Lost and Found: The LGBT+ Veteran Community and the Impacts of the Gay Ban
Abstract: Prior to 12th January 2000, the UK Armed Forces enforced a ban on all LGBT+ service personnel. Known as the ‘gay ban’, there was no distinction made between sexual orientation and gender identity. Under this ban, LGBT+ service personnel had medals, awards, and commissions taken, pensions and gratuities disregarded or degraded and their association with the Armed Forces barred. A significant number of LGBT+ military personnel during the ban experienced traumatic investigations to uncover evidence of homosexuality and subsequent dishonourable discharges, forced resignations, and alienation from the military family without access to social, financial, or mental health support, which reduced overall well-being. Despite over two decades since the gay ban was repealed, little is known of the UK LGBT+ veterans’ community or the long-term impact of serving during the Armed Forces gay ban. A mixed methods approach was carried out over two phases. Phase One consisted of a qualitative exploratory study involving semi-structured interviews with 15 LGBT+ veterans to understand their lived experience of the LGBT+ Armed Forces ban. Findings from the Phase One interviews informed the development of an online survey completed by 101 LGBT+ veterans, the quantitative element to gain a greater understanding of the impact of the ban, social isolation, and loneliness. All participants enlisted before 12th January 2000, self-identified as being LGBT+ and as having been affected by the ban. Following the analysis of Phase One and Phase Two, the findings were triangulated. Three overarching themes were identified - Emotional Impact; Changing to Adapt and Adapting to Change; and Aftermath: Barriers to Help Seeking. Underpinning the themes is the risk to health and well-being and the resultant social isolation and loneliness as a consequence of decades of employing camouflage techniques to blend into military life and expected cultural norms. This work advances knowledge on the lived experience of LGBT+ veterans by providing an evidence base for the development of effective service provision to enhance and improve the health and well-being of LGBT+ veterans. In addition to recognising the harm and cumulative vulnerability, brought about by discriminatory practice and abuse, there is a need to recognise that the risk of life-limiting social isolation and loneliness. Recommendations from the research and LGBT+ veterans themselves are also presented.
Abstract: Novel and automated means of opioid use and relapse risk detection are needed. Unstructured electronic medical record data, including written progress notes, can be mined for clinically relevant information, including the presence of substance use and relapse-critical markers of risk and recovery from opioid use disorder (OUD). In this study, we used natural language processing (NLP) to automate the extraction of opioid relapses, and the timing of these occurrences, from veteran patients' electronic medical record. We then demonstrated the utility of our NLP tool via analysis of pre-/post-COVID-19 opioid relapse trends among veterans with OUD. For this demonstration, we analyzed data from 107,606 veterans OUD enrolled in Veterans Health Administration, comparing a pandemic-exposed cohort (n = 53,803; January 2019-March 2021) to a matched prepandemic cohort (n = 53,803; October 2017-December 2019). The recall of our NLP tool was 75% and our precision was 94%, demonstrating moderate sensitivity and excellent specificity. Using the NLP tool, we found that the odds of opioid relapse postpandemic onset were proportionally higher compared to prepandemic trends, despite patients having fewer mental health encounters from which to derive instances of relapse postpandemic onset. In this research application of the tool, and as hypothesized, we found that opioid relapse risk was elevated postpandemic. The application of NLP Methods: to identify and monitor relapse risk holds promise for future surveillance, risk prevention, and clinical outcome research.