Elizabeth W Jackson

University of North Carolina at Chapel Hill, North Carolina, United States

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Publications (12)21.76 Total impact

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    ABSTRACT: In behavioral health services research, self-reporting provides comprehensive information on service use, but may have limited reliability because of recall bias and misclassification. This study examines test-retest reliability of self-reported health service use, factors affecting reliability, and the impact of inconsistent reporting on the robustness of cost estimates using the test-retest data from the Women, Co-occurring Disorders, and Violence Study (n = 186). Reliability varies widely across service types: moderate to substantial (k = 0.65-0.94) for any use; slight to substantial (ICC = 0.12-0.93) for quantity of use; and none to moderate (k = -0.06-0.79) for service content, but is not affected by psychiatric symptom severity. Cost estimates do not differ according to the use of test or retest data. Findings suggest that self-reporting provides reliable data on service quantity and is adequate for economic evaluations. However, self-reporting of treatment content in highly specified service categories (e.g., individual counseling during residential treatment) may not be reliable.
    The Journal of Behavioral Health Services & Research 08/2008; 35(3):265-78. · 0.78 Impact Factor
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    ABSTRACT: This research examines the relationship between the characteristics of physicians who routinely provide medical care for postpartum mothers and their treatment preferences for managing postpartum depression (PPD) by means of a self-administered postal survey. A survey was sent to a random sample of 600 obstetricians/gynecologists and 600 family practitioners in North Carolina. The overall response rate was 42%. Forty-six percent of the responding physicians (N = 228) reported that they had seen women for postpartum visits during the past 3 months. Physician age, gender, race, and practice type were significantly associated with differences in their treatment preferences of PPD. Older physicians and non-white physicians were less likely to prefer treatment of PPD with antidepressants. Older physicians and physicians trained in obstetrics/gynecology (OB/GYN) were less likely to treat PPD with referral to a social worker or psychologist for counseling, but physicians trained in family practice and female physicians were more likely to do so.
    Community Mental Health Journal 03/2008; 44(1):47-56. · 1.03 Impact Factor
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    ABSTRACT: As part of a national, multi-site treatment outcome study, an instrument was designed to assess consumers' perceptions of key services integrating trauma, mental health, and substance abuse issues, the Consumer Perceptions of Care (CPC). This study evaluates the psychometric properties of this instrument and analyzes consumers' perceptions of the services they received. The results suggest that the measure has four factors: services integration, choice in services, trauma-informed assessment, and respect for cultural identity. These factors demonstrated adequate reliability, and the overall results suggested that the measure is a reliable, sensitive, and valid reflection of consumers' perceptions of their services and their providers for diverse racial and ethnic groups. Women in the intervention programs perceived their services as more highly integrated for trauma, mental health, and substance use than women in the services as usual or comparison programs, supporting its utility as a measure of programs designed to provide integrated services.
    The Journal of Behavioral Health Services & Research 02/2008; 35(1):71-90. · 0.78 Impact Factor
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    ABSTRACT: Postpartum depression occurs in 13% of women after delivery making it one of the most common puerperial complications. The purpose of the study was to examine: (1) the extent to which obstetricians/gynecologists and family physicians report discussing depression and other psychosocial issues during postpartum visits and (2) how physician specialty and gender are related to whether physicians report discussing depression and other psychosocial issues with patients during postpartum visits. A survey was sent to a random sample of 600 obstetricians/gynecologists and 600 family practitioners in North Carolina. The overall response rate was 42%. Forty-six percent of the responding physicians (N=228) reported that they had seen women for postpartum visits during the past 3 months. Of physicians conducting postpartum visits within this time period, 43% of physicians were almost certain to ask whether the woman felt down, depressed, or hopeless and 27% were almost certain to ask about the woman's interest in her usual activities. Seventy-nine percent of physicians stated that they were unlikely to use a formal screen for depression. Obstetricians/gynecologists were less likely to ask about a womans social support network (OR=0.33, 95% CI=0.14, 0.75), to ask about her relationship with her partner (OR=0.40, 95% CI=0. 18, 0.87), and to use a formal depression screen (OR= 0. 16, 95% CI=0.04, 0.57) than family practitioners. The study only examined physician self-report of the extent to which they communicated about different issues with women during postpartum visits. Communication about depression and related psychosocial issues during postpartum visits is substantially limited, likely contributing to the underdiagnosis of this common disorder.
    North Carolina medical journal 01/2007; 68(3):151-5.
