Engaging depressed African American adolescents in treatment: lessons from the AAKOMA PROJECT

Abstract

The authors describe and illustrate means of engaging depressed African American adolescents in treatment. Twenty-eight youth participated in focus groups or individual interviews. Using grounded theory and transcript based analysis, they derived 5 themes describing African American adolescents’ experience of depression and suggested mechanisms for improving African American youth treatment engagement. Practitioners can educate African American youth about depression as a medical disorder, build trust, and apply innovative approaches to recognizing differential manifestations of depression in African American youth.

Predictors of lifestyle behaviors, trust of health care provider, and utilization of health services among adolescents living in a rural area.

“…A lack of trust of the HCP was frequently reported by adolescents as a reason for not utilizing health services (BrelandNoble et al, 2010;Charman, Harms, & Myles-Pallister, 2010;Elliott & Larson, 2004;Scott & Davis, 2006). In health care, trust has been demonstrated to influence many situations including adolescent patients' willingness to seek care (Breland-Noble et al, 2010;Charman et al, 2010), to disclose sensitive information (Blake et al, 2012;Farrant & Watson, 2004;Leonard, Markham, Bui, Shegog, & Paul, 2010), to submit to treatment (McKee, O'Sullivan, et al, 2006;Renker, 2006;Sayles, Macphail, Newman, & Cunningham, 2010), to participate in research (Broome & Richards, 2003), to adhere to prescribed treatments (Brown, 2007), to continue a HCP relationship (Hudson, Nyamathi, & Sweat, 2008), and to recommend a HCP to others (Ingram & Salmon, 2007).…”

“…Trust of HCP increases with age, with early adolescents reporting the lowest levels of trust and older adults reporting higher levels of trust (Hall, Dugan, Zheng, & Mishra, 2001;Klostermann et al, 2005). Lacking trust of one's HCP inhibits utilization of health services among vulnerable populations (Breland-Noble et al, 2010;Kilbourne, Switzer, Hyman, Crowley-Matoka, & Fine, 2006) and results in delayed care or foregone care (Mollborn, Stepanikova, & Cook, 2005). A vulnerable population is a population in which health disparities are more likely to exist (Centers for Disease Control and Prevention, 2013).…”

“…Trust of HCP (See Table 1) was selected for inclusion in the adapted model because adolescents have been known to report low levels of trust of HCP (Breland-Noble et al, 2010;Britto et al, 2004;Broome & Richards, 2003;Brown, Arden, & Hurst, 2007;Charman et al, 2010) and trust of HCP influences many situations in health care. While trust of HCP was an individual characteristic that influenced health behavior (See Figure 2) and was considered a predictor variable in this study, it is also true that other factors in the model may have logically influenced trust of HCP.…”

“…Participants disclosed distrusting HCP whom they perceived to have failed to effectively treat their depressive symptoms, did not maintain confidentiality, did not make an effort to listen, or did not demonstrate care (Breland, 2010). Phenomenological analysis of focus groups discussing trust of both traditional and internet-based mental health care revealed adolescents' concerns were maintaining privacy and confidentiality (Charman, 2010).…”

“…African-American adolescents (n = 28) revealed distrust of HCPs who break confidentiality or fail to help with symptoms of depression (Breland, 2010). Focus groups with Australian adolescents (n = 20) seeking mental health services revealed experiencing breaches in trust when HCPs discussed the adolescent's health care with parents without discussing it with the adolescent first (Charman, 2010).…”