title: Mental Health of Transgender Veterans in US States With and Without Discrimination and Hate Crime Legal Protection.
abstract: OBJECTIVE
  To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health.
  
  
  METHODS
  We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt.
  
  
  RESULTS
  Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased odds of self-directed violence (AOR = 0.57; 95% CI = 0.34, 0.95).
  
  
  CONCLUSIONS
  Understanding lesbian, gay, bisexual, and transgender social stressors can inform treatment and care coordination for transgender populations.
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: John R
authors.initials: JR
authors.lastname: Blosnich
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: Mary C
authors.initials: MC
authors.lastname: Marsiglio
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: Shasha
authors.initials: S
authors.lastname: Gao
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Gordon
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: Jillian C
authors.initials: JC
authors.lastname: Shipherd
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: Michael
authors.initials: M
authors.lastname: Kauth
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: George R
authors.initials: GR
authors.lastname: Brown
authors.affiliation: At the time of the study, John R. Blosnich, Shasha Gao, Adam J. Gordon, and Michael J. Fine were with the Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA. Mary C. Marsiglio was with the Mental Illness Research Education and Clinical Center, Portland VA Medical Center, Portland, OR. Jillian C. Shipherd and Michael Kauth were with the VA Office of Patient Care Services, Department of Veterans Affairs, Washington, DC. George R. Brown was with the Mountain Home VA Medical Center, Mountain Home, TN.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Fine
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008603:Mental Health / Q000706:statistics & numerical data*; D008875:Middle Aged; D019964:Mood Disorders / Q000453:epidemiology; D011057:Politics; D011287:Prejudice / Q000331:legislation & jurisprudence* / Q000523:psychology*; D012959:Socioeconomic Factors; D013313:Stress Disorders, Post-Traumatic / Q000453:epidemiology; D019966:Substance-Related Disorders / Q000453:epidemiology; D059020:Suicidal Ideation; D013406:Suicide, Attempted / Q000706:statistics & numerical data; D063106:Transgender Persons / Q000523:psychology*; D014728:Veterans / Q000523:psychology*