Non-affirmation minority stress, internalized transphobia, and subjective cognitive decline among transgender and gender diverse veterans aged 45 years and older.

OBJECTIVES: To examine the associations of two measures of minority stress, non-affirmation minority stress and internalized transphobia, with subjective cognitive decline (SCD) among transgender and gender diverse (TGD) veterans. METHOD: We administered a cross-sectional survey from September 2022 to July 2023 to TGD veterans. The final analytic sample included 3,152 TGD veterans aged ≥45 years. We used a generalized linear model with quasi-Poisson distribution to calculate prevalence ratios (PR) and 95% confidence intervals (CIs) measuring the relationship between non-affirmation minority stress and internalized transphobia and past-year SCD. RESULTS: The mean age was 61.3 years (SD = 9.7) and the majority (70%) identified as trans women or women. Overall, 27.2% (n = 857) reported SCD. Adjusted models revealed that TGD veterans who reported experiencing non-affirmation minority stress or internalized transphobia had greater risk of past-year SCD compared to those who did not report either stressor (aPR: 1.09, 95% CI: 1.04-1.15; aPR: 1.19, 95% CI: 1.12-1.27). CONCLUSION: Our findings demonstrate that proximal and distal processes of stigma are associated with SCD among TGD veterans and underscore the need for addressing multiple types of discrimination. Above all, these results indicate the lasting sequelae of transphobia and need for systemic changes to prioritize the safety and welfare of TGD people.

Intimate partner violence among lesbian, gay, and bisexual veterans.

The present study describes intimate partner violence (IPV) perpetration and victimization alongside theoretically associated variables in a sample of lesbian, gay, and bisexual veterans. We conducted bivariate analyses (chi-square tests and independent t test) to examine whether the frequencies of IPV perpetration and victimization varied by demographic characteristics, military sexual trauma, alcohol use, and mental health symptoms. Out of the 69 lesbian, gay, and bisexual (LGB) veterans who answered the questions on IPV, 16 (23.2%) reported some form of IPV victimization in the past year, and 38 (55.1%) reported past-year perpetration. Among the 43 veterans who reported psychological IPV, roughly half (48.9%) reported bidirectional psychological IPV, 39.5% reported perpetration only, and 11.6% reported victimization only. LGB veterans who reported bidirectional psychological IPV in their relationships were younger and reported greater symptoms of posttraumatic stress disorder symptoms and depression. The results presented here call for universal screening of IPV perpetration and victimization to both accurately assess and ultimately intervene among all veterans. Inclusive interventions are needed for all genders and sexual orientations, specifically interventions that do not adhere to gendered assumptions of perpetrators and victims. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

"The VA was the first place as a trainee that I felt like I had to hide many parts of myself": Lived experiences and recommendations for empowering transgender, nonbinary, and gender expansive VA psychology supervisors and supervisees.

Psychology trainees are increasingly diverse in terms of gender identity and gender expression (Lund & Thomas, 2022), yet clinical supervision models often overlook the unique needs, strengths, and experiences of transgender, nonbinary, and gender expansive (TNBGE) trainees and supervisors. The Department of Veterans Affairs (VA) remains the largest training network for psychology trainees and many American Psychological Association-accredited VA sites advertise focused training opportunities in lesbian, gay, bisexual, transgender, and queer health at both the internship and postdoctoral levels. As such, VA psychology training programs are uniquely positioned to impact the professional experiences of TNBGE psychology trainees and supervisors. Critical issues in supervision with TNBGE supervisees and supervisors in VA health care settings are reviewed utilizing themes and examples from the authors' lived experiences as TNBGE supervisors and supervisees. Recommendations are provided for supervisees, supervisors, and training directors in VA psychology training programs. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Temporal and Geographic Patterns of Documentation of Sexual Orientation and Gender Identity Keywords in Clinical Notes.

