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Stay-At-Home-Fathers Navigating Depression: a Consensual Qualitative Research Study

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Stay-At-Home-Fathers Navigating Depression: a Consensual Qualitative Research Study Marquette University e-Publications@Marquette Dissertations, Theses, and Professional Dissertations (1934 -) Projects Stay-at-home-fathers Navigating Depression: A Consensual Qualitative Research Study William Douglas Meyers Caperton Marquette University Follow this and additional works at: https://epublications.marquette.edu/dissertations_mu Part of the Counseling Psychology Commons, Health Psychology Commons, and the Psychiatric and Mental Health Commons Recommended Citation Caperton, William Douglas Meyers, "Stay-at-home-fathers Navigating Depression: A Consensual Qualitative Research Study" (2015). Dissertations (1934 -). 548. https://epublications.marquette.edu/dissertations_mu/548 STAY-AT-HOME FATHERS NAVIGATING DEPRESSION: A CONSENSUAL QUALITATIVE RESEARCH STUDY by William Caperton, MA A Dissertation submitted to the Faculty of the Graduate School, Marquette University, in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy Milwaukee, Wisconsin August 2015 ABSTRACT STAY-AT-HOME FATHERS NAVIGATING DEPRESSION: A CONSENSUAL QUALITATIVE STUDY William Caperton, M.A. Marquette University, 2015 Evidence suggests that the practices through which men are socialized to become masculine may serve both to restrict their potential in ways that lead to psychological distress, and also to restrict the ways in which they respond to such distress (Addis & Mahalik, 2003; Mahalik, Good, Tager, Levant, & Mackowiak, 2012; O’Neil, 2008). While we are beginning to understand masculine depression (Cochran & Rabinowitz, 2000; Magovcevic & Addis, 2008) and paternal depression (Paulson & Bazemore, 2010; Ramachandani & Psychogiou, 2009), almost nothing is known about how SAHFs experience depression, nor their experiences and beliefs regarding help-seeking and psychotherapy. The trend towards increased SAHFs does not seem to be slowing (Latshaw, 2011; Rochlen, McKelly, Whittaker, 2010), and given the impacts of paternal depression individually, and famillially, a greater understanding of this unique population is sorely needed. To that end, this qualitative study focused on how SAHFs experience depression, including ways in which they have coped, and how they think about help-seeking. Where they have sought help from mental health professionals, this study also explored their experiences of psychotherapy. Results indicated that SAHFs who have experienced depression during their tenure as SAHFs focused on relational distress, isolation, loss of independence, and social stigma as contributing to their depression. They appeared to retain a high value on providing for their families, both in the decision to take on the role of SAHF and in deciding to ultimately seek help for depression. The idea of seeking help as a means to protect and provide for their families appeared congruent with their descriptions of masculinity, which recast the SAHF role as being definitionally masculine. Finally, this growing but still somewhat marginalized group of men appeared to be building social networks both on- and offline to support their sense of identity and as a means for coping with the unique stressors they face. Implications for practice, as well as future areas for research, are discussed. i ACKNOWLEDGEMENTS William Caperton, M.A. I would like to acknowledge a few people who have made this dissertation possible. To my parents, for instilling a thirst for knowledge, for reading to me early and often, and for letting me find my own way. To my advisor, Dr. Sarah Knox, who helped me funnel back down to earth, from the confusion of the 10,000 ideas. You have helped me become a better researcher, writer, and psychologist. To my team members, Dakota Kaiser and Meghan Butler, thank you for the hours of phone calls, and your commitment to seeing this project through. I absolutely couldn’t have managed without you both. To Abigail: for your patience, your passion. Your strength, your style. Your grit, your grace. Dark winters, fog lifting through canyons, building, dancing, silently waiting. You are my song. ii TABLE OF CONTENTS ACKNOWLEDGEMENTS……………………………………………………………….i CHAPTER I. INTRODUCTION………………………………………………………………1 II. LITERATURE REVIEW…………………………………………………….14 Male depression frameworks…………………………………………….14 Sex Differences Framework……………………………………..14 Masked Depression Framework…………………………………22 Masculine Depression Framework………………………………34 Gendered Responding Framework………………………………31 Cultural Differences in Men’s Depression………………………37 Barriers to Treatment…………………………………………………….40 Facilitative Factors……………………………………………………….44 Stay-at-home Fathers…………………………………………………….46 Consensual Qualitative Research………………………………………...58 