# Understanding Suicide Risks among LGBT Veterans in VA Care

> **NIH VA I01** · VA CONNECTICUT HEALTHCARE SYSTEM · 2020 · —

## Abstract

One of the key challenges in suicidality research is that outcomes may be multi-determined and rare. The
causes of suicidal behaviors may consist of a combination of factors, which vary over time, and between
individuals and groups. Risk factors may be distal or proximal, and distal exposures may increase risk for
suicide given changes in proximal risk factor(s). Despite literature on suicidality among lesbian, gay, bisexual,
and transgender (LGBT) persons, little research has examined LGBT Veterans. We hypothesize that LGBT
status is a pre-disposing factor that increases risk due to minority stress, the stress of prior and potentially
ongoing discrimination, including military sexual trauma, that may be further increased due to proximal factors
such as comorbid mental health and medical conditions, a lack of engagement in care, system and providers
lack of awareness or insensitivity to their unique needs, and pain among other factors. With the 2011 repeal of
the Don't Ask, Don't Tell (DADT) policy, LGB personnel are currently able to openly serve in the US military,
while the status of T personnel remains uncertain. While LGBT Veterans, especially those who served prior to
repeal of DADT, may suffer similar discrimination, stigma and stress, they may each have dissimilar suicide
risks. One study in the VA found that the prevalence of gender identity disorder diagnosis was >5 times higher
than in the general US population, and that the rate of suicide-related events was > 20 times higher than the
VA population. However, the engagement of LGBT Veterans in VA care is difficult to estimate: sexual
orientation and gender identity (SO/GI) data is not collected in a structured manner. The VA's Evidence
Review: Social Determinants of Health for Veterans found “only two articles examined sexual orientation for
Veterans and non-Veterans and included only women. No articles addressed gender identity for Veterans and
non-Veterans”. In addition to LGBT status, there is less study of other suicide risk factors such as pain and
opioid prescriptions as well as potential protective factors such as receipt of complementary and integrative
health services, which may treat both pain and PTSD. Little is known about how race/ethnicity, gender,
morbidity, and treatment intersect with sexual orientation/gender identity to impact suicidality risk. Using VA
electronic health record data, will identify LGBT Veterans to ascertain pathways to suicidal behavior, and
assess both risk and protective factors related to LGBT individuals in all gender, age, and racial and ethnic
groups. In a current project (IIR 16-262), our team is developing natural language processing (NLP) and
machine learning (ML) tools to study CIH services' effect on opioid prescribing among Veterans with
musculoskeletal disorder diagnoses (MSD) and PTSD. In another project (CRE 12-012), we identified 15,000+
Veterans with suicide attempts near the MSD diagnosis date, and 17,000+ suicide deaths in the coho...

## Key facts

- **NIH application ID:** 9985619
- **Project number:** 5I01HX002679-02
- **Recipient organization:** VA CONNECTICUT HEALTHCARE SYSTEM
- **Principal Investigator:** Joseph Lucien Goulet
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2019-06-01 → 2024-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9985619

## Citation

> US National Institutes of Health, RePORTER application 9985619, Understanding Suicide Risks among LGBT Veterans in VA Care (5I01HX002679-02). Retrieved via AI Analytics 2026-05-25 from https://api.ai-analytics.org/grant/nih/9985619. Licensed CC0.

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