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    ABSTRACT: The purpose of the current study was to examine how African American race was related to the use of antidepressants and counseling among homeless depressed women. Women were recruited in 18 homeless shelters in four counties in central North Carolina. Head of household homeless mothers with psychiatric and/or substance abuse disorders who had dependent children were eligible to participate. One hundred and sixty four women enrolled into the study. Fifty-six percent (N=92) of the homeless women were currently depressed at the time of enrollment into the study. Nineteen of the depressed women reported having received counseling during the past 3 months and there were no racial differences in counseling use. A total of 19 depressed women were currently taking antidepressants. Non-Black depressed women (60%) were significantly more likely than Black depressed women (16%) to be currently using antidepressant medication (OR=0.14, 95% CI=0.02, 0.90). Fourteen of the 92 depressed women reported needing mental health services but not receiving them during the past 3 months and all of these women were Black.
    Community Mental Health Journal 03/2006; 42(1):77-85. · 1.03 Impact Factor
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    ABSTRACT: The relation of medical literacy to women-reported barriers to taking medication themselves or giving medication to their children was studied. Women in 18 homeless shelters in four counties in central North Carolina were recruited. Head-of-household homeless mothers with psychiatric or substance-abuse disorders and dependent children were eligible to participate. Trained interviewers administered a site-specific questionnaire on medication use. One hundred sixty-four homeless women participated. Forty-two percent of the women were currently taking a medication. Forty-six percent of the women stated that there was a barrier to taking their medications as prescribed. Medical literacy was not significantly related to whether women felt there were barriers to taking a medication. Seventy-five percent of the women reported having one or more children living with them. Thirty-seven percent reported having a child with asthma live with them, and 12% reported having a child with attention-deficit disorder. Forty percent reported a barrier to giving their child a needed medication. Taste was the most commonly reported barrier. Women with lower medical literacy and younger women were significantly more likely to report a barrier to giving their children a needed medication. Over 80% of women listed pharmacists as their first or second choice for receiving drug information orally. Race and perceived barriers to medication use affected the medication-taking behavior of homeless women, while their age and literacy level affected the reporting rates of the barriers to medication use for their children. Homeless women preferred receiving both written and oral drug information from a physician or a pharmacist.
    American Journal of Health-System Pharmacy 03/2006; 63(4):346-51. · 1.98 Impact Factor
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    ABSTRACT: Women with co-occurring mental health and substance use disorders frequently have a history of interpersonal violence, and past research has suggested that they are not served effectively by the current service system. The goal of the Women, Co-occurring Disorders, and Violence Study was to develop and test the effectiveness of new service approaches specifically designed for these women. A quasi-experimental treatment outcome study was conducted from 2001 to 2003 at nine sites. Although intervention specifics such as treatment length and modality varied across sites, each site used a comprehensive, integrated, trauma-informed, and consumer-involved approach to treatment. Substance use problem severity, mental health symptoms, and trauma symptoms were measured at baseline, and follow-up data were analyzed with prospective meta-analysis and hierarchical linear modeling. A total of 2,026 women had data at the 12-month follow-up: 1,018 in the intervention group and 1,008 in the usual-care group. For substance use outcomes, no effect was found. The meta-analysis demonstrated small but statistically significant overall improvement in women's trauma and mental health symptoms in the intervention relative to the usual-care comparison condition. Analysis of key program elements demonstrated that integrating substance abuse, mental health, and trauma-related issues into counseling yielded greater improvement, whereas the delivery of numerous core services yielded less improvement relative to the comparison group. A few person-level characteristics were associated with increases or decreases in the intervention effect. These neither moderated nor supplanted the effects of integrated counseling. Outcomes for women with co-occurring disorders and a history of violence and trauma may improve with integrated treatment.
    Psychiatric Services 11/2005; 56(10):1213-22. · 2.01 Impact Factor
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    ABSTRACT: The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a multi-site cooperative study to evaluate new service models for women with co-occurring mental health and substance use disorders and a history of physical and/or sexual abuse. Despite common features in the service interventions and evaluation procedures, diversity across the nine sites plus differences introduced by non-random assignment led to numerous methodological challenges. This article describes the design, measurement, and analysis decisions behind the WCDVS and lays the foundation for understanding participant-level outcomes and service costs. This article also describes the study population, as recruited and following attrition at the 6-month follow-up, in order to address the threat of selection bias to inferences drawn from this multi-site study.
