Skip to main content

Advertisement

SpringerLink
Log in

Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don’t Ask, Don’t Tell

  • Military Mental Health (CH Warner, Section Editor)
  • Published:
Current Psychiatry Reports Aims and scope Submit manuscript

Abstract

Lesbian, gay, and bisexual service members can serve openly in the military with the repeal of the Don’t Ask, Don’t Tell policy. The fate of transgender service members remains uncertain as the policy preventing them from serving in the military remains under review. The health care needs of these populations remain for the most part unknown, with total acceptance and integration in the military yet to be achieved. In this paper, we review the literature on the health care needs of lesbian, gay, bisexual, and transgender (LGBT) service members, relying heavily on what is known about LGBT civilian and veteran populations. Significant research gaps about the health care needs of LGBT service members are identified, along with recommendations for closing those gaps. In addition, recommendations for improving LGBT acceptance and integration within the military are provided.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Gates GJ. Discharges under the Don’t Ask, Don’t Tell policy: women and racial/ethnic minorities. 2010. http://williamsinstitute.law.ucla.edu/category/research/military-related/#sthash.ikBT7Fr9.dpuf. Accessed 11 Sept 2013. Provides excellent discharge statistics on the LGBT service members.

  2. Kerrigan MF. Transgender discrimination in the military: the new Don’t Ask Don’t Tell. Psychol Public Policy Law. 2012;18(3):500–18.

    Article  Google Scholar 

  3. United States Department of Defense. Qualification standards for enlistment, appointment, and induction. Washington, D.C.: DoD Directive 1304.26″, March 4, 1994. http://biotech.law.lsu.edu/blaw/dodd/corres/pdf/d130426wch1_122193/d130426p.pdfAccessed 11 Sept 2013.

  4. Bérubé A. Coming out under fire: the history of gay men and women in World War II. Univ of North Carolina Press; 2010. This book provides an excellent history of lesbian and gay service members in the U.S. military.

  5. RAND Corporation. Sexual orientation and U.S. military personnel policy: an update of RAND’s 1993 study, Santa Monica, Calif.: RAND Corporation, MG-1056-OSD. 2010. http://www.rand.org/pubs/monographs/MG1056.html. Accessed 24 December 2015. This independent report debunks many of the arguments against LGBT civilians from serving in the military.

  6. Burks DJ. Lesbian, gay, and bisexual victimization in the military: an unintended consequence of “Don’t Ask, Don’t Tell”? Am Psychol. 2011;66(7):604–13.

    Article  PubMed  Google Scholar 

  7. Biddix JM, Fogel CI, Perry Black B. Comfort levels of active duty gay/bisexual male service members in the military healthcare system. Mil Med. 2013;178(12):1335–40. doi:10.7205/MILMED-D-13-00044.

    Article  PubMed  Google Scholar 

  8. U.S. Department of Veterans Affairs. VA Boston Healthcare System. 2012. http://www.boston.va.gov/services/images/LGBT_VABOSTON_POLICY_LGBT_PATIENTS.pdf. Accessed 11 Sept 2013.

  9. Thoits PA. On merging identity theory and stress research. Soc Psychol Q. 1991;54(2):101–12. Describes minority stress theory.

    Article  Google Scholar 

  10. Meyer IH. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129:674–97.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Williamson IR. Internalized homophobia and health issues affecting lesbians and gay men. Health Educ Res. 2000;15:97–107.

    Article  CAS  PubMed  Google Scholar 

  12. Cochran SD, Mays VM. Burden of psychiatric morbidity among lesbian, gay, and bisexual individuals in the California Quality of Life Survey. J Abnorm Psychol. 2009;118:647–58.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Roberts AL, Austin SB, Corliss HL, Vandermorris AK, Koenen KC. Pervasive trauma exposure among U.S. sexual orientation minority adults and risk of posttraumatic stress exposure. Am J Public Health. 2010;100:2433–41.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Institute of Medicine. The health of lesbian, gay, bisexual, and transgender people: building a foundation for better understanding. Washington: National Academies Press; 2011. This authoritative study identifies a responsible strategy for improving the health and wellbeing of the LGBT population.

    Google Scholar 

  15. Kim H-J, Fredriksen-Goldsen KI. Hispanic lesbians and bisexual women at heightened risk of health disparities. Am J Public Health. 2012;102(1):9–15.

