Purpose: The prevalence of posttraumatic stress disorder (PTSD) and other psychiatric disorders is high among military veterans and even higher among transgender veterans. Prior prevalence estimates have become outdated, and novel methods of estimation have since been developed but not used to estimate PTSD prevalence among transgender veterans. This study provides updated estimates of PTSD prevalence among transgender and cisgender veterans.
Methods: We examined Veterans Health Administration (VHA) medical record data from October 1, 1999 to April 1, 2021 for 9995 transgender veterans and 29,985 cisgender veteran comparisons (1:3). We matched on age group at first VHA health care visit, sex assigned at birth, and year of first VHA visit. We employed both probabilistic and rule-based algorithms to estimate the prevalence of PTSD for transgender and cisgender veterans.
Results: The prevalence of PTSD was 1.5–1.8 times higher among transgender veterans. Descriptive data suggest that the prevalence of depression, schizophrenia, bipolar disorder, alcohol and non-alcohol substance use disorders, current/former smoking status, and military sexual trauma was also elevated among transgender veterans.
Conclusion: The PTSD and overall psychiatric burden observed among transgender veterans was significantly higher than that of their cisgender peers, especially among recent users of VHA care. These PTSD findings are consistent with prior literature and minority stress theory, and they were robust across probabilistic and two rule-based methods employed in this study. As such, enhanced and careful screening, outreach, and evidence-based practices are recommended to help reduce this disparity among transgender veterans.

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Information & Authors


Published In

cover image LGBT Health
LGBT Health
Volume 9Issue Number 2February/March 2022
Pages: 94 - 102
PubMed: 34981963


Published online: 2 March 2022
Published in print: February/March 2022
Published ahead of print: 4 January 2022


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Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.
VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Scott L. DuVall, PhD
VA Informatics and Computing Infrastructure, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.
Division of Epidemiology, Department of Internal Medicine, University of Utah, Salt Lake City, Utah, USA.
Jillian C. Shipherd, PhD https://orcid.org/0000-0001-6742-7912
Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts, USA.
Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, Boston, Massachusetts, USA.
LGBTQ+ Health Program, Veterans Health Administration, Washington, District of Columbia, USA.


Address correspondence to: Nicholas A. Livingston, PhD, Behavioral Science Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Avenue, Boston, MA 02130, USA [email protected]

Authors' Contributions

N.A.L., K.E.L., and J.C.S. developed the study concept. K.E.L. performed data analysis and drafted the results section. E.G. performed data extraction and management. N.A.L., K.E.L., J.C.S., Z.H., E.G., and S.L.D. contributed to data interpretation. N.A.L. drafted the article. K.E.L., J.C.S., Z.H., E.G., and S.L.D. contributed to article writing and revisions. All authors reviewed and approved the article before submission.

Author Disclosure Statement

No competing financial interests exist.

Funding Information

This work was supported by using resources and facilities at the VA Salt Lake City Health Care System and the VA Informatics and Computing Infrastructure (VINCI), VA HSR RES 13-457.

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