Themes Identified

The themes identified in our analysis captured both the individual’s experience and their reflected efforts to reconcile symptoms of depression with their previous identities, as well as the themes of navigating treatment, ascertaining their relationships with others, and adjusting to the role transitions inherent in the development from adolescence to adulthood (Table 1). Figure 1 describes a hypothesized relationship between these themes. In Figure 1, depressed mood, identity concerns, adverse relationship interactions and problematic transactions with the health care system adversely impact acquisition of developmental milestones. Similarly, impairment of developmental progress through young adulthood exacerbates concerns about identity and worsens depressed mood.

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Fig. 1

Interrelationships between themes.

Identification as an individual with depression

With regard to identity, sub-themes included “interruption of identity,” “cultural cues and biological models,” “ambiguity over medical definitions,” and “sadness versus depression.” For many individuals, depressive disorders seemed to both interrupt the development of a sense of identity as a young adult (by making them feel “other than themselves”), and simultaneously became a part of their identities that they mourned or felt they had learned from. While most accepted a biomedical model to explain their depressive disorder, others were concerned that this approach limited alternative frameworks (e.g. psychosocial) that might be helpful to redress their current situation. For example, as one individual said, “It’s your balance of chemicals trying to be balanced out” (#002). However, when asked whether she considered depression to be a medical illness another participant said, “… it seems to undercut the possibility that there are much more complicating factors as to why one is feeling depressed than just drugs can solve” (#009). Depression In An Emerging Adulthood Essay. Lack of clarity about the medical definition of the disorder and the boundary between ordinary sadness and depression seemed to make several participants reluctant to fully embrace the perception that they had a disorder which might require clinical treatment. Though few participants mentioned religious experience or coursework in high school or college as an important part of how they understood their experiences with depression, several specifically mentioned advertisements as affecting how they thought about their experiences with depression. Participants did not clearly separate between self-assessment of a possible depressive disorder, their own process of identity development, cultural cues and models, and ideas about what constitutes a reasonable level of ordinary sadness. For example, one participant summarized, “It could be just sadness or it could just be an amalgamation of other sorts of emotions and this is sort of the current cultural construct that we’ve created to place on top of those feelings. I don’t know if depression exists or not really, I just know that I feel really sad” (#007).

Healthcare experiences related to diagnosis and treatment

Several healthcare concerns emerged as topics of concern to study participants, including concerns about access to care (e.g. costs of insurance), a lack of effective treatments, and the stigma of mental illness. Lack of ability to either maintain employment or good standing as student because of depression symptoms often resulted in loss of health insurance. Individuals also lacked families willing and capable of supporting them with either insurance coverage (parent plan) or direct financial assistance for treatment found obtaining mental heath services particularly challenging. Other problems encountered included: long waiting periods, difficulties working with providers, and even problems with transportation. Stigma was both perceived by the depressed individual (“shame”) and from others, in terms of being judged by authority figures and announcing a sense of failure to friends and family. Many participants remained concerned that treatments were not effective or that they could not trust health care providers to care for such critical personal problems. Those who finally turned to community mental health centers or charitable agencies often found waiting lists, transportation challenges, and administrative complexities. Continued concerns about stigma tended to override the motivation and energy need for treatment-seeking endeavors. Depression In An Emerging Adulthood Essay.

Relationships and social support

A central concern seen in the data involved subjects’ relationships and methods of social support. Sub-themes included “concerns about meeting parents expectations,” “inability to be understood,” “social withdrawal and isolation,” and “exhaustion of performing normalcy.” Most participants expressed some level of desire not to disappoint their parents with the “failure” of depressive disorders. Several individuals reported that their families were unable to assist or support them because of some combination of conflicts, poverty, or divorce, while others noted the importance of supportive, economically secure parents in facilitating their recovery. Despite the fact that all the individuals in this sample acknowledged social support as an important part of their daily lives, the belief that others cannot understand their experiences often caused individuals to feel alone. Many appeared to react to these concerns by withdrawing or feeling a sense of exhaustion at having to behave as though nothing was wrong. One participant explained, “You just feel so self defeated. It’s like you have run a marathon and someone tells you, you have to run another one an you’re just like, hands up, like I really can’t do this like just physically you can’t or mentally or emotionally, you’re just drained” (#002). Consequently, many individuals reported that they lacked a peer support system sufficient to provide meaningful assistance.

Labeling one’s experience and identity formation

The process of identifying and labeling one’s experience with depression was found to be a complex process affecting both the experience of distress and treatment seeking [35, 36]. Previous research has demonstrated that emerging adults incorporate negative attitudes toward depression treatment into their self-assessment of their need for treatment [36, 37]. The degree to which “depression” represented a “negative” identity for emerging adults was surprising in light of rising rates of treatment for depression as well as higher levels of mental health literacy in more recent birth cohorts [21, 23, 38, 39]. The deep ambivalence regarding identification as a person with a depressive disorder and the disruption of normal developmental milestones both were important findings.

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The critical role of identity formation in emerging adulthood may explain why “identity” concerns with regard to depression were so important to these emerging adults. Depressive experiences may be highly contextualized within the prominent issues during each life stage. Adolescent girls with depression have been noted to be predominantly preoccupied with a sense of disconnection from others [34]. Women and men in middle years report themes focused on present time coping, restoration of health, resumption of current roles, and finding meaning [40, 41]. Elderly women report depressive experiences merged with past events to create “unbearable summation” of the whole life experience [42]. Previous qualitative research has suggested that an individual’s decision that a problem, warranting a formal remedy, exists represents a fundamental transformation in perception and identity [43].

Life stage: role transitions

Depressive symptoms demonstrate a complex interaction with the emerging adult’s developmental process regarding role transitions. As noted, depressive disorders in adolescence and emerging adulthood are associated with less favorable relationship, educational, and work outcomes and may also be associated with other adverse events [2, 5-12]. However, these correlations have left open the question of whether the poor outcomes are caused by actual depressive symptoms or rather a factor common to both depressive illness and functional impairment. Emerging adults in this study consistently identified current depressive symptoms as important impediments to achieving valued life goals closely related to past and present disappointments. Moreover, an unfortunate cycle existed for many subjects whereby depressed mood included depressive symptoms leading to relational and work-related disappointments, which were then amplified in meaning as they were thought to connote “failure” in the adult life process. Depression In An Emerging Adulthood Essay.