Risk and Resilience: A Review of the Health Literature of Veterans Who Identify as LGBT

  • Heliana RamirezEmail author
  • Katharine Bloeser


Service members who identify as lesbian, gay, bisexual, and/or transgender (LGBT) were an almost invisible population since the dawn of the Continental Army in 1775. The decision to serve in the US Armed Forces despite a ban on their service was not an easy one. The literature shows that LGBT service members experienced harassment and violence and lived in constant fear of being “outed.” Theory suggests that the combination of this strain, along with the daily stress of the military as an occupation, placed LGBT service members at greater risk for adverse health conditions like posttraumatic stress disorder (PTSD). A review of recent research suggests that this theory may be true—LGBT veterans report high rates of depression, PTSD, and suicidality. The following chapter explores this important research but also highlights the need to explore experiences of resilience in this population. Because of their dedicated service despite historic bans and institutionalized discrimination, LGBT veterans represent a unique opportunity to explore resilience and posttraumatic growth.


LGBT people in the military Military LBGT personnel Don’t Ask, Don’t Tell LGBT and PTSD risk in military personnel Literature review of veterans who identify as LGBT Minority stress model for LGBT in the military 


  1. 1.
    Trivette SA. Secret handshakes and decoder rings: the queer space of don’t ask/don’t tell. Sex Res Soc Policy. 2010;7(3):214–28.CrossRefGoogle Scholar
  2. 2.
    Berube A. Coming out under fire: the history of gay men and women in world war two. New York: The Free Press; 2000.Google Scholar
  3. 3.
    Estes S. Ask and tell: gay and lesbian veterans speak out. Chapel Hill: The Univesrity of North Carolina Press; 2007.CrossRefGoogle Scholar
  4. 4.
    Seefried J. Our time: breaking the silence of don’t ask don’t tell. New York: Penguin Group; 2012.Google Scholar
  5. 5.
    Frank N. Unfriendly fire: how the gay ban undermines the military and weakens America. New York: St. Martin’s Press; 2009.Google Scholar
  6. 6.
    Beck K. Transgender ex-Navy SEAL: here’s a question for you. [Internet]. (2014). Available from:
  7. 7.
    Symons J. Ask not. Persistent films. USA: LLC; 2008.Google Scholar
  8. 8.
    Savin-Williams RC. Then and now: recruitment, definition, diversity, and positive attributes of same-sex populations. Dev Psychol. 2008;44(1):135–8.CrossRefPubMedGoogle Scholar
  9. 9.
    Ramirez MH, Rogers SJ, Johnson HL, Banks J, Seay WP, Tinsley BL, et al. If we ask, what they might tell: clinical assessment lessons from LGBT military personnel post-DADT. J Homosex. 2013;60(2/3):401–18.CrossRefPubMedGoogle Scholar
  10. 10.
    Ramirez MH, Sterzing PR. Coming out in camouflage: a queer theory perspective on the strength, resilience, and resistance of lesbian, gay, bisexual, and transgender service members and veterans. J Gay Lesbian Stud. 2017;29(1):68–86. CrossRefGoogle Scholar
  11. 11.
    Butler J. Gender trouble: feminism and the subversion of identity. New York: Routledge; 1990.Google Scholar
  12. 12.
    Meyer I. Identity, stress, and resilience in lesbians, gay men, and bisexuals or color. J Couns Psychol. 2010;38(3):1–9.Google Scholar
  13. 13.
    Daley AE, Macdonnell JA. Gender, sexuality and the discursive representation of access and equity in health services literature: implications for LGBT communities. Int J Equity Health. 2011;10(1):40.CrossRefPubMedPubMedCentralGoogle Scholar