    Article  Google Scholar 

  16. Remafedi G, French S, Story M, Resnick MD, Blum R. The relationship between suicide risk and sexual orientation: results of a population-based study. Am J Public Health. 1998;88:57–60.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  17. Russell ST, Joyner K. Adolescent sexual orientation and suicide risk: evidence from a national study. Am J Public Health. 2001;91(8):1276–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  18. Tjepkema M. Health care use among gay, lesbian and bisexual Canadians. Health Rep. 2008;19:53–64.

    PubMed  Google Scholar 

  19. Poynten IM, Grulich AE, Templeton DJ. Sexually transmitted infections in older populations. Curr Opin Infect Dis. 2013;26(1):80–5. doi:10.1097/QCO.0b013e32835c2173.

    Article  PubMed  Google Scholar 

  20. Abuse S, Administration MHS. Top health issues for LGBT populations information & resource kit. HHS Publication No. (SMA) 12–4684. Substance Abuse and Mental Health Services Administration: Rockville, MD; 2012. http://store.samhsa.gov/shin/content/SMA12-4684/SMA12-4684.pdf. Accessed 11 Sept 2013.

    Google Scholar 

  21. Brown GR, Jones KT. Mental health and medical health disparities in 5135 transgender veterans receiving healthcare in the Veterans Health Administration: a case–control study. LGBT Health; 16 Dec 2015. doi:10.1089/lgbt.2015.0058.

  22. Brown GW, Harris TO, editors. Social origins of depression: a study of psychiatric disorder in women. London: Tavistock; 1978.

    Google Scholar 

  23. Rosario M, Schrimshaw EW, Hunter J, Gwadz M. Gay-related stress and emotional distress among gay, lesbian and bisexual youths: a longitudinal examination. J Consult Clin Psychol. 2002;70(4):967–75.

    Article  PubMed  Google Scholar 

  24. Goldbach JT, Tanner-Smith EE, Bagwell M, Dunlap S. Minority stress and substance use in sexual minority adolescents: a meta-analysis. Prev Sci. 2014;15(3):350–63. doi:10.1007/s11121-013-0393-7.

    Article  PubMed  Google Scholar 

  25. Marshal MP, Sucato G, Stepp SD, Hipwell A, Smith HA, Friedman MS, et al. Substance use and mental health disparities among sexual minority girls: results from the Pittsburgh girls study. J Pediatr Adolesc Gynecol. 2012;25:15–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Balsam KF, Rothblum ED, Beauchaine TP. Victimization over the life span: a comparison of lesbian, gay, bisexual, and heterosexual siblings. J Consult Clin Psychol. 2005;73:477–87.

    Article  PubMed  Google Scholar 

  27. Tjaden P, Thoennes N, Allison CJ. Comparing violence over the life span in samples of same-sex and opposite-sex cohabitants. Violence Vict. 1999;14:413–25.

    CAS  PubMed  Google Scholar 

  28. Alvy LM, Hughes TL, Kristjanson AF, Wilsnack SC. Sexual identity group differences in child abuse and neglect. J Interpers Violence. 2013;28:2088–111.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Herek GM. Hate crimes and stigma-related experiences among sexual minority adults in the United States: prevalence estimates from a national probability sample. J Interpers Violence. 2009;24:54–74.

    Article  PubMed  Google Scholar 

  30. Gibbs J, Goldbach JT. Religious conflict, sexual identity, and suicidal behaviors among sexual minority youth. Arch Suicide Res. 2015;19(4):472–88. doi:10.1080/13811118.2015.1004476.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Cochran BN, Balsam K, Flentje A, Malte CA, Simpson T. Mental health characteristics of sexual minority veterans. J Homosex. 2013;60:419–35. doi:10.1080/00918369.2013.744932.

    Article  PubMed  Google Scholar 

  32. Kemp J, Bossarte RM. Surveillance of suicide and suicide attempts among veterans: addressing a national imperative. Am J Public Health. 2012;102 Suppl 1:e4–5.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Kemp J, Bossarte R. Suicide data report, 2012. Department of Veterans Affairs, Mental Health Services/Suicide Prevention Program; 2012b.

  34. United States Department of Defense. The challenge and the promise strengthening the force, preventing suicide and saving lives. Final Report of the Department of Defense Task Force on the Prevention of Suicide of Suicide by Members of the Armed Forces; 2010. http://www.sprc.org/sites/sprc.org/files/library/2010-08_Prevention-of-Suicide-Armed-Forces.pdf. Accessed 10 Feb 2016.

