Pregnant Teenage Hispanic Women and Depression: Determining Coping Approaches - Research Paper Example

Pregnant Teenage Hispanic Women and Depression: Determining Coping Approaches Abstract This research aims to understand the coping mechanisms used by teenage Latinas who are pregnant and depressed. The research question is: What are the coping mechanisms for pregnant Hispanic teenagers and are they effective? This paper will describe the process of forming the research design. Due to the high rate of depression among pregnant Hispanic teenagers, it is important to understand their coping mechanisms using the qualitative research design, so that psychologists and counselors can help them improve handle their depression. This paper has prepared the researcher for actual research and resolving its needs of finding relevant research questions, as well as choosing the right research design, sampling, instruments, and analytical models. Introduction Teenage pregnancy is not a minor health and social issue that can be overlooked and undermined: “Thirty-four percent of girls in the United States become pregnant before age 20” (Henshaw, 2004, as cited in Shanok & Miller, 2007, p.252). Numerous pregnancies, however, are not completed because of legal abortion (29%) and miscarriage (14%) (Shanok & Miller, 2007, p.252). The major antecedent of teenage pregnancies is the socio-economic status of these women, where teenagers in low socio-economic levels have a higher rate of being pregnant than those in middle and upper-class levels (Shanok & Miller, 2007, p.252). Young et al.'s study presents evidence that psychological reasons also result to higher teenage pregnancy rates.Other causes of teenage pregnancies are “low self-efficacy, external locus of control, low expectations of educational achievement, and traditional occupational expectations in eighth grade” (Young, Martin, Young, & Ting, 2001, as cited in Shanok & Miller, 2007, p.252). Race is a common denominator of early pregnancies. Based on a national sample, Hispanic adolescents have a higher birth rate than non-Latina Whites, with the former having an 81 per 1,000 birth rate, compared to 26 per 1,000 birth rate for white, non-Hispanic adolescents (Dehlendorf et al., 2010, p.194). This can related to the reality that many of these Hispanic teenagers also happen to be poor. Being poor and pregnant, with little economic resources, and possibly even experiencing state welfare support concerns because of illegal immigrant status, numerous Hispanic teenagers also become depressed. The depression rates in pregnant adolescents have reached 26 to 44% incidence with the upper range including urban minorities of low socio-economic status (Schoenbach, Garrison, & Kaplan, 1984; Troutman & Cutrona, 1990, as cited in Dehlendorf et al., 2010, p.194). Depression is also found to be more prevalent for pregnant adolescents than pregnant adults (Gotlib, Whiffen, Mount, & Milne, 1989; O’Hara, Zekoski, Philipps, & Wright, 1990as cited in Dehlendorf et al., 2010, p.194 ) and also when compared to non-pregnant adolescents. This paper aims to use a qualitative research design through combining the use of Coping Response Inventory-Youth (CRI-Y) form and structured interviews. The research question is: What are the coping mechanisms for pregnant Hispanic teenagers and are they effective? This paper will explore the research design and process of forming it. Due to the high rate of depression among pregnant Hispanic teenagers, it is important to understand their coping mechanisms using the qualitative research design, so that psychologists and counselors can help them improve these coping mechanisms and also prepare other young mothers who are not yet using any coping approach to handle their depression. Selection of a Research Focus and Applied Design The database used for reviewing literature is EBSCO database. After entering the words “depression,” “pregnant Hispanic teenagers,” and “coping,” no relevant studies have shown up. Nevertheless, several studies on depression among pregnant teenagers in general (Hurley, 2010; Richards et al., 2007; Shanok & Miller, 2007a, 2007b) have been found, as well as studies on teen pregnancy among Latinas, because it is a growing health concern with its increasing rates for the past fifteen years (Dehlendorf et al., 2010; Rocca et al., 2010). Majority of the research on the topic, however, is focused on reproductive health (Foulkes et al., 2005) and understanding how contraceptive use before and after pregnancies impact the high rate of teen pregnancies among Hispanic women (Gilliam, Warden, & Tapia, 2004; Wilson et al., 2011). Apparently, there is little research on the psychological health of pregnant teenage Hispanics, which is why this paper has decided to focus on this research topic. For the applied design, qualitative and quantitative research designs were considered. Qualitative research generally uses non-statistical methods of inquiry in analyzing social phenomena (McRoy, 2009). It is also described as using the inductive process, wherein themes and categories are determined. Data collection methods are interviews, observations, videotapes, and case studies (McRoy, 2009). Samples are also small and the sampling strategy is purposive, instead of random (McRoy, 2009). Qualitative research also uses exhaustive descriptions from the