Graduation Year

2012

Document Type

Dissertation

Degree

Ph.D.

Degree Granting Department

Community and Family Health

Major Professor

Julie Baldwin, Ph.D

Co-Major Professor

Robert J. McDermott, Ph.D., M.S.

Committee Member

Carla VandeWeerd, Ph.D.

Committee Member

Dinorah Martinez Tyson, Ph.D., M.P.H, M.A.

Committee Member

Susan McMillan, Ph.D., R.N., F.A.A.N.

Keywords

Cognitive Stress Theory, Depression, Distress, Ecological Model, Hispanic, Social Support

Abstract

Women with breast cancer commonly experience depression. However, this condition often goes unrecognized, undertreated, and understudied, especially in ethnic minorities. If left untreated, co-existing depression in women with cancer can complicate cancer treatment, lead to poor treatment adherence for both conditions, and decrease survival. These negative consequences are considerably higher among Latinas. With the growing number of Latinos and diversity within the Latino community, the literature has identified the need to disaggregate Latinos by region of origin. Unfortunately, few studies account for these differences and no study to date has examined risk factors of depression among Latinas diagnosed with breast cancer within 5 years or by region of origin. To begin exploring predictors of depression among Latina breast cancer survivors, a theory-driven mixed-methods approach was used to identify potential risk factors for depression as a group and by region of origin (e.g., South and Central America, and Spanish-speaking Caribbean countries). This study also sought to contextualize Latina breast cancer survivors' perceptions of risk factors of depression, necessary to shape culturally and linguistically appropriate interventions and programs.

The guiding theoretical framework for this study was Lazarus and Folkman's Cognitive Stress Theory and McLeroy and colleagues' Ecological Model for Health Promotion. Sixty-eight Latinas meeting eligibility criteria were recruited from Latino cancer support groups and other community organizations in the West Central Florida area. Both purposive and snowball-sampling procedures were used to recruit participants. A researcher-administered closed-ended questionnaire, followed by a semi-structured interview addressed research aims and the primary outcome variable. Descriptive statistics (mean, standard deviations, frequency, percent), bivariate and multiple linear regression analyses were completed using IBM SPSS V20. Thematic and content analyses were completed for qualitative data using Atlas.ti 6.2.

Findings revealed the need for easily accessible, culturally and linguistically appropriate psychosocial services to help women adjust to cancer diagnosis and emphasized the need to disaggregate Latinos in future studies as findings may differ by Latino region of origin. Multivariate analyses showed appraisal variables (more perceived harm, more perceived threat, less perceived challenge - overcoming cancer), coping variables (less active coping and more self-blame), and poor body image to be significantly associated with an increased risk for the likelihood of depression. Appraisal variables accounted for greatest explained variance (36%). Risk factor differences by region of origin were observed in sub-group multivariate analyses, but this study was unable to conclude if risk factors play a different role by region of origin in a combined model. Twenty-two salient themes emerged from the thematic analyses of the qualitative data on all levels of the ecological model (e.g., acceptance of illness, lack of family and peer support, lack of access to care, language barriers). Content analyses demonstrated agreement on a majority of salient themes amongst groups (presence of depression symptoms and by region of origin) about the perceptions of risk factors for depression. "Helping oneself" and "discrimination" demonstrated significant difference in terms of the frequency these themes were discussed by presence of depression symptoms and "poor body-image" by region of origin.

In conclusion, data from this study provided quantitative and qualitative data of potential risk factors of depression, which in turn can be used to conduct additional epidemiological studies to examine prognostic factors longitudinally. Study findings may also contribute to the existing literature of risk factors for depression to encourage future intervention and programs to reduce mental health disparities, to raise the awareness of the need for mental health services, and to inform mental health screening guidelines.

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