title: Prior Military Service, Identity Stigma, and Mental Health Among Transgender Older Adults.
abstract: Converging evidence from large community-based samples, Internet studies, and Veterans Health Administration data suggest that transgender adults have high rates of U.S. military service. However, little is known about the role of prior military service in their mental health later in life, particularly in relation to identity stigma. In this article, we examine relationships between prior military service, identity stigma, and mental health among transgender older adults.
  
  
  
  We used a subsample of transgender older adults (n = 183) from the 2014 survey of Aging with Pride: National Health, Aging, and Sexuality/Gender Study (NHAS). We employed weighted multivariate linear models to evaluate the relationships between psychological health-related quality of life (HRQOL), depressive symptomatology (Center for Epidemiological Studies Depression Scale [CES-D] scores), identity stigma, and prior military service, controlling for background characteristics.
  
  
  
  Identity stigma was significantly related with higher depressive symptomatology and lower psychological HRQOL. Having a history of prior military service significantly predicted lower depressive symptomatology and higher psychological HRQOL. The relationships between psychological HRQOL, identity stigma, and prior military service were largely explained by depressive symptomatology. Prior military service significantly attenuated the relationship between identity stigma and depressive symptomatology.
  
  
  
  By identifying the role of military service in the mental health of transgender older adults, this study provides insights into how prior military service may contribute to resilience and positive mental health outcomes. Directions for future research are discussed.
authors.affiliation: College of Social Work, University of Utah, Salt Lake City. charles.hoy-ellis@socwk.utah.edu.
authors.forename: Charles P
authors.initials: CP
authors.lastname: Hoy-Ellis
authors.affiliation: School of Social Work, University of Washington, Seattle.
authors.forename: Chengshi
authors.initials: C
authors.lastname: Shiu
authors.affiliation: School of Social Work, University of Washington, Seattle.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Sullivan
authors.affiliation: School of Social Work, University of Washington, Seattle.
authors.forename: Hyun-Jun
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: School of Social Work, University of Washington, Seattle.
authors.forename: Allison M
authors.initials: AM
authors.lastname: Sturges
authors.affiliation: School of Social Work, University of Washington, Seattle.
authors.forename: Karen I
authors.initials: KI
authors.lastname: Fredriksen-Goldsen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003863:Depression / Q000453:epidemiology* / Q000523:psychology; D005260:Female; D005783:Gender Identity; D006304:Health Status; D006801:Humans; D016014:Linear Models; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D011788:Quality of Life; D057545:Social Stigma; D063106:Transgender Persons / Q000523:psychology / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014728:Veterans / Q000706:statistics & numerical data*
keywords: Depression; Gender identity; Quality of life; Resilience; Veterans