  14. 14.
    Gates GJ. Williams Institute (University of California LAS of L. Lesbian, gay, and bisexual men and women in the US military: updated estimates. Statistics (Ber). 2010;(May):2006–9.Google Scholar
  15. 15.
    Gates GJ, Herman J. Transgender military service in the United States. Los Angeles: The Willimas Institute; 2014.Google Scholar
  16. 16.
    Sinclair GD. (2008). Homosexuality and the U.S. military: a study of homosexual identity and choice of military service. Doctoral Dissertation. University of Texas Arlington.Google Scholar
  17. 17.
    Adams P, Alexander SED, Baillie P, Ballard L, Cleghorn J. Veterans speak out : a collection of essays from the documenting courage project. Hofstra Labor Employ Law J. 2004;21(2):461–82.Google Scholar
  18. 18.
    Brown GR. Transsexuals in the military: flight into hypermasculinity. Arch Sex Behav. 1988;17(6):527–37.CrossRefPubMedGoogle Scholar
  19. 19.
    Blosnich JR, Brown GR, Shipherd JC, Kauth M, Piegari RI, Bossarte RM. Prevalence of gender identity disorder and suicide risk among transgender veterans utilizing veterans health administration care. Am J Public Health. 2013;103(10):27–32.CrossRefGoogle Scholar
  20. 20.
    Belkin A. Spam filter: gay rights and the normalization of male-male rape in the US military. Radic Hist Rev. 2008;2008(100):180–5.CrossRefGoogle Scholar
  21. 21.
    Shipherd JC, Mizock L, Maguen S, Green KE. Male-to-female transgender veterans and VA health care utilization. Int J Sex Health. 2012;24(November 2011):78–87.CrossRefGoogle Scholar
  22. 22.
    McDuffie E, Brown GR. 70 US veterans with gender identity disturbances: a descriptive study. Int J Transgend. 2010;12(1):21–30.CrossRefGoogle Scholar
  23. 23.
    Shilts R. Conduct unbecoming. New York: Ballantine Books; 1993.Google Scholar
  24. 24.
    Nedelman M, Ramirez MH. The camouflage closet. 2014.
  25. 25.
    Cass VC. Homosexuality identity formation: a theoretical model. J Homosex. 1979;4(3):219–35.CrossRefPubMedGoogle Scholar
  26. 26.
    Moradi B. Sexual orientation disclosure, concealment, harassment, and military cohesion: perceptions of LGBT military veterans. Mil Psychol. 2009;21:513–33.CrossRefGoogle Scholar
  27. 27.
    Cameron RP, Mona LR, Syme ML, Cordes CC, Fraley SS, Chen SS, et al. Sexuality among wounded veterans of operation enduring freedom (OEF), operation Iraqi freedom (OIF), and operation new dawn (OND): implications for rehabilitation psychologists. Rehabil Psychol. 2011;56(4):289–301.CrossRefPubMedGoogle Scholar
  28. 28.
    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.CrossRefPubMedGoogle Scholar
  29. 29.
    Service Members Legal Defense Network. Freedome to serve: the definitive guide to LGBT military service. 2011.Google Scholar
  30. 30.
    Smith DM. Active duty military personnel presenting for care at a gay men’s health clinic. J Homosex. 2008;54(3):277–9.CrossRefPubMedGoogle Scholar
  31. 31.
    Johnson WB, Buhrke RA. Service delivery in a “don’t ask, don’t tell” world : ethical care of gay, lesbian, and bisexual military personnel. Prof Psychol Res Pract. 2006;37(1):91–8.CrossRefGoogle Scholar
  32. 32.
    Wescott K, Sawyer R. Silent sacrifices: the impact of “don’t ask, don’t tell” on lesbian and gay military families. Duke J Gend Law Policy. 2007;14:1121–39.Google Scholar
  33. 33.
