Veterans Affairs Puget Sound Health Care System.
Department of Social Work, University of Washington.
Psychol Serv. 2013 May;10(2):223-232. doi: 10.1037/a0031281.
According to recent census reports, nearly a million veterans have a same-sex partner, yet little is known about them or their use of Veterans Health Care Administration (VHA) services. Gay, lesbian, and bisexual (GLB) veterans recruited from the community (N = 356) completed an on-line survey to assess their rates of VHA utilization and whether they experience specific barriers to accessing VHA services. Andersen's model of health care utilization was adapted to provide an analytic and conceptual framework. Overall, 45.5% reported lifetime VHA utilization and 28.7% reported past-year VHA utilization. Lifetime VHA health care utilization was predicted by positive service connection, positive screen for both posttraumatic stress disorder (PTSD) and depression, and history of at least one interpersonal trauma during military service related to respondent's GLB status. Past-year VHA health care utilization was predicted by female gender, positive service connection, positive screen for both PTSD and depression, lower physical functioning, a history of military interpersonal trauma related to GLB status, and no history of stressful experiences initiated by the military to investigate or punish GLB status. Rates of VHA utilization by GLB veterans in this sample are comparable to those reported by VHA Central Office for all veterans. Of those who utilized VHA services, 33% reported open communication about their sexual orientation with VHA providers. Twenty-five percent of all participants reported avoiding at least one VHA service because of concerns about stigma. Stigma and lack of communication between GLB veterans and their providers about sexual orientation are areas of concern for VHA.
根据最近的人口普查报告，近 100 万退伍军人有同性伴侣，但对他们或他们使用退伍军人健康管理局 (VHA) 服务的情况知之甚少。从社区招募的同性恋、双性恋和双性恋退伍军人（N=356）完成了一项在线调查，以评估他们使用 VHA 的比率，以及他们是否遇到获得 VHA 服务的具体障碍。安德森的医疗保健利用模型经过改编，提供了一个分析和概念框架。总的来说，45.5%的人报告有过终身使用 VHA 的经历，28.7%的人报告有过去一年使用 VHA 的经历。积极的服务联系、积极的创伤后应激障碍 (PTSD) 和抑郁筛查，以及与受访者的 GLB 身份相关的服役期间至少一次人际创伤的历史，预测了终身使用 VHA 医疗保健。过去一年使用 VHA 医疗保健的预测因素包括女性性别、积极的服务联系、PTSD 和抑郁的积极筛查、较低的身体功能、与 GLB 身份相关的军事人际创伤史，以及没有因调查或惩罚 GLB 身份而发起的军事压力经历。本样本中 GLB 退伍军人的 VHA 使用比率与 VHA 中央办公室报告的所有退伍军人的比率相当。在使用 VHA 服务的人中，33%的人报告与 VHA 提供者公开交流过他们的性取向。25%的参与者报告因担心耻辱感而至少避免了一项 VHA 服务。耻辱感和 GLB 退伍军人与他们的提供者之间关于性取向的沟通不畅是 VHA 关注的领域。
