The unfolding depressive symptoms, disease self-management, and treatment utilization for Latina adolescents

Indiana University-Purdue University Indianapolis (IUPUI)Latina adolescents are more likely to suffer from depressive symptoms and less likely to receive mental health services for depression than their White peers, and this mental health disparity is poorly understood. The purpose of this dissertation study is to describe how Latina adolescents experience and seek mental health services for their depressive symptoms. The dissertation includes three components. The first is an integrative literature review to determine which cultural stressors are associated with depressive symptoms among Latino/a youth. The results indicate that discrimination, family culture conflict, acculturative and bicultural stress, intragroup rejection, immigration stress, and context of reception are associated with depressive symptoms in this population. The second and third components were based on interviews with 25 Latinas (ages 13-20) who experienced depressive symptoms during adolescence. In the second component, a content analysis was conducted to determine cultural stressors experienced by contemporary Latinas living in a tumultuous sociopolitical climate in the United States. The stressors included (a) pressure to succeed, (b) parental oversight, (c) being treated differently, and (d) fears of deportation. In the third component, grounded theory methods were used to develop a theoretical framework to describe the process by which Latina adolescents self-managed and sought treatment for depressive symptoms. In this framework, participants shared a psychosocial problem labeled Being Overburdened and Becoming Depressed. They responded to this problem through the psychosocial process labeled Getting a Grip on My Depression, which consisted of five phases: 1) hiding my depression, 2) keeping my depression under control, 3) having my depression revealed, 4) skirting treatment for my depression, and 5) deciding to move on from depression. The Latino family, peer groups, and mainstream authorities influenced the participants’ experiences. The process of experiencing, self-managing, and seeking treatment for depressive symptoms for Latina adolescents is both similar to and unique from the processes by which other groups of adolescents experience depressive symptoms. These results will contribute to the development of culturally-sensitive strategies to prevent, identify, and treat depressive symptoms in Latina adolescents

Ethical considerations for involving Latina adolescents in mental health research

TOPIC: US Latina adolescents experience significant mental health disparities, such as depressive symptoms and suicidal ideation and, therefore, should be involved in research studies focused on minimizing these health disparities. However, researchers must consider the specific ways this population is vulnerable and provide adequate protections to reduce risks related to these vulnerabilities. PURPOSE: The purpose of this article is to describe the different ways that Latina adolescents with mental health problems can be vulnerable research participants, identify strategies to protect this population during a research study, and describe steps taken to apply these strategies in an ongoing qualitative study examining depression in Latina adolescents. SOURCES USED: Kipnis's (2003) article describes seven ways that children can be vulnerable research participants. These seven vulnerabilities are used to describe the vulnerabilities of Latina adolescents with mental health problems. Specific strategies to protect this population are synthesized to provide a list of strategies that can be used by researchers to reduce the risks associated with the vulnerabilities of this group. CONCLUSIONS: In order to minimize risks for Latina adolescents, researchers must be engaged in Latino/a communities, use culturally and linguisticall

Emerging Adult Women’s Views-of-Self in Intimate Partner Relationships that are Troubled

The purpose of this study is to describe how emerging adult (EA) women describe their views-of-self in troubled relationships. Fourteen EA women (ages 18–25) wrote four stories about their troubled relationships during a guided-writing intervention. Qualitative descriptive methods and content analysis were used to identify common views-of-self. Four views-of-self in troubled relationships and contrasting views-of-self emerged: (1) silent self-vocal self, (2) sacrificing self-prioritized self, (3) caretaking self-boundary-setting self, and (4) insecure self-secure self. Mental health nurses and other clinicians can use these views-of-self pairs to guide their discussions with EA young women who are involved in troubled relationships

A feasibility test of an online intervention to prevention dating violence in emerging adults

Dating violence in emerging adults is a significant problem and few prevention programs based on the developmental needs of this age group have been developed. Our research team developed an online dating violence prevention program called WISER (Writing to Improve Self-in-Relationships) for emerging adults. The program is based on narrative therapy principles and uses structured writing techniques. A single group pre-post feasibility test of WISER was conducted with 14 college women. WISER was demonstrated to be feasible and acceptable and to show promise as an effective program to decrease dating violence in this population

Getting a Grip on My Depression: How Latina Adolescents Experience, Self-Manage, and Seek Treatment for Depressive Symptoms

Latina (female) adolescents are more likely to experience depressive symptoms and less likely to receive mental health services than their non-Latina White peers. We aimed to develop a framework that explains how Latina adolescents experience, self-manage, and seek treatment for depressive symptoms. Latina young women (n = 25, M age = 16.8 years) who experienced depressive symptoms during adolescence were recruited from clinical and community settings and interviewed about experiences with depressive symptoms. The framework was developed using constructivist grounded theory methods. Participants experienced a psychosocial problem that we labeled being overburdened and becoming depressed. They responded to this problem through a five-phase psychosocial process that we labeled Getting a Grip on My Depression. Family members, peer groups, and mainstream authorities were influential in how participants experienced these phases. Future research should further develop this framework in diverse samples of Latino/a youth. Clinicians can use this framework in discussions with Latina adolescents about depressive symptoms

Barriers to and Facilitators of Mental Health Treatment Engagement among Latina Adolescents

