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Balderrama-Durbin C, Cigrang JA, Snyder DK, Gupta A, Slep AMS, Heyman RE, Parsons AM, Simonson J, Lindahl KM, Pound L. Still "Don't Ask" more than a decade later: The impact of research barriers for LGB+ military couples. MILITARY PSYCHOLOGY 2024:1-13. [PMID: 39241155 DOI: 10.1080/08995605.2024.2396174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2024] [Accepted: 08/19/2024] [Indexed: 09/08/2024]
Abstract
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.
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Affiliation(s)
| | - Jeffrey A Cigrang
- School of Professional Psychology, Wright State University, Dayton, Ohio
| | - Douglas K Snyder
- Department of Psychological and Brain Sciences, Texas A&M University, College Station, Texas
| | - Avantika Gupta
- School of Professional Psychology, Wright State University, Dayton, Ohio
| | - Amy M Smith Slep
- Family Translational Research Group, New York University, New York, New York
| | - Richard E Heyman
- Family Translational Research Group, New York University, New York, New York
| | - Aleja M Parsons
- Family Translational Research Group, New York University, New York, New York
| | - Jordan Simonson
- Headquarters Air Force, A1Z - Integrated Resilience, Pentagon, Airlington, Virginia
| | - Kristin M Lindahl
- Department of Psychology, University of Miami, Coral Gables, Florida
| | - Leah Pound
- Headquarters Air Force, A1Z - Integrated Resilience, Pentagon, Airlington, Virginia
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Oblea PN, Adams AR, Nguyen-Wu ED, Hawley-Molloy JS, Balsam K, Badger TA, Witwer AR, Cartwright J. Lesbian Gay Bisexual Transgender and Queer Health-Care Experiences in a Military Population. JOURNAL OF HOMOSEXUALITY 2023; 70:1098-1118. [PMID: 35007488 DOI: 10.1080/00918369.2021.2015952] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
ABTRACTThis study aimed to understand the experiences of lesbian, gay, bisexual, transgender, and queer of former military service members. Data for this analysis was collected from the two open-ended survey questions as part of a larger online survey. The analysis was performed using the web-based data analysis application Dedoose. Eighty-eight qualitative responses were used. Analysis of the responses revealed five main themes: (1) identity, (2) negative experiences, (3) impact of experiences, (4) policy, and (5) positive experiences. These findings can influence future military research by focusing on the effects of the Don't Ask Don't Tell policy, negative and positive experiences, and the impact of those experiences.
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Affiliation(s)
- Pedro N Oblea
- Department of Inpatient Services, Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | - Ashley R Adams
- Clinical Investigation Department, Naval Medical Center Camp Lejeune, Camp Lejeune, North Carolina, USA
| | - Elizabeth D Nguyen-Wu
- Department of Inpatient Services, Center for Nursing Science and Clinical Inquiry, Tripler Army Medical Center, Honolulu, Hawaii, USA
| | | | - Kimberly Balsam
- Department of Psychology, Palo Alto University, Palo Alto, California, USA
| | - Terry A Badger
- College of Nursing, Division of Community and Systems Health, University of Arizona, Tucson, Arizona, USA
| | - Amanda R Witwer
- School of Criminal Justice, Michigan State University, East Lansing, Michigan, USA
| | - Joel Cartwright
- Department of Behavioral Sciences and Leadership, United States Military Academy, West Point, New York, USA
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3
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O’Leary KB, Marcelli M. Mental Health Outcomes Among Transgender Veterans and Active-Duty Service Members in the United States: A Systematic Review. Fed Pract 2022; 39:418-425. [PMID: 36744015 PMCID: PMC9896366 DOI: 10.12788/fp.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Background It has been shown that veterans and active-duty service members may experience worse mental health outcomes compared with civilians and nonveterans. In addition, transgender veterans and service members face unique challenges. We conducted a systematic review of articles presenting data on mental health outcomes in transgender veterans and active-duty service members. Outcomes examined in this review include symptoms of depression, anxiety, and posttraumatic stress disorder, suicidality, substance use, and military sexual trauma. Observations In the military, transgender individuals face stigma and discrimination. Transgender veterans and service members have worse mental health outcomes and higher odds of suicidality compared with their cisgender counterparts. Drug and alcohol use disorders are more prevalent among transgender veterans compared with cisgender veterans. Transgender veterans are also more likely to report military sexual trauma than cisgender veterans. Conclusions In the literature, evidence exists that transgender veterans and service members experience worse mental health outcomes than their cisgender counterparts. Additional research is required to measure the effect of gender-affirming care on health outcomes among transgender veterans and active-duty service members to better serve this population and provide optimal care.
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Affiliation(s)
| | - Marco Marcelli
- Baylor College of Medicine, Houston, Texas,Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas
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4
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Thompson MF, Luk JW, LaCroix JM, Perera KU, Goldston DB, Weaver JJ, Soumoff A, Ghahramanlou-Holloway M. Understanding the clinical characteristics of lesbian, gay, and bisexual military service members and adult beneficiaries within an inpatient psychiatric sample. Suicide Life Threat Behav 2022; 52:268-279. [PMID: 34889465 DOI: 10.1111/sltb.12819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 08/26/2021] [Accepted: 10/04/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND Limited knowledge exists regarding targets for suicide-focused care among high-risk United States (U.S.) civilian and military sexual minorities. PURPOSE This study aimed to understand the demographic and clinical characteristics of a suicidal sexual minority sample, psychiatrically hospitalized in military treatment facilities, to advance future targeted care for this vulnerable subgroup. METHODS Secondary analysis of baseline data from a multisite psychotherapy randomized controlled trial was performed comparing those who self-identified as lesbian, gay, or bisexual (LGB; n = 39) to heterosexual participants (n = 170). RESULTS LGB participants were more likely than heterosexual participants to be younger, female, never married, and enlisted rank. LGB participants reported significantly lower family support, higher perceived burdensomeness, lower acquired capability for suicide, and were twice as likely to report that they could not control their suicidal thoughts. LGB and heterosexual participants reported similar levels of other suicide risk indicators and similar lifetime suicidal ideation and attempt histories. CONCLUSIONS Compared to heterosexual participants, LGB participants reported increased risk indicators for suicide yet similar lifetime suicidal ideation and attempt histories. Suicide prevention programs should address the unique needs of this vulnerable subgroup. Interventions targeting family support, perceived burdensomeness, and controllability of suicidal thoughts may be promising.
