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Militaries

Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study

Citation:

Brown, George R., and Kenneth T. Jones. 2016. “Mental Health and Medical Health Disparities in 5135 Transgender Veterans Receiving Healthcare in the Veterans Health Administration: A Case-Control Study.” LGBT Health 3 (2): 122–31. 

Authors: George R. Brown, Kenneth T. Jones

Abstract:

Purpose: There are no large controlled studies of health disparities in transgender (TG) or gender dysphoric patients. The Veterans Health Administration (VHA) is the largest healthcare system in the United States and was an early adopter of electronic health records. We sought to determine whether medical and/or mental health disparities exist in VHA for clinically diagnosed TG veterans compared to matched veterans without a clinical diagnosis consistent with TG status.
 
Methods: Using four ICD-9-CM codes consistent with TG identification, a cohort of 5135 TG veterans treated in VHA between 1996 and 2013 was identified. Veterans without one of these diagnoses were matched 1:3 in a case–control design to determine if medical and/or mental health disparities exist in the TG veteran population.
 
Results: In 2013, the prevalence of TG veterans with a qualifying clinical diagnosis was 58/100,000 patients. Statistically significant disparities were present in the TG cohort for all 10 mental health conditions examined, including depression, suicidality, serious mental illnesses, and post-traumatic stress disorder. TG Veterans were more likely to have been homeless, to have reported sexual trauma while on active duty, and to have been incarcerated. Significant disparities in the prevalence of medical diagnoses for TG veterans were also detected for 16/17 diagnoses examined, with HIV disease representing the largest disparity between groups.
 
Conclusion: This is the first study to examine a large cohort of clinically diagnosed TG patients for psychiatric and medical health outcome disparities using longitudinal, retrospective medical chart data with a matched control group. TG veterans were found to have global disparities in psychiatric and medical diagnoses compared to matched non-TG veterans. These findings have significant implications for policy, healthcare screening, and service delivery in VHA and potentially other healthcare systems.

Keywords: disparity, gender dysphoria, military, Transgender, Veteran

Topics: Combatants, Health, HIV/AIDS, Mental Health, PTSD, Trauma, LGBTQ, Military Forces & Armed Groups, Militaries Regions: Americas, North America Countries: United States of America

Year: 2016

Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans

Citation:

Mattocks, Kristin M., Anne Sadler, Elizabeth M. Yano, Erin E. Krebs, Laurie Zephyrin, Cynthia Brandt, Rachel Kimerling, Theo Sandfort, Melissa E. Dichter, Jeffrey J. Weiss, Jeroan Allison, and Sally Haskell. 2013. “Sexual Victimization, Health Status, and VA Healthcare Utilization Among Lesbian and Bisexual OEF/OIF Veterans.” Journal of General Internal Medicine 28 (S2): S604–8. 

Authors: Kristin M. Mattocks, Anne Sadler, Elizabeth M. Yano, Erin E. Krebs, Laurie Zephyrin, Cynthia Brandt, Rachel Kimerling, Theo Sandfort, Melissa E. Dichter, Jeffrey J. Weiss, Jeroan Allison, Sally Haskell

Abstract:

BACKGROUND: Many lesbian and bisexual (LB) women veterans may have been targets of victimization in the military based on their gender and presumed sexual orientation, and yet little is known regarding the health or mental health of LB veterans, nor the degree to which they feel comfortable receiving care in the VA. 
 
OBJECTIVE: The purpose of this study was to examine the prevalence of mental health and gender-specific conditions, VA healthcare satisfaction and trauma exposure among LB veterans receiving VA care compared with heterosexually-identified women veterans receiving. 
 
DESIGN: Prospective cohort study of Operation Enduring Freedom/Operation Iraqi Freedom (OEF/OIF) women veterans at two large VA facilities. 
 
PARTICIPANTS: Three hundred and sixty five women veterans that completed a baseline survey. Thirty-five veterans (9.6 %) identified as gay or lesbian (4.7 %), or bisexual (4.9 %). 
 
MAIN MEASURES: Measures included sexual orientation, military sexual trauma, mental and gender-specific health diagnoses, and VA healthcare utilization and satisfaction. 
 
KEY RESULTS: LB OEF/OIF veterans were significantly more likely to have experienced both military and childhood sexual trauma than heterosexual women (MST: 31 % vs. 13 %, p<.001; childhood sexual trauma: 60 % vs. 36 %, p=.01), to be hazardous drinkers (32 % vs. 16 %, p=.03) and rate their current mental health as worse than before deployment (35 % vs. 16 %, p<.001). 
 
