Women's Experiences Living with Depression

155 Pages·2016·0.77 MB·English

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
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Jarchow, Susan Marie, "Women's Experiences Living with Depression" (2014).Teses and Dissertations. 462.
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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.
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Copyright by Susan M. Jarchow, 2014
All Rights Reserved

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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
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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

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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
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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
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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
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