Staff Perspective: Beginning to Fill the Void - Recent Publications on Healthcare Experiences in LGBTQ Service Members

Staff Perspective: Beginning to Fill the Void - Recent Publications on Healthcare Experiences in LGBTQ Service Members

Dr. Jenny Phillips

A frequent question that we receive during our Military Family trainings (i.e., workshops on working with military families, couples, and children) is some version of “What about LGBTQ individuals?”. Participants want to know if there are statistics specific to LGBTQ populations or if the research and statistics that we provide come from samples that are inclusive of LGBTQ individuals. They are curious about the experiences of LGBTQ service members or if there are targeted options to better support their military-connected LGBTQ clients. And, as discussed in a previous blog about how military families are defined for research purposes, the answer to these questions is often “No” or, more generously, “Not yet”.

But there are indications of change within the literature. Research is becoming more inclusive and both researchers and providers are more likely to recognize the need for more information and resources for our increasingly diverse military service members and families. One area that has seen recent expansion within the literature is that of the relationship between gender and sexual diversity (GSD) and the health and healthcare experiences of individuals in the military. With an estimated 85,000+ individuals on active duty who identify as lesbian, gay or bisexual and nearly 9,000 active duty service members who identify as transgender or queer (Meadows et al., 2021), the need for a better understanding of their healthcare experiences is critical.

In just the past year (2022), several articles providing information about the health care experiences of LGBTQ service members have been published. A selection of these publications include:

  • Oblea and colleagues (2022a) published a recent commentary in Military Medicine that reviews both the history of GSD service members as well as a variety of health care variables (i.e., utilization, outcomes, disparities, challenges) that have been impacted by their identities and experiences in the military. In addition to a brief review of the literature in these areas, the authors also suggest strategies to improve healthcare for LGBTQ service members and to advance research for appropriate care within the military.
  • Parallel to this commentary, Oblea also worked with a second group of researchers to publish findings from a qualitative analysis of survey responses from lesbian, gay, transgender and queer Veterans, focusing on their healthcare experiences in the military (Oblea et al., 2002b). This effort identified five primary themes related to LGBTQ service members’ experiences with military healthcare: identity, negative experiences, impact of experiences, policy, and positive experiences. The authors provide examples of participant responses relevant to each of the themes and discuss the potential implications for military healthcare moving forward.
  • Carey and colleagues (2022) also examined survey data, analyzing responses from the 2016 Millennium Cohort Study follow-up questionnaire to assess the relationships between sexual identity, military experiences, and service separation experiences in lesbian, gay, and bisexual (LGB) individuals. Concluding that less positive military- and separation-specific experiences disproportionately affected LGB service members, the authors provided commentary on the potential role of healthcare experiences in this disparity as well as recommendations for how to improve experiences for LGB individuals.

A common conclusion of these recent studies and reviews was the need for better training in cultural sensitivity among the military and civilian healthcare providers supporting GSD and LGBTQ service members. Consistent with this identified need, Oblea and colleagues (2022c) also published a paper examining outcomes for a specialized training in LGBTQ cultural sensitivity for both civilian and military healthcare personnel. The training, a four-hour module entitled Delivering Culturally Sensitive Care to LGBT+ Patients: An Advocacy Program, was first created in 2017 and has been successfully implemented in a variety of civilian settings. The authors reported significant increases in knowledge and skills, openness and support, and oppression awareness for the training participants, a group that included psychologists, social workers, and counselors, among other health professionals. These findings complement previous studies of similar, but shorter and less comprehensive trainings with similarly positive outcomes in military samples (e.g., Shrader et al., 2017, Kaiafas et al., 2021).

This sampling of relevant 2022 articles present a nice snapshot of the state of the research on healthcare experiences and LGBTQ+ individuals in the military; it spans historical commentary, research on the relationship between sexual and gender identities and health experiences, and recommendations and efforts to address disparities and inequities in military healthcare for this population. It also represents a significant step forward in an area where literature searches just 5-10 years ago yielded few, if any, results.

As a CDP trainer, I am excited to have new publications to read and share during our trainings and answers to more of our participants questions; as someone in the field of behavioral health, I am heartened to see the progress being made towards understanding and providing better healthcare experiences for ALL of our service members and their families.

The opinions in CDP Staff Perspective blogs are solely those of the author and do not necessarily reflect the opinion of the Uniformed Services University of the Health Science or the Department of Defense.

Jenny Phillips, Ph.D., is the Assistant Director of Evaluation for the Center for Deployment Psychology (CDP) at the Uniformed Services University of the Health Sciences in Bethesda, MD.

Meadows, S.O., Engel, C.C., Collins, R.L. et al., (2021). 2018 Department of Defense
Health Related Behaviors Survey (HRBS).

Oblea, P. N., & Siaki, L. A. (2022). Looking back, a view to the future of the health and readiness
of gender and sexual diverse US service members. Military Medicine.

Oblea, P. N., Adams, A. R., Nguyen-Wu, E. D., Hawley-Molloy, J. S., Balsam, K., Badger, T. A.,
Witwer, A. R., & Cartwright, J. (2022). Lesbian gay bisexual transgender and queer health-care
experiences in a military population
. Journal of Homosexuality, 1-21.

Carey, F. R., Jacobson, I. G., Lehavot, K., LeardMann, C. A., Kolaja, C. A., Stander, V. A., & Rull, R. P.
(2022). Military service experiences and reasons for service separation among lesbian, gay, and
bisexual individuals in a large military cohort. BMC Public Health, 22(1), 1-13.

Oblea, P. N., Bathan, N. Q., Gaa, C. A., Lustik, M. B., Tartavoulle, T. M., Nguyen-Wu, E. D., & Siaki,
L. A. (2022). Outcomes of LGBTQ culturally sensitive training among civilian and military
healthcare personnel. Journal of Public Health.

Shrader, A., Casero, K., Casper, B., Kelley, M., Lewis, L., & Calohan, J. (2017). Military lesbian, gay,
bisexual, and transgender (LGBT) awareness training for health care providers within the military
health system. Journal of the American Psychiatric Nurses Association, 23(6), 385-392.

Kaiafas, K. N., & Kennedy, T. (2021). Lesbian, gay, bisexual, transgender, queer cultural
competency training to improve the quality of care: an evidence-based practice project. Journal
of Emergency Nursing
, 47(4), 654-660.