Graduation Year

2023

Document Type

Dissertation

Degree

Ph.D.

Degree Name

Doctor of Philosophy (Ph.D.)

Degree Granting Department

Curriculum and Instruction

Major Professor

Kathy Bradley-Klug, Ph.D.

Committee Member

Joshua Nadeau, Ph.D.

Committee Member

Shannon Suldo, Ph.D.

Committee Member

Deirdre Cobb-Roberts, Ph.D.

Committee Member

John Ferron, Ph.D.

Keywords

Behavioral Activation, Major Depressive Disorder, Quality of Life

Abstract

Behavioral Activation (BA) is a treatment approach that has demonstrated promising outcomes for the adolescent population (Martin & Oliver, 2019). However, more studies are needed to examine its effectiveness with Hispanic adolescents. The prevalence and severity of depressive symptoms tend to be higher among Hispanic adolescents in comparison to their non-Hispanic White peers (Pratt & Brody, 2014). In addition, depressive symptoms are associated with poor social, academic, and later health outcomes (Naicker et al., 2013; Owens, Stevenson, Hadwin, 2012). Given the lack of prior investigations on the effectiveness of BA for Hispanic adolescents, this study aimed to fill a gap in the current literature by examining how Hispanic adolescents responded to BA treatment, as evidenced by changes in depressive symptoms and health-related quality of life. Hispanic adolescents in the study sought care at behavioral health clinics throughout the United States and were seen at multiple levels of care within intensive mental health care settings (i.e., intensive outpatient, partial hospitalization, and residential levels of care). In addition, providers underwent a 5-part allyship and belongingness training and targeted discussions to increase their knowledge of concepts such as privilege, bias, microaggressions. Therefore, the current study also assessed patient ratings of their satisfaction with care overall and as it related to provider sensitivity to their cultural identities. Lastly, this study aimed to examine the relationship between treatment outcomes and satisfaction with care overall, and the relationship between treatment outcomes and satisfaction with level of providers’ cultural sensitivity.

The study found BA treatment significantly improved health-related quality of life and depressive symptoms for Hispanic adolescents. In addition, the study found that Hispanic adolescents ranged from “more satisfied than dissatisfied” to “very satisfied” with their care overall and as being sensitive to their cultural identity. When the relationship between treatment outcomes and satisfaction with care overall was examined, researchers found satisfaction with care overall was not correlated with changes in depressive symptom severity or health-related quality of life. When the relationship between treatment outcomes and satisfaction with care as it relates to provider’s level of cultural sensitivity was examined, researchers found satisfaction with care as it relates to provider’s level of cultural sensitivity was negatively correlated with changes in health-related quality of life. It should be noted that clinic procedures included patients debriefing with a staff member if they had ratings on the Patient Satisfaction Survey below a 3. This procedure may have resulted in higher ratings on the Patient Satisfaction Survey for patients who did not want to engage in this debriefing. Future research should examine effectiveness in community health settings, utilize a standardized measure of satisfaction, and explore factors like acculturation to examine how they affect treatment outcomes or satisfaction with care.

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