Week 7 - Assignment: Summarize and Evaluate a Peer-Reviewed Journal Article

BRIEF REPORT

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

Ruth S. Buzi and Peggy B. Smith Baylor College of Medicine

Maxine L. Weinman University of Houston

The Center for Epidemiologic Studies Depression Scale (CES-D) was used to assess depression among 535 African American and Hispanic young males ages 14 to 27 attending a family planning clinic. The assessment indicated that 119 (22.2%) males met criteria for depression. The study also examined the associations between depression, sociodemographics, and service requests. Depressed males were more likely than nondepressed males to be Hispanic and to request services related to relationships, feelings, financial resources, physical issues, and well-being. The findings indicated that young males who are affected by depression have unmet needs, but when given an opportunity, are able to express those needs. Because family planning clinics are increasing the number of male clients, they are well positioned to screen them for depression.

Keywords: young males, depression, request for services

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), ap- proximately 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%).

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 socioeco- nomic status (Brown, Meadows, & Elder, 2007). Risk factors for African American men’s depression include economic strain, interpersonal conflicts, and racial discrimination (Wat- kins, Green, Rivers, & Rowell, 2006). Hispanic and African American males also display significantly earlier onset of MDD compared with their White counterparts (Riolo, Nguyen, Gre- den, & 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 weak- nesses 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).

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 depres- sion, 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 article was published Online First February 18, 2013. Ruth S. Buzi and Peggy B. Smith, Population Program, Baylor College

of Medicine; Maxine L. Weinman, Graduate College of Social Work, University of Houston.

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.

Correspondence concerning this article should be addressed to Ruth S. Buzi, LCSW, PhD, Associate Professor, Population Program, Baylor Col- lege of Medicine, One Baylor Plaza, Houston, TX 77030. E-mail: [email protected]

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Psychology of Men & Masculinity © 2013 American Psychological Association 2014, Vol. 15, No. 1, 116 –119 1524-9220/14/$12.00 DOI: 10.1037/a0031574

116

this study was to assess depression among young males attend- ing 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 popula- tion.

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 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 reproduc- tive health services to indigent adolescents and young adults who reside in the inner city. Services provided include repro- ductive health screening related to puberty development, im- munization 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 col- lection. 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 Amer- ican, 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.

Procedure

Participants were recruited to the study during their visit to the family planning clinic on male designated days. Recruit- ment 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 ques- tionnaires in a private room. The staff member was also avail- able to clarify answers to any questions. The Institutional Review Board of the affiliated institution approved the study.

Measures

Depression. Depression was measured using the Center for Epidemiologic Studies Depression Scale (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 hopeless- ness, 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 indi- cated 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 so- ciodemographic characteristics included age, ethnicity, school sta- tus, 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 anal- yses were conducted to compare the depressed and nonde- pressed males based on sociodemographic characteristics. The results indicated Hispanic males were more depressed than African American males (28.6% vs. 19.0%, �2 � 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 sociode- mographic characteristics. Employment was the only demo- graphic characteristic that was statistically significant. Hispan- ics were more likely to be employed than African Americans (42.9% vs. 33.4%, �2 � 4.59, df � 1, n � 535, p � .032).

Request for Services

Of the 20 services, 10 showed significant statistical differ- ences 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 contra- ception (see Table 2).

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

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117DEPRESSION AMONG MINORITY YOUNG MALES

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 depres- sion. 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 (Na- tional Prevention Council, 2011). As young males are now included in family planning clinics, screening them for depres- sion 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.

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. Addition- ally, 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

Table 1 Socio-Demographic by Depression

Non- depressed Depressed

Characteristic n % n % �2 p value

Ethnicity African American 286 81.0 67 19.0 6.38 .011 Hispanic 130 71.4 52 28.6

In School Yes 194 47.8 49 42.2 1.11 .29 No 212 52.2 67 57.8

Health insurance Yes 96 23.7 28 23.5 .002 .969 No 309 76.3 91 76.5

Marital status Single 375 92.4 107 91.5 .104 .747 Married 31 7.6 10 8.5

Fatherhood Yes 125 30.3 40 33.6 .484 .487 No 288 69.7 79 66.4

Employed Yes 153 36.8 43 36.1 .017 .898 No 263 63.2 76 63.9

t-test

Age 20.08 SD � 2.67

119 20.03 SD � 2.64

416 t � .188 df � 533

.85

Table 2 Interest in Services by Depression

Non-depressed Depressed

Topic of interest n % n % �2 p value

STD prevention 156 37.5% 58 48.7% 4.87 .027 Getting along with your partner 39 9.4% 22 18.5% 7.60 .006 Getting a job 101 24.3% 43 36.1% 6.61 .010 Working out/eating well 80 19.2% 33 27.7% 4.01 .045 Depression/feeling down 21 5.0% 26 21.8% 32.59 .000 Testicular cancer 29 7.0% 22 18.5% 14.23 .000 College applications/loans 41 9.9% 20 16.8% 4.42 .035 Getting along with your family 19 4.6% 13 10.9% 6.65 .010 Vasectomies 11 2.6% 10 8.4% 8.13 .004 Emergency contraception for girlfriend/wife 12 12.9% 9 7.6% 5.37 .020

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118 BUZI, SMITH, AND WEINMAN

settings. To further our understanding of the extent and nature of depression among young males, more studies will be re- quired. Multiple approaches may contribute to a better under- standing 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).

References

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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 influ- encing primary care attendance in adolescents with high levels of de- pressive symptoms. Social Psychiatry and Psychiatry Epidemiology, 44, 825– 833. doi:10.1007/s00127-009-0004-x

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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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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 Medi- cine, 158, 760 –765. doi:10.1001/archpedi.158.8.760

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Received August 26, 2012 Revision received December 13, 2012

Accepted December 15, 2012 �

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119DEPRESSION AMONG MINORITY YOUNG MALES