Introduction
People often make decisions about revealing their ideas, motives, and character traits in their relationships. For people with features that may be stigmatized in their surroundings, deciding to share that stigmatized feature can be intimidating. Homosexual (lesbian and gay), bisexual, and transgender (LGBT) individuals often consider the benefits and costs of revealing their sexual or minority gender identity during their life. For example, in the workplace, LGBT workers rate colleagues’ measure acceptance, rejection, and neutrality while constantly evaluating the possible level of openness. The US Army is one example of a workplace where a history of LGBT exclusion and stigmatization policies can influence LGBT military personnel’s decision to disclose information to colleagues. For comparison, LGBT civilians have shown an increased risk of psychiatric disorders compared to heterosexual civilians. Military personnel, both active and veterans, display higher rates of the same diagnoses; moreover, their conditions have a high rate of exacerbations among them. Consequently, LGBT military personnel are potentially even more vulnerable to mental health issues due to the combined stress of being LGBT (fear of individual discrimination) and being in the military (structural discrimination).
Informational Background
Suppose the military Command confirmed that the individual was involved in a same-sex relationship or had same-sex romantic interests; in that case, he could be fired without benefits. In 1994, the US Congress, supported by the President’s signature, passed the so-called “Don’t Ask, Don’t Tell, Don’t Pursue” policy (McNamara et al., 2020). This policy stated that “homosexuals” could serve in the military but could not openly convey their sexual identity nor be asked about it. In addition, they could not be prosecuted by superiors due to suggestions that they might be lesbians, gay, or bisexual. However, due to DADT violation, more than 13,000 military personnel have been discharged for being identified as lesbian, gay, or bisexual (McNamara et al., 2020). The situation has slightly improved in the next century. Since 2011, LGB military personnel have been allowed to serve openly, and in 2016 the ban on transgender service was lifted (McNamara et al., 2021). Historically, there has been little to no research on the health and well-being of LGBT people in the world’s armed forces. Consequently, in the modern days, this topic draws much scholarly attention.
For this review, seven studies regarding the state and changes in LGBT minority soldiers’ mental health were chosen for the discussion and comparison. Mark et al. (2019) and McDonald et al. (2020) assessed the mental health and well-being of the target group in general. Mark et al. (2019) undertook the screening emphasizing mental health and well-being, stigma and healthcare utilization, sexual trauma, and physical health. They concluded that LGBT personnel generally display poorer health status and higher rates of psychological trauma than non-LGBT counterparts. McDonald et al. (2020) did the same for behavioral health rates, behavioral health care utilization, loneliness, perceived prejudice, and received support. The latter was found to be lacking; in the meantime, the biases were proved to form certain social and organizational barriers for LGBT people.
McNamara et al. (2020), McNamara et al. (2021), and Schuyler et al. (2020) studied the impact of the “outness” of LGBT military personnel on their surroundings. The first study describes the general “coming out” experiences that followed the repeal of LGBT bans. Their findings state that the overall situation has slightly improved; however, people still feel anxious about the disclosure due to the fear of discrimination. The second study showcases a deeper insight into the disclosure topic, providing the division of research results by the ranks of participants in the army. The results showcase the inverse relationship between the army rank and the desire to reveal sexual identity. In the meantime, the third study confirmed the persisting victimization of uncovered LGBT members, classifying it into sexual harassment, assault, and stalking.
Holloway et al. (2021) and Moody et al. (2020) focus on the experiences and outcomes of various stress factors on the mental health of LGBT representants and health risk behaviors. The first research indicated the increased predisposition of smoking and alcohol use among the sexual minority personnel compared to heterosexual members. The second research confirmed the relationship between sexual orientation-based discrimination and the poorer mental state of its victims, which increases the risk of detrimental habits among them.
