Prevalence of Co-Morbid Mental Health Diagnoses in Transgender Military Veterans at the Salt Lake City Veterans Affairs Medical Center.

Introduction: Although a relatively uncommon medical condition, individuals with Gender Identity Disorder (GID) have unique concerns related to health care (1).  Studies show higher rates of GID in the military and its veterans than the general American population, with most recent estimates suggesting a rate of GID in patients in the Veterans Affairs Health Care System (VAHCS) of 22.9/100,000 persons compared to 4.3/100,000 persons in the general population (2,3). High rates of depression and other mental health disorders are documented in veterans; those with GID are particularly at risk (3,4). Notably, estimated rates of suicide-related events among GID veterans are 20 times higher than the general VAHCS population (3). Mental health disorders frequently contribute to decreased compliance with medical therapies, complicating GID management (5).

Objectives: To address these concerns, we recently formed a multi-disciplinary Gender Dysphoria Team with endocrinology, mental health, pharmacy, speech therapy, and vocational rehab providers at the Salt Lake City Veterans Affairs Medical Center (SLC VAMC).  Providers meet with patients individually and bi-monthly as a team to discuss patients and treatment plans. We defined baseline characteristics of mental health diagnoses in our population.

Methods: We examined SLC VAMC electronic medical records between January 1, 2014 and October 1, 2015 for encounters using the ICD-9 code for Gender Identity Disorder in Adolescents or Adults. Charts with the code were then examined for ICD-9 codes for tobacco use disorder, posttraumatic stress disorder (PTSD), depression, and anxiety-related conditions. Other ICD-9 codes for mental health diagnoses and suicide attempt/ideation requiring crisis contact were noted.

Results: Thirty-nine patients were found with the GID ICD-9 code. Of those, 31 (79.5%) identified as male-to-female, 8 (20.1%) female-to-male; 19 (48.7%) had a history of suicide attempt/ideation. PTSD was the most commonly identified mental health diagnosis (18/39 (46.1%)), depression second (16 (41.0%)), followed by tobacco use disorder (13 (33.3%)), other (substance abuse, bipolar disorder, schizotypal disorder) (9 (23.1%)), and anxiety (6 (15.4%)). When further examined, four (10.2%) patients were identified as having no mental health co-morbidities, 17 (42.6%) carried one mental health diagnosis and 18 (46.2%) carried 2 or more diagnoses (maximum number documented in one patient: 4 (10.2%)).

Conclusions: Of patients with GID at the SLC VAMC, 90% have mental health co-morbidities, nearly 50% having two or more diagnoses. Nearly 50% required intervention for suicide attempt/ideation. We have formed the multi-disciplinary Gender Dysphoria Team in an effort to reduce the impact of these diagnoses on the management of GID, however, further research into the optimization of management for this population is still needed.