Mental Health

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

Intimate Partner Violence as seen in Post-Conflict Eastern Uganda: Prevalence, Risk Factors and Mental Health Consequences

Citation:

Kinyanda, Eugene, Helen Weiss, Margaret Mungherera, Patrick Onyango-Mangen, Emmanuel Ngabirano, Rehema Kajungu, Johnson Kagugube, Wilson Muhwezi, Julius Muron, and Vikram Patel. 2016. "Intimate Partner Violence as seen in Post-Conflict Eastern Uganda: Prevalence, Risk Factors and Mental Health Consequences." BMC International Health & Human Rights 16 (5): 1-11.

Authors: Eugene Kinyanda, Helen Weiss, Margaret Mungherera, Patrick Onyango-Mangen, Emmanuel Ngabirano, Rehema Kajungu, Johnson Kagugube, Wilson Muhwezi, Julius Muron, Vikram Patel

Abstract:

Background: Conflict and post-conflict communities in sub-Saharan Africa have a high under recognized problem of intimate partner violence (IPV). Part of the reason for this has been the limited data on IPV from conflict affected sub-Saharan Africa. This paper reports on the prevalence, risk factors and mental health consequences of IPV victimization in both genders as seen in post-conflict eastern Uganda.

Methods: A cross-sectional survey was carried out in two districts of eastern Uganda. The primary outcome of IPV victimization was assessed using a modified Intimate Partner Violence assessment questionnaire of the American Congress of Obstetricians and Gynecologists.

Results: The prevalence of any form of IPV victimization (physical and/or sexual and/or psychological IPV) in this study was 43.7 % [95 % CI, 40.1-47.4 %], with no statistically significant difference between the two genders. The factors significantly associated with IPV victimization were: sub-county (representing ecological factors), poverty, use of alcohol, and physical and sexual war torture experiences. The mental health problems associated with IPV victimization were probable problem alcohol drinking, attempted suicide and probable major depressive disorder.

Conclusion: In post-conflict eastern Uganda, in both genders, war torture was a risk factor for IPV victimization and IPV victimization was associated with mental health problems.

Keywords: Intimate partner violence, post-conflict, Africa, risk factors, Mental health consequences

Topics: Armed Conflict, Domestic Violence, Economies, Poverty, Health, Mental Health, Trauma, Post-Conflict, Sexual Violence, Torture, Sexual Torture Regions: Africa, East Africa Countries: Uganda

Year: 2016

A Grounded Theory Investigation Into the Experiences of African Women Refugees: Effects on Resilience and Identity and Implications for Service Provision.

Citation:

Sherwood, Katie, and Helen Liebling-Kalifani. 2012. “A Grounded Theory Investigation Into The Experiences Of African Women Refugees: Effects On Resilience And Identity And Implications For Service Provision1.” Journal of International Women’s Studies 13 (1): 86-108.

Authors: Katie Sherwood, Helen Liebling-Kalifani

Abstract:

The current study aims to explore African women’s experiences of violence during conflict. The research was undertaken in 2009 in part fulfilment for a Doctorate degree in Clinical Psychology. Previous research on women refugees’ experiences has focused on the negative impact on psychological functioning despite indications that they show great strength and resilience. Using qualitative methods the study sought to identify the impact of violence on mental health as well as develop a greater understanding of the roles of resilience, coping and identity. Women from Somalia and Zimbabwe who attended a refugee centre in the UK were interviewed; analysis of the results identified a relationship between resilience, access to rights and support and identity. It also recognised cultural and societal influences and experiences in the United Kingdom as contributing factors. Findings support the move toward a more holistic model of understanding refugee women’s experiences. However, the study also reveals the importance of support and treatment assisting women to utilise their resilience in reconstructing their identities from traumatic events and recovery process.

Keywords: women, refugees, trauma, Africa, gender based violence

Topics: Displacement & Migration, Refugees, Gender-Based Violence, Health, Mental Health, Trauma, Humanitarian Assistance, Context-Appropriate Response to Trauma, Rights, Violence Regions: Africa, East Africa, Southern Africa, Northern Europe Countries: Somalia, United Kingdom, Zimbabwe

Year: 2012

Precious Resources: Adolescents in the Reconstruction of Sierra Leone : Participatory Research Study with Adolescents and Youth in Sierra Leone, April-July 20

Citation:

Lowicki, Jane, Allison A Pillsbury, and Women’s Commission for Refugee Women and Children. 2002. Precious Resources: Adolescents in the Reconstruction of Sierra Leone : Participatory Research Study with Adolescents and Youth in Sierra Leone, April-July 2002. New York, N.Y.: Women’s Commission for Refugee Women and Children.