    Blosnich J, Foynes MM, Shipherd JC. Health disparities among sexual minority women veterans. J Womens Health. 2013;22(7):631–6.CrossRefGoogle Scholar
  34. 34.
    Kimerling R, Iverson KM, Dichter ME, Rodriguez AL, Wong A, Pavao J. Prevalence of intimate partner violence among women veterans who utilize veterans health administration primary care. J Gen Intern Med. 2016;31(8):888–94.CrossRefPubMedPubMedCentralGoogle Scholar
  35. 35.
    Lehavot K, Browne KC, Simpson TL. Examining sexual orientation disparities in alcohol misuse among women veterans. Am J Prev Med. 2014;47(5):554–62.CrossRefPubMedGoogle Scholar
  36. 36.
    Mattocks KM, Sadler A, Yano EM, Krebs EE, Zephyrin L, Brandt C, et al. Sexual victimization, health status, and va healthcare utilization among lesbian and bisexual OEF/OIF veterans. J Gen Intern Med. 2013;28(SUPPL.2):4–7.Google Scholar
  37. 37.
    Booth BM, Mengeling M, Torner J, Sadler AG. Rape, sex partnership, and substance use consequences in women veterans. J Trauma Stress. 2011;24(3):287–94.CrossRefPubMedGoogle Scholar
  38. 38.
    Blosnich JR, Bossarte R, Silver E, Silenzio V. Health care utilization and health indicators among a national sample of US veterans in same sex partnerships. Mil Med. 2013;178(2):207–12.CrossRefPubMedPubMedCentralGoogle Scholar
  39. 39.
    Blosnich JR, Mays VM, Cochran SD. Suicidality among veterans: implications of sexual minority status. Am J Public Health. 2014;104(SUPPL. 4):535–7.CrossRefGoogle Scholar
  40. 40.
    Brown GR, Jones KT. Mental health and medical disparities in 5135 transgender veterans receiving healthcare in the veterans health administration: A case-control study. LGBT Health. 2016;3(2):122–31. Scholar
  41. 41.
    Drescher J. Queer diagnoses: parallels and contrasts in the history of homosexuality, gender variance, and the diagnostic and statistical manual. Arch Sex Behav. 2010;39(2):427–60.CrossRefPubMedGoogle Scholar
  42. 42.
    Zucker KJ, Spitzer RL. Was the gender identity disorder of childhood diagnosis introduced into DSM-III as a backdoor maneuver to replace homosexuality? A historical note. J Sex Marital Ther. 2005;31:31–42.CrossRefPubMedGoogle Scholar
  43. 43.
    Alessi EJ. A framework for incorporating minority stress theory into treatment with sexual minority clients. J Gay Lesbian Ment Health. 2014;18(April):47–66.CrossRefGoogle Scholar
  44. 44.
    Brooks VR. Minority stress and lesbian women. Lexington: Lexington Press; 1981.Google Scholar
  45. 45.
    Meyer I. Prejudice, social stress, and mental health in lesbian, gay, and bisexual populations: conceptual issues and research evidence. Psychol Bull. 2003;129(5):674–97.CrossRefPubMedPubMedCentralGoogle Scholar
  46. 46.
    Meyer I. Minority stress and mental health in gay men. J Health Soc Behav. 1995;36(1):38–56.CrossRefPubMedGoogle Scholar
  47. 47.
    Hendricks ML, Testa RJ. A conceptual framework for clinical work with transgender and gender nonconforming clients: an adaptation of the minority stress model. Prof Psychol Res Pract. 2012;43(5):460–7.CrossRefGoogle Scholar
  48. 48.
    Mays VM, Cochran SD. Mental health correlates of perceived discrimination among lesbian, gay, and bisexual adults in the United States. Am J Public Heal. 2001;91(11):1869–76.CrossRefGoogle Scholar
  49. 49.
    Cochran BN, Balsam K, Flentje A, Malte CA, Simpson T. Mental health characteristics of sexual minority veterans. J Homosex. 2013;60(2–3):419–35.CrossRefPubMedGoogle Scholar
  50. 50.
