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partnership paradigms that support cooperative and effectual higher than suicide rates of individuals who identify as cisgen-
outreach and treatment are reviewed. der. 12–24 The American Psychiatric Association reports that sui-
cide attempts for LGB individuals are four times greater than
12
cisgender individuals. It should be noted that LGBT MSMV
Risk Factors Associated With Veteran Suicide
may experience dual mental health disparities, as well as social
According to the Department of Veteran Affairs National stigma related to cisgender norms and practices of the military.
5
Veteran Suicide Prevention Annual Report, an average of 20 When reviewing reported suicide attempts for sexual minority
US military Servicemembers and veterans (MSMV) die by sui- MSMV, national surveys report that LGB individuals attempt
17
cide every day. After adjusting for population differences in suicide at a rate of three times that of cisgender veterans. In
5
age and sex, veterans die by suicide at a rate of 1.5 times more comparison, transgender MSMV die by suicide at a rate of
than that of non-veterans, accounting for 18.3% of all deaths twice that of cisgender MSMV and 5.85 times the rate of the
by suicide in the US. general population. 17–20
Researchers have long since acknowledged that contributing Historically, the Department of Defense (DoD) had a long-
factors to suicidal behaviors are both complex and multi- standing ban on sexual minorities serving in the military, citing
faceted, often representing a culmination of intersecting fac- the potential for sexual diversity to “undermine unit cohesion
tors such as prior suicide attempt(s), stressful life event(s), and threaten combat effectiveness.” The aforementioned ban
25
financial stressors, mental health concerns, and/or the avail- was modified under the Clinton administration with the pas-
ability of lethal means. Historically, literature has indicated sage of 10 U.S.C. § 654, commonly known as “Don’t Ask
that the prototypical veteran to die by suicide is likely to be Don’t Tell (DADT).” This act made the distinction between
26
an older male with poor social support, experiencing medical sexual orientation and conduct. Under DADT, the military
and/or psychiatric conditions, as well as having availability removed questions regarding sexual orientation during the
6
and knowledge of firearms. Conversely, the characteristics of enlistment process, and it prohibited Servicemembers from
the prototypical Servicemember to attempt or die by suicide openly revealing their sexual orientation. While it was the in-
are slightly different. Female Servicemembers are more than tent for DADT to minimize discrimination based on the sexual
twice as likely to report a suicide attempt, and both female and orientation of Servicemembers, it did very little to change the
male Servicemembers who die by suicide are typically under military culture as it relates to LGB Servicemembers and their
7,8
the age of 30. While there are slight differences in gender ability to serve in the US Military as their authentic selves.
and age, psychosocial stressors were found to be similar across Noting the need for continued improvement in this area, the
both MSMV. The increasing rate of MSMV who continue to Obama administration signed legislation repealing DADT on
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die by suicide highlights the importance of gaining a better 22 December 2010. Effective 20 September 2011, the appeal
understanding of psychosocial factors (e.g., sexual minority, ceased the involuntary separation of Servicemembers based
marital status, social integration, and military sexual trauma) solely on sexual orientation, allowed previously separated
that are highly correlated with suicidal behaviors. This is one members to reapply, and precluded that statements about sex-
of the first steps to improving suicide prevention efforts. ual orientation would no longer bar potential recruits from
military service. 27
Sexual Minorities
Alas, none of the previous legislation or policies addressed the
The term sexual minority includes a variety of gender and needs of transgender Servicemembers. Over a decade later, the
sexual identities that differ from the majority of society. The passage of the DoD Directive 16-005, commonly known as
group sexual minority typically includes lesbian, gay, bisex- Military Service for Transgender Service Members, was passed
9
ual, and transgender (LGBT) individuals. The percentage of in 2016 under the Obama administration. This piece of legis-
American adults who self-identify as LGBT has consistently lation allowed transgender individuals to openly serve in the
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increased since 2012. According to Newport, 4.5% of the military without fear of discharge. Unfortunately, the repeal
American adult population self-identify as LGBT. This per- of DADT has done very little to minimize discrimination
27
10
centage equates to more than 10 million American adults. It related to sexual orientation or gender identity, and the his-
is reasonable to assume that the percentage of LGBT MSMV torical significance of the passage of DoD Directive 16-005
has increased as well. The National Defense Research Institute was short-lived. 27,28 Voiding portions of the DoD Directive
estimated that 6.1% of individuals serving in the US Military 16-005, the previous Trump administration implemented a
self-identify as lesbian, gay, or bisexual (LGB). National sur- law that did not allow new recruits who identified as trans-
11
veys estimate that transgender individuals actually volunteer gender to serve in any capacity in the US Military. The new
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for military services at a rate of 2 to 3 more times than that policy ended military coverage of transition medical services
of the general adult population. 12–14 A national survey imple- for currently serving troops, and required them to serve in
mented by researchers from The Williams Institute estimates their birth gender. 29
that 134,000 veterans self-identify as transgender, with 15,500
currently serving in US Military active duty, reserves, or Na- Almost 30 years from the date of the initial policy aimed at
tional Guard. 15 minimizing discrimination based on sexual orientation and
gender identifiers, LGBT individuals continue to experience
LGBT individuals, in general, are at increased risk of suicide unique stressors. These include concealment of sexual orien-
due to vulnerability to several mental health disorders, such as tation, harassment, fear of discharge on the basis of same-sex
depression, anxiety, substance use, and suicidal behaviors. 13,16 behavior, and loss of VA benefits, in addition to historical
They are twice as likely as their cisgender counterparts to ex- stressors related to sexual orientation and gender identifica-
perience these mental health diaorders. 12–20 Correspondingly, tion. Acknowledging the percentage of LGBT individuals
19
estimated suicide rates among sexual minorities are slightly who are service-connected, correlating risks factors associated
Risk Factors and Suicide Reduction Services for Veterans | 135