By Lieutenant Nicholas Grant, Ph.D., ABPP
June 10, 2022

DOD Graphic

A pivotal moment in the Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) Rights Movement started early in the morning of June 28, 1969, at the Stonewall Inn, a New York City bar where members of the community often gathered. The events that took place that evening and the subsequent five days of local protests are often identified as where Pride began and are the reason June is celebrated as LGBTQ Pride Month in the United States each year. Today, Pride celebrations draw millions of people and often include parades, memorials, and other events that both remember those who have lost their lives to HIV/AIDS or hate crimes, and celebrate the impact that LGBTQ people have had on history around the world.

Less commonly known about this history is that Marsha P. Johnson and Sylvia Rivera, two transgender women of color, emerged from the Stonewall uprising as leaders in what was then known as the Gay Liberation Movement. Johnson and Rivera became the first trans women of color to lead an organization in the United States when they founded Street Transvestite Action Revolutionaries (STAR) and STAR House, the first LGBTQ youth shelter in North America. They were motivated by their recognition of the increased risks of danger for LGBTQ youth in New York City, and, more specifically, for transgender youth, who were often faced with discrimination and prejudice, family rejection, and homelessness.

Johnson and Rivera's early insights are strong examples of examining societal influence on marginalized groups. Today, the current prevailing theory used when conducting research and informing care with members of the LGBTQ community remains the minority stress theory. It puts forth that the stressors faced by marginalized communities are unique, chronic, and socially based, and increased experience of such stressors contribute to greater risk of psychological distress and physical health issues. As the field of LGBTQ health has expanded over time, increased research funding has granted a more robust understanding of the unique needs and experiences of LGBTQ individuals, including the health disparities they may face. While there is limited data on LGBTQ military personnel, it is notable that they experience similar stressors to the larger LGBTQ community while also serving on active duty. Understanding the specific mental health needs of the community at large can help inform the care and support provided to LGBTQ service members and help strengthen care quality within the military health care system.

The following are current key highlights from the field at large that should be taken into consideration when working with individuals who belong to both LGBTQ and military communities:

Demographics

• 4.5% of adults in the U.S. identify as LGBTQ. The previous estimate was 10%; however, research has shown this to be an overestimate.¹

• 6.1% of military personnel identify as LGBTQ.²

• 8.2% of Millennials (born between 1980 and 1999) identify as LGBTQ, compared to 3.5% of Generation X individuals (born between 1965 and 1979)³

Mental Health Disparities

• LGBTQ people are more than twice as likely as their heterosexual counterparts to experience a mental health disorder in their lifetime.¹

• LGBTQ teens are six times more likely to report symptoms of depression than their heterosexual peers.⁴

• LGBTQ youth are more than twice as likely to report the experience of suicidal ideations and over four times as likely to attempt suicide compared to their heterosexual peers.⁵

• LGBTQ older adults may face both anti-LGBTQ stigma and ageism. Approximately 31% of LGBTQ older adults report depressive symptoms; 39% report serious thoughts of taking their own lives.⁶

• 48% of transgender adults report that they have considered suicide in the last year, compared to 4% of the overall U.S. population.⁷

• There is no scientific evidence that conversion therapies, or change-efforts aimed at changing one's sexual orientation or gender identity, are effective. While research has been limited on these abusive practices, what does exist has consistently included anecdotal reports of harm from such efforts.⁸

Access to Care

• LGBTQ individuals engage with mental health services at a higher rate than their heterosexual peers.⁹

• Approximately 8% of LGBTQ individuals and nearly 27% of transgender individuals report being denied needed health care outright.¹⁰

• Stigma, lack of cultural competency, and unconscious and conscious bias all impact the effectiveness of mental health care.¹¹

• An area for growth within military mental health care specifically lies in training and education on the provision of gender-affirming care for transgender services members.

Queer Identities

While the term "queer" was once weaponized against LGBTQ people, it has been reclaimed by many within the community. When coming from an affirming place, it is often seen as an umbrella term that can describe someone who self-identifies as LGBTQ, or sexual orientation and gender identity that do not match other commonly used labels or identities. Queer identities can include:

• Questioning: The process or experience of a person exploring their sexual orientation and/or gender identity.

• Asexual: A term used by people who do not experience sexual attraction.

• Aromantic: A term used by people who do not experience romantic attraction.

• Pansexual: A term used by people who are attracted to multiple or many genders.

• Genderqueer: Another umbrella term used to describe gender identity that does not conform to the male-female gender binary.

