Papers by Jillian Shipherd
Journal of behavioral medicine, Jan 10, 2017
Childhood sexual abuse (CSA) is associated with post-traumatic stress disorder (PTSD), which can ... more Childhood sexual abuse (CSA) is associated with post-traumatic stress disorder (PTSD), which can be associated with condomless sex among men who have sex with men (MSM). However, the impact of moderating factors on the relationship between PTSD symptom severity and condomless sex is poorly understood. We examined whether PTSD symptom severity was associated with condomless sex among MSM with CSA histories, and whether substance dependence, self-esteem, and distress tolerance moderated that relationship (n = 288). Notably, no direct relationship between PTSD symptom severity and condomless sex was found. Adjusted models indicated that condomless sex was differentially impacted by PTSD symptom severity among those without substance dependence (ΔR(2) = 0.03, p = 0.034) and, counterintuitively, those with high self-esteem (ΔR(2) = 0.07, p = 0.005). PTSD symptom severity was associated with condomless sex across levels of distress tolerance. Findings indicate that substance use, self-est...
Journal of Aggression, Maltreatment & Trauma, 2022
American journal of preventive medicine, 2017
Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicid... more Transgender individuals experience pronounced disparities in health (e.g., mood disorders, suicide risk) and in the prevalence of social determinants of housing instability, financial strain, and violence. The objectives of this study were to understand the prevalence of social determinants among transgender veterans and assess their associations with medical conditions. This project was a records review using administrative data from the U.S. Department of Veterans Affairs databases for 1997-2014. Transgender veterans (N=6,308) were defined as patients with any of four ICD-9 diagnosis codes associated with transgender status. Social determinants were operationalized using ICD-9 codes and Department of Veterans Affairs clinical screens indicating violence, housing instability, or financial strain. Multiple logistic regression was used to assess the associations of social determinants with medical conditions: mood disorder, post-traumatic stress disorder, alcohol abuse disorder, illi...
Transgender Health, 2016
Purpose: The Veteran's Health Administration (VHA) has created a training program for interdiscip... more Purpose: The Veteran's Health Administration (VHA) has created a training program for interdisciplinary teams of providers on the unique treatment needs of transgender veterans. An overview of this program's structure and content is described along with an evaluation of each session and the program overall. Methods: A specialty care team delivered 14 didactic courses supplemented with case consultation twice per month over the course of 7 months through video teleconferencing to 16 teams of learners. Each team, consisting of at least one mental health provider (e.g., social worker, psychologist, or psychiatrist) and one medical provider (e.g., physician, nurse, physician assistant, advanced practice nurse, or pharmacist), received training and consultation on transgender veteran care. Results: In the first three waves of learners, 111 providers across a variety of disciplines attended the sessions and received training. Didactic topics included hormone therapy initiation and adjustments, primary care issues, advocacy within the system, and psychotherapy issues. Responses were provided to 39 veteran-specific consult questions to augment learning. Learners reported an increase in knowledge plus an increase in team cohesion and functioning. As a result, learners anticipated treating more transgender veterans in the future. Conclusion: VHA providers are learning about the unique healthcare needs of transgender veterans and benefitting from the training opportunity offered through the Transgender Specialty Care Access Network-Extension of Community Healthcare Outcomes program. The success of this program in training interdisciplinary teams of providers suggests that it might serve as a model for other large healthcare systems. In addition, it provides a path forward for individual learners (both within VHA and in the community) who wish to increase their knowledge.
American journal of public health, Jan 21, 2016
To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgend... more To examine whether indicators of community- and state-level lesbian, gay, bisexual, and transgender equality are associated with transgender veterans' mental health. We extracted Veterans Administration data for patients who were diagnosed with gender identity disorder, had at least 1 visit in 2013, and lived in a zip code with a Municipality Equality Index score (n = 1640). We examined the associations of whether a state included transgender status in employment nondiscrimination laws and in hate crimes laws with mood disorders; alcohol, illicit drug, and tobacco use disorders; posttraumatic stress disorder; and suicidal ideation or attempt. Nearly half (47.3%) of the sample lived in states with employment discrimination protection, and 44.8% lived in states with hate crimes protection. Employment nondiscrimination protection was associated with 26% decreased odds of mood disorders (adjusted odds ratio [AOR] = 0.74; 95% confidence interval [CI] = 0.59, 0.93) and 43% decreased o...
