ABSTRACT Title of Document: DEPRESSION AND EMOTIONAL DISTRESS IN YOUNG, LOW-INCOME AFRICAN- AMERICAN MEN AND FATHERS Megan E. Fitzgerald, M.S. Directed By: Associate Professor Kevin Roy, Department of Family Science Depression is a debilitating mental illness that in its most serious form, major depression, has affected between 3.6% to 12.7% of men in the United States (Cochran & Rabinowitz, 2000; Jonas, Brody, Roper, & Narrow, 2003; Kessler, McGonagle, Zhao, & Nelson, 1994). It has consistently been found to be twice as prevalent in women as in men, and yet the suicide rate of men is four to five times that of women (Singh, Kochanek, & MacDorman, 1996; World Health Organization, 2005). Despite this, little is known about the experience and expression of the full range of depression in men, and specifically, young, low-income men of color who are fathers. When young fathers suffer from depression, there are enormous consequences for young families, both financial and emotional (Ansseau et al., 2008; Mirowsky & Ross, 2002; Montgomery, Cook, Bartley, & Wadsworth, 1999; Patten et al., 2006; Rehman, Gollan, & Mortimer, 2008; Soares, Macassa, Grossi, & Viitasara, 2008). It is possible that the risk for depression increases when fatherhood includes the challenges of nonresidential parenting and financial stress (Cochran & Rabinowitz, 2002; Roy, 2004). This has implications for their co-parenting relationships, and shapes their identities and roles as parents and providers (Bouma, Ormel, Verhulst, & Oldehinkel, 2008; Kim, Capaldi, & Stoolmiller, 2003). However, fatherhood also brings many opportunities for young men; it is a chance for them to be generative for the first time in their lives and to experience the joys that accompany the challenges of parenthood (Palkovitz, Copes, & Woolfolk, 2001). I conducted research guided by a combination of symbolic interaction theory and the cognitive theory of depression to answer the following questions: how does depression emerge in toxic environments, how do young men experience and express the full range of depression in those environments over time, and, what was the reciprocal relationship between depression and fatherhood? I conducted in-depth interviews with 40 at risk, low-income young African-American men and fathers. Growing up in high crime neighborhoods meant that many had strained and fractured relationships with law enforcement, teachers, peers, and families. Young men engaged in identity work while trying to avoid problems at school and with law enforcement. They also reported substantial substance abuse, usually starting recreationally, but moving to daily self-medication for stress and anger. Depression was expressed at multiple points, through depressive language, extensive anger histories, fatigue, protracted cycles of avoidance, and episodes of major depression. Young men who were also young fathers found that fatherhood brought added responsibilities, which added to stress, but also found great joy and motivation in their children. DEPRESSION AND EMOTIONAL DISTRESS IN YOUNG, LOW-INCOME AFRICAN-AMERICAN MEN AND FATHERS By Megan E. Fitzgerald Dissertation submitted to the Faculty of the Graduate School of the University of Maryland, College Park, in partial fulfillment of the requirements for the degree of Doctor of Philosophy 2012 Advisory Committee: Associate Professor, Kevin Roy, Chair Professor Elaine Anderson Associate Professor Mia Smith Bynum Professor Norman Epstein Associate Professor Donna Howard © Copyright by Megan E. Fitzgerald 2012 DEDICATION Do not worry if you have built your castles are in the air. That is where they should be. Now put the foundations under them. Henry David Thorough I dedicate this work to my father. I have tried to use his humanity and commitment to truth as guides through this process. He once gave me card with the above quote, and wrote, “Meg, your dreams are in the air. Let’s work together to build the foundations.” I think he would be proud, and equally grateful to the many people who have helped me build that foundation in his absence. ii ACKNOWLEDGEMENTS I would like to express my gratitude to both the members of my committee and multiple research partners in the Baltimore community. My deepest goes thanks to Dr. Kevin Roy for his endless support, depth of knowledge, and persistent guidance. I am very grateful for your commitment to me as a person, parent, and scholar, demonstrated multiple times and many ways, with remarkable timing, throughout this process. And for toast night. I would like to extend a special thanks to Dr. Elaine Anderson, for her support, generous volunteering of time, and helping me to develop my knowledge through multiple research projects throughout my time at the University of Maryland. I would also like to thank Dr. Norm Epstein, for challenging me and helping to further my understanding of depression and mental health; Dr. Mia Smith Bynum, for both her expertise and for recognizing ideas that I tried to express and offering suggestions as to how to better understand and articulate my work; and to Dr. Donna Howard, for bringing a broader perspective to this work and reminding me of the context and greater community in which all of this takes place. Thank you to the 40 young men and fathers who shared their time and experience with me, and, in turn, many others. I would also like to thank Dr. Darius Tandon from Johns Hopkins University and Lois Mitchell, Director of HEBCAC (Historic East Baltimore Community Action Coalition) Programs, as well as all of the amazing staff at the Get Ready Program for their support and insight, without which, this project would not have been possible. iii And thank you to my many friends and large family for their incredible support, particularly my two lovely daughters, Amelia Jane and Violet, who appeared and joined in along the way. Most especially, thank you to my amazing husband, Jay Ferrari, general contractor for the air castle and maker of the toast. iv Table of Contents Table of Contents .......................................................................................................... v CHAPTER 1: INTRODUCTION ................................................................................. 1 CHAPTER 2: REVIEW OF THE LITERATURE ...................................................... 9 Current Definitions and Measurement of Depression .................................................. 9 Types of Depression ................................................................................................. 9 Measurement of Depression ................................................................................... 13 Prevalence According to Major Surveys ................................................................ 14 Depression in Men ...................................................................................................... 16 Consequences of Depression in Men ...................................................................... 17 Depression in Men is Controversial ........................................................................ 19 Symptom expression difference. ......................................................................... 19 Masking............................................................................................................... 20 Gender socialization............................................................................................ 21 Prevalence of Depression in Marginalized Populations ......................................... 21 Prevalence in low-income men. .......................................................................... 22 Prevalence in racial and ethnic groups................................................................ 23 Racism and discrimination. ................................................................................. 24 Depression in Young Men .......................................................................................... 25 Experience of Depression from Childhood to Young Adulthood .......................... 26 Longitudinal Impact of Depression from Childhood to Young Adulthood ............ 27 Symptoms in Young Adulthood ............................................................................. 29 Socio-economic Status and Race Ethnicity ............................................................ 30 Socio-economic status and race ethnicity in adolescents. .................................. 30 Socio-economic status and race ethnicity in young men. ................................... 33 School Failure and Dropout .................................................................................... 34 Juvenile Justice ....................................................................................................... 35 Depression in Young Fathers ...................................................................................... 36 Prevalence of Depression in Young Fathers ........................................................... 37 Young fathers at risk. .......................................................................................... 37 Depression in young fathers................................................................................ 38 Additional challenges for young fathers. ............................................................ 39 Generativity in Young Fathers ................................................................................ 40 Theory ........................................................................................................................