Higher Rates of Mental Health Problems in Transgender Veterans

Among military veterans identifying as transgender, 90 percent have at least one mental health diagnosis, such as posttraumatic stress disorder (PTSD) or depression, and nearly 50 percent had a hospitalization after a suicide attempt or suicidal thoughts. These study findings, from a single veterans’ hospital, will be presented Friday at The Endocrine Society’s 98th annual meeting in Boston.

“As more of our active military returns from deployment and transitions to veteran status, the health care system will be faced with treating more transgender veterans who have mental health issues,” said principal investigator Marissa Grotzke, MD, an endocrinologist at Salt Lake City Veterans Affairs Medical Center (VAMC), Salt Lake City.

Compared with the general U.S. population, the military and its veterans have a fourfold higher rate of gender dysphoria, according to Grotzke. Formerly called gender identity disorder, gender dysphoria is substantial distress associated with nonconformity to one’s assigned sex.

Patients with gender dysphoria have unique health care concerns, Grotzke said. In general, they have high rates of depression, anxiety and suicidal thoughts. Past research also has shown high rates of mental health disorders in military veterans, including PTSD and depression. Less is known, however, about the mental health of veterans with gender dysphoria, she noted.

By examining medical records at Salt Lake City VAMC between January 1, 2014, and October 1, 2015, Grotzke and her colleagues found 39 patients who had a diagnosis of gender dysphoria. Eight transgender patients identified as transitioning from female to male, and the other 39 as male-to-female. They included both combat and noncombat veterans and ranged in age from 21 to 68 years.

The researchers then searched the medical records for mental health conditions that coexisted with the gender dysphoria. They found that PTSD was the most commonly identified mental health diagnosis, affecting 46 percent of these veterans, followed by depression in 41 percent. Tobacco use disorder reportedly occurred in one-third, and anxiety was present in 15 percent. Nine patients (23 percent) had other substance abuse, bipolar disorder or schizotypal personality disorder.

Diagram of the hippocampus.
Compared with the general U.S. population, the military and its veterans have a fourfold higher rate of gender dysphoria, according to Grotzke. Formerly called gender identity disorder, gender dysphoria is substantial distress associated with nonconformity to one’s assigned sex. Image is in the public domain.

Eighteen patients (46 percent) carried two or more mental health diagnoses, according to the researchers. Only four patients (10 percent) with gender dysphoria had no additional mental health problem.

“These findings highlight the need to improve the quality of care for our transgender veterans,” Grotzke said.

To address these concerns, the Salt Lake City VAMC formed a multidisciplinary gender dysphoria team composed of an endocrinologist, mental health professional, pharmacist, speech therapist and vocational rehabilitation providers. Team members meet together twice a month to discuss patients and treatment plans, which Grotzke said already has been “very beneficial” for patients.

Probably multiple reasons exist for the increased rates of mental health disorders they observed in transgender veterans. Grotzke said that traumatic brain injuries sustained in combat, military sexual abuse, and stigma related to gender struggles are common in this population.

About this psychology research

The research report has been accepted for publication in the Journal of Physiology, a respected journal both in the field of neurosciences as well as physiology.

Funding: Research on the connection between physical exercise and the preconditions for learning is continued in the AFIS consortium funded by the Academy of Finland.

Source: Jenni Gingery – Endocrine Society
Image Credit: The image is in the public domain
Original Research: The research will be presented at the The Endocrine Society’s 98th annual meeting in Boston.

Abstract for “Prevalence of Co-Morbid Mental Health Diagnoses in Transgender Military Veterans at the Salt Lake City Veterans Affairs Medical Center” by Marissa Paige Grotzke, Breeze Hannaford, Melissa Brewster, Ken Adamson, Nathan Askerlund, Tiffany Atkinson, Misty Guevara, Brandon Gwilliam, Joan Hadley, Cynthia Hudgens, Cheryl Kaye, Robin Lines, Jo Merrill, Alan Morris and Amber Taylor, Veterans Health Administration Salt Lake City Health Care System, Salt Lake City, UT, and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT is available at the ENDO 2016 website.


Abstract

Prevalence of Co-Morbid Mental Health Diagnoses in Transgender Military Veterans at the Salt Lake City Veterans Affairs Medical Center.

Introduction: Although a relatively uncommon medical condition, individuals with Gender Identity Disorder (GID) have unique concerns related to health care. Studies show higher rates of GID in the military and its veterans than the general American population, with most recent estimates suggesting a rate of GID in patients in the Veterans Affairs Health Care System (VAHCS) of 22.9/100,000 persons compared to 4.3/100,000 persons in the general population. High rates of depression and other mental health disorders are documented in veterans; those with GID are particularly at risk. Notably, estimated rates of suicide-related events among GID veterans are 20 times higher than the general VAHCS population. Mental health disorders frequently contribute to decreased compliance with medical therapies, complicating GID management.

Objectives: To address these concerns, we recently formed a multi-disciplinary Gender Dysphoria Team with endocrinology, mental health, pharmacy, speech therapy, and vocational rehab providers at the Salt Lake City Veterans Affairs Medical Center (SLC VAMC). Providers meet with patients individually and bi-monthly as a team to discuss patients and treatment plans. We defined baseline characteristics of mental health diagnoses in our population.

Methods: We examined SLC VAMC electronic medical records between January 1, 2014 and October 1, 2015 for encounters using the ICD-9 code for Gender Identity Disorder in Adolescents or Adults. Charts with the code were then examined for ICD-9 codes for tobacco use disorder, posttraumatic stress disorder (PTSD), depression, and anxiety-related conditions. Other ICD-9 codes for mental health diagnoses and suicide attempt/ideation requiring crisis contact were noted.

Results: Thirty-nine patients were found with the GID ICD-9 code. Of those, 31 (79.5%) identified as male-to-female, 8 (20.1%) female-to-male; 19 (48.7%) had a history of suicide attempt/ideation. PTSD was the most commonly identified mental health diagnosis (18/39 (46.1%)), depression second (16 (41.0%)), followed by tobacco use disorder (13 (33.3%)), other (substance abuse, bipolar disorder, schizotypal disorder) (9 (23.1%)), and anxiety (6 (15.4%)). When further examined, four (10.2%) patients were identified as having no mental health co-morbidities, 17 (42.6%) carried one mental health diagnosis and 18 (46.2%) carried 2 or more diagnoses (maximum number documented in one patient: 4 (10.2%)).

Conclusions: Of patients with GID at the SLC VAMC, 90% have mental health co-morbidities, nearly 50% having two or more diagnoses. Nearly 50% required intervention for suicide attempt/ideation. We have formed the multi-disciplinary Gender Dysphoria Team in an effort to reduce the impact of these diagnoses on the management of GID, however, further research into the optimization of management for this population is still needed.

“Prevalence of Co-Morbid Mental Health Diagnoses in Transgender Military Veterans at the Salt Lake City Veterans Affairs Medical Center” by Marissa Paige Grotzke, Breeze Hannaford, Melissa Brewster, Ken Adamson, Nathan Askerlund, Tiffany Atkinson, Misty Guevara, Brandon Gwilliam, Joan Hadley, Cynthia Hudgens, Cheryl Kaye, Robin Lines, Jo Merrill, Alan Morris and Amber Taylor, Veterans Health Administration Salt Lake City Health Care System, Salt Lake City, UT, and Salt Lake City Veterans Affairs Medical Center, Salt Lake City, UT is available at the ENDO 2016 website.

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