CONCLUSIONS: Many LB veterans have experienced sexual victimization, both within the military and as children, and struggle with substance abuse and poor mental health. Health care providers working with female Veterans should be aware of high rates of military sexual trauma and childhood abuse and refer women to appropriate VA treatment and support groups for sequelae of these experiences. Future research should focus on expanding this study to include a larger and more diverse sample of lesbian, gay, bisexual, and transgender veterans receiving care at VA facilities across the country. (C) Society of General Internal Medicine 2013

Keywords: lesbian, health services research, veterans, women

Topics: Combatants, Female Combatants, Gender, Women, Health, Mental Health, PTSD, Trauma, LGBTQ, Military Forces & Armed Groups, Militaries, Sexual Violence, SV against women Regions: Americas, North America Countries: United States of America

Year: 2013

Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care

Citation:

Blosnich, John R., PhD, George R. Brown, MD, Jillian C. Shipherd, PhD, Michael Kauth, PhD, Rebecca I. Piegari, MS, and Robert M. Bossarte, PhD. 2013. “Prevalence of Gender Identity Disorder and Suicide Risk Among Transgender Veterans Utilizing Veterans Health Administration Care.” American Journal of Public Health 103 (10): 27–32.

Authors: John R. Blosnich, George R. Brown, Jillian C. Shipherd, Michael Kauth, Rebecca I. Piegari, Robert M. Bossarte

Abstract:

Objectives: We estimated the prevalence and incidence of gender identity disorder (GID) diagnoses among veterans in the Veterans Health Administration (VHA) health care system and examined suicide risk among veterans with a GID diagnosis.
 
Methods: We examined VHA electronic medical records from 2000 through 2011 for 2 official ICD-9 diagnosis codes that indicate transgender status. We generated annual period prevalence estimates and calculated incidence using the prevalence of GID at 2000 as the baseline year. We cross-referenced GID cases with available data (2009–2011) of suicide-related events among all VHA users to examine suicide risk.
 
Results: GID prevalence in the VHA is higher (22.9/100 000 persons) than are previous estimates of GID in the general US population (4.3/100 000 persons). The rate of suicide-related events among GID-diagnosed VHA veterans was more than 20 times higher than were rates for the general VHA population.
 
Conclusions: The prevalence of GID diagnosis nearly doubled over 10 years among VHA veterans. Research is needed to examine suicide risk among transgender veterans and how their VHA utilization may be enhanced by new VA initiatives on transgender care.

Topics: Combatants, Health, Mental Health, LGBTQ, Military Forces & Armed Groups, Militaries Regions: Americas, North America Countries: United States of America

Year: 2013

Clients, Contractors, and the Everyday Masculinities in Global Private Security

Citation:

Chisholm, Amanda. 2017. “Clients, Contractors, and the Everyday Masculinities in Global Private Security.” Critical Military Studies 3 (2): 120–41. 

Author: Amanda Chisholm

Abstract:

This article explores the intimate relationships between the client and the security contractor. It draws upon autoethnography to bring into focus the client/contractor encounters and demonstrate how such encounters (re)shape the marginal and hegemonic men/masculinities of the security industry – masculinities which work to legitimize not only who and what are appropriate security providers but also how value/valuation of security is understood and practised. As such it contributes to the broader debates about gender and war by (1) demonstrating how the researcher is always embedded in and shaped by the research she produces; and (2) by bringing to the fore the multitude of masculinities, beyond the hegemonic militarized, that emerge in private security markets.

Keywords: autoethnography, military, militarization, private military and security companies, masculinities, feminist political economy

Topics: Gender, Men, Masculinity/ies, Gendered Power Relations, Military Forces & Armed Groups, Private Military & Security, Militaries, Militarization, Political Economies, Security

Year: 2017

Peacebuilding Through a Gender Lens and the Challenges of Implementation in Rwanda and Côte d'Ivoire

Citation:

Hudson, Heidi. 2009. “Peacebuilding Through a Gender Lens and the Challenges of Implementation in Rwanda and Cote d'Ivoire.” Security Studies 18 (2): 287–318.

Author: Heidi Hudson

Abstract:

With the hypothesis in mind that discrimination against women increases the likelihood that a state will experience internal conflict, this article contends that considering gender is a key part of an effective peacebuilding process. Evidence gathered by studying peacebuilding from a feminist perspective, such as in Rwanda and Cote d’Ivoire, can be used to reconceptualize the peace agenda in more inclusive and responsible ways. Following from this, the article argues that a culturally contextual gender analysis is a key tool, both for feminist theory of peacebuilding and the practice of implementing a gender perspective, in all peace work. Using the tools of African feminisms to study African conflicts, this contribution warns against “adding women” without recognizing their agency, emphasizes the need for an organized women’s movement, and suggests directions for the implementation of international laws concerning women’s empowerment at the local level. The article concludes by suggesting that implementation of these ideas in practice is dependent on the way in which African feminists employ main- streaming, inclusionary, and transformational strategies within a culturally sensitive context of indigenous peacebuilding processes.