LGBTQ Resources

The Behavioral Health of Minority Active Duty Service Members (Sponsored by PHCoE)
https://www.rand.org/pubs/research_reports/RR4247.html

LGBTQI+ Health & Well-being from the U.S. Department of Health & Human Services
https://www.hhs.gov/programs/topic-sites/lgbtqi/index.html

Lesbian, Gay, Bisexual, Transgender, Queer, and Intersex (LGBTQI+) from the Substance Abuse and Mental Health Services Administration (SAMHSA)
https://www.samhsa.gov/behavioral-health-equity/lgbtqi

LGBT Resources from MyNavy HR
https://www.mynavyhr.navy.mil/Support-Services/21st-Century-Sailor/LGBT-Resources/

Legal and Financial Consideration for Lesbian and Gay Service Members from Military OneSource
https://www.militaryonesource.mil/financial-legal/legal/other-legal-issues/legal-and-financial-considerations-for-lesbian-and-gay-service-members/

LGBTQ in the Military: A Brief History, Current Policies and Safety from Military One Source
https://www.militaryonesource.mil/military-life-cycle/friends-extended-family/lgbtq-in-the-military/

LGBT Service Members and Veterans from the U.S. Department of Veterans Affairs
https://www.benefits.va.gov/persona/lgbt.asp

References

1. Newport, F. (2018, May 22). In U.S., estimate of LGBT population rises to 4.5 percent. Gallup. https://news.gallup.com/poll/234863/estimate-lgbt-population-rises.aspx
2. Meadows, Sarah O., Charles C. Engel, Rebecca L. Collins, Robin L. Beckman, Matthew Cefalu, Jennifer Hawes-Dawson, Molly Waymouth, Amii M. Kress, Lisa Sontag-Padilla, Rajeev Ramchand, and Kayla M. Williams, 2015 Health Related Behaviors Survey: Sexual Orientation, Transgender Identity, and Health Among U.S. Active-Duty Service Members, Santa Monica, Calif.: RAND Corporation, RB-9955/6-OSD, 2018. As of May 16, 2022: https://www.rand.org/pubs/research_briefs/RB9955z6.html
3. Medley, G., Lipari, R. N., Bose, J., Cribb, D. S., Kroutil, L. A., & McHenry, G. (2016, Oct.). Sexual orientation and estimates of adult substance use and mental health: Results from the 2015 National Survey on Drug Use and Health. NSDUH Data Review. Retrieved from https://www.samhsa.gov/data/
4. LGBTQ+ communities: Anxiety and Depression Association of America, ADAA. LGBTQ+ Communities | Anxiety and Depression Association of America, ADAA. https://adaa.org/lgbtq-communities
5. Human Rights Campaign Foundation. (n.d.). Mental health and the LGBTQ Community. https://suicidepreventionlifeline.org/wp-content/uploads/2017/07/LGBTQ_MentalHealth_OnePager.pdf
6. Fredriksen-Goldsen, K. I. (2011). Resilience and disparities among lesbian, gay, bisexual, and transgender older adults. The Public policy and aging report, 21 (3), 3.
7. National Center for Transgender Equality. (2016). The report of the 2015 U.S. Transgender Survey. https://transequality.org/sites/default/files/docs/usts/USTS-Full-Report-Dec17.pdf
8. Flentje, A., Heck, N. C., & Cochran, B. N. (2013). Sexual reorientation therapy interventions: Perspectives of ex-ex-gay individuals. Journal of Gay & Lesbian Mental Health,17(3), 256-277.
9. Platt, L. F., Wolf, J. K., & Scheitle, C. P. (2018). Patterns of mental health care utilization among sexual orientation minority groups. Journal of Homosexuality, 65(2), 135-153
10. National Women's Law Center. (2014). Health care refusals harm patients: The threat to LGBT people and individuals living with HIV/AIDS. Retrieved from https://nwlc.org/resource/health-care-refusals-harm-patients-threat-lgbt-people-and-individuals-living-hivaids/
11. Sabin, J. A., Riskind, R. G., & Nosek, B. A. (2015). Health care providers' implicit and explicit attitudes toward lesbian women and gay men. American Journal of Public Health 105(9), 1831-1841: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4539817/

Lieutenant Grant is a board-certified clinical psychologist serving in the U.S. Navy as the Group Psychologist for Commander, Naval Surface Group Middle Pacific in Pearl Harbor, Hawaii. He additionally serves as the current President of GLMA: Health Professionals Advancing LGBTQ Equality. He is a fellow of the American Psychological Association, as well as Divisions 9, 19 and 44.