Estimating prevalence of PTSD among veterans with minoritized sexual orientations using electronic health record data.

Abstract

Objective: Questionnaire studies show people with minoritized sexual orientations (MSOs) face increased risk for conditions including posttraumatic stress disorder (PTSD). This study replicated Harrington et al.'s (2019) electronic health record probabilistic algorithm to evaluate lifetime PTSD prevalence in Veterans Health Administration (VHA)-using veterans. Method: In 115,853 MSO veterans and a 1:3 matched (on sex assigned at birth, and age at and year of first VHA visit) sample of non-MSO veterans. Each veteran was given a probability of "likely PTSD" (0.0-1.0) and thresholds (e.g., 0.7) applied to minimize false positive classifications. Results: Veterans with MSO were 2.35 times, CI [2.33, 2.38], more likely to have "likely PTSD" than veterans with non-MSO. The prevalence of "likely PTSD" using the rule-based International Classification of Diseases (ICD) approach was 40.8% among the MSO group compared to 22.0% among the non-MSO group after excluding those with bipolar or schizophrenia diagnoses and those with limited VHA engagement. Without those exclusions, prevalence was slightly higher in both groups (46.1% vs. 24.3%, respectively; prevalence ratio: 1.90). Despite increased prevalence of exposure to military sexual trauma (MST; MSO = 20.7%; non-MSO = 8.3%) and double "likely PTSD" among MSO veterans, they were less likely to have a service-connected PTSD disability than their matched non-MSO (MSO = 78.1%; non-MSO = 87.6%) comparators. Conclusions: VHA-using veterans with MSO were twice as likely to have "likely PTSD" and exposure to MST than veterans with non-MSO. Veterans with MSO were less likely to be service connected for PTSD than non-MSO counterparts.What is the public health significance of this article? Gay, lesbian, and bisexual veterans who use VA healthcare are more likely to have posttraumatic stress disorder (PTSD) and have had military sexual trauma than straight veterans who use VA healthcare. However, gay, lesbian, and bisexual veterans are less likely to get disability payments for PTSD than straight veterans.

Experiences of discrimination and mental health treatment seeking among LGBQ+ veterans.

“…Veterans who identify as lesbian, gay, bisexual, queer, and other minoritized sexual orientations (LGBQ+) in the United States experience greater prevalence and severity of psychiatric disorders compared with their heterosexual counterparts (Shipherd et al, 2021). In addition to military-related stressors, such as combat exposure, deployments, and reintegration into civilian life, LGBQ+ veterans experience discrimination and stigma due to the broader sociopolitical context in which they live and aspects of military culture in which they served in (Livingston et al, 2019).…”

“…Due to the prevalence and severity of psychiatric disorders, it would be expected that LGBQ+ veterans would utilize greater mental health care compared with heterosexual veterans. Indeed, research suggests that LGBQ+ veterans tend to use greater amounts of mental health care compared with heterosexual veterans (Lynch et al, 2022; Shipherd et al, 2021). However, this research has not evaluated how treatment need (e.g., symptom severity) relates to mental health care seeking in the LGBQ+ veteran population as compared with that of heterosexual veterans (Lynch et al, 2022; Mattocks et al, 2013; Shipherd et al, 2021).…”

“…Indeed, research suggests that LGBQ+ veterans tend to use greater amounts of mental health care compared with heterosexual veterans (Lynch et al, 2022; Shipherd et al, 2021). However, this research has not evaluated how treatment need (e.g., symptom severity) relates to mental health care seeking in the LGBQ+ veteran population as compared with that of heterosexual veterans (Lynch et al, 2022; Mattocks et al, 2013; Shipherd et al, 2021). Research indicates that LGBQ+ veterans experience unique barriers to mental health care, including past negative experiences with mental health care, discrimination in the military, and fear of discriminatory treatment by providers due to sexual orientation (Mattocks et al, 2015; Sherman et al, 2014; Shipherd, Darling, et al, 2018; Simpson et al, 2013).…”

“…As such, we expect that, in this study, LGBQ+ veterans will be more likely to seek mental health treatment than non-LGBQ+ veterans. However, evidence of either higher or lower treatment utilization would clarify potential avenues for intervention, a critical pursuit in light of the magnitude of psychiatric disparities observed among LGBQ+ veterans (Lynch et al, 2022; Shipherd et al, 2021).…”

“…Based on the higher prevalence of mental disorders and mental distress related to stigma and discrimination among LGBQ+ veterans (J. Blosnich et al, 2013; Shipherd et al, 2021), we expected that lesbian or gay and bisexual veterans would be more likely to use mental health treatment than heterosexual veterans even after adjusting for mental health symptom severity (Hypothesis 1). Regarding perceptions of care, we hypothesized that lesbian or gay and bisexual veterans would have lower satisfaction and perceived helpfulness of mental health care compared with heterosexual veterans based on prior research on satisfaction with health care generally (J.…”