Transcript The impact of depression on African American Men

Keneshia Bryant-Bedell, PhD, RN, FNP-BC
Assistant Professor
University of Arkansas for Medical Sciences
College of Nursing
Little Rock, Arkansas USA
Acknowledgements
Azusa Pacific University – School of Nursing
PhD Dissertation Scholarship
Objectives
(1) Identify signs & symptoms of major depressive
disorder among African American men
(2) Understand the pattern of major depressive disorder
among African American men
(3) Distinguish barriers to effective patient-provider
communication when considering depressed African
American men
Introduction
Depression is projected to become the leading
cause of disability & second leading
contributor to the global burden of disease in
approximately 10 years (Kerr & Kerr, 2001)
Approximately 14.8 million American adults
have a depressive disorder
(National Institute of Mental Health,
2010)
Introduction
Evidence shows that signs & symptoms included
in diagnostic criteria may not capture all of
those who are depressed
(National Mental Health Association,2004; Campinha-
Bacote, 1994)
Men have shown to exhibit additional symptoms
of depression including anger, hostility and
reckless behavior, which are not included in
the diagnostic criteria for MDD
(Cochran & Rabinowitz, 2000)
Introduction
African Americans are less likely to be diagnosed
with MDD; may be that their presentation of
depression differs leading to under diagnosis
(Baker, 2001; Das, et al., 2006)
Limited research has focused on African
American men with depression
(Watkins, et al., 2003)
Research Questions
 How do the signs & symptoms of depression
affect African American men?
 How do African American men express &
recognize symptoms of depression?
Descriptive qualitative method was used to address
the research questions.
Sample:
 Self-identified African American men born in
United States residing in Los Angeles area
 Self-reported diagnosis of major depression by
health care provider
Exclusion Criteria:
 Diagnosis of Schizophrenia; anxiety; history
of psychosis, mania or hypomania
 Abused drugs or alcohol in the past year
 Severe or life-threatening medical illness
 Mental Retardation
“The Funk”
“Life Events”
Racism
Sexism
Cultural
Differences
Stressors:
Drugs/Alcohol
Dysfunctional Family
Unemployment
Divorce/Break-up
Economy
Homelessness
Iraq War
Death in Family
Chronic Illness
Child Abuse
The “Breakdown”
Interpersonal
Relationship
Strain
The Mind:
Frustration
Suicidal Ideation
Hopeless
Anger
Overwhelmed
Depressed/Sad
Loneliness
Self Blame
Agitation
Lack of Interest
Lack of
Concentration
Stress
No Motivation
Coping:
Distraction
Positive Thinking
Journaling
Exercise
Group Meetings
Drugs
Alcohol
Eating
“Wearing the
Mask”
Isolation
The Body:
Fatigue
Body Aches
Weight Changes
Change in Sleep
Pattern
Change in Appetite
Neglect of Self
Spirituality:
Prayer
Meditation
Purpose in Life
Dreams/Aspirations
Fellowship
Others:
Family
Friends
Providers
Treatment
Recognition:
Defining Moment
Suicide Attempt
“The Black Hole”
Loss of Control
“Down in the
dumps”
Depression
Diagnosis
No
Treatment
Self
Phase 1: Stressors
“I broke up with my girlfriend. This was a long-term
relationship. That was difficult. That adds to the
stress.”
“My family kind of imploded, you know, it was very
dysfunctional. Everybody except my mother drank or
did drugs. My parents got divorced. So it was really
crazy. My father was stressful.”
“Well, when you’re stressed out from not having a job or
not having the money to pay for your bills just to
survive”
Phase 2: “The Funk”
“Kind of depressed; kind of in a funk; couldn’t get out of
it”
“I think that I am more hyper aware of when I’m getting
into a funk & can work through it a lot faster”
“I call those years the dark years. I remember feeling like
I was in a black hole spinning down. And I couldn’t
bring myself out of it…Just weird”
Phase 3:
The Breakdown & Diagnosis
“…and I was encouraged by a friend to go seek mental
health. I said ‘Ain’t nothing wrong with me’”
“…all the advice I got was from friends & neighbors &
relatives that ‘you’ll get over it,’ you know or ‘oh well,
live with it,’ so that’s been my experience”
“I really didn’t recognize it as depression until it got
really bad. It just got worse.”
Phase 4: Treatment
“He [referring to his psychologist] really thinks that it’s a
little hard to read me because I put on a good face & I
sort of play the role”
“Eventually, I did seek help. And that’s when I found out
they actually had a term called depression for what I
was experiencing”
“I mean being low income, medical attention wasn’t
readily available. So a lot of that should’ve been
treated early, which wasn’t”
Terminology & Depression
 Kendrick et al. (2006) men referred to
depression as “stress”.
 Current study men used term “funk”; which is
similar to findings from Wisdom & Green
(2004) among adolescents.
 Each culture, ethnicity, gender or generation
may have their own terminology for depression
& its experience that is not understood by
healthcare providers.
Discussion:
>Interventions are needed during all phases of the
depression experience
>Symptoms only provide a narrow view of a complex
phenomenon.
>Important for men to share their stories, this was
also noted in study by Kendrick et al. (2006).
>A trusting patient-provider relationship is needed
for appropriate diagnosis & treatment.
Limitations:
»Recruitment in one geographical location
»Medical records were not reviewed
»Average year of initial diagnosis 9.5 years ago
Implications for Nursing:
Education of patients, the community, and
healthcare providers in regards to the
experience and expression of depression
among African American males.
Recommendations
for Future Research:
 Exploration of primary, secondary & tertiary
prevention of MDD among African American
males.
 Identify how African American males across
generations experience & describe MDD
 Investigate how the patient-provider relationship
influences the diagnosis & treatment of MDD