The Gerontologist, 2016
To examine differences in all-cause and cause-specific mortality by sexual orientation and Vetera... more To examine differences in all-cause and cause-specific mortality by sexual orientation and Veteran status among older women. Data were from the Women's Health Initiative, with demographic characteristics, psychosocial factors, and health behaviors assessed at baseline (1993-1998) and mortality status from all available data sources through 2014. Women with baseline information on lifetime sexual behavior and Veteran status were included in the analyses (N = 137,639; 1.4% sexual minority, 2.5% Veteran). The four comparison groups included sexual minority Veterans, sexual minority non-Veterans, heterosexual Veterans, and heterosexual non-Veterans. Cox proportional hazard models were used to estimate mortality risk adjusted for demographic, psychosocial, and health variables. Sexual minority women had greater all-cause mortality risk than heterosexual women regardless of Veteran status (hazard ratio [HR] = 1.20, 95% confidence interval [CI]: 1.07-1.36) and women Veterans had greate...
Psychological Trauma: Theory, Research, Practice, and Policy, 2013
The relationship between partner violence and physical health symptoms is well-established. Altho... more The relationship between partner violence and physical health symptoms is well-established. Although some researchers have theorized that the physical health effects of partner violence may be worse for ethnic minority women, there is little research addressing this topic. The current study examined whether African American women demonstrate a differential association in this relationship than Caucasian women. This study included 323 women (232 African American, 91 Caucasian) who participated in a larger investigation of the psychological and psychophysiological correlates of recent partner violence among women seeking help for the abuse. Race was examined as a moderator of the relationship between partner violence frequency and physical health symptoms. Although mean levels of partner violence frequency and physical health symptoms did not significantly differ between African American and Caucasian women, linear regression analyses demonstrated a significant positive relationship between partner violence frequency and physical health symptoms for African American women; whereas there was no association observed between these variables for Caucasian women. Post hoc analyses revealed that posttraumatic stress disorder symptoms partially mediated the association between partner violence frequency and physical health symptoms for the African American women. The current findings underscore the importance of considering race when studying the effect of partner violence on women's health.
Psychological services, 2014
Approximately one million gay and lesbian Americans are veterans, and rates of engagement in the ... more Approximately one million gay and lesbian Americans are veterans, and rates of engagement in the Veterans Affairs (VA) health care system may be increasing for both sexual and gender minority veterans. Very little research has examined the experience of these veterans when receiving care at VA health care facilities. The purpose of this study was to explore the experiences, beliefs, and preferences of lesbian, gay, bisexual, or transgender (LGBT) veterans in their communication with VA health care providers. LGBT veterans (n = 58) participated in focus groups or individual interviews and completed self-report measures at two southern VA hospitals. Approximately 2/3 of veterans report that none of their VA providers have specifically asked about their sexual orientation, and 24% of the veterans indicate that they have not disclosed their orientation to any VA provider. Although some veterans want providers to initiate these discussions, veterans also expressed fears about disclosure ...
Suicide and Life-Threatening Behavior, 2012
American Journal of Public Health, 2014
A 2011 Veterans Health Administration directive mandated medically necessary care for transgender... more A 2011 Veterans Health Administration directive mandated medically necessary care for transgender veterans. Internal education efforts informed staff of the directive and promoted greater access to care. For fiscal years 2006 through 2013, we identified 2662 unique individuals with International Classification of Diseases, Ninth Revision diagnoses related to transgender status in Veterans Health Administration medical records, with 40% of new cases in the 2 years following the directive. A bottom-up push for services by veterans and top-down education likely worked synergistically to speed implementation of the new policy and increase access to care.
Journal of Psychopathology and Behavioral Assessment, 2003
This study explored differences among pain patients classified as Dysfunctional, Interpersonally ... more This study explored differences among pain patients classified as Dysfunctional, Interpersonally Distressed, and Adaptive Copers on the Multidimensional Pain Inventory with respect to PTSD symptomatology, anxiety, and depression. Eighty-five patients with pain complaints who had experienced a serious motor vehicle accident were classified into these three pain coping categories and assessed using clinician and self-report measures. Results indicated that patients
Traumatology, 2011
... Jillian C. Shipherd,1,2,3 Shira Maguen,4,5 W. Christopher Skidmore,1 and Sarah M. Abramovitz1... more ... Jillian C. Shipherd,1,2,3 Shira Maguen,4,5 W. Christopher Skidmore,1 and Sarah M. Abramovitz1,2 ... are criti-cally related to risk for and resilience to posttraumatic psychopathology (eg, Ehlers & Clark, 2000; Ehlers et al., 2002; Foa & Rothbaum, 1998; Horowitz, 1986; Janoff ...
