 16.8%, OR = 6.30, CIs: 4.57-8.58; study 2: 52.9% vs. 26.9%, OR = 3.08, CIs: 2.38-3.98), and post-military SV (study 1: 12.4% vs. 0.9%, OR = 15.49, CIs: 6.42-36.97; study 2: 7.5% vs. 1.5%, OR = 5.20, CIs: 2.26-11.99). Women were more likely than men to experience lifetime IPV (study 1: 45.7% vs. 37.1%, OR = 1.38, CIs: 1.04-1.82; study 2: 45.4% and 34.8%, OR = 1.60, CIs: 1.25-2.04) but not past-year IPV (study 1: 27.9% vs. 28.3%, OR = 0.95, CIs: 0.70-1.28; study 2: 33.1% vs. 28.5%, OR = 1.24, CIs: 0.95-1.61). When controlling for gender, there were few differences across other sociodemographic groups, with the exception of sexual orientation.

CONCLUSIONS

Understanding veterans' experiences of SV and IPV can inform identification and intervention efforts, especially for women and sexual minorities.

The Association of Food Insecurity, Mental Health, and Healthcare Access and Use Among Lesbian, Gay, and Bisexual Adults in the United States: Results From the 2021 National Health Interview Survey

PURPOSE

We sought to describe the prevalence of food insecurity and its relationship with mental health, health care access, and use among lesbian, gay, and bisexual (LGB) adults in the U.S.

DESIGN AND SETTING

We analyzed data from the National Health Interview Survey (NHIS), a cross-sectional study of noninstitutionalized adults from all 50 states and the District of Columbia.

SAMPLE

The study sample was restricted to LGB adults ≥18 years (N = 1178) from the 2021 NHIS survey.

MEASURES

Food security was assessed using the 10-item U.S Adult Food Security Survey Module. Study outcomes were mental health (depression, anxiety, life satisfaction, and serious psychological distress), health care utilization, and medication adherence.

ANALYSIS

Descriptive statistics and linear and generalized linear regressions.

RESULTS

The study sample consisted of 69% White, 14% Hispanic/Latinx, 9% Black, and 8% people of other races. Approximately half (53%) identified as bisexual and 47% identified as gay or lesbian. Eleven percent were food insecure. Sexual orientation, income-to-poverty ratio, and health insurance were significant correlates of food insecurity. In multivariable analyses, food insecurity was significantly associated with mental illness (including depression, anxiety, and serious psychological distress), limited health care access and use (including inability to pay medical bills, delay in getting medical and mental health care, and going without needed medical and mental health care), and medication nonadherence (including skipping medication, taking less medication, delay filling prescription, and going without needed prescription).

CONCLUSION

Food insecurity is a constant predictor of adverse mental health and low medical and mental health care use rates among LGB adults in the United States. Achieving food security in LGB people requires improving their financial and nonfinancial resources to obtain food.

The Experiences of LGBTQ Healthcare Professionals within Military Medical Culture

BACKGROUND

Creating a positive workplace culture affects patient outcomes and force readiness. An inclusive workplace culture is especially important for lesbian, gay, bisexual, transgender, and queer (LGBTQ) military healthcare professionals, who have historically faced discrimination within the United States military. While research has examined LGBTQ service members' experiences in the military as a whole, there is a gap in the professional literature regarding LGBTQ healthcare workers' experiences within military medicine.

METHODS

This qualitative phenomenological study explored the experiences of ten LGBTQ military healthcare professionals. We interviewed each participant for one hour. Our research team then coded each interview and came to a consensus on how to organize these codes into emerging themes. We used reflexivity and member checking to increase the credibility of our results.

RESULTS

Four themes emerged from our data analysis: (1) implicit bias; (2) explicit bias; (3) response to discrimination; and (4) recommendations for improving workplace culture. The participants described both the underlying and outright discrimination they faced at work. They made recommendations for reducing this discrimination through education, training, and increased leadership representation.

CONCLUSIONS

Our results revealed that LGBTQ healthcare professionals continue to face discrimination in the workplace. This discrimination must be addressed to create an inclusive workplace environment within military medicine, which will enhance force readiness.

