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Women's Experiences Living with Depression PDF

155 Pages·2016·0.77 MB·English
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University of Wisconsin Milwaukee UWM Digital Commons Teses and Dissertations 5-1-2014 Women's Experiences Living with Depression Susan Marie Jarchow University of Wisconsin-Milwaukee Follow this and additional works at: htps://dc.uwm.edu/etd Part of the Nursing Commons, and the Psychiatric and Mental Health Commons Recommended Citation Jarchow, Susan Marie, "Women's Experiences Living with Depression" (2014).Teses and Dissertations. 462. htps://dc.uwm.edu/etd/462 Tis Dissertation is brought to you for free and open access by UWM Digital Commons. It has been accepted for inclusion in Teses and Dissertations by an authorized administrator of UWM Digital Commons. For more information, please contact WOMEN’S EXPERIENCES LIVING WITH DEPRESSION By Susan M. Jarchow A Dissertation Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy In Nursing At The University of Wisconsin-Milwaukee May 2014 ABSTRACT WOMEN’S EXPERIENCES LIVING WITH DEPRESSION By Susan M. Jarchow The University of Wisconsin-Milwaukee, 2014 Under the Supervision of Aaron Buseh, Ph.D. In the United States, depression affects many Americans at different levels. Depression among women is a major public health problem. According to the National Alliance on Mental Illness), about 1 in 5 women develop depression at some point in their lives, and are nearly twice as likely as men to have depression. Much of the research about depression in women are quantitative studies aimed mostly at collecting epidemiological or survey data that focus on rates of mental illness, while not taking into account the qualitative subjective and contextual illness perspectives of women living with depression. The purpose of this study was to explore the perspectives of women living with depression in the context of their daily lives including (a) their experiences of symptoms and sequelae; (b) their cumulative exposure to social adversity; and (c) their efforts at recovery in the context of their larger sociocultural and sociopolitical environments. Qualitative in-depth interviews were conducted with women (N = 17) who self- identified as having experienced depression at some time in their lives, to learn about their experiences living with and recovering from depression. Participants were recruited from a private psychological counseling practice and peer-led mental health recovery- focused organizations, and were interviewed twice, 5 to 14 days apart, to add credibility to the study’s findings. The transcripts of their illness narratives were analyzed using thematic analysis. Findings emerging from the analysis were clustered and into six broad themes: (a) Suffering Adversity in Childhood and Adolescence; (b) Shutting Down and Giving Up; (c) Isolation, Not Fitting In, and Social Stigma; (d) Managing Symptoms and Experiences with Healthcare; (e) Coming to Terms: Facing It and Working Through It; and (f) Becoming a Resource Person: Connecting, Learning, and Giving Back. Results from this study have implications for healthcare providers working with women living with depression. Eliciting illness narratives from women living with depression is an important starting point for mental healthcare professionals as they try to gain an understanding of what these women deal with every day in order to better meet their mental healthcare needs. iii Copyright by Susan M. Jarchow, 2014 All Rights Reserved                 iv TABLE OF CONTENTS Acknowledgements ..............................................................................................................x CHAPTER 1: INTRODUCTION AND BACKGROUND ................................................1 Introduction ..........................................................................................................................1 Background ..........................................................................................................................2 Statement of the Problem .....................................................................................................5 Purpose and Specific Aims of the Study ..............................................................................7 Purpose .....................................................................................................................7 Specific Aims of the Study ......................................................................................7 Assumptions .........................................................................................................................7 Definitions of Terms ............................................................................................................8 Significance of the Study .....................................................................................................8 Justification for Use of Illness Narratives to Reflect Subjective Illness Experiences ................................................................................9 Contributions to Nursing and Mental Healthcare ..................................................10 Summary ............................................................................................................................12 CHAPTER II: REVIEW OF RELATED LITERATURE Social Theories of Health and Factors Influencing Depression in Women .......................13 Individual Factors .................................................................................................14 Social or Contextual Factors ..................................................................................15 Protective Factors...................................................................................................16 Social Theories and Social Adversity ....................................................................17 Reciprocal Relationships of Stress, Depression, and Protective Factors...................................................................................................18 v Summary ................................................................................................................21 Challenges in Treating Women Living With Depression ..................................................22 Nature of Depression .............................................................................................22 Mental Healthcare Delivery ...................................................................................24 Social Adversity and Variability in Outcomes ......................................................25 Summary ................................................................................................................26 Recovery Paradigm, Narratives, and Women’s Recovery from Depression .....................26 Recovery Paradigm ................................................................................................27 Illness Narratives ...................................................................................................28 Recovery: Narrative Findings ...............................................................................33 Essential Aspects of Recovery ...............................................................................35 Gender-Based Differences in Mental Illnesses ......................................................36 Women’s Recovery from Depression ................................................................................38 Summary ............................................................................................................................46 