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Screening for Depression Among Minority Young Males Attending a Family Planning Clinic

Buzi, Ruth S. Smith, Peggy B. Weinman, Maxine L.

PSYCHOLOGY OF MEN & MASCULINITY; JAN 2014, 15 1, p116-p119, 4p.

EDUCATIONAL PUBLISHING FOUNDATION-AMERICAN PSYCHOLOGICAL ASSOC

15249220

10.1037/a0031574

Journal

young males depression request for services

English

000330845600016

Copyright (c) Clarivate Analytics Web of Science

Social Sciences Citation Index

Screening for Depression Among Minority

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Young Males Attending a Family Planning Clinic / BRIEF REPORT

By: Ruth S. Buzi Population Program, Baylor College of Medicine; Peggy B. Smith Population Program, Baylor College of Medicine Maxine L. Weinman Graduate College of Social Work, University of Houston Acknowledgement: This project was funded in part by the Texas Department of State Health Services (TDSHS), the Office of Population Affairs/Office of Family Planning (OPA/OFP) Department of Health and Human Service, and the McGovern Foundation.

Major Depressive Disorder (MDD) is recognized as one of the most common chronic conditions today. According to the U.S. Department of Health and Human Services (2012), approximately 2 million adolescents, or 8.0% of the population ages 12 to 17, had at least one major depressive episode during 2010. A recent report by the Substance Abuse and Mental Health Services Administration (SAMHSA, 2012) indicates that one in five American adults aged 18 or older, or 45.6 million, people had mental illness in the past year. The rate of mental illness was twice as high among those 18–25 (29.8%) than among those aged 50 and older (14.3%). Psy5110 Week 7 Assignment

Males experience more persistent depressive symptoms and disorders from adolescence into adulthood than females (Dunn & Goodyer, 2006; Colman, Wadsworth, Croudace, & Jones, 2007). Non-Hispanic African American males tend to have the highest rates of MDD at 13.2%, followed by Hispanics or Latinos (12.7%) and then non-Hispanic Whites (8.7%) U.S. Department of Health & Human Services, 2012). Depression among minority adolescents and young adults was found to be related to stress, lack of social resources, and low socioeconomic status (Brown, Meadows, & Elder, 2007). Risk factors for African American men’s depression include economic strain, interpersonal conflicts, and racial discrimination (Watkins, Green, Rivers, & Rowell, 2006). Hispanic and African American

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males also display significantly earlier onset of MDD compared with their White counterparts (Riolo, Nguyen, Greden, & King, 2005).

Despite the fact that males also suffer from depression, they seek mental help from health care professionals less frequently than females, which only further decreases the likelihood of diagnosing their mental health disorders (Addis & Mahalik, 2003; Smith, Braunack-Mayer, & Wittert, 2006). Males often feel pressured to avoid emotional expression, conceal weaknesses and vulnerability, and solve problems without requesting the help of others (Rochlen, McKelley, & Pituch, 2006). That pressure to be “masculine” may explain why men more readily than women express anger and irritability when depressed (Winkler, Pjrek, & Kasper, 2005). Psy5110 Week 7 Assignment

Previous studies have found a strong association between somatic symptoms and depression (Saluja et al., 2004; Haug, Mykletun, & Dahl, 2004). Research also has indicated males who experience physical symptoms of depression are more likely to seek medical attention (Ferrin, Gledhill, Kramer, & Garrada, 2009). The National Institute of Mental Health has reported males are not always aware of symptoms of depression, which include physical issues such as headaches, stomach problems, and chronic pain (Harvard Medical School, 2011).

Family planning clinics provide access to reproductive health services to males. This can provide an opportunity to assess and address their mental health needs. However, research on mental health needs of males in these settings is scant. The purpose of this study was to assess depression among young males attending a family planning clinic and whether depression varied by sociodemographics and service requests. This study can begin to fill the gaps and provide some useful information for future studies and interventions targeting this understudied population.

Method

Participants The study included a convenience sample of 535 African American and Hispanic young males who attended a family planning clinic with designated hours for males ages 13–25. The sample reflects the profile of clients receiving services at the clinic. The clinic is located

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in an inner-city neighborhood in a large city in the southwest United States. The clinic provides low-cost to free comprehensive family planning and reproductive health services to indigent adolescents and young adults who reside in the inner city. Services provided include reproductive health screening related to puberty development, immunization status, abuse history, mental health, substance abuse history, sexual health risk assessment, screening and treatment for a sexually transmitted disease (STD), and risk reduction counseling. Males come to the clinic mainly for STD testing and treatment. Informed consent was obtained before data collection. Parental consent for clinical services is solicited but not required from minors serviced at Title X–funded clinics.

