Theses and Dissertations - Department of Health Science

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Browsing Theses and Dissertations - Department of Health Science by Subject "Mental health"

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    Coping at the intersection: a transformative mixed methods study of gendered racism as a root cause of mental health challenges in black college women
    (University of Alabama Libraries, 2017) Burton, Wanda Martin; Birch, David A.; Paschal, Angelia M.; University of Alabama Tuscaloosa
    Background. Racism negatively impacts mental health. Racial identity has been suggested as a buffer against the impact of racism. But women of color are exposed to gendered racism; based on intersectionality theory. The purpose of this study was to understand the impact of and coping strategies used to deal with gendered racism on the mental health of Black college women. Methods. The mixed methods design included a nonrandom sample of 213 Black college women. Mental health was operationalized as depression (PHQ-9) and psychological distress (K-6). Correlation and regression analyses tested the impact of gendered racism on mental health; examined the role of racial identity; and, explored coping strategies. Through intensity sampling, the qualitative phase included individual interviews (n=12) and a focus group (n=6). Narrative inquiry was used to construct composite counter-narratives, using thematic narrative analysis. Findings. Quantitative results suggested that 84% of the sample require mental health treatment. Gendered racism negatively correlated with mental health; the most significant correlation was between depression and the frequency of gendered racism, r(95) = .405, p ≤ .01. Racial identity was not related to mental health and therefore could not be tested as a mediating factor. The qualitative phase revealed narratives of gendered racism across multiple levels. The institutional level helped to create the normative experience of gendered racism through lack of effective policy; it also impacted the individual and interpersonal levels. Internalized gendered racism resulted in an acceptance of limitations to one's full humanity. The interpersonal level included narratives of sexual assault, being mistaken as ‘the help,’ and assumptions about communication style and educational level. The mixed methods results suggested that effective coping depends on increased education and the deconstruction of gendered racism followed by the use of humor and social support. Discussion. Gendered racism negatively impacts the mental health of Black college women. Interventions should include an emphasis on gendered racism. Narratives revealed how Black college women accept and resist the normative experience of gendered racism. The mixed methods design provided a more nuanced understanding of how Black women cope with gendered racism.
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    Emotional determinants of health: exploring prevalence and the impact of adverse childhood experiences on physical and mental health outcomes of black adult men using the 2012 behavioral risk factor surveillance system
    (University of Alabama Libraries, 2020) Johnson III, Lee Presley; Paschal, Angelia M.; Burton, Wanda M.; University of Alabama Tuscaloosa
    Background. In the United States, Black men face a disproportionate burden of preventable mortality and morbidity rates. Among the possible factors associated with the disproportionality in these rates among Black men, studies suggest, are adverse childhood experiences (ACEs). Moreover, depression, one of the world’s most pervasive psychiatric disorders, researchers suggest, also contributes to disparate mortality and morbidity rates among Black men. Purpose. The purpose of this study and research inquiry was to describe the relationship between differential exposure to ACE’s and depression in Black men, controlling for effects of social demographic factors, presence of chronic medical conditions, and behavioral health risks using the 2012 Behavioral Risk Factor Surveillance System (BRFSS) data. Methods. A secondary data analysis was employed using a community sample of 3,084 Black men originating from the 2012 BRFSS. The 2012 BRFSS included an ACE module questionnaire. ACE module survey questions were used to determine the presence (yes/no) for types (e.g., direct or environmental) of ACEs. Composite measures of the ACE type subscales were computed to determine the total number of ACEs that could be reported (e.g., range 0 to ≥ 5). Additional BRFSS questions assessed depression, chronic medical conditions, and health risk behaviors. Results. Physical abuse, a direct ACE, and household member incarceration, an environmental ACE, was significantly associated with current depressive symptoms. Approximately 32.1% of Black men reported exposure to verbal abuse before age 18, the most prevalent direct ACE. In contrast, a larger proportion (48.6%) of Black men reported exposure to divorce before 18, the most prevalent environmental ACE. Physical abuse and stroke were statistically significant (OR = 4.14; 95% CI [1.69, 10.12]; p < 0.05). Approximately 9.2% of the Black men in the study reported experiencing five or more ACEs. Health risk behaviors did not mediate depression among Black men. Conclusion. Physical abuse and household member incarceration exert a significant impact on current depression. Indeed, verbal abuse and divorce demonstrated a significant relationship with a lifetime diagnosis of depression. The study findings have implications for health education practitioners, researchers, and policymakers interested in improving mental health through prevention and reducing childhood exposure to abuse.