Keneshia Bryant-Bedell, PhD, RN, FNP-BC Assistant Professor

1. The Caribbean Exploratory (NCMHD) Research Center of Excellence (CERC)“State of Mental Health & Substance Abuse: An Issue for all Ethnic/Minority & Caribbean Populations”Lost in Communication: Depressed African American men & clinician interaction KeneshiaBryant-Bedell, PhD, RN, FNP-BC Assistant Professor University of Arkansas for Medical Sciences College of Nursing Little Rock, Arkansas USA

2. Acknowledgements Azusa Pacific University – School of Nursing PhD Dissertation Scholarship

3. Objectives • Identify signs & symptoms of major depressive disorder among African American men • Understand the pattern of major depressive disorder among African American men • Distinguish barriers to effective patient-provider communication when considering depressed African American men

4. 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)

5. 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)

6. 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)

7. 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.

8. 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

9. 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

10. “The Funk” “Life Events” The “Breakdown” Interpersonal Relationship Strain Racism Sexism Cultural Differences Others: Family Friends Providers The Mind: Frustration Suicidal Ideation Hopeless Anger Overwhelmed Depressed/Sad Loneliness Self Blame Agitation Lack of Interest Lack of Concentration Stress No Motivation “Wearing the Mask” Treatment Stressors: Drugs/Alcohol Dysfunctional Family Unemployment Divorce/Break-up Economy Homelessness Iraq War Death in Family Chronic Illness Child Abuse Isolation Depression Diagnosis The Body: Fatigue Body Aches Weight Changes Change in Sleep Pattern Change in Appetite Neglect of Self No Treatment Self Coping: Distraction Positive Thinking Journaling Exercise Group Meetings Drugs Alcohol Eating Spirituality: Prayer Meditation Purpose in Life Dreams/Aspirations Fellowship Recognition: Defining Moment Suicide Attempt “The Black Hole” Loss of Control “Down in the dumps”

11. 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”

12. 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”

13. 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.”

14. 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”

15. 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.

16. 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.

17. Limitations: »Recruitment in one geographical location »Medical records were not reviewed »Average year of initial diagnosis 9.5 years ago

18. Implications for Nursing: Education of patients, the community, and healthcare providers in regards to the experience and expression of depression amongAfrican American males.

19. 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

20. THANK YOU!