The study included 535 African American and Hispanic young males. Their mean age was 20.07, SD = 2.64, range 14–27. Three hundred fifty-three (66.0%) were African American, and 182 (34.0%) were Hispanic. The majority, 482 (92.2%), were single. One hundred sixty- five (31.0%) were fathers. Two hundred forty-three (46.6%) were in school, and 67.2% had graduated high school or were in college. A total of 196 (36.6%) young males were employed, and 124 (23.7%) had health insurance. Three hundred sixty-one (67.7%) reported they came for STD testing or treatment, and 247 (46.3%) reported they came for a check-up. Psy5110 Week 7 Assignment

Procedure Participants were recruited to the study during their visit to the family planning clinic on male designated days. Recruitment to the study took place only on the designated days for males. Males who came on other days were not recruited to the study. The sample reflects approximately 61% of the males seen during the study period at the clinics. A clinic staff member explained that the purpose of the study was to better understand the needs of young males who access family planning services. Informed consent was obtained before data were collected. To protect participants’ confidentiality, they completed the questionnaires in a private room. The staff member was also available to clarify answers to any questions. The Institutional Review Board of the affiliated institution approved the study. Psy5110 Week 7 Assignment

Measures Depression

Depression was measured using the Center for Epidemiologic Studies Depression Scale

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(CES-D) (Radloff, 1977). The CES-D consisted of 20 questions pertaining to depressive symptoms, prefaced with “How often have you felt this way during the past week?” Respondents were asked to rate items such as depressed mood, feelings of worthlessness, feelings of hopelessness, loss of appetite, poor concentration, and sleep disturbance. Possible scores ranged from 0 to 60, with higher scores indicating more severe depressive symptoms. A score of 16 or higher indicated a depressive disorder. In cases with unanswered items, the Radloff scoring procedure was used to rescore each case to match the standard CES-D score. Participants who had more than one missing score on any of the 20 items were excluded from the analysis.

Sociodemographic characteristics

The measures for sociodemographic characteristics included age, ethnicity, school status, owning health insurance, marital status, fatherhood status, and employment status.

Service Requests Males were given a list of 20 services and asked if they wanted to know more about any of these areas. The list included services to assist with health screenings, relationships, anger management, eating well and exercising, employment, and education.

Results

Sociodemographic Characteristics Of the 535 young males who participated in the study, 119 (22.2%) met criteria for a depressive disorder. Chi-square analyses were conducted to compare the depressed and nondepressed males based on sociodemographic characteristics. The results indicated Hispanic males were more depressed than African American males (28.6% vs. 19.0%, χ = 6.38, df = 1, n = 535, p = .011). No other sociodemographic characteristics distinguished depressed and nondepressed males (see Table 1). Ethnic differences were also examined with regard to sociodemographic characteristics. Employment was the only demographic characteristic that was statistically significant. Hispanics were more likely to be employed than African Americans (42.9% vs. 33.4%, χ = 4.59, df = 1, n = 535, p = .032).

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Socio-Demographic by Depression

Request for Services Of the 20 services, 10 showed significant statistical differences between depressed and nondepressed males. Depressed males requested services related to STD prevention, getting along with family and partners, getting a job, working out, eating well, being depressed/feeling down, testicular cancer, college applications/loans, vasectomies, and emergency contraception (see Table 2). Psy5110 Week 7 Assignment

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Interest in Services by Depression

Discussion

This study assessed depression and the associations between depression, sociodemographics, and service requests among young minority males attending a family planning clinic. A little over 20% of the men in this sample met criteria for depression. Depression was higher among Hispanic males than African American males. This finding is inconsistent with other studies that have shown higher rates of depression among African American males than Hispanic males. Risk factors for depression among Hispanics include ethnic Microaggressions, a form of everyday, interpersonal discrimination that can increase feelings of depression and sickness (Huynh, 2012). Findings indicated depressed males were more likely to express interest in services. These service requests related to relationships, feelings, financial resources, physical issues, and well-being. Interest in physical issues was consistent with interest indicated in previous studies. These studies found that African American individuals focus more on somatic and physical symptoms to express depression (Kennard et al., 2006).

Although the young males in the study did not attend the family planning clinic for mental health services, when given the opportunity, they acknowledged issues related to depression. Data suggest that minorities with depression are more likely to seek care for mental health problems from primary care providers rather than from mental health specialists (National Prevention Council, 2011). As young males are now included in family planning clinics, screening them for depression may be an important aspect of comprehensive health assessments. Although these clinics cannot provide continuous mental health care, they can screen and link males with the appropriate care. Psy5110 Week 7 Assignment

This study had limitations related to its cross-sectional design and reliance on one self- reported instrument. The study also did not inquire about accessing mental health services. However, the findings of the initial assessment suggested that because males have limited access to health care services, they need to be screened for depression in settings they frequent. Additionally, young males may be more receptive to acknowledging mental health issues in family planning clinics because these clinics may be perceived as less stigmatizing than mental health settings. To further our understanding of the extent and