Similarities Found Between Studies
After the comparative study of the seven mentioned pieces of research, a set of unpromising similarities were uncovered. All seven pieces indicate the increased exposure of LGBT community members in the military forces to different types of stress. The heightened danger to mental health is predominantly caused by the attitude and societal prejudices toward their chosen sexual identity and representation. In comparison to heterosexual participants, LGBT soldiers proved to have poorer mental health, physical health, and well-being and more frequently display signs of sexual trauma (Mark et al., 2019). In addition, minority soldiers had higher rates of positive screenings for anxiety, suicidality, and post-traumatic stress disorder (PTSD) (McDonald et al., 2020). In the meantime, half of the participants that took part in the “outness” survey showed fear toward their acceptance in the military environment, both individual and institutional (McNamara et al., 2020). This evidence is strengthened by the lower percentage of people who are not afraid to show their authenticity among higher army ranks (McNamara et al., 2021). Nevertheless, the main reasoning behind “coming outs” is the display of authentic identity to help pave the way for other LGBT people.
In the case of the experiences of stress exposure and risk behaviors, researchers agree on several points. As the main reasons for the poorer mental health, they state sexual orientation based discrimination (SOBD), such as sexual and stalking victimization, and military sexual trauma (MST) (Moody et al., 2020; Schuyler et al., 2020). The consequent risk behaviors caused by them include cigarette smoking, and alcohol use, while among the overall health outcomes were found anxiety, depression, PTSD, and suicidality (Holloway et al., 2021; Moody et al., 2020). The relationship between SOBD, MST, anxiety, depression, and distress proved to be reciprocal and common for both sexes (Holloway et al., 2021, Schuyler et al., 2020). In addition, Schuyler et al. (2020) mention an increased risk of sexual harassment among male LGB representants, which coincides with a greater probability of male suicidal ideation indicated in Holloway et al.’s (2021) findings. Such indirect correlations in mentioned research only solidify the evidence of the poorer health state of LGBT soldiers.
Differences Found Between Studies
However, specific differences are present in the research comparison. Firstly, there are different findings on behavioral healthcare utilization by heterosexual and LGBT military personnel. According to McDonald et al. (2020), the frequency of requests of LGBT representatives for professional care varies from more frequent to equal, depending on the sources. In contrast, Mark et al. (2019) found those requests less frequent than among heterosexual soldiers due to the fear of future stigmatization. However, in this regard, they mention that the research concerned only a transgender minority; thus, the results across all LGBT spectrums might be different. Another difference was found in the reasoning behind health risk behavior, such as alcohol use. Holloway et al. (2021) showcase evidence of a positive causal relationship between MST and alcohol use. In the meantime, Moody et al. (2020) showcase the outcome of a causality study in the groups of SOBD and alcohol use, MST and alcohol use, and SOBD, MST, and alcohol use. While the first two approve the causality, the latter shows the MST’s insignificance (Moody et al., 2020). Overall, the difference might be caused by the chosen emphasis of mentioned approaches.
Role of Individual and Structural Discrimination
Discrimination plays a central role in the poor general health state of LGBT military personnel; it can be classified into individual and structural. In the former case, discrimination is represented by negative interpersonal relationships and attitudes. In the latter case, the discrimination occurs on a larger scale. For example, the infamous DADT prohibited the participation of specific LGBT members in military affairs and any forms of sexual authenticity expression inside the army. Despite its annulation and seeming improvement in the minority soldiers’ treatment – a decrease in structural discrimination – individual discrimination of sexual minority personnel still persists. As a result of these factors, LGBT people often develop undesired mental health states, such as anxiety, depression, and frequent suicidal ideation. In addition, if a victim of discrimination previously received psychological trauma resulting from sexual harassment or assault, mentioned health states might contribute to PTSD development.
Key Findings of Previous Research
In the previous research, the focus was set on the discrimination toward LGBT military personnel and veterans in the U.S. military. The first study by Gurung et al. (2017) investigated their level of stress exposure after the update to the transgender policy and the nullification of the DADT. The survey concerning the sexual discrimination prevalence and military sexual trauma persistence uncovered that men and women experience the same level of discrimination; however, the trauma is more frequent among the latter (Gurung et al., 2017). The second study by Tucker et al. (2018) targeted stress factors related to suicide ideation in transgender veterans. They concluded that external minority stresses, such as discrimination and rejection, and internal minority stresses, such as a feeling of shame, predicted the frequency of suicide ideation (Tucker et al., 2018). Moreover, there was a registered indication of military external and internal minority stresses contributing to the suicide outcomes. Finally, the research by Livingston et al. (2019) assessed the consequences of stress and trauma among LBGT veterans. Based on their findings, they provided the guidelines for possible clinical treatment.