Latina adolescents are more likely to experience depressive symptoms and less likely to receive mental health treatment than White peers. The purpose of this study is to describe barriers to and facilitators of engagement in depression treatment among Latina adolescents. Twenty-five Latina young women (mean age=16.7 years) with a history of depressive symptoms during adolescence participated in this qualitative descriptive study. Participants were recruited from clinical and community settings and were interviewed about their experiences with depression treatment. Using qualitative content analysis, we identified barriers to and facilitators of engagement in treatment for depression. Barriers included beliefs about depression and its treatments, negative experiences with treatment, and logistical problems. Facilitators included positive treatment outcomes, meaningful connection with a therapist, and family support of depression treatment. Mental health providers should minimize barriers and maximize facilitators to promote mental health treatment use and engagement among Latina adolescents with depressive symptoms

Designing an Internet Intervention for Emerging Adults Who Experience Troubled Relationships

This article describes how the Internet Intervention Model (IIM) was used as an organizing framework to design a theoretically based Internet intervention for emerging adults who experience troubled intimate partner relationships. In the design process, the team addressed six fundamental questions related to the several components of the IIM. Decisions made regarding the design of the intervention based on the six questions are described. We focus in particular on how the intervention is based on the Theory of Emerging Adulthood and the Theory of Narrative Identity

Suicide Screening in Primary Care: Use of an Electronic Screener to Assess Suicidality and Improve Provider Follow-Up for Adolescents

Purpose The purpose of this study was to assess the feasibility of using an existing computer decision support system to screen adolescent patients for suicidality and provide follow-up guidance to clinicians in a primary care setting. Predictors of patient endorsement of suicidality and provider documentation of follow-up were examined. Methods A prospective cohort study was conducted to examine the implementation of a CDSS that screened adolescent patients for suicidality and provided follow-up recommendations to providers. The intervention was implemented for patients aged 12–20 years in two primary care clinics in Indianapolis, Indiana. Results The sample included 2,134 adolescent patients (51% female; 60% black; mean age = 14.6 years [standard deviation = 2.1]). Just over 6% of patients screened positive for suicidality. A positive endorsement of suicidality was more common among patients who were female, depressed, and seen by an adolescent−medicine board-certified provider as opposed to general pediatric provider. Providers documented follow-up action for 83% of patients who screened positive for suicidality. Documentation of follow-up action was correlated with clinic site and Hispanic race. The majority of patients who endorsed suicidality (71%) were deemed not actively suicidal after assessment by their provider. Conclusions Incorporating adolescent suicide screening and provider follow-up guidance into an existing computer decision support system in primary care is feasible and well utilized by providers. Female gender and depressive symptoms are consistently associated with suicidality among adolescents, although not all suicidal adolescents are depressed. Universal use of a multi-item suicide screener that assesses recency might more effectively identify suicidal adolescents

The Influence of Peer Relationships on Latina Adolescents’ Experiences with Depressive Symptoms

Purpose: Previous research has demonstrated that peers may play an integral role in the development of depressive symptoms among Latina adolescents; however, little is known about the function of peers in the ongoing management of depressive symptoms for Latina adolescents. The purpose of this study was to describe how peers influence Latina adolescents' experiences with the onset and ongoing management of depressive symptoms. Design and methods: Qualitative descriptive methods were used in conducting semi-structured interviews with twenty-five young Latinas (ages 13-20) who had a history of depressive symptoms during adolescence. Participants were asked to describe their experiences with depressive symptoms and how they interacted with others in relation to their depressive symptoms. Thematic analysis methods were used to identify common themes in how peers influenced Latina adolescents' experiences with depressive symptoms. Results: Latina adolescents experienced tensions with peers in the development, disclosure, and self-management of depressive symptoms. Peers were: 1) allies and bullies; 2) confidants and betrayers; and 3) up-lifters and downers. Conclusions: Peer relationships can be a source of risk and resiliency for Latina adolescents throughout the process of experiencing depressive symptoms. Practice implications: Interventions preventing or treating depression among Latina adolescents should capitalize on the strengths of peer relationships, while recognizing that peers may also contribute to risk

SIMPLE TRANSIENT CALCULATIONS OF CELL FLAMMABLE GAS CONCENTRATIONS

The Saltstone Facility at Savannah River Site (SRS) mixes low-level radiological liquid waste with grout for permanent disposal as cement in vault cells. The grout mixture is poured into each cell in approximately 17 batches (8 to 10 hours duration). The grout mixture contains ten flammable gases of concern that are released from the mixture into the cell. Prior to operations, simple parametric transient calculations were performed to develop batch parameters (including schedule of batch pours) to support operational efficiency while ensuring that a flammable gas mixture does not develop in the cell vapor space. The analysis demonstrated that a nonflammable vapor space environment can be achieved, with workable operational constraints, without crediting the ventilation flow as a safety system control. Isopar L was identified as the primary flammable gas of concern. The transient calculations balanced inflows of the flammable gases into the vapor space with credited outflows of diurnal breathing through vent holes and displacement from new grout pours and gases generated. Other important features of the analyses included identifying conditions that inhibited a well-mixed vapor space, the expected frequency and duration of such conditions, and the estimated level of stratification that could develop