The processes of disease management in African American adolescents with depression

Abstract

Depression in African American (AA) adolescents is a prevalent mental health problem, can result in serious concurrent and long-term effects, and is associated with health disparities due to underutilization of mental health services. Initiatives to reduce disparities among depressed AA adolescents require a greater understanding of the experience of depression from their own point of view. The purpose of this dissertation was to generate a comprehensive theoretical framework that describes how AA adolescents experience depression throughout adolescence. The information gained about how AA adolescents understand and manage depressive symptoms, and in some cases seek and use mental health services will contribute to initiatives to reduce behavioral health disparities. This dissertation project was composed of two components. The first component was an integrative review of studies that explored associations between adolescent coping responses and depression. The integrative review summarized and integrated research from the past ten years that examined coping techniques of depressed adolescents. It revealed that the use of active coping strategies plays an important role in recovery from depression. The second component was a grounded theory study which included a sample of 22 community-based AA young adults (ages 18-21) and 5 clinic-based AA adolescents (ages 13-17). During semi-structured interviews, participants described their experiences with depression as adolescents. In addition, a timeline was constructed that included major events related to the unfolding of depression, including treatment seeking, which occurred during adolescence. Data generated from the grounded theory study were analyzed and resulted in two qualitatively derived products. The first is a typology titled Being With Others that depicts interaction patterns of depressed AA adolescents with people in their lives. The five categories in the typology are keeping others at bay, striking out at others, seeking help from others, joining in with others, and having others reach out. The second product is a theoretical framework titled Weathering through the Storm that describes how depression in AA adolescents unfolds over time. The five phases of the framework are labeled enduring stormy weather, braving the storm alone, struggling with the storm, finding shelter in the storm, and moving out of the storm.