Title

Narratives of “living well”: Exploring the experiences of family members living with a family member with depression

Author Identifiers

Amanda Cole-Heath

https://orcid.org/0000-0002-5309-3496

Date of Award

2022

Degree Type

Thesis

Degree Name

Doctor of Philosophy

School

School of Nursing and Midwifery

First Advisor

Lisa Whitehead

Second Advisor

Julie Ann Pooley

Abstract

Depression, originally termed melancholia, can be traced as far back as the Mesopotamian era (first civilisation, 3500 BCE). In ancient scriptures of the time, depression was considered a spiritual illness, and thought to be caused by demonic possession (Hercelinkskyj & Alexander, 2020). By the 21st century a vastly differently understanding of depression emerged. In contemporary mental health care, depression is viewed as a complex condition comprising physiological, psychological, social and environmental factors. Depression has a significant impact on both the national and the global burden of disease and is thought to affect around 300 million people worldwide (World Health Organization, 2018). Depression, a chronic mental health condition, is enduring globally and can be debilitating for the sufferer, affecting their emotional and mood regulation (Moxham et al., 2018). Given the high prevalence of depression, there is an increasing number of families assuming the role of caregiver to family members with the condition. Exploring the strengths of families managing and living with depression is important in supporting all family members to “live well.”

The aim of this study was to explore the family member experience of “living well” when living with a family member with depression. A qualitative approach and narrative inquiry were employed. Identified through convenience sampling, family members living with a family member with depression were invited to recount their stories and perception of living well with a family member with depression. Eight individuals with an adult family member who was diagnosed with depression, or undiagnosed, but met the criteria for a major depressive disorder, participated. Data were collected through individual, face-to-face narrative interviews, which facilitated discussion and garnered a rich depth of data. One interview was conducted with each participant. Narrative and thematic analysis was used. Through a re-storying process, each interpretive narrative was co-constructed between the researcher and the participant. Thematic narrative analysis facilitated the temporality of the experience, and the “wholeness” of each story. The content was further interpreted into themes.

Four themes were generated: “a time of uncertainty and distress,” when disruption and chaos ensued and family members lived in a heightened state of stress leading to feelings of anxiousness, worry and fear; “a time of change and adaptation,” when changes in environment or circumstances demanded adjustment, modification and accommodation, sometimes leading to transformation; “a time of perseverance and endurance,” when a family member continued to “function” and show determination and persistence in spite of difficulties or adverse conditions and “a time of hope and healing,” when family members’ experienced hope and hopefulness after having “survived” living iv through depression. During this fourth stage, family members sought a path toward healing linked to acceptance and personal growth.

The findings highlight the necessity for health professionals to adopt an integrated way of examining a family’s dynamics, strengths and concerns around health and illness, and consider the impact of depression on whole-of-family health. A family health systems approach, underpinned by shared decision-making, may best support the individual with depression, other family members and the integrity of the family unit. Nurses in general and mental health settings, general practitioners, mental health services, including psychological and counselling services, are best positioned to identify families and family members at risk of carer fatigue and distress. It is important for health professionals to act on the “living well narratives” of family members in order to support individual and family health and their positive functioning, while