LGBQ+ Veteran and service member health and health care: A scoping review of research from 1994 to 2023

Abstract:Background: People who are lesbian, gay, bisexual, queer, and other minoritized sexual orientations (LGBQ+) have served in the US military for generations. Despite well-documented health disparities between LGBQ+ and heterosexual individuals, research addressing the health of LGBQ+ veterans remains limited. This scoping review provides a map of the literature on LGBQ+ veteran health and health care from 1994 to 2023, identifying trends, gaps, and future directions. Methods: Articles were identified in PubMed, PsycINFO, CINAHL, EMBASE, Web of Science, Cochrane Library, and Google Scholar. Articles had to be available in English, be empirical studies, and include LGBQ+ veterans or service members and health or health care. Of 716 articles coded for eligibility, 106 articles were included. Articles were double coded; data were extracted for generation of disparities research (i.e., 1st: identifying disparities, 2nd: understanding drivers of disparities, and 3rd: intervening to reduce disparities), health or health care topics, sample demographics, and study design and quality. Results: The first article was published in 1999, and the quantity of published articles increased over time. Nearly half of the articles were first generation (48.1%), 45.5% were second generation, and 3.8% were third generation. Most research focused on mental health (e.g., substance use, depression, suicidality), with limited attention to physical health. Twenty-two percent of articles included samples composed solely of LGBQ+ participants. Most articles included quantitative (82.1%), retrospective, and/or cross-sectional (93.4%) study designs. Quality ratings were highest among articles with qualitative (85.7%) and mixed methods (58.0%) and lowest for quantitative (31.0%) methods. Discussion: Research on LGBQ+ veterans and service members is nascent but growing. Gaps remain in addressing physical health outcomes, utilizing advanced study designs, and integrating sexual orientation as a central focus. Future research should prioritize interventional studies, implementation strategies, and expanded efforts to include physical health outcomes.