Effects of Bullying on Anxiety, Depression, and Posttraumatic Stress Disorder Among Sexual Minority Youths: Network Analysis

BACKGROUND

Bullying victimization is highly prevalent among sexual minority youths, particularly in educational settings, negatively affecting their mental health. However, previous studies have scarcely explored the symptomatic relationships among anxiety, depression, and posttraumatic stress disorder (PTSD) among sexual minority youths who experienced bullying on college campuses.

OBJECTIVE

The objectives of our study were to (1) characterize the anxiety-depression-PTSD network structures of gay or lesbian, bisexuals, and other sexual minority youths previously bullied on college campuses; and (2) compare symptomatic associations in the anxiety-depression-PTSD networks among bullied sexual minority youths and heterosexual youths' groups.

METHODS

This cross-sectional study recruited college participants from Jilin Province, China. Data were analyzed using a subset of the data extracted after screening for sexual orientation and history of bullying victimization. Sexual minority youths were then divided into 3 subgroups: gay or lesbian (homosexual), bisexual, and other. Mental health symptom severity was assessed using scales: the 7-item Generalized Anxiety Disorder Scale measuring anxiety, the 9-item Patient Health Questionnaire measuring depression, and the 10-item Trauma Screening Questionnaire measuring PTSD symptoms. Combining the undirected and Bayesian network analyses, the anxiety-depression-PTSD networks were compared among sexual minority youths subgroups, and the difference between heterosexual youths and sexual minority youths was investigated. Chi-square tests were used to compare the difference in categorical variables, while independent-sample t tests were run on continuous variables.

RESULTS

In this large-scale sample of 89,342 participants, 12,249 identified as sexual minority youths, of which 1603 (13.1%, 95% CI 12.5%-13.7%) reported being bullied on college campuses in the past year. According to the expected influence (EI) and bridge expected influence (bEI) index, in the global network structure of anxiety, depression, and PTSD, sad mood (EI=1.078, bEI=0.635) and irritability (EI=1.077, bEI=0.954) were identified as central and bridge symptoms; emotional cue reactivity (EI=1.015) was a central symptom of PTSD in this global network. In the anxiety-depression-PTSD Bayesian network, anhedonia had the highest prediction priority for activating other symptoms; and feeling afraid linked symptoms from anxiety to the PTSD community. Compared to their heterosexual counterparts, sexual minority youths exhibited a stronger association between difficulty concentrating and appetite. The "sad mood-appetite" edge was strongest in the gay or lesbian network; the "irritability-exaggerated startle response" edge was strongest in the bisexual network.

CONCLUSIONS

For the first time, this study identified the most central and bridge symptoms (sad mood and irritability) within the depression-anxiety-PTSD network of sexual minority youths with past bullying-victim experiences on college campuses. Emotional cue reactivity, anhedonia, and feeling afraid were other vital symptoms in the comorbid network. Symptomatic relationships existed showing heterogeneity in bullied heterosexual youths and sexual minority youth networks, which also was present within the sexual minority youth subgroups. Consequently, refined targeted interventions are required to relieve anxiety, depression, and PTSD symptoms.

Military Sexual Trauma and its Association with Mental Health Among Sexual Minority and Heterosexual Veterans in the United States

Purpose: The purpose of this study was to examine the prevalence of military sexual trauma (MST) by sexual orientation, characteristics of sexual minority (SM) and heterosexual veterans who have experienced MST, and associations between sexual orientation and mental health symptoms among veterans who have experienced MST. Methods: Data were analyzed from a nationally representative web-based survey of 4069 U.S. veterans (4.9% SM), which assessed sociodemographic (e.g., age, sexual orientation) and military (e.g., branch) characteristics, and lifetime and current mental health symptoms. Bivariate analyses compared sociodemographic and military characteristics and mental health symptoms among veterans who have experienced MST by sexual orientation. Multivariable logistic regressions examined associations between sexual orientation and mental health symptoms among veterans who have experienced MST, while controlling for differences in sociodemographic characteristics and non-MST traumatic events. Results: The prevalence of MST (7.5% of weighted sample) was higher among SM veterans compared to heterosexual veterans, with bisexual/pansexual/queer veterans endorsing the highest prevalence (22.7%), followed by gay/lesbian (17.0%) and heterosexual (6.5%) veterans. SM veterans who experienced MST were more likely than heterosexual veterans to screen positive for lifetime and current posttraumatic stress disorder (odds ratio [OR] = 3.06 and 3.38, respectively), and current drug use disorder (OR = 3.53). Conclusions: This study adds to growing evidence that mental health symptoms associated with MST disproportionately impact SM veterans relative to heterosexual veterans. Approaches to reducing barriers and tailoring MST-related care to SM veterans, including through addressing cumulative effects of minority stress, are discussed.

