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Blosnich JR, Marsiglio MC, Gao S, Gordon AJ, Shipherd JC, Kauth M, Brown GR, Fine MJ. Am. J. Public Health 2016; 106(3): 534-540.


At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.


(Copyright © 2016, American Public Health Association)






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. (Am J Public Health. Published online ahead of print January 21, 2016: e1-e7. doi:10.2105/AJPH.2015.302981).

Language: en


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