Authors: Jane Lowicki, Allison A. Pillsbury

Annotation:

TABLE OF CONTENTS

Introduction pg. 1

Chapter II. Executive Summary pg. 3

Chapter III. Map pg.  9 

Chapter IV. Adolescence and Youth: A Community in Crisis pg. 10

Chapter V. Education: A Linchpin for Peace and Recovery pg. 14

Chapter VI. Livelihood: Young People Need Skills and Jobs pg. 22

Chapter VII. Health: Myth Versus Reality pg. 26

Chapter VIII. Protection: Few Resources, Many Categories of Vulnerability pg. 36

Chapter IX. Psychosocial: Moving Beyond Manipulation and Abuse pg. 55

Chapter X. Survey Results: Education, Poverty and Health Care Are Top Concerns pg. 64

Chapter XI. Adolescent Researchers Lead the Study: Methodology and Lessons Learned pg. 80

Chapter XII. International, Regional, National and Local Responses to Adolescent and Youth Concerns pg. 90

Chapter XIII. Recommendations pg. 101

Chapter XIV. Appendices pg. 108

Sierra Leone: Glossary of Key Players and Other Basics pg. 108

Methodological Materials pg. 112

Task Force on Protection From Sexual Exploitation and Abuse in Humanitarian Crises pg.117

Youth Organizations pg. 118

Acronyms pg. 120

Chapter XV. Endnotes pg. 122

Topics: Age, Youth, Gender, Girls, Boys, Health, Mental Health, Post-Conflict, Post-Conflict Reconstruction, Sexual Violence, Sexual Exploitation and Abuse Regions: Africa, West Africa Countries: Sierra Leone

Year: 2002

Possible Contributions of a Psychology of Liberation: Whither Health and Human Rights?

Citation:

Lykes, M. Brinton. 2000. “Possible Contributions of a Psychology of Liberation: Whither Health and Human Rights?” Journal of Health Psychology 5 (3): 383–97.

Author: M. Brinton Lykes

Abstract:

This article explores the possible contributions of a psychology of liberation for the practice of health psychology. It explores alternative psychological 'practices', for example participatory action research, with groups historically marginalized from access to power and resources. Selected lenses for crafting a liberatory psychology include: discourse of human rights and mental health; cultural and constructivist psychological theory; and reflexivity. Specific examples from the author's work with Mayan women in rural Guatemala in the context of ongoing war and subsequent efforts at peace building are discussed to clarify possible contributions of psychologists committed to accompanying local communities in creating more just futures. Selected challenges and contradictions encountered in this work are discussed.

Keywords: health, human rights, liberatory psychology

Topics: Armed Conflict, Gender, Women, Health, Mental Health, Peacebuilding, Rights, Human Rights Regions: Americas, Central America Countries: Guatemala

Year: 2000

The Gendered Nature of Education under Siege: A Palestinian Feminist Perspective

Citation:

Shalhoub-Kevorkian, Nadera. 2008. “The Gendered Nature of Education under Siege: A Palestinian Feminist Perspective.” International Journal of Lifelong Education 27 (2): 179–200.

Author: Nadera Shalhoub-Kevorkian

Abstract:

Military occupation affects educational space and places, transforming them into politicized, sexed, gendered, and racialized ones. The uncontrolled political violence in conflict zones causes psychological trauma, internal displacement and economic stagnation, and intersect to shape the gendered nature of education. This article is based on data collected from young Palestinian women in the Occupied Palestinian Territories between 2004–2007. Its theoretical background departs from the perspective that women's education in conflict zones is simultaneously a site of empowerment, resistance, and victimization. As such, the article demonstrates that the personal is political, and highlights how education can be both a source of consciousness-raising and a powerful mobilizing force for young women while simultaneously being oppressive in nature. The results show that the covert and overt acts of political violence against Palestinians has transformed Palestinian gender relations in complex, contradictory, and diverse ways while both militarizing and violating their right to education. In addition, the article argues that the study of gender and education requires close attention to women's words and acts in order to identify revolutionary modes of resistance that are capable of promoting social justice. It concludes by arguing that the daily terror facing young women on their way to school, the systematic denial of school permits, and other actions that interfere with their right to obtain an education not only necessitates the re-conceptualization of education conceived as a neutral zone and separated from the politics of the state, but also requires a close scrutiny of the gendered nature of education under siege. 

