Pride in all Who Served: Development, Feasibility, and Initial Efficacy of a Health Education Group For LGBT Veterans

ABSTRACT

Many of the more than 1 million military veterans who identify as lesbian, gay, bisexual, and/or transgender (LGBT) have encountered “rejecting experiences in the military” and stigma from prior “Don’t Ask Don’t Tell” policies. Associated minority stress and social isolation have been linked to a disproportionate risk for depression and suicide, as well as a reluctance to seek medical care at Veterans Health Administration (VHA) facilities. This paper describes feasibility and preliminary outcomes of the newly developed, Pride in All Who Served Health Education Group created to meet the unique needs of sexual and gender minority veterans. The 10-week, closed, health education group (e.g., continuums of identity, military culture) enables open dialogue, fosters social connectedness, and empowers veterans to be more effective self-advocates within the healthcare system. Feedback from formative evaluations (n = 29 LGBT veterans and n = 25 VHA stakeholders) was incorporated before conducting a small scale, non-randomized pilot. Preliminary pre-post surveys (n = 18) show promise (i.e., Cohen’s d range ± 0.40 to 1.59) on mental health symptoms (depression/anxiety, suicidal ideation), resilience indicators (identity affirmation, community involvement, problem-focused coping), and willingness to access care within the VA system (satisfaction with VA services, perception of staff competence). Results suggest that the 10-week Pride Group may be an effective tool for addressing minority-related stress in LGBT veterans. A full-scale, randomized clinical trial of this intervention is needed to determine short and long-term impacts on clinical and healthcare access-related outcomes.

KEYWORDS:

• Veterans
• sexual orientation
• gender identity
• stigma
• coping
• health services
• resilience

Acknowledgments

This work was supported in part by the Spark-Seed-Spread Innovation Investment Program [FY18, ID# a55t0000000PBMI] from the United States (U.S.) Department of Veterans Affairs Innovation Network. It is also the result of work supported with resources and the use of facilities at the Hampton VA Medical Center in Hampton, Virginia and the Tuscaloosa VA Medical Center in Tuscaloosa, AL. This project would not have been possible without leadership support from each VA Medical Center and the dedication of April Jones, Tuscaloosa VA Innovation Specialist.

Disclaimer

The contents do not represent the views of the U.S. Department of Veterans Affairs or the United States Government.

Declaration of conflicts

Authors declare no conflicts of interest.

Notes

¹ Missing data on scale items ranged from 0% to 40.9%, yielding analyzable data available from 18 to 22 (81.8%) of LGBT veterans.

² This approach to data imputation has documented limitations in the statistical literature.

Additional information

Funding

This work was supported by the VHA Innovation Network Spark Seed Spread Program.