Health Care Access Linked to Lower PTSD Burden in LGBTQ+ US Military Recruits
Key Takeaways
- Among lesbian, gay, bisexual, transgender, and queer (LGBTQ+) US military recruits (mean age 22.6), 61.4% reported trauma exposure and 24.4% met criteria for probable post-traumatic stress disorder (PTSD); sexual assault was the most common trauma and linked to greater symptom severity.
- Bisexual cisgender women had nearly fourfold higher odds of probable PTSD vs lesbian/gay/queer peers, identifying a high-risk subgroup.
- Greater access to general health care and openness with providers were associated with lower PTSD symptom severity and reduced likelihood of diagnosis.
Among LGBTQ+ US military recruits, better general health care access was linked to lower PTSD burden, while bisexual cisgender women emerged as a group at especially high risk for probable PTSD, according to study results published in the Journal of Traumatic Stress.
“This cross-sectional secondary analysis examined how demographic characteristics and structural factors relate to PTSD symptom severity and probable diagnosis among LGBTQ+ community adults recruited from urban and rural US regions,” explained the study’s authors.
Study Overview and Population
Researchers analyzed baseline data from 133 participants recruited between October 2019 and January 2021 through university participant pools, LGBTQ+-friendly social media, listservs, and community flyers. The sample was nearly evenly split between rural Maine (n = 68) and urban New York City (n = 65), with a mean age of 22.6 years. Participants most often identified as cisgender women, bisexual, and White.
Trauma Exposure and PTSD Prevalence
Overall, 61.4% of participants reported a DSM-5 Criterion A traumatic event, and 24.4% met criteria for a probable PTSD diagnosis. Sexual assault was the most commonly reported trauma type, accounting for 52.6% of index traumatic events, and was primarily reported by cisgender LGBQ+ women and transgender or gender-diverse participants. Participants who reported sexual assault had higher PTSD symptom severity scores than those reporting other trauma types, with mean scores of 23.9 vs 17.4.
Contrary to the researchers’ initial hypothesis, rural participants did not show significantly higher PTSD burden than urban participants. Rural participants had somewhat higher PTSD symptom severity scores than urban participants, with mean scores of 22.9 vs 15.6, but this difference did not reach statistical significance. Probable PTSD diagnosis rates were also not significantly different, at 29.3% in rural participants and 18.9% in urban participants.
Instead, the strongest signals came from identity and health care factors. PTSD symptom severity was significantly higher among cisgender women than cisgender men, and bisexual participants reported higher symptom severity than those in the combined lesbian, gay, and queer reference group. A significant interaction between gender identity and sexual orientation showed that bisexual cisgender women faced a particularly elevated risk. In the adjusted logistic model, bisexual cisgender women had nearly fourfold higher odds of probable PTSD diagnosis compared with the reference group (adjusted odds ratio, 3.96; 95% CI, 1.15-13.7; P =.030).
Higher general health care access was associated with lower PTSD symptom severity and 50% lower odds of a probable PTSD diagnosis (adjusted odds ratio, 0.50; 95% CI, 0.29-0.84; P =.009). Greater LGBTQ+ identity disclosure to health care providers was also associated with lower symptom severity.
Clinical Implications and Future Directions
“The findings reveal that bisexual cisgender women reported higher odds of a probable PTSD diagnosis, underscoring the urgency of addressing trauma-related disparities among bisexual cisgender women,” concluded the study authors.
Reference
Kenyon EA, Stage MA, Kiefer R, et al. Associations between health care access and posttraumatic stress disorder symptoms among rural and urban lesbian, gay, bisexual, transgender, and queer adults. J Trauma Stress. doi:10.1002/jts.70039