Personality and Social Psychology Bulletin, 2008
Although many studies have examined hardiness as a protective factor against stress reactions, to... more Although many studies have examined hardiness as a protective factor against stress reactions, to the authors' knowledge no studies have yet examined the impact of stress reactions on hardiness. However, there is theoretical support for this notion. In this longitudinal study of 1,571 Marine recruits who participated in a highly stressful training program, the authors applied regression-based cross-lagged analyses to examine associations between stress reactions and hardiness over time for both men and women, and they investigated social support as a moderator of these relationships. Men who were hardier at Time 1 (T1) reported lower stress reactions at Time 2 (T2), and men who experienced more stress reactions at T1 were less hardy at T2. Although the negative impact of stress reactions on hardiness was strongest when social support was low for both genders, stress reactions predicted enhanced hardiness when social support was high for women only.
Military Medicine, 2014
Transgender individuals face challenges dealing with health care providers. For reasons that are ... more Transgender individuals face challenges dealing with health care providers. For reasons that are poorly understood, the prevalence of gender dysphoria (GD) in veterans is higher than in the general population. LGBT (lesbian, gay, bisexual, transgender) health issues, particularly those of the transgender community, are inadequately covered in recent medical publications and most training programs, and previous negative experiences in health care settings have created barriers for appropriate care of transgender veterans resulting in decreased preventive services, continuity of care, and life expectancy. Future research must focus on the unique needs of transgender veterans so that health care providers have greater understanding and are better prepared to render appropriate care. The Department of Veterans Affairs (VA) is committed to providing sensitive, evidenced-based care and has made significant progress in achieving this goal although much remains to be done. Transgender individuals, including those who meet Diagnostic and Statistical Manual-5 (DSM-5; APA, 2013) criteria
Journal of Women's Health, 2013
Background: Lesbian and bisexual (i.e., sexual minority) identity is more common among women vete... more Background: Lesbian and bisexual (i.e., sexual minority) identity is more common among women veterans than among male veterans. Unique health issues have been identified among women veterans and among sexual minority women, but little is known about women who are both sexual minorities and veterans. This study aimed to compare demographic and health information from sexual minority women veterans with sexual minority women non-veterans and heterosexual women veterans. Methods: Behavioral Risk Factor Surveillance Survey data were pooled from ten U.S. states that elected to ask sexual identity during 2010. The analytic sample was comprised of women who identified both their sexual identity and veteran status (n = 1,908). Mental health indicators were frequent mental distress, sleep problems, low social/emotional support, and low satisfaction with life. Health risk indicators included current smoking, overweight, and obesity. Physical health status was defined by three components: disability requiring assistive equipment, > 14 days of poor physical health in the past 30 days, and activity limitations. Results: Compared with heterosexual women veterans, sexual minority women veterans had higher odds of mental distress (odds ratio [OR] = 3.03, 95% confidence interval [CI]: 1.61-5.70) and smoking (OR = 2.31, 95%CI: 1.19-4.48). After adjusting for demographic correlates, sexual minority women veterans had three times the odds of poor physical health (OR = 3.01, 95%CI: 1.51-5.99) than their sexual minority non-veteran peers. Conclusions: Results suggest sexual minority women veterans may experience unique health disparities relevant to provision of care in both Veterans Affairs (VA) and non-VA healthcare systems. Future research requires availability of data that include sexual minority status.
Journal of Traumatic Stress, 2012
Journal of Trauma & Dissociation, 2011
The Journal of Rehabilitation Research and Development, 2007
Our primary aim was to document the rate of comorbidity of physician-diagnosed chronic pain condi... more Our primary aim was to document the rate of comorbidity of physician-diagnosed chronic pain conditions in veterans who were seeking treatment for posttraumatic stress disorder (PTSD). Chronic pain diagnoses (e.g., chronic lowback pain and osteoarthritis) were examined with retrospective chart review. Of the patients with PTSD, 66% had chronic pain diagnoses at pretreatment. These findings are consistent with previous studies that documented the high comorbidity of chronic pain and PTSD using samples of pain patients. Our secondary aim was to examine pain ratings before, during, and after PTSD treatment. Using data that were a part of clinical practice, we found that patients with more pain before treatment reported reductions in pain over the course of PTSD treatment and in the 4 months following treatment. While our results must be interpreted cautiously because of multiple confounding factors and the absence of experimental manipulation, they highlight the importance of PTSD and pain comorbidity.
Journal of Gay & Lesbian Mental Health, 2010
This study examined mental healthcare use and barriers to mental healthcare utilization in a samp... more This study examined mental healthcare use and barriers to mental healthcare utilization in a sample of 130 transgender volunteers. Roughly a third of participants sought treatment for mental health issues including depression, anxiety, and relationship problems. Sixty-eight participants (52% of sample) showed evidence of psychological distress but had not received mental health services in the past year. Results point to potential barriers to seeking mental health services. Specifically, cost of treatment, previous bad experiences with healthcare, fear of treatment, and stigma concerns were the most frequently endorsed barriers related to seeking mental health services. Implications for practitioners are discussed.
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Papers by Jillian Shipherd