    Cochran SD, Mays VM. A systematic review of sexual orientation and the prevalence of mental health disorders: implications for research and mental health services. In: Patterson CJ, D’Augelli AR, editors. Handbook of psychology and sexual orientation. New York: Oxford University Press; 2013. p. 204–22.Google Scholar
  51. 51.
    Fletcher D, Sarkar M. Psychological resilience: a review and critique of definitions, concepts, and theory. Eur Psychol. 2013;18:12–23.CrossRefGoogle Scholar
  52. 52.
    Herrick AL, Stall R, Chmiel JS, Guadamuz TE, Penniman T, Shoptaw S, et al. It gets better: resolution of internalized homophobia over time and associations with positive health outcomes among MSM. AIDS Behav. 2013;17(4):1423–30.CrossRefPubMedPubMedCentralGoogle Scholar
  53. 53.
    Hill CA, Gunderson CJ. Resilience of lesbian, gay, and bisexual individuals in relation to social environment, personal characteristics, and emotion regulation strategies. Psychol Sex Orientat Gend Divers. 2015;2(3):232–52.CrossRefGoogle Scholar
  54. 54.
    Riggle EDB, Rostosky SS, Horne SG. Marriage amendments and lesbian, gay, and bisexual individuals in the 2006 election. Sex Res Soc Policy. 2009;6(1):80–9.CrossRefGoogle Scholar
  55. 55.
    Russell GM, Bohan JS. The gay generation gap : communicating across the LGBT generational divide. Policy J Inst Gay Lesbian Strateg Stud. 2005;8(1):1–8.Google Scholar
  56. 56.
    Beasley CR, Jenkins RA, Valenti M. Special section on LGBT resilience across cultures: introduction. Am J Community Psychol. 2015;55(1–2):164–6.CrossRefPubMedGoogle Scholar
  57. 57.
    Bariola E, Lyons A, Leonard W, Pitts M, Badcock P, Couch M. Demographic and psychosocial factors associated with psychological distress and resilience among transgender individuals. Am J Public Health. 2015;105(10):2108–16.CrossRefPubMedPubMedCentralGoogle Scholar
  58. 58.
    Kwon P. Resilience in lesbian, gay, and bisexual individuals. Personal Soc Psychol Rev. 2013;17(4):371–83.CrossRefGoogle Scholar
  59. 59.
    Breslow AS, Brewster ME, Velez BL, Wong S, Geiger E, Soderstrom B. Resilience and collective action: exploring buffers against minority stress for transgender individuals. Psychol Sex Orientat Gend Divers. 2015;2(3):253–65.CrossRefGoogle Scholar
  60. 60.
    Testa RJ, Habarth J, Peta J, Balsam K, Bockting W. Development of the gender minority stress and resilience measure. Psychol Sex Orientat Gend Divers. 2015;2(1):65–77.CrossRefGoogle Scholar
  61. 61.
    Frost DM, Meyer IH. Minority stress and physical health among sexual minority individuals. J Behav Med. 2015;38(1):1–8.CrossRefPubMedGoogle Scholar
  62. 62.
    Meyer IH. Resilience in the study of minority stress and health of sexual and gender minorities. Psychol Sex Orientat Gend Divers. 2015;2(3):209–13.CrossRefGoogle Scholar
  63. 63.
    Herrick AL, Stall R, Goldhammer H, Egan JE, Mayer KH. Resilience as a research framework and as a cornerstone of prevention research for gay and bisexual men: theory and evidence. AIDS Behav. 2014;18(1):1–9.CrossRefPubMedGoogle Scholar
  64. 64.
    Colpitts E, Gahagan J. The utility of resilience as a conceptual framework for understanding and measuring LGBTQ health. Int J Equity Health. 2016;15(1):60.CrossRefPubMedPubMedCentralGoogle Scholar
  65. 65.
    Karlin BE, Ruzek JI, Chard KM, Eftekhari A, Monson C, Hembree EA, et al. Dissemination of evidence-based psychological treatments for posttraumatic stress disorder in the Veterans Health Administration. J Trauma Stress. 2010;23(6):663–73.CrossRefPubMedGoogle Scholar
