Late Life Depressed Mood: Crafting Meaning from Experience and Knowledge By Kristen Ann Gustavson A dissertation in partial satisfaction of the requirements for the degree of Doctor of Philosophy in Social Welfare in the Graduate Division of the University of California, Berkeley Committee in charge: Professor Andrew E. Scharlach, Chair Professor Eileen Gambrill Professor Lawrence Cohen Professor Sharon Kaufman Spring 2010 Abstract Late Life Depressed Mood: Crafting Meaning from Experience and Knowledge By Kristen Ann Gustavson Doctor of Philosophy in Social Welfare University of California, Berkeley Professor Andrew E. Scharlach, Chair This exploratory study elicited descriptions of the experience of depressed mood in later life as well as older adults’ knowledge about depression. The researcher purposively recruited thirty‐six participants age 75 and older, who participated in an in‐depth, in‐ person interview. The research design and analysis were informed by a conceptual framework integrating Pearlin’s Stress Process model and social learning theory. Three major themes emerged from the data: the importance of context and life experience, the power of personal choice, and the disconnection between knowledge and personal experience. Study participants, in describing their experiences of depressed mood, reported the importance of the context in which their depressed mood developed. Further, they saw themselves in light of their whole life experience and conveyed the relevance of earlier significant life events to their late life depressive symptoms. Early life events shaped both how they saw the world and how they coped with stressful life events in later life. Study participants also described the power of their own attitudinal and behavioral choices to improve their mood, often choosing to do things by sheer force of will, even though they didn’t feel like doing these things because of their depressive symptoms. Participants understood depression in terms of both social and biological explanatory models. However, though they understood that depression may be caused by biological factors, none of the participants attributed such causes to their own depressed mood, but instead, relied on social causes to explain their own experience. In other words, no one spoke about biological causes of their own depressive symptoms even though they knew about such possible causes when relaying their knowledge about depression. This finding has possible implications for the stress process theory, which suggests that knowledge influences the judgments we make about our own experience. However, these study findings suggest that the influence of external knowledge may not be as powerful an influence on the judgments and meanings older adults ascribe to their own experience of depressive symptoms as are the context and lived experience of the individual. Practice and research implications of these findings include the need to explore across more diverse samples of older adults the choices older adults make related to improving their mood. Research exploring the knowledge older adults have about 1 depression and the explanatory models they use to describe their own experience is an important next step. Study participant’s stress on the importance of context in understanding depressive symptoms in later life should cause clinicians to rethink their dependence on diagnostic and treatment tools that ignore the larger experience in which depressive symptoms arise for older adults. 2 Dedication This work is dedicated first to my husband, Jan Erik, whose love, faith, and encouragement sustained me in many ways. He listened to endless dissertation minutia without nodding off and brought home dinner more times than I can count so that I could work and write. It is also dedicated to my darling sons, Lenny and Martin, who kept me grounded with dirty diapers that needed changing and trips to the park that could not be delayed. They made me laugh and yet stayed out of the office when I needed to work. It is dedicated to the older people who participated in this study. Without their honesty and commitment, this research would have been impossible. Finally, this dissertation is for my parents who read to me from a young age and instilled in me a love of learning that was allowed to flourish. They repeatedly told me that I could be anything I wanted to be; for that, I will be eternally grateful. i Table of Contents Abstract.........................................................................................................................................................................1 Dedication..................................................................................................................................................................... i Table of Contents......................................................................................................................................................ii Preface..........................................................................................................................................................................iv Acknowledgements ................................................................................................................................................. v Chapter 1: Introduction.........................................................................................................................................1 Depression in Late Life..................................................................................................................................................... 1 Purpose of the study.......................................................................................................................................................... 2 Overview of Chapters........................................................................................................................................................ 2 Chapter 2: Depression in the Elderly: Theoretical Constructs, Previous Studies and Conceptual Framework .........................................................................................................................................4 Definitions and Concepts................................................................................................................................................. 4 Controversies in Conceptualizing Deviant Behavior ........................................................................................... 5 Epidemiology........................................................................................................................................................................ 8 Theories of Late Life Depression................................................................................................................................16 Depression in Late Life: Experience, Meaning, Understanding and Knowledge....................................23 Conceptual Framework..................................................................................................................................................27 Conclusions ......................................................................................................................................................................... 29 Chapter 3: Research Design and Methods.................................................................................................. 31 Study Design .......................................................................................................................................................................31 Methodological Approach and Ethical Considerations.....................................................................................31 Study Procedures..............................................................................................................................................................32 Sampling and Recruitment ...........................................................................................................................................34 Data Collection...................................................................................................................................................................37 Data Analysis ...................................................................................................................................................................... 40 Chapter 4: Results ................................................................................................................................................. 44 Purpose of the study........................................................................................................................................................44 Conceptual and Theoretical Framework ................................................................................................................44 Antecedents – The Context of Depressed Mood ..................................................................................................45 Reaction – The Lived Experience of Depressed Mood ......................................................................................46 ii Judgment – Crafting Meaning from Depressed Mood........................................................................................49 Action – Coping with Depressed Mood....................................................................................................................58