OBJECTIVE: Disclosure of sexual orientation and gender identity correlates with better outcomes, yet data may not be available in structured fields in electronic health record data. To gain greater insight into the care of sexual and gender-diverse patients in the Veterans Health Administration (VHA), we examined the documentation patterns of sexual orientation and gender identity through extraction and analyses of data contained in unstructured electronic health record clinical notes. METHODS: Salient terms were identified through authoritative vocabularies, the research team's expertise, and frequencies, and the use of consistency in VHA clinical notes. Term frequencies were extracted from VHA clinical notes recorded from 2000 to 2018. Temporal analyses assessed usage changes in normalized frequencies as compared with nonclinical use, relative growth rates, and geographic variations. RESULTS: Over time most terms increased in use, similar to Google ngram data, especially after the repeal of the "Don't Ask Don't Tell" military policy in 2010. For most terms, the usage adoption consistency also increased by the study's end. Aggregated use of all terms increased throughout the United States. CONCLUSION: Term usage trends may provide a view of evolving care in a temporal continuum of changing policy. These findings may be useful for policies and interventions geared toward sexual and gender-diverse individuals. Despite the lack of structured data, the documentation of sexual orientation and gender identity terms is increasing in clinical notes.

"We've been here all along:" The collective resilience of transgender and gender diverse U.S. service members.

Transgender and gender diverse (TGD) people in the United States face high rates of minority stressors, such as social rejection, homelessness, discrimination, and identity-based violence (James et al., 2016). Transgender and gender diverse service members are also exposed to unique military-specific stressors such as discriminatory military policies, combat stress, and military sexual trauma (Tucker et al., 2019). However, little is known about TGD troops' experiences of resilience when navigating stress and trauma exposure during their military service. A transaffirmative participatory research design and interpretative phenomenological analysis (IPA) analytic method were used to explore how troops made sense of their experiences of oppression and resilience. Researchers interviewed TGD service members (N = 40) about their gender identity and military service. Superordinate themes included: (a) understanding oppression; (b) survival strategies; (c) individual stress and resilience factors; and (d) collective resilience factors. Results suggest that both intrasubjective and intersubjective factors impacted how TGD troops made sense of their experiences of oppression and resilience. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Affirmative neuropsychological practice with transgender and gender diverse individuals and communities.

Objective: To provide guidance and resources on how to practice culturally safe and humble neuropsychology with transgender and gender diverse (TGD) individuals and communities. Methods: We gathered a multidisciplinary team of clinicians with relevant professional and/or lived experience to review pertinent literature, discuss important concepts, and identify key resources. From this process, we outline practical steps to advance gender affirmative neuropsychological practice. Results: Professional awareness and knowledge regarding how to gather context-relevant, gender identity information is critical. TGD individuals form a heterogenous group; a one-size-fits-all approach is not adequate. It is incumbent upon neuropsychologists to engage in clinical and research practices in a manner that does not perpetuate gender minority stress and trauma. Creating an open, safe environment of care requires intentionality and careful thinking to determine what information is relevant for a particular referral question. We provide recommendations and resources for neuropsychologists. Conclusion: When neuropsychologists are proactive, responsible, and intentional, they can better provide individualized, person-centered, and trauma-informed care to TGD individuals.

Transphobia, encoded: an examination of trans-specific terminology in SNOMED CT and ICD-10-CM.

Transgender people experience harassment, denial of services, and physical assault during healthcare visits. Electronic health record (EHR) structure and language can exacerbate the harm they experience by using transphobic terminology, emphasizing binary genders, and pathologizing transness. Here, we investigate the ways in which SNOMED CT and ICD-10-CM record gender-related terminology and explore their shortcomings as they contribute to this EHR-mediated violence. We discuss how this "standardized" gender-related medical terminology pathologizes transness, fails to accommodate nonbinary patients, and uses derogatory and outmoded language. We conclude that there is no easy fix to the transphobia beleaguering healthcare, provide options to reduce harm to patients, and ultimately call for a critical examination of medicine's role in transphobia. We aim to demonstrate the ways in which the [mis]use and [mis]understanding of gender-specific terminology in healthcare settings has harmed and continues to harm trans people by grounding our discussion in our personal experiences.