viewpoints of research participants themselves (McRoy, 2009). Quantitative research, on the contrary, collects data from large samples, using standardized measures; analysis also greatly relies on the deductive approach, and if interviews are used, highly structured interview instruments are employed to collect data for hypothesis testing (Marlow, 1993). Concepts are also quantifiable and concretely measured (McRoy, 2009). Qualitative and quantitative research designs are chosen for their different focuses and how researchers deal with issues regarding their designs. For instance, the main issues with qualitative research are reliability, validity, and generalization, because of the subjective approach, while for quantitative research, some concerns are ethics and possibility of lacking validity too, if the wrong research instruments are used. After considering these issues, I decided to use a qualitative research design with a small sample, because I am also interested in identifying themes and categories. I will be using the Coping Response Inventory-Youth (CRI-Y) form to improve the validity of my data and analysis, and will combine this with a structured interview, so that I can enhance the data texture of my analysis. I want to probe deeper too into the coping approaches of pregnant Hispanic adolescents, because this is an under-researched area, which is important in helping this group handle their conditions. Indeed, while other studies aim to curtail teenage pregnancies, my specific goal is understanding what is happening to these pregnancies, in terms of depression and coping mechanisms. Background Information and Primary Research Question Based on existing research, race, culture, educational attainment, economic status, and self-image are critical factors that are related to teenage pregnancies among Hispanic adolescents. Dehlendorf et al. (2010) examined the relationship between socio-economic status, acculturation, and teenage Latina pregnancies. They used logistic regression to analyze the connections of measures of acculturation (language spoken at home, nativity, and age at immigration) and parents’ education of the sampling in a stratified sample of teenage Latina women who gave birth in California. Findings showed that speaking English and Spanish at home, as well as speaking only Spanish at home corresponded to 17% increase in teen birth among Latinas compared to non-Hispanic Whites, while parental education accounted for 23% increase among Hispanics born in the U.S. and 55% increase for immigrant Latinas (Dehlendorf et al., 2010, p.199). They noted that their study opposed general assumptions and findings that being more acculturated can decrease pregnancy rates (Dehlendorf et al., 2010, p.199). Findings also showed that when parents lived in low-income communities, the risk of getting pregnant during teenage years also increases (Dehlendorf et al., 2010, p.199). When parents have high educational level, however, they decrease the odds of their children being pregnant, because they could have more information and better communication skills in expressing why it is important to avoid early pregnancies, such as being able to complete their studies and having more career options (Dehlendorf et al., 2010, p.199). Shannon and Miller conducted studies in 2007 (2007a, 2007b), where they found out high rates of depression among pregnant teenagers, and where majority of these teenagers were Latinas. They used qualitative research design to undertake their studies which were based on the an earlier Interpersonal psychotherapy (IPT) sessions conducted by Dr. Miller and colleagues, where they aimed to reduce or prevent depression among pregnant teenagers. In their article “Depression and Treatment with Inner City Pregnant and Parenting Teens,” Shannon and Miller (2007a) used qualitative analyses of therapy sessions, clinical notes and post hoc interviews of clinicians to determine the characteristics and correlates of the participants’ depression and the dimensions of the treatment and/or participants’ broader lives that were related to symptoms relief. To measure depression, they used the Beck Depression Inventory and the Edinburgh Postnatal Depression Scale. Findings showed that the common symptoms of depression were anger/irritability and sadness, followed by anxiety, and the four most basic reasons related with the symptoms of depression were “all socially embedded,” and they are: “feeling trapped or powerless, feeling wronged, when a significant family member was sad or rejecting and when symptoms aided in goal achievement” (Shannon & Miller, 2007a, p.207). The most important factors that lead to symptom reduction were also “socially embedded” (Shannon & Miller, 2007a, p.207). The social factors that shape the psychological well-being of teenage pregnant mothers were also replicated in their other article, “Stepping Up to Motherhood among Inner-city Teens.” These studies show how important social factors and systems are to pregnant Hispanic adolescents, especially when they come from low socio-economic status. Shannon and Miller (2007b) and Richards et al. (2007), nevertheless, determined that some Hispanic adolescents were not depressed during pregnancy, because they focused on the positive side of their conditions. For instance, some adolescent mothers in Shannon and Miller (2007b)'s study