Outcomes of LGBTQ culturally sensitive training among civilian and military healthcare personnel

BACKGROUND

Lesbian, gay, bisexual, transgender, or queer (LGBTQ) military servicemembers are at higher risk of developing health problems compared to heterosexual peers. To improve outcomes and address negative attitudes, previous literature has recommended education of healthcare personnel. The purpose of our study was to evaluate the knowledge and skill outcomes of an LGBTQ cultural sensitivity training program.

METHODS

We used a pretest/posttest design. Participants completed the Ally Identity Measure (AIM) to assess three subscales: knowledge and skills, openness and support, and oppression awareness. Participants included both military and civilian healthcare personnel from multiple disciplines. Descriptive statistics and pairwise analyses were used.

RESULTS

A total of 101 participants answered both pretest and posttest. Across all AIM subscales, posttest scores demonstrated statistically significant (P < 0.001) increases from mean pretest scores. Completion rates for the pretest and posttest were 99% and 93%, respectively. The majority of participants were female (75%) and non-Hispanic (87%), composed of Caucasians (39%) and Asians (33%). Over one-third (39%) of participants were aged 30-39. Fifty percent were active-duty military and more than half (58%) of all participants did not have prior training in LGBTQ patient care. Statistically significant differences were found between the pretest and posttest scores for the knowledge and skills subscale (M = 2.64-3.70). The most significant increases were observed in Item 12 and Item 15 (M = 2.72-3.70) regarding awareness of theories and skill development to provide proper support, respectively.

CONCLUSION

These significant findings contribute to the currently limited research exploring LGBTQ cultural sensitivity training in both civilian and military settings. To our knowledge, this is the first time a cultural sensitivity training of this depth has been provided to active-duty servicemembers. Further research and development of similar educational programs integrating interactive participation can potentially aid in the delivery of improved care and military readiness for all servicemembers.

Obesity in Sexual and Gender Minority Populations: Prevalence and Correlates

PURPOSE OF REVIEW

The purpose of this review is to explore the prevalence and correlates of obesity among members of sexual and gender minority (SGM) populations.

RECENT FINDINGS

Research overall finds higher rates of obesity among lesbian and bisexual women than heterosexual women, lower rates of obesity among gay and bisexual men than heterosexual men, and inconsistent findings on obesity among transgender individuals. Rates of mental health disorders and disordered eating are high among all SGM groups. Rates of comorbid medical conditions differ among groups. More research needs to be conducted within all SGM groups but particularly among transgender populations. All members of SGM encounter stigma, including when seeking healthcare, and this may lead to individuals avoiding healthcare. Therefore, it is important to educate providers about population-specific factors. This article serves as an overview of important considerations for providers treating individuals within SGM populations.

Assessing Enacted Sexual Stigma toward Gay and Bisexual Men in the Military: The Enacted Sexual Stigma Experiences Scale in Military Service

Gay and bisexual military servicemembers experience disproportionately high rates of victimization due to enacted sexual stigma (ESS). This study formulated a new scale, called the Enacted Sexual Stigma Experiences Scale in Military Service (ESSESiMS) for gay and bisexual servicemembers, and examined its psychometric propensities. The five-item ESSESiMS was first developed based on the results of focus group interviews with 12 participants. A total of 399 gay and bisexual men who have experience of the military service participated in the study. Exploratory factor analysis (EFA) was implemented to determine the factor structure of the ESSESiMS; the internal consistency and concurrent validity of the ESSESiMS was also examined. The EFA results indicate that the ESSESiMS should have a single-item structure. The ESSESiMS exhibited acceptable internal consistency and concurrent validity. Incidents of ESS in the ESSESiMS were significantly associated with perceived sexual stigma outside the military service and with higher levels of depression, loneliness, and suicidal ideation. The results of our study supported the psychometric properties of the newly developed ESSESiMS for assessing the experiences of ESS among gay and bisexual servicemembers in Taiwan. Experiences of ESS toward gay and bisexual servicemembers were common; ESS was significantly associated with adverse mental health outcomes.