A MIXED METHODS EXAMINATION OF DEPRESSIVE SYMPTOMATOLOGY AND USUAL SOURCES OF CARE AMONG BLACK MEN

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  • March 20, 2019
Creator
  • Adams, Leslie
    • Affiliation: Gillings School of Global Public Health, Department of Health Behavior
Abstract
  • Background: Black men report having a usual source of care (USOC) less frequently than non-Black men and women. Yet, few studies examine the role of depressive symptoms and psychosocial factors and its relationship to USOC reporting in this population. Thus, the goal of this dissertation study to investigate the direct and moderated associations between Black men’s depressive symptom factors and USOC reporting. Methods: Data from Manuscripts 1 and 2 were drawn from a cross-sectional, community-based sample of Black men (n=683) from the African American Men’s Health and Social Life Study. Manuscript 1 assesses the dimensional structure of the Center for Epidemiological Studies Depression (CES-D) 12-item scale using exploratory and confirmatory factor analysis. Manuscript 2 builds on these findings to assess the association between the confirmed CES-D factor structure and USOC status using a latent moderated structural equation modeling approach. This study tests the direct depression factor-USOC status relationship and assesses race and gender-related moderators (John Henryism, Masculine role norms salience, Restrictive Emotionality, and Racial Centrality). Finally, Manuscript 3 uses concept mapping data collected from Black men and stakeholders (n=36) to determine how depressive symptoms are conceptualized and connected to Black men’s USOC use. Results: In Manuscript 1, two latent factors emerged from CES-D scale: interpersonal negative affect (INA) and diminished positive affect (DPA). In Manuscript 2, the INA factor was negatively associated with USOC reporting (β = -0.770, p<0.01). In contrast, the DPA factor was not significantly associated with USOC reporting (β = 0.693, p=0.096). Interactive effects from the latent moderated analyses showed no significant psychosocial moderators. Finally, in Manuscript 3, participants identified 68 unique characteristics of depression reflected across five conceptual domains: (1) physical states, (2) emotional states, (3) diminished drive, (4) internal conflicts, and (5) communication with others. Of these, the physical states cluster was most commonly associated with USOC use, followed by diminished drive. Conclusions : Findings from this study will inform efforts to improve existing mental health care delivery models for Black men. Additionally, results reflect the diverse range of symptomatology that reflect gendered aspects of the depression experience.
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  • In Copyright
Advisor
  • Gottfredson, Nisha
  • Powell, Wizdom
  • Lightfoot, Alexandra
  • Golin, Carol
  • Corbie-Smith, Giselle
Degree
  • Doctor of Philosophy
Degree granting institution
  • University of North Carolina at Chapel Hill Graduate School
Graduation year
  • 2018
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