EXAMINING THE EFFECTS OF MINORITY STRESS AND RESILIENCE ON SEXUAL MINORITY VETERANS’ HEALTHCARE UTILIZATION

Prior studies have noted significant health disparities experienced by sexual minority individuals with military histories compared to their heterosexual peers. Often the minority stress model, which posits sexual minority individuals experience unique chronic stressors that affect their well-being and fuel health disparities, is used to conceptualize these differences. Results from several studies have identified that fears or experiences of anticipated stigma and experiences of discrimination related to one's sexual orientation with health care providers are significant barriers to health care utilization for LGB+ people. However, these studies have concentrated on civilian samples, veterans who served primarily before Don't Ask, Don't Tell (DADT) was repealed, or with individuals who primarily use VHA care. Further, most studies have not examined a more comprehensive array of minority stressors as potential predictors of healthcare utilization. Therefore, the current study utilized a cross-sectional online survey of sexual minority individuals who have served in the military since DADT's repeal to examine the direct and indirect impact of minority stress during military service on health care utilization. To accomplish these goals, cisgender sexual minority adults with military service history after the repeal of DADT were recruited from a Qualtrics panel to participate in an online survey examining the relations between minority stress during time in service and utilization of healthcare services. Data were collected and analyzed regarding LGB+ individuals' demographics, military history, healthcare need, resilience, and minority stress during time in service, including experiences with discrimination, harassment, violent and nonviolent victimization, anticipated stigma, internalized heterosexism, and concealment of one's sexual minority status. Results showed that distal and proximal stressors did not account for significant variance in healthcare utilization after accounting for demographics and chronic health conditions. Instead, chronic physical and mental health conditions, bisexual/pansexual orientation, and resilience predicted healthcare utilization. Resilience did not moderate the relation between minority stress and healthcare utilization but was an independent predictor of healthcare utilization. Gender moderated the relation between both anticipated stigma and healthcare utilization and internalized heterosexism and healthcare utilization, such that higher levels of these stressors predicted less utilization in men and more utilization in women. The results illustrate the impact of health need and use of integrated healthcare systems in shaping adherence to recommend preventative screening and vaccinations in sexual minority veterans. The results demonstrate the role of stigma, heterosexism, and gender in determining how sexual minority service members and veterans receive care and suggests the need for different strategies when working with men and women veterans, with a need to encourage men who experienced sexual stigma to receive preventative healthcare as recommended. The results also highlight the need to explore the role of resilience in this population and the subpopulation of bisexual/pansexual women as they may have experienced protective factors that led them to engage in greater healthcare utilization. Lastly, while minority stress during time in service did not predict healthcare utilization, current minority stress or minority stress in healthcare settings may be a worthwhile area to examine in relation to healthcare utilization. Work in these areas can help to decrease the disparities in healthcare utilization between LGB+ veterans and their heterosexual peers