CHAPTER III: METHODS AND PROCEDURES Introduction ........................................................................................................................49 Research Design .................................................................................................................49 Assumptions of Naturalistic Methods ....................................................................50 Limitations of Naturalistic Methods ......................................................................50 Strengths of Qualitative Methods ..........................................................................51 Philosophical Basis: Narrative Inquiry .................................................................52 vi Procedures ..........................................................................................................................53 Sample....................................................................................................................53 Sample Recruitment ...............................................................................................54 Data Collection: In-depth Interviews .....................................................................54 Data Analysis .....................................................................................................................58 Thematic Analysis: Overview ................................................................................58 Thematic Analysis: Coding of Transcripts ............................................................58 Ensuring Scientific Rigor .......................................................................................60 Ethical Considerations ...........................................................................................63 CHAPTER IV: FINDINGS Introduction ........................................................................................................................64 Description of the Study Participants ................................................................................65 Themes ...............................................................................................................................66 Suffering Adversity in Childhood and Adolescence .........................................................66 Shutting Down and Giving Up ..........................................................................................68 Shutting Down .......................................................................................................68 Giving Up...............................................................................................................71 Isolation, Not Fitting In, and Social Stigma ......................................................................72 Self-imposed Isolation ...........................................................................................73 Not Fitting In..........................................................................................................73 Social Stigma .........................................................................................................75 Credibility ..................................................................................................75 Competency ...............................................................................................76 vii Being Labeled ............................................................................................78 Managing Symptoms and Experiences with Healthcare ...................................................79 Access to Care: Hospitalizations ...........................................................................79 Medications Use and Adherence ...........................................................................80 Relationships and Experiences with Healthcare Providers ....................................82 Other Healthcare Interventions Strategies/Approaches .........................................84 Coming to Terms: Facing it and Working Through It .......................................................85 Gaining Insight.......................................................................................................87 Self-Acceptance .....................................................................................................89 Becoming a Resource Person: Connecting, Learning, and Giving Back ..........................90 Social Support and Belonging ...............................................................................90 Role Models for Recovery .....................................................................................90 Improving Themselves and Learning ....................................................................91 Instilling Hope and Building on Past Successes ....................................................91 Giving Back and Helping Others ...........................................................................92 Summary of Major Findings ..............................................................................................93 CHAPTER V: DISCUSSION Research Aim 1 ..................................................................................................................96 Symptom Management: Experiences with Healthcare ..........................................98 Research Aim 2 ..................................................................................................................99 Isolation, Not Fitting In, and Social Stigma ..........................................................99 Research Aim 3 ................................................................................................................102 Facing It, Gaining Insight and Self-Acceptance ..................................................102 viii Involvement with Peer-Run Mental Health Recovery Focused Organizations .......................................................................................................104 Limitations of the Study...................................................................................................106 Implications......................................................................................................................107 Implications for Future Research .........................................................................107 Implications for Training and Education .............................................................109 Implications for Policy .........................................................................................110 Implications for Practice ......................................................................................111 Conclusion .......................................................................................................................113 REFERENCES ................................................................................................................115 APPENDICES Appendix A: Ethical Approval Notices from UWM Institutional Review Board ..............................................................................................136 Appendix B: Socio-Demographic Information Sheet ......................................................138 Appendix C: Interview Guide #1 .....................................................................................141 Appendix D: Interview Guide #2 .....................................................................................142 Appendix E: Curriculum Vitae ----------------------------------------------------------------- 143 ix

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