Topics: Armed Conflict, Occupation, Education, Gender, Women, Girls, Gender-Based Violence, Health, Mental Health, Military Forces & Armed Groups, Rights, Violence Regions: MENA, Asia, Middle East Countries: Palestine / Occupied Palestinian Territories

Year: 2008

Palestinian Women’s Voices Challenging Human Rights Activism

Citation:

Shalhoub-Kevorkian, Nadera, and Sana Khsheiboun. 2009. “Palestinian Women’s Voices Challenging Human Rights Activism.” Women’s Studies International Forum 32 (5): 354–62. doi:10.1016/j.wsif.2009.07.012.

Authors: Nadera Shalhoub-Kevorkian, Sana Khsheiboun

Abstract:

A recent study in the Occupied Territories has shown that the most vulnerable groups of society (women, children, and the elderly) are psychologically influenced by the attacks on Palestinian home and land. Psychological and sociological research in Gaza has shown that women suffer the most from psychosomatic problems, while the children and the elderly are subject to depression, severe trauma, and post-traumatic stress disorder. Women's testimonies in the region have demonstrated their capacity to protect themselves, their work, and even their studies despite the dangers involved. These appear to heighten women's defensive mechanisms for facing continuously aggressive acts and practices. Women's stories about homelessness and loss are mainly constructed through their own understanding that the attack on the Palestinian home is part of a larger trend of dominating military forces against the Palestinian ‘Other’. Women have maintained that the destruction of their homes hindered their own progress especially in the domain of protecting family unity, and they have concluded that it is precisely the goal of such policies to destabilize society in this manner. This article uses case studies and interviews with Palestinian women to support a socio-political analysis of this particular situation in the Occupied Territories.

Topics: Armed Conflict, Gender, Women, Health, Mental Health, PTSD, Trauma, Rights, Human Rights Regions: MENA, Asia, Middle East Countries: Palestine / Occupied Palestinian Territories

Year: 2009

Stress, Mental Health, and Burnout in National Humanitarian Aid Workers in Gulu, Northern Uganda

Citation:

Ager, Alastair, Eba Pasha, Gary Yu, Thomas Duke, Cynthia Eriksson, and Barbara Lopes Cardozo. 2012. “Stress, Mental Health, and Burnout in National Humanitarian Aid Workers in Gulu, Northern Uganda.” Journal of Traumatic Stress 25 (6): 713–20. doi:10.1002/jts.21764.

Authors: Alastair Ager, Eba Pasha, Gary Yu, Thomas Duke, Cynthia Eriksson, Barbara Lopes Cardozo

Abstract:

This study examined the mental health of national humanitarian aid workers in northern Uganda and contextual and organizational factors predicting well-being. A cross-sectional survey was conducted among 376 national staff working for 21 humanitarian aid agencies. Over 50% of workers experienced 5 or more categories of traumatic events. Although, in the absence of clinical interviews, no clinical diagnoses were able to be confirmed, 68%, 53%, and 26% of respondents reported symptom levels associated with high risk for depression, anxiety disorders, and posttraumatic stress disorder (PTSD), respectively. Between one quarter and one half of respondents reported symptom levels associated with high risk regarding measured dimensions of burnout. Female workers reported significantly more symptoms of anxiety, depression, PTSD, and emotional exhaustion than males. Workers with the United Nations and related agencies reported fewest symptoms. Higher levels of social support, stronger team cohesion, and reduced exposure to chronic stressors were associated with improved mental health. National humanitarian staff members in Gulu have high exposure to chronic and traumatic stress and high risk of a range of poor mental health outcomes. Given that work-related factors appear to influence the relationship between the two strategies are suggested to support the well-being of national staff working in such contexts.

Topics: Gender, Women, Gender Roles, Gender Analysis, Health, Mental Health, PTSD, Trauma, Humanitarian Assistance Regions: Africa, East Africa Countries: Uganda

Year: 2012

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