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Affiliation(s)
- Matthew F Thompson
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Jeremy W Luk
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Jessica M LaCroix
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - Kanchana U Perera
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
| | - David B Goldston
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, North Carolina, USA
| | | | - Alyssa Soumoff
- Walter Reed National Military Medical Center, National Intrepid Center of Excellence, Bethesda, Maryland, USA
| | - Marjan Ghahramanlou-Holloway
- Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences (USUHS), Bethesda, Maryland, USA
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Sullivan KS, Dodge J, McNamara KA, Gribble R, Keeling M, Taylor-Beirne S, Kale C, Goldbach JT, Fear NT, Castro CA. Perceptions of family acceptance into the military community among U.S. LGBT service members: A mixed-methods study. JOURNAL OF MILITARY, VETERAN AND FAMILY HEALTH 2021. [DOI: 10.3138/jmvfh-2021-0019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
LAY SUMMARY There are approximately 16,000 families of lesbian, gay, bisexual, or transgender (LGBT) service members in the U.S. military, but very little is known about how accepted they feel in the communities in which they live. This study begins to address this question by considering the perspectives of LGBT service members, which they shared both in response to an online survey and in interviews. Findings suggest that many service members believe their spouses and families are accepted by their chain of command. However, a smaller but important group continued to express concerns about their family being accepted in their military community. Many service members appear concerned that family services available to them through the military are not appropriate for LGBT families. Altogether, this article highlights the need for more research to understand the well-being and needs of this group.
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Affiliation(s)
- Kathrine S. Sullivan
- Silver School of Social Work, New York University, New York, New York, United States
| | - Jessica Dodge
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
| | | | - Rachael Gribble
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Mary Keeling
- Department of Social Sciences, University of the West of England, Bristol, United Kingdom
| | - Sean Taylor-Beirne
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Caroline Kale
- Silver School of Social Work, New York University, New York, New York, United States
| | - Jeremy T. Goldbach
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
| | - Nicola T. Fear
- King’s Centre for Military Health Research, King’s College London, London, United Kingdom
| | - Carl A. Castro
- Center for Innovation and Research on Veterans and Military Families, University of Southern California, Los Angeles, California, United States
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Beltran RM, Schuyler AC, Blair CS, Goldbach JT, Castro CA, Holloway IW. "That's kind of like the big struggle right now is can we get PrEP?": Facilitators and Barriers to PrEP Uptake Among Active Duty Gay and Bisexual Men. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2021; 20:413-425. [PMID: 37250806 PMCID: PMC10212805 DOI: 10.1007/s13178-021-00622-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2021] [Indexed: 05/27/2023]
Abstract
Introduction The US Military is experiencing a rise in HIV infections among gay and bisexual men (GBM) serving on active duty, yet little is known about this population's uptake of pre-exposure prophylaxis (PrEP), an evidence-based intervention for HIV prevention. This mixed methods study examines the facilitators and barriers to PrEP access and uptake among active duty GBM. Methods Active duty GBM were recruited using respondent-driven sampling (2017 and 2018). Participants (n = 93) answered quantitative survey questions on PrEP interest and accessibility. Another set of participants (n = 10) discussed their PrEP experiences in qualitative interviews. We conducted descriptive and bivariate analyses of quantitative data, while qualitative data were analyzed using structural and descriptive coding techniques. Results Approximately 71% of active duty GBM indicated interest in accessing PrEP. A greater proportion of those who disclosed (vs. did not disclose) their sexual orientation to their military doctor discussed (p < 0.001) or accessed (p = 0.017) PrEP. The following qualitative themes emerged: (1) providers' negative views and knowledge gaps related to PrEP; (2) lack of a systems approach to PrEP access; (3) confidentiality concerns; and (4) reliance on peer networks for PrEP guidance and support. Conclusions Study results indicate that active duty GBM are interested in and want to discuss PrEP with their military doctors, but gaps in providers' PrEP-related knowledge and skills, as well as mistrust in the military health care system, remain. Policy Implications A system-wide approach that addresses confidentiality concerns and removes procedural barriers to PrEP access is recommended to improve PrEP uptake in this population.
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Affiliation(s)
- Raiza M. Beltran
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA USA
| | - Ashley C. Schuyler
- School of Social and Behavioral Health Sciences, College of Public Health and Human Sciences, Oregon State University, Corvallis, OR USA
| | - Cherie S. Blair
- Division of Infectious Diseases, UCLA David Geffen School of Medicine, University of California Los Angeles, 10833 Le Conte Avenue, Los Angeles, CA USA
| | - Jeremy T. Goldbach
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Carl A. Castro
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Ian W. Holloway
- Department of Social Welfare, School of Public Affairs, UCLA Luskin, University of California, Los Angeles, Los Angeles, CA USA
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