Topics: Armed Conflict, Civil Wars, Ethnic/Communal Wars, Feminisms, Gender, Women, Gender Roles, Gender Analysis, Femininity/ies, Gender Balance, Gender Mainstreaming, Gendered Power Relations, Gender Equity, Genocide, Gendered Discourses, Governance, Post-conflict Governance, International Law, Military Forces & Armed Groups, Militaries, Non-state Armed Groups, Peacebuilding, Peace Processes, Post-Conflict, Post-Conflict Reconstruction, UN Security Council Resolutions on WPS, UNSCR 1325, Sexual Violence, SV against women Regions: Africa, Central Africa, East Africa, West Africa Countries: Côte D'Ivoire, Rwanda

Year: 2009

Sexed Bodies and Military Masculinities: Gender Path Dependence in EU's Common Security and Defense Policy

Citation:

Kronsell, Annica. 2016. “Sexed Bodies and Military Masculinities: Gender Path Dependence in EU's Common Security and Defense Policy.” Men and Masculinities 19 (3): 311–36.

Author: Annica Kronsell

Abstract:

This article explores the European Union (EU)’s Security and Defense Policy (CSDP) through a framework based on feminist institutional theory that highlights the durability in the dynamics of gender relations. Path dependency based on historic features of military institutions—a strict sex division based on ‘‘gender war roles’’— has influenced the development of different CSDP bodies. The CSDP is sexed because male bodies dominate the organizations studied, yet this remains invisible through normalization. A dominant EU hierarchical military masculinity is institutionalized in the EU’s Military Committee, combat heterosexual masculinity in the Battle groups, and EU protector masculinity in the EU Training missions. The CSDP embodies different types of military masculinities; the relations between them are important for the reproduction of the gender order through a gendered logic of appropriateness. Yet, this too is invisible as part of the informal aspects of organizations. While women’s bodies are written out of the CSDP, the construction of femininity in relation to the protector/protected binary is central to it. Two protected femininities are read in the texts. The vulnerable femininity of women in conflict areas is important for how the CSDP understands itself in relation to gender mainstreaming. In relation to the vulnerable femininity, CSDP constructs an EU protector masculinity, in turn, set against an aggressive violent masculinity in the areas where missions are deployed. Women’s bodies are absent from the CSDP and they lack agency but are nevertheless associated with a protected femininity. 

Keywords: conflict, Europe, feminism, gender equality, hegemonic masculinity

Topics: Armed Conflict, Combatants, Male Combatants, Feminisms, Gender, Masculinity/ies, Gender Roles, Gender Analysis, Femininity/ies, Gender Mainstreaming, Gendered Power Relations, Gender Equality/Inequality, Gendered Discourses, International Organizations, Military Forces & Armed Groups, Militaries, Militarization, Security, Security Sector Reform Regions: Europe

Year: 2016

Women and Weapons: Redressing the Gender Gap: A Danish Response

Citation:

Nielsen, Jenny. 2014. "Women and Weapons: Redressing the Gender Gap: A Danish Response." Bulletin of the Atomic Scientists 70 (5): 17-20.

Author: Jenny Nielsen

Abstract:

In nuclear war, women would suffer at least as much as men. But women tend to be underrepresented in fieldssuch as high-level politics, diplomacy, military affairs, and science and technologythat bear on nuclear policy. Authors from four countriesSalma Malik of Pakistan (2014), Polina Sinovets of Ukraine (2014), Reshmi Kazi of India (2014), and Jenny Nielsen of Denmarkdiscuss how women might gain greater influence on nuclear weapons policy and how their empowerment might affect disarmament and nonproliferation efforts.

Keywords: Comprehensive Nuclear Test Ban Treaty, disarmament, gender, International Atomic Energy Agency, nonproliferation, nuclear weapons, nuclear weapons policy, Rebecca Johnson, Rose Gottemoeller, women

Topics: Gender, Women, Gender Balance, Gendered Power Relations, Gender Equality/Inequality, Military Forces & Armed Groups, Militaries, Weapons /Arms Regions: Europe, Nordic states, Northern Europe Countries: Denmark

Year: 2014

Women, Violence, and Social Change in Northern Ireland and Chiapas: Societies Between Tradition and Transition

Citation:

Hoewer, Melanie. 2013. “Women, Violence, and Social Change in Northern Ireland and Chiapas: Societies Between Tradition and Transition.” International Journal of Conflict and Violence 7 (2): 216–31.