III. METHOD……………………………………………………………………63 Participants……………………………………………………………….63 Research Team…………………………………………………………...64 Research Team Biases…………………………………………………...65 Measures…………………………………………………………………66 Procedures………………………………………………………………..68 Data Analysis…………………………………………………………….70 IV. RESULTS……………………………………………………………………74 iii Contexts and roles of SAHFs…………………………………………….74 Role as a SAHF…………………………………………………..75 How Others Perceive Their Role As SAHFs…………………….81 Self-perception of Masculinity…………………………………..83 Depression and Help-Seeking While SAHFs……………………………88 Mental Health History Prior to Becoming SAHF………………..88 Experiences of Depression While SAHFs……………………….89 Help-Seeking Related to Depression While a SAHF……………96 Therapy Experience While a SAHF……………………………100 Closing results…………………………………………………………..106 Why Participate…………………………………………………106 How Participants Learned About the Study…………………….106 Experience of Interview………………………………………...107 Illustrative example……………………………………………………..108 V – DISCUSSION……………………………………………………………...111 Context and Roles of SAHFs…………………………………………...111 Role as SAHF…………………………………………………..111 How Others Perceive SAHF Role………………………………117 Self-Perception of Masculinity…………………………………120 Depression and Help-Seeking While a SAHF………………………….123 Mental Health History Prior to Becoming SAHF………………123 Descriptions of Depression While a SAHF…………………….124 Perceived Causes……………………………………………….125 iv Coping…………………………………………………………..129 Effect of Depression on Others…………………………………130 Help-Seeking for Depression While a SAHF…………………..131 Therapy Experiences While a SAHF…………………………...133 Closing Results…………………………………………………………137 Limitations……………………………………………………………...138 Implications for Practice………………………………………………..139 Implications for Research………………………………………………144 Conclusion……………………………………………………………...147 REFERENCES…………………………………………………………………………149 APPENDICES Appendix A: Demographic Form………………………………………………………170 Appendix B: Interview Protocol………………………………………………………..172 Appendix C: Participant Information…………………………………………………...174 Appendix D: Letter to Potential Participants…………………………………………...175 Appendix E: Informed Consent Form (Participant copy)………………………………177 Appendix F: Informed Consent Form (Researcher copy)………………………………179 Appendix G: Letter To Participants To Provide Feedback On Draft Of MS…………..181 Appendix H: Email Recruitment Letter………………………………………………...182 1 Stay-at-Home Fathers Navigating Depression Chapter I Statement of the Problem Men and Depression Depression has long been thought to affect women at about twice the rate of men. Population-based studies such as the National Comorbidity Survey (Kessler, McGonagle, Zhao, Nelson, Hughes, Eshelman, Wittchen, & Kendler, 1995) have found a female-to- male ratio of 1.69:1, with male respondents reporting a 12.7% lifetime prevalence rate and female respondents reporting a 21.3% lifetime prevalence rate for major depressive episodes. However, many theoreticians and researchers interested in men’s mental health have criticized these findings, arguing that men’s rates of depression may be under- estimated for a variety of reasons, including clinician bias (Potts, Burnam, & Wells, 1991), and perhaps more importantly, differential symptom patterns within men (Cochran & Rabinowitz, 2000; Pollack, 2005). Indeed, more recent studies have identified a phenotypic variant labeled masculine-depression (Magovcevic & Addis, 2008; Zierau, Bille, Rutz, Bech, 2002). When this form of depression has been included in population- based data, rates of depression between men and women are approximately equal (Martin, Neighbors, & Griffiths, 2013). Whatever the sex differences, if any, in depression, a significant number of men suffer from this often chronic and frequently debilitating condition. Research has begun to unpack some of the ways in which masculinity may intersect with the experience of depression, including how adherence to masculine roles can impinge upon help-seeking (e.g. Addis & Mahalik, 2003; Mahalik, Good, Tager, 2 Levant, & Mackowiak, 2012; O’Neil, 2008; Smiler, 2006). As our understanding of masculinity has evolved, a more nuanced view into the positive and negative aspects of maintaining this potentially privileged position have been disclosed. In a general sense, psychological understandings of masculinity have moved from a static, biologically- determined personality trait position (Terman & Miles, 1936), to a social role position (Pleck, 1981), to a view of masculinity that emphasizes its socially-constructed, dynamic nature in which “masculinity” is seen as an institutionally backed form of power independent of gender (Connell & Messerschmidt, 2005). What has become more apparent is the paradoxical nature of masculine power and privilege, in which the socialization practices in place to support masculine ideologies and the social roles required to “perform” masculine behavior and accrue
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