  35. Matarazzo BB, Barnes SM, Pease JL, Russell LM, Hanson JE, Soberay KA, et al. Suicide risk among lesbian, gay, bisexual, and transgender military personnel and veterans: what does the literature tell us? Suicide Life Threat Behav. 2014;44:200–17. doi:10.1111/sltb.12073.

    Article  PubMed  Google Scholar 

  36. Garofalo R, Wolf RC, Wissow LS, Woods ER, Goodman E. Sexual orientation and risk of suicide attempts among a representative sample of youth. Arch Pediatr Adolesc Med. 1999;153(5):487–93.

    Article  CAS  PubMed  Google Scholar 

  37. King M, Semlyen J, Tai SS, Killaspy H, Osborn D, Popelyuk D, et al. A systematic review of mental disorder, suicide, and deliberate self-harm in lesbian, gay, and bisexual people. BMC Psychiatry. 2008;8:70. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2533652/. Accessed 10 Feb 2016. This paper reviews the current literature on self-harm and suicide among the LGB population.

  38. Blosnich JR, Mays VM, Cochran SD. Suicidality among veterans: implications of sexual minority status. Am J Public Health. 2014;104 Suppl 4:S535–7. doi:10.2105/AJPH.2014.302100.

    Article  PubMed  PubMed Central  Google Scholar 

  39. United States Department of Defense. Task force on the future of military health care: final report; 2007. http://www.naus.org/wp-content/uploads/2015/07/MilHealthCare TaskForceFINALREPORT12-07.pdf.pdf. Accessed 20 May 2008.

  40. Katz KA. Health hazards of “don’t ask, don’t tell.”. N Engl J Med. 2010;363:2380–1.

    Article  CAS  PubMed  Google Scholar 

  41. Smith DM. Active duty military personnel presenting for care at a gay men’s health clinic. J Homosex. 2008;54(3):277–9.

    Article  PubMed  Google Scholar 

  42. Seaver MR, Freund KM, Wright LM, Tjia J, Frayne SM. Healthcare preferences among lesbians: a focus group analysis. J Womens Health (Larchmt). 2008;17(2):215–25. doi:10.1089/jwh.2007.0083.

    Article  Google Scholar 

  43. Biddix JM, Fogel CI, Black BP. Comfort levels of active duty gay/bisexual male service members in the military healthcare system. Mil Med. 2013;178:1335–40.

    Article  PubMed  Google Scholar 

  44. Mattocks K. Viewpoints: Kristin M. Mattocks, Patient ‘wait times’ a wider problem than VA hospital in Northampton. Daily Hampshire Gazette; 2014. http://www.gazettenet.com/home/12410323-95/kristin-m-mattocks-patient-wait-times-a-wider-problem-than-va-hospital-in-northampton. Accessed 11 Feb 2016.

  45. Office of the Under Secretary of Defense (Personnel and Readiness). Review of the effectiveness of the application and enforcement of the Department’s policy on homosexual conduct in the military. (13 pp.) Department of Defense; 1998.

  46. Gade DM. Where did you serve? Veteran identity, representative bureaucracy, and vocational rehabilitation. J Public Admin Res Theory. 2012;23:267.

    Article  Google Scholar 

  47. Yerke AF, Mitchell V. Transgender people in the military: don’t ask? don’t tell? don’t enlist! J Homosex. 2013;60(2–3):436–57. doi:10.1080/00918369.2013.744933.

    Article  PubMed  Google Scholar 

  48. Bowling UB, Sherman MD. (2008). Welcoming them home: supporting service members and their families in navigating the tasks of reintegration. Prof Psychol Res Pract. 2008;39(4):451–8.

    Article  Google Scholar 

  49. Witten TM. Gender identity and the military: transgender, transsexual, and intersex-identified individuals in the U.S. armed forces. 2007. http://www.palmcenter.org/files/active/0/TransMilitary2007.pdf. Accessed 11 Feb 2016.

  50. Devor H. Witnessing and mirroring: a fourteen stage model of transsexual identity formation. J Gay Lesbian Psychotherapy. 2004;8:41–67.

    Google Scholar 

  51. Mosher DL, Sirkin M. Measuring a macho personality constellation. J Res Personality. 1984;18(2):150–63.

    Article  Google Scholar 

  52. Frye PR. Transgendered Vet. Breaking the silence…Grethe Cammermeyer. 2004. http://www.cammermeyer.com/board.htm?step= thread&threadid = 244. Accessed 11 Feb 2016.