Author: Melanie Hoewer

Abstract:

Violence against women occurs in peacetime, intensifies during wartime, and continues in the aftermath of armed conflict. Women sometimes make gains during conflict and their efforts to break the pattern of violence have led to a greater awareness of gender-based violence. However, a lack of acknowledgement of transformations in gender identity at the macro-level during peace processes may create conflict in intimate partnerships. This study brings to light the complexity of changes occurring during peace processes in a multi-level analysis of women’s perceptions and positioning towards the state, their community, and their intimate partnership. This comparative analysis of fifty-seven female activists’ narratives from Chiapas and Northern Ireland demonstrates how a one-dimensional peace process (Northern Ireland) can limit the space for addressing women’s concerns, while peace processes that transcend the ethno- national dimension of conflict (Chiapas) can open a dialogue on issues of contention in male-female relationships.

Topics: Armed Conflict, Ethnic/Communal Wars, National Liberation Wars, Combatants, Domestic Violence, Ethnicity, Gender, Women, Men, Gender Roles, Gender-Based Violence, Gendered Power Relations, Gender Hierarchies, Gender Equality/Inequality, Governance, Post-conflict Governance, Military Forces & Armed Groups, Militaries, Paramilitaries, Non-state Armed Groups, Peacebuilding, Peace Processes, Post-Conflict, Post-Conflict Reconstruction, Violence Regions: Americas, North America, Europe, Northern Europe Countries: Mexico, United Kingdom

Year: 2013

Foreign Military Intervention and Women's Rights

Citation:

Peksen, Dursun. 2001. “Foreign Military Intervention and Women’s Rights.” Journal of Peace Research 48 (4): 455-68. 

Author: Dursun Peksen

Abstract:

A large body of scholarly work has been devoted to the possible consequences of foreign military intervention for the target state. This literature, however, tends to be state-centric and mostly neglects the insight from gender-specific theoretical and empirical perspectives. The purpose of this article is to examine the extent to which military intervention affects women’s rights. It is argued that unilateral interventions are prone to diminishing women’s status by encouraging the persistence or creation of repressive regimes and contributing to political disorder in the target state. If the use of armed forces ever helps or causes no damage to women’s well-being, it will likely be during interventions led by intergovernmental organizations (IGOs). This is because IGO interventions are unlikely to protect or support an authoritarian, patriarchal political system. Furthermore, such multilateral missions will increase international awareness of women’s status along with other human rights issues in the target society, thereby creating more pressure on the government to enforce women’s rights. To empirically substantiate these arguments, three different indicators that tap socio-economic and political aspects of women’s status are used, including the indices of women’s economic, political, and social rights from the Cingranelli-Richards database. The results indicate that while women’s political and economic status suffer most during unilateral US interventions, IGO interventions are likely to have a positive influence on women’s political rights. Non-US unilateral interventions, on the other hand, are unlikely to cause any major change in women’s status. Finally, military interventions in general have no major statistically significant impact on women’s social rights.

Keywords: military conflicts, foreign military intervention, women's rights

Topics: Armed Conflict, Gender, Women, Gendered Power Relations, Patriarchy, Military Forces & Armed Groups, Militaries, Rights, Women's Rights Regions: Americas, North America Countries: United States of America

Year: 2001

Assessing the Significance of Women in Combat Roles

Citation:

Trisko Darden, Jessica. 2015. "Assessing the Significance of Women in Combat Roles." International Journal: Canada’s Journal Of Global Policy Analysis 70 (3): 454-462. 

Author: Jessica Trisko Darden

Abstract:

What should we know about the roles of women in armed conflicts? I review the existing literature on women’s roles in regular and irregular conflicts to identify gaps in our understanding of the significance of female combatants. I draw on contemporary and historical cases of women’s combat participation across world regions and, in so doing, I challenge existing assumptions about the limits of women’s participation in armed conflict. Examining women as a group and expecting conflict to affect this group in predictable and easily identifiable ways only reinforces existing assumptions about women and war. To understand the range of motivations underlying women’s decisions to fight or to not fight, we should give greater attention to opportunity structures and other social conditions rather than simply assuming that women have different incentives than men.

Keywords: gender, combat, conflict, militaries, security, war, women

Topics: Armed Conflict, Combatants, Female Combatants, Gender, Women, Military Forces & Armed Groups, Militaries, Security

Year: 2015

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