5 - (IOP 27) Does State-level Restrictive Policy Predict Mental Health Outcomes Among Transgender and Gender Diverse Veterans?

Introduction: Transgender and Gender Diverse (TGD) veterans are at increased risk for adverse health outcomes due to discrimination within cisnormative systems. These experiences hold significant implications for veteran health, including risk for depression and suicide. TGD veterans also face greater barriers to care, highlighting the important role VA medical services can play in care provision. Additionally, structural protections and discriminatory policies, such as state legislation, may have downstream effects on mental health and quality of life. Furthermore, state-level policies may reflect local attitudes towards TGD veterans, and experiences of TGD veterans in those states. The aim of this study was to explore whether state level policies were associated with differences in depression, quality of life, and suicide outcomes for TGD veterans overall, and to examine whether those associations differed among receiving vs. not receiving respectful care at VA.

Methods: We analyzed data from the Gender-Affirming Care Evaluation (GRACE) study that surveyed TGD Veterans in the United States from September 2022-July 2023. State level restrictive policy (yes/no) was from the Movement Advancement Project website, as of May 2023 to coincide with GRACE data collection. We analyzed frequencies and prevalence ratios of depression, physical and mental quality of life, and suicide outcomes among Veterans in restrictive (vs. non-restrictive) states who were treated with respect at VA (vs. not).

Results: Our sample included 5,851 TGD veterans who received VA care in the past year and for whom we had state-level data. Most veterans reported living in non-restrictive states (71.8%) and reported receiving respectful care at VA across restrictive and non-restrictive states (85.5% and 89.0%, respectively). TGD veterans who endorsed not receiving respectful care were more likely to report depression and suicide behaviors (i.e., ideation, plan, attempt) over the past year. In unadjusted regression analyses, and when controlling for demographics and stratifying by respectful care, restrictive policy was not significantly associated with mental health outcomes or quality of life. In multinomial logistic regressions controlling for demographics, restrictive policy was not associated with suicide outcomes (i.e., ideation, plan, attempt). Prevalence ratios suggested worse mental health outcomes were more common in veterans in restrictive states, but differences were not statistically significant.

Discussion: In our sample, restrictive state policy was not associated with significant differences in mental health and quality of life outcomes when controlling for demographics and stratifying by respectful care. State-level policy may not be proximal to veteran experiences, and thus there may be variables better suited to capture environmental experience of TGD-related stressors that impact mental health and quality of life for veterans. Continued research is important as state level policy has become broadly more restrictive in recent years.