Depression and Suicide among Adolescents in Medellín, Colombia: A Mixed-methods Approach to Understanding Family-level Risk and Protective Factors Public

Long, Jeanne Louise (2012)

Permanent URL: https://etd.library.emory.edu/concern/etds/1j92g800d?locale=fr
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Abstract

Abstract
Background: Suicide is the 3rd leading cause of death for people 15-44; people under 25 are
considered most at risk. Data suggests that adolescents in Medellín have a higher prevalence
of suicide outcomes than national estimates: suicide ideation (15% vs. 10%), suicide plans
(5.2% vs. 3.6%), and suicide attempts (5.8% vs. 4.4%).
Purpose: Develop a fuller understanding of how multiple risk and protective factors shape
youth's experience of depression and suicide.
Methods: Secondary data analysis from the 2009 Medellín Adolescent Mental Health Study
was performed from surveys of 4,764 youth, ages 10-19. Gender-stratified multivariate
logistic regression models were developed to examine risk and protective factors associated
with depression and suicide outcomes. Model trends were evaluated and informed qualitative
life-history interviews on family/social protective factors among 23 high school youth.
Results: Quantitative finding revealed that interfamily abuse and low family cohesion were
the strongest predictors for depression for both sexes. Girls had more depression predictors
than boys, including chronic PTSD. The strongest gender-shared predictor for suicide plans
and attempts was having no family/social support system. Qualitative interviews revealed
that dysfunctional family dynamics were the most salient contributor to chronic adversity
facing youth. Elements of family "closeness" included practical and emotional support,
guidance, and reciprocity.
Discussion: Family cohesion and family/social support are important predictors for
depression and suicidal behavior, but neither variable accounts for important elements of
support or closeness between family members. Closeness with an adult may matter more
than family cohesion, and demonstrate the extent of support that youth receive. Resilient
youth present vivid self-concepts and positive perspectives about their past, present, and
future. Findings suggests that there is a need to re-structure how family-level risk and
protective factors and religiosity are measured among the Medellín adolescent population. A
critical next-step for the Medellín public health community is to move from research to
practice, translating their findings into concrete outreach programs aimed at those youth
most at-risk for depression and suicide.

Table of Contents


TABLE OF CONTENTS
Chapter 1: Introduction ........................................................................................................................ 1
Introduction and Rational .........................................................................................................................1
Depression and Suicide in Colombia ........................................................................................................... 2
Problem Statement ................................................................................................................................ 3
Significance Statement ........................................................................................................................... 3
Purpose Statement and research questions ................................................................................................ 4
Definition of Terms ................................................................................................................................. 4
Chapter 2: Comprehensive Review of the Literature ............................................................................... 6
Mental Health: Depression & Suicide .......................................................................................................... 6
Gender Disparities and the Gender Paradox ................................................................................................. 8
Stress and PTSD ................................................................................................................................... 9
The Influence of Family on Mental Health .................................................................................................. 11
Friendship & Religion .............................................................................................................................. 13
Examining mental health, depression, and suicide in Colombia . ...................................................................... 13
The Case for Medellín ............................................................................................................................. 16
Chapter 3: Project Content ................................................................................................................... 21
Mixed-Methods Study Overview ................................................................................................................ 21
Quantitative Methods ............................................................................................................................. 21
Covariates ............................................................................................................................................ 23
Protective Factors ................................................................................................................................. 23
Quantitative Analysis .............................................................................................................................. 25
Connection between Quantitative and Qualitative Methods: ........................................................................... 26
Qualitative Methods ................................................................................................................................ 26
Participants ........................................................................................................................................... 26
Participant Recruitment ........................................................................................................................... 27
In-depth Interviews ................................................................................................................................. 28

Data analysis .......................................................................................................................................... 31
Quantitative Results ................................................................................................................................. 34
Study Population ...................................................................................................................................... 34
Associations between Risk and Protective Factors and Depression .................................................................... 39
Associations between Risk and Protective Factors and Suicidal Behaviors ........................................................... 40
Multivariate Analysis ................................................................................................................................. 47
Qualitative Results ................................................................................................................................... 55
Adversity ................................................................................................................................................ 55
The Role of Family .................................................................................................................................... 67
Religiosity ................................................................................................................................................ 88
Resilience: "Chose your path" ...................................................................................................................... 93
Chapter 4: Discussion ............................................................................................................................ 109
Adversity and Family ................................................................................................................................ 109
We are what we measure .......................................................................................................................... 111
Family structure, family cohesion, and support systems ................................................................................... 111
Religiosity ............................................................................................................................................... 113
Limitations .............................................................................................................................................. 114
Research Implications and Recommendations ................................................................................................. 115
Conclusion .............................................................................................................................................. 117
References ............................................................................................................................................ 118
Appendices ........................................................................................................................................... 124
Appendix 1: IRB Approval Letter .................................................................................................................. 124
Appendix 2: In-depth Interview Guide (Spanish) ............................................................................................. 125
Appendix 3: Interview Life History Matrix ....................................................................................................... 128
Appendix 4: 2009 Medellín Adolescent Mental Health Study survey Questions (Spanish).......................................... 129

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