found a greater purpose in life, while Richards et al. (2007) showed mothers who were pleased with these changes, because they had critical social resources to help them, such as the support of their families and co-habiting spouses. These mothers also used coping strategies that were effective to them, which indicate the value of coping approaches to dealing with life-changing conditions such as early pregnancy. In line with this research, it is important to ask about depression among pregnant Hispanic adolescents. The research question is: What are the coping mechanisms for pregnant Hispanic teenagers and are they effective? The research aims to understand the current breadth of coping mechanisms for the group of pregnant Latina teenagers and how if they think that these approaches are effective. The underlying goal is to help them improve their coping styles, so that they can handle their conditions better and have a healthier pregnancy and childbirth. Sampling and Variables/Concepts The sampling will come from an urban setting. To acquire the sampling, the researcher will contact an organization that is helping teenage pregnant Latinas. The target number is ten Latinas. The main variables to be assessed for this research are depression and coping mechanisms or approaches. Depression can be a central or associated symptom of mental illness. Clinical depression can be defined as persistent or long terms of low moods, lack of interest in otherwise interesting activities, insomnia, social withdrawal, decrease in physical activities, loss of weight and appetite, negative self-view, and suicide ideation (Mufson, 2010). Coping approaches refer to“cognitive and behavioral efforts to manage external or internal demands that are appraised as taxing or exceeding the resources of person” (Lazarus & Folkman, 1984, p. 141, as cited in Hamdan-Mansour et al., 2008, p.372). There are different scales that measure coping and one of them is the Coping Response Inventory-Youth Form (CRI-Y; Moos, 1993, as cited in Hamdan-Mansour et al., 2008, p.372) that have been usually used to asses adolescents’ coping skills for stressful conditions. Moos, Nichol, and Moos (2002) emphasized that coping skills can be determined in two ways: “in respect to their focus (approach and avoidance) and in respect to their method (cognitive and behavioral).” Approach coping pertains to the “cognitive and behavioral efforts to master or resolve life stressors” (Moos, 1993, p. 1, as cited in Hamdan-Mansour et al., 2008, p.372); avoidance coping refers to the “cognitive and behavioral attempts to avoid thinking about the stressors and its implications, or try to manage the affect associated with it” (p. 1, as cited in Hamdan-Mansour et al., 2008, p.372). Coping styles used during adolescence can impact adulthood coping styles. Adolescents who use approach coping have a higher chance of having more self-confidence and more capable of resolving their problems (Moos, Nichol, & Moos, 2002, as cited in Hamdan-Mansour et al., 2008, p.372). Adolescents who prefer avoidance coping tend to reap negative outcomes, such as anger and not resolving underlying problems (Moos, Nichol, & Moos, 2002, as cited in Hamdan-Mansour et al., 2008, p.372). Instruments and Analysis Depression will be measured using the Beck Depression Inventory (BDI) and the Edinburgh Postnatal Depression Scale (EPDS) (Shanok & Miller, 2007b, p.254). The BDI (Beck, Steer, & Garbin, 1988, as cited in Shanok & Miller, 2007b, p.254) is a self-report measure that assesses the incidence and severity of depressive symptoms through 21 items. The BDI had been tested using 25 studies on adolescents and adults with different cultural backgrounds and “the correlation with clinical assessments was .72, internal consistency yielded a mean coefficient alpha of .86, and testretest reliability ranged from .60 to .90” (Shanok & Miller, 2007b, p.254). The EPDS (Cox, Holden, & Sagovsky, 1987) has ten items and it is a self-report questionnaire too that had been validated with both pregnant and postpartum women (Shanok & Miller, 2007b, p.254). When the following are measured, the values reached the following: Sensitivity (84%), specificity (88%), and positive predictive (48%) values (Shanok & Miller, 2007b, p.254). Test-retest reliability was shown to reach .83 (Aduard, Glangeaud-Freudenthan, & Glose, 2005, as cited in Shanok & Miller, 2007b, p.254). For the coping approach, the approach coping strategies are: “logical analysis (LA), positive reappraisal (PR), seeking guidance and support (SG), and problem solving (PS) subscales” (Hamdan-Mansour et al., 2008, p.372). The avoidance coping strategies are composed of “cognitive avoidance (CA), acceptance or resignation (AR), seeking alternative rewards (SR), and emotional discharge (ED) subscales” (Hamdan-Mansour et al., 2008, p.372). The structured interview will consists of open-ended questions that ask about the participants' coping styles. Coping styles will be defined first before they are asked. Interviews will be audio-taped with permission from the participants. The analysis will be based on the instruments and finding additional themes and categories from the structured interviews. This will be done through coding the interviews after audio-taping them. Final Observations This research aims to understand the coping mechanisms used by teenage