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nature of depression among young males, more studies will be required. Multiple approaches may contribute to a better understanding of cultural and developmental aspects related to mental health care issues among young males. Focus groups with young minority males attending family planning clinics have shown to contribute to an in-depth understanding of unmet needs, challenges and barriers related to their physical and mental well-being (Buzi & Smith, in press). Psy5110 Week 7 Assignment

References Addis, M. E., & Mahalik, J. R. (2003). Men, masculinity, and the contexts of help-seeking. American Psychologist, 58, 5–14. doi:10.1037/0003-066X.58.1.5

Brown, J. S., Meadows, S. O., & Elder, G. H. (2007). Race-ethnic inequality and psychological distress: Depressive symptoms from adolescence to young adulthood. Developmental Psychology, 43, 1295–1311. doi:10.1037/0012-1649.43.6.1295

Buzi, R. S., & Smith, P. B. (in press). Access to sexual and reproductive health care services: Young men’s perspectives. Journal of Sex & Marital Therapy.

Colman, I., Wadsworth, M., Croudace, T., & Jones, P. (2007). Forty-year psychiatric outcomes following assessment for internalizing disorder in adolescence.

Dunn, V., & Goodyer, I. M. (2006). Longitudinal investigation into childhood–and adolescent–onset depression: Psychiatric outcome in early adulthood. The British Journal of Psychiatry, 188, 216–222. doi:10.1192/bjp.188.3.216

Ferrin, M., Gledhill, J., Kramer, T., & Garralda, E. (2009). Factors influencing primary care attendance in adolescents with high levels of depressive symptoms. Social Psychiatry and Psychiatry Epidemiology, 44, 825–833. doi:10.1007/s00127-009-0004-x

Harvard Medical School. (2011). Recognizing depression in men. Harvard Mental Health Letter, June, 4–5.

Haug, T. T., Mykletun, A., & Dahl, A. (2004). The association between anxiety, depression,

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and somatic symptoms in a large population: The HUNT-II Study. Psychosomatic Medicine, 66, 845–851. doi:10.1097/01.psy.0000145823.85658.0c

Huynh, V. W. (2012). Ethnic Microaggressions and the depressive and somatic symptoms of Latino and Asian American adolescents. Journal of Youth and Adolescence, 41, 831–846. doi:10.1007/s10964-012-9756-9

Kennard, B. D., Stewart, S. M., Hughes, J. L., Patel, P. G., & Emslie, G. J. (2006). Cognitions and depressive symptoms among ethnic minority adolescents. Cultural Diversity and Ethnic Minority Psychology, 12, 578–591. doi:10.1037/1099-9809.12.3.578

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Radloff, L. S. (1977). The CES-D Scale A Self-Report Depression Scale for Research in the General Population. Applied Psychological Measurement, 1, 385–401. doi:10.1177/014662167700100306

Riolo, S. A., Nguyen, T. A., Greden, J. F., & King, C. A. (2005). Findings from the National Health and Nutrition Examination Survey III. American Journal of Public Health, 95, 998– 1000. doi:10.2105/AJPH.2004.047225

Rochlen, A. B., McKelley, R. A., & Pituch, K. A. (2006). A preliminary examination of the “Real Men. Real Depression” campaign. Psychology of Men & Masculinity, 7, 1–13. doi:10.1037/1524-9220.7.1.1

Saluja, G., Iachan, R., Scheidt, P. C., Overpeck, M. D., Sun, W., & Giedd, J. N. (2004). Prevalence of and risk factors for depressive symptoms among young adolescents. Archives of Pediatric and Adolescent Medicine, 158, 760–765. doi:10.1001/archpedi.158.8.760

Smith, J. A., Braunack-Mayer, A., & Wittert, G. (2006). What do we know about men’s help- seeking and health service use?The Medical Journal of Australia, 184, 81–83.

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Substance Abuse and Mental Health Services Administration (SAMHSA). (2012). Results from the 2011 National Survey on Drug Use and Health: Mental Health Findings and Detailed Tables. Retrieved December 2, 2012 from http://www.samhsa.gov/data/NSDUH/2k11MH_FindingsandDetTables/index.aspx

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Watkins, D. C., Green, B. I., Rivers, B. M., & Rowell, K. L. (2006). Depression and black men: Implications for future research. The Journal of Men’s Health & Gender, 3, 227–235. doi:10.1016/j.jmhg.2006.02.005

Winkler, D., Pjrek, E., & Kasper, S. (2005). Anger attacks in depression–Evidence for a male depressive syndrome. Psychotherapy and Psychosomatics, 74, 303–307. doi:10.1159/000086321

Submitted: August 26, 2012 Revised: December 13, 2012 Accepted: December 15, 2012

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Source: Psychology of Men & Masculinities. Vol. 15. (1), Jan, 2014 pp. 116-119) Accession Number: 2013-05712-001 Digital Object Identifier: 10.1037/a0031574

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