  66. 66.
    McWhorter L. Bodies and pleasures: foucault and the politics of sexual normalization. Indianapolis: University Press; 1999.Google Scholar
  67. 67.
    Belkin A, Ender M, Frank N, Furia S, Lucas GR, Packard G, et al. One year out : an assessment of DADT repeal’s impact on military readiness. Los Angeles: Palm Center; 2012.CrossRefGoogle Scholar
  68. 68.
    Herbst JH, Beeker C, Mathew A, McNally T, Passin WF, Kay LS, et al. The effectiveness of individual-, group-, and community-level HIV behavioral risk-reduction interventions for adult men who have sex with men. A systematic review. Am J Prev Med. 2007;32(4 SUPPL):38–67.CrossRefGoogle Scholar
  69. 69.
    Meyer IH, Dietrich J, Schwartz S. Lifetime prevalence of mental disorders and suicide attempts in diverse lesbian, gay, and bisexual populations. Am J Public Health. 2008;98(6):1004–6.CrossRefPubMedPubMedCentralGoogle Scholar
  70. 70.
    Moradi B, Wiseman MC, DeBlaere C, Goodman MB, Sarkees A, Brewster ME, et al. LGB of color and white individuals’ perceptions of heterosexist stigma, internalized homophobia, and outness: comparisons of levels and links. Couns Psychol. 2010;38(3):397–424.CrossRefGoogle Scholar
  71. 71.
    Rutter M. Resilience as a dynamic concept. Dev Psychopathol. 2012;24:335–44.CrossRefPubMedGoogle Scholar
  72. 72.
    Follins LD, Walker JJ, Lewis MK. Resilience in black lesbian, gay, bisexual, and transgender individuals: a critical review of the literature. J Gay Lesbian Ment Health. 2014;18(2):190.CrossRefGoogle Scholar
  73. 73.
    Wong FY. In search for the many faces of community resilience among LGBT individuals. Am J Community Psychol. 2015;55(1–2):239–41.CrossRefPubMedGoogle Scholar
  74. 74.
    Zimmerman L, Darnell DA, Rhew IC, Lee CM, Kaysen D. Resilience in community: a social ecological development model for young adult sexual minority women. Am J Community Psychol. 2015;55(1–2):179–90.CrossRefPubMedPubMedCentralGoogle Scholar
  75. 75.
    Calhoun LG, Tedeschi RG. Facilitating posttraumatic growth: a clinician’s guide. Mahwah: Lawrence Erlbaum Associates, Inc; 1999.Google Scholar
  76. 76.
    Tsai J, El-Gabalawy R, Sledge WH, Southwick SM, Pietrzak RH. Post-traumatic growth among veterans in the USA: results from the National Health and resilience in veterans study. Psychol Med. 2015;45(1):165–79.CrossRefPubMedGoogle Scholar
  77. 77.
    Wang K, Rendina HJ, Pachankis JE. Looking on the bright side of stigma: how stress-related growth facilitates adaptive coping among gay and bisexual men. J Gay Lesbian Ment Health. 2016;0(0):1–13.Google Scholar
  78. 78.
    Meyer IH. Minority stress and positive psychology : convergences and divergences to understanding LGBT health. Psychol Sex Orientat Gend Divers. 2014;1(4):348–9.CrossRefGoogle Scholar
  79. 79.
    Lehavot K, Simpson TL. Incorporating lesbian and bisexual women into women veterans’ health priorities. J Gen Intern Med. 2013;28(SUPPL.2):33–7.Google Scholar

Copyright information

© Springer International Publishing AG 2018

Authors and Affiliations

  1. 1.VA Palo Alto Health Care SystemPalo AltoUSA
  2. 2.University of CaliforniaBerkeleyUSA
  3. 3.Silberman School of Social Work at Hunter College, The City University of New YorkNew York CityUSA
  4. 4.The War Related Illness and Injury Study Center at the Washington, DC VA Medical CenterWashington, DCUSA

Personalised recommendations