Latinas who are pregnant and depressed. It is important to deal with teenage pregnancy, not only with the purpose of averting it, but already doing something about it as it persists. Many of these teenagers are depressed. They are poor, maybe the fathers of their children left them or their parents already threw them out of their house for being pregnant, and they may also be uneducated or have stopped studying. These are factors that can easily make any pregnant woman depressed and prone to suicide or abortion. Despite these realities, few studies study how this group copes with depression. Some focus on clinical therapies, but informal coping approaches cannot be underestimated, especially when they are used in the future as adults. These coping mechanisms can also improve the health of the mother and her fetus or baby. The research design is a qualitative research that combines measures of depression and coping approaches and structured interviews. The main concepts are depression and coping mechanisms. For analysis, statistical analysis will be completed, together with coding themes and categories. The paper is interested in finding new coping mechanisms, such as using technology and the Internet. Perhaps for those who can access the Internet, social networking sites may be serving as a new knowledge and support resource. The conceptualization of the research design has been difficult, because this paper aims for a combination of qualitative and quantitative research design. The result is a more qualitative design with a quantitative aspect. I realized that it is possible to apply simple statistics to qualitative studies too. I also learned that it is critical to use instruments that fit the racial identity of the participants, because cultural and language factors can impact how the instruments are read and interpreted. Participants should be able to interpret these instruments in the same way that they were meant to be read. If not, they will render invalid data. This is why the paper will be conducting a structured interview too. This interview will ensure that the participants are asked the right questions that will help them provide as much valid and accurate answers as possible. These answers can be related to the results of the self-report measures, for verification of the answers there. In conclusion, preparing a research design is harder than expected. There should be a clear problem statement that will identify the need for the research. Concepts should be accurately defined according to the sampling's important characteristics, so that the right instruments can be chosen. Analysis should also fit the research design and research question. These concerns cannot be addressed without rigorous research on concepts and instruments, until the most appropriate ones are known and chosen. Finally, this paper has enhanced the researcher's personal knowledge of the different research designs and how they can fit diverse research questions. It prepared the researcher for actual research and resolving its predicaments of finding relevant research questions, as well as accompanying research design, sampling, instruments, and analytical models. References Dehlendorf, C., Marchi, K., Vittinghoff, E., & Braveman, P. (2010). Sociocultural determinants of teenage childbearing among Latinas in California. Maternal & Child Health Journal, 14 (2), 194-201. Foulkes, R., Donoso, R., Fredrick, B., Frost, J.J., & Singh, S. (2005). Opportunities for action: Addressing Latina sexual and reproductive health. Perspectives on Sexual & Reproductive Health, 37 (1), 39-44. Gilliam, M.L., Warden, M.M., & Tapia, B. (2004). Young Latinas recall contraceptive use before and after pregnancy: A focus group study. Journal of Pediatric & Adolescent Gynecology, 17 (4), 279-287. Hamdan-Mansour, A.M., Kim, Y., Puskar, K., & Amer, H.M. (2008). Psychometric qualities of the coping response inventory-youth form. Issues in Mental Health Nursing, 29 (4), 371-385. Hurley, A. (2010). Reparation by proxy: Experiences of working with pregnant teenagers and adolescent mothers. Journal of Child Psychotherapy, 36 (2), 101-118. McRoy, R.G. (2009). Qualitative research. Retrieved from http://www.uncp.edu/home/marson/qualitative_research.html Mufson, L. (2010). Interpersonal Psychotherapy for Depressed Adolescents (IPT- A): Extending the reach from academic to community settings. Child & Adolescent Mental Health, 15 (2), 66-72. Richards, J., Papworth, M., Corbett, S., & Good, J. (2007). Adolescent motherhood: a Q-methodological re-evaluation of psychological and social outcomes. Journal of Community & Applied Social Psychology, 17 (5), 347-362. Rocca, C.H., Doherty, I., Padian, N.S., Hubbard, A.E., & Minnis, A.M. (2010). Pregnancy intentions and teenage pregnancy among Latinas: A mediation analysis. Perspectives on Sexual & Reproductive Health, 42 (3), 186-196. Shanok, A. F. & Miller, L. (2007a). Depression and treatment with inner city pregnant and parenting teens. Archives of Women's Mental Health, 10 (5), 199-210. Shanok, A.F. & Miller, L. (2007b). Stepping up to motherhood among inner-city teens. Psychology of Women Quarterly, 31 (3), 252-261. Wilson, E.K., Samandari, G., Koo, H.P., & Tucker, C. (2011). Adolescent mothers' postpartum contraceptive use: A qualitative study. Perspectives on Sexual & Reproductive Health, 43 (4), 230-237. Read More