  53. McDuffie E, Brown GR. Seventy U.S. veterans with gender identity disturbances: a descriptive study. Int J Transgend. 2010;12:21–30.

    Article  Google Scholar 

  54. Shipherd JC, Maguen S, Skidmore WC, Abramovitz SM. Potentially traumatic events in a transgender sample: frequency and associated symptoms. Traumatology. 2011;17(2):56–67.

    Article  Google Scholar 

  55. Gates GJ, Herman JL. Transgender military service in the United States. UCLA School of Law: Williams Institute; 2014.

    Google Scholar 

  56. Grant JM, Mottet LA, Tanis J, Harrison J, Herman JL, Keisling M. Injustice at every turn: a report of the National Transgender Discrimination Survey. Washington: National Center for Transgender Equality and National Gay and Lesbian Task Force; 2011.

    Google Scholar 

  57. Bryant K, Schilt K. Transgender people in the U.S. military: summary and analysis of the 2008 Transgender American Veterans Association survey. Palm Center Blueprints for Sound Public Policy; 2008. http://www.palmcenter.org/files/TGPeopleUSMilitary.pdf. Accessed 11 Feb 2016

  58. Brown George R. and Jones Kenneth T. LGBT Health. December 2015 doi:10.1089/lgbt.2015.0058. This study provides key health concerns involving LGBT people.

  59. Lombardi E. Enhancing transgender health care. Am J Public Health. 2001;91(6):869–72. doi:10.2105/AJPH.91.6.869.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Stalsburg BL. After repeal: LGBT service members and veterans the facts. 2011. http://www.servicewomen.org/wp-content/uploads/./LGBT-Fact-Sheet-091411.pdf. Accessed 11 Feb 2016.

    Google Scholar 

  61. Bliese PD, Castro CA. Role clarity, work overload and organizational support: multilevel evidence of the importance of support. Work Stress. 2000;14:65–73.

    Article  Google Scholar 

  62. Castro CA, McGurk D. The intensity of combat and behavioral health status. Traumatology. 2007;13:6–23.

    Article  Google Scholar 

  63. Wong L, Kolditz TA, Millen RA, Potter TM. Why they fight: combat motivation in the Iraq war. Strategic Studies Institute, U.S. Army War College: Carlisle, PA; 2003.

    Google Scholar 

  64. Kaplan D, Rosenmann A. Unit social cohesion in the Israeli military as a case study of “Don’t Ask, Don’t Tell”. Political Psychology. 2012;33:419–36. doi:10.1111/j.1467-9221.2012.00914.xpo.

    Article  Google Scholar 

  65. Moradi B. Sexual orientation disclosure, concealment, harassment and military cohesion: perceptions of LGBT former service members. Mil Psychol. 2009;21:513–33. This study represents a foundational study for what life is like in the military from the perspective of LGBT veterans.

    Article  Google Scholar 

  66. Department of Defense. Anti-harassment action plan. Washington: Author; 2000.

    Google Scholar 

  67. Bowling K, Firestone JM, Harris RJ. Analyzing questions that cannot be asked of respondents who cannot respond. Armed Forces & Society. 2005;31(4):411–437.

  68. Castro CA, Kintzle S, Schuyler AC, Lucas CL, Warner CH. Sexual assault in the military. Curr Psychiatry Rep. 2015;17:54. doi:10.1007/s11920-015-0596-7.

    Article  PubMed  Google Scholar 

  69. Turchik JA, Wilson SM. Sexual assault in the U. S military: a review of the literature and recommendations for the future. J Aggress Violent Behav. 2010;15:267–77.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. University of Southern California School of Social Work, 1150 South Olive Street, Suite 1400, Los Angeles, CA, 90015, USA

    Jeremy T. Goldbach & Carl Andrew Castro

Authors
  1. Jeremy T. Goldbach
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Carl Andrew Castro
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Carl Andrew Castro.

Ethics declarations

Conflict of Interest

Jeremy T. Goldbach and Carl Andrew Castro have received a grant from the Department of Defense.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Military Mental Health

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goldbach, J.T., Castro, C.A. Lesbian, Gay, Bisexual, and Transgender (LGBT) Service Members: Life After Don’t Ask, Don’t Tell. Curr Psychiatry Rep 18, 56 (2016). https://doi.org/10.1007/s11920-016-0695-0

Download citation

  • Published:

  • DOI: https://doi.org/10.1007/s11920-016-0695-0

Keywords

Search

Navigation