Conclusion
The actual state of contemporary research confirms the increased danger to the mental health of LGBT representatives in the military forces due to discrimination. In general, sexual minority personnel displays poorer mental health and a higher risk of anxiety, depression, suicidality, and mental disorders because they have to face bias and lack the needed support. Despite decreasing structural discrimination, they are indecisive in their disclosure, which motivates detrimental behavior to cope with the stress. However, there is still some inconsistency between particular studies’ outcomes and, thus, inaccuracy in the overall results, which motivates a broader standardization of chosen techniques and approaches. In addition, while having the ability to deal with the problem post-factum can be an asset, further research could be oriented toward the source of the problem. The suppression of structural discrimination is a significant step; nevertheless, an issue of individual sexual-oriented discrimination persists in society in general and in the military in particular, requiring it to be addressed accordingly.
References
Gurung, S., Ventuneac, A., Rendina, H. J., Savarese, E., Grov, C., & Parsons, J. T. (2017). Prevalence of military sexual trauma and sexual orientation discrimination among lesbian, gay, bisexual, and transgender military personnel: A descriptive study.Sexuality Research and Social Policy, 15(1), 74-82. Web.
Holloway, I. W., Green, D., Pickering, C., Wu, E., Tzen, M., Goldbach, J. T., & Castro, C. A. (2021). Mental health and health risk behaviors of active-duty sexual minority and transgender service members in the United States military.LGBT Health, 8(2), 152–161. Web.
Livingston, N. A., Berke, D. S., Ruben, M. A., Matza, A. R., & Shipherd, J. C. (2019). Experiences of trauma, discrimination, microaggressions, and minority stress among trauma-exposed LGBT veterans: Unexpected findings and unresolved service gaps.Psychological Trauma, 11(7), 695-703. Web.
Mark, K. M., McNamara, K. A., Gribble, R., Rhead, R., Sharp, M.-L., Stevelink, S. A., Schwartz, A., Castro, C., & Fear, N. T. (2019). The health and well-being of LGBTQ serving and ex-serving personnel: A narrative review.International Review of Psychiatry, 31(1), 75–94. Web.
McDonald, J. L., Ganulin, M. L., Dretsch, M. N., Taylor, M. R., & Cabrera, O. A. (2020). Assessing the well-being of sexual minority soldiers at a military academic institution. Military Medicine, 185(Supplement_1), 342–347. Web.
McNamara, K. A., Lucas, C. L., Goldbach, J. T., Holloway, I. W., & Castro, C. A. (2020). “You don’t want to be a candidate for punishment”: A qualitative analysis of LGBT service member “Outness.”Sexuality Research and Social Policy, 18(1), 144–159. Web.
McNamara, K. A., Lucas, C. L., Goldbach, J. T., Castro, C. A., & Holloway, I. W. (2021). “Even if the policy changes, the culture remains the same”: A mixed-methods analysis of LGBT service members’ outness patterns.Armed Forces and Society, 47(3), 505–529. Web.
Moody, R. L., Savarese, E., Gurung, S., Rendina, H. J., & Parsons, J. T. (2020). The mediating role of psychological distress in the association between harassment and alcohol use among lesbian, gay, and bisexual military personnel.Substance use & misuse, 55(12), 2055-2063. Web.
Schuyler, A. C., Klemmer, C., Mamey, M. R., Schrager, S. M., Goldbach, J. T., Holloway, I. W., & Castro, C. A. (2020). Experiences of sexual harassment, stalking, and sexual assault during military service among lgbt and non‐lgbt service members.Journal of traumatic stress, 33(3), 257-266. Web.
Tucker, R. P., Testa, R. J., Reger, M. A., Simpson, T. L., Shipherd, J. C., & Lehavot, K. (2019). Current and military‐specific gender minority stress factors and their relationship with suicide ideation in transgender veterans.Suicide and Life‐Threatening Behavior, 49(1), 155-166. Web.