    Journal of Substance Abuse Treatment 04/2005; 28(2):91-107. · 3.14 Impact Factor
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    ABSTRACT: Six-month outcomes are evaluated from a 9-site quasi-experimental study of women with mental health and substance use disorders who have experienced physical or sexual abuse who enrolled in either comprehensive, integrated, trauma-informed, and consumer/survivor/recovering person-involved services (N = 1023) or usual care (N = 983). Mental health, post-traumatic stress symptoms, and substance use outcomes are assessed with multilevel regression models, controlling for program and personal characteristics. Person-level variables predict outcomes independent of intervention condition and, to a small extent, moderate intervention and program effects. In sites where the intervention condition provided more integrated counseling than the comparison condition, there are increased effects on mental health and substance use outcomes; these effects are partially mediated by person-level variables. These results encourage further research to identify the longer-term effects of integrated counseling for women with co-occurring disorders and trauma histories.
    Journal of Substance Abuse Treatment 04/2005; 28(2):121-33. · 3.14 Impact Factor
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    ABSTRACT: The Women, Co-occurring Disorders, and Violence Study (WCDVS) was a large (N = 2729) multisite study of the effectiveness of integrated and trauma-informed services for women with substance use and mental health disorders and a history of interpersonal violence (physical or sexual abuse). Study participants' exposure to lifetime and current traumatic events was assessed at baseline and follow-up via in-person interviews. This article describes the choice of the Life Stressor Checklist-Revised (LSC-R) to assess trauma history to meet the WCDVS's research aims and to respond to consumer input. Quantitative data address the breadth and prevalence of potentially traumatic events in the past and current lives of study participants, the formation and properties of summary measures, and test-retest reliability. Qualitative data address tolerance of the instrument by interviewers and respondents and the generalizability of quantitative findings about trauma prevalence. Finally, recommendations are offered for improvements to the WCDVS version of the LSC-R for use in future research.
    The Journal of Behavioral Health Services & Research 04/2005; 32(2):113-27. · 0.78 Impact Factor
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    ABSTRACT: Program-level effects at 6 months are reported from meta-analysis of a nine-site quasi-experimental study of comprehensive, integrated, trauma-informed, and consumer-involved services for women who have mental health problems, substance use disorders, and who have experienced interpersonal violence. The average weighted effect size is significant for the treatment condition for improved post-traumatic symptoms (p < 0.02), drug use problem severity (p < 0.02), and nearly significant for mental health symptoms (p < 0.06). There is significant heterogeneity in effect sizes across sites. Program-level variables were examined in an effort to explain this heterogeneity. The findings indicate that sites which provided significantly more integrated counseling produced more favorable results in mental health symptoms (p < 0.01) and both alcohol (p < 0.001) and drug use problem severity (p < 0.001). The same trend is observable for reductions in post-traumatic stress symptoms, although the difference does not attain statistical significance.
    Journal of Substance Abuse Treatment 03/2005; 28(2):109-19. · 3.14 Impact Factor
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    ABSTRACT: Although several studies have identified posttransplant neurologic sequelae in patients with acute liver failure (ALF), the effects of these sequelae on neuropsychologic functioning after transplant is unknown. This study compared neuropsychologic functioning of ALF patients with chronic liver disease patients after liver transplantation. After liver transplantation, seven ALF patients were compared with a matched control group of patients who had been transplanted for chronic liver disease. The patients were matched by gender, age (within 5 years), and time since transplantation (within 2 years). Patients completed a 2-hour battery of tests, which included measures of attention, memory, motor performance, abstract conceptualization, and visuospatial perception. There were no significant differences between the groups on measures of socioeconomic status or education. Significant differences were found on three separate tests: WAIS-III Vocabulary, WAIS-III Similarities, and WMS-III Paired Associate Learning II. Although these tests measure distinct functions (vocabulary knowledge, abstract conceptualization, and delayed verbal recall), they may be influenced by broader verbal functions, such as verbal fluency, conceptualization, and the ability to articulate ideas. When patients were asked what functions had noticeably deteriorated since transplantation, nearly all complained of memory difficulties, and there was no difference between groups. However, more ALF than chronic liver disease (CLD) patients complained of concentration difficulties. The results of this study suggest that ALF patients may experience more neuropsychologic dysfunction after transplant. Further studies are required to expand on these initial observations with the potential to improve patient care and referral to appropriate rehabilitative services.
    Liver Transplantation 11/2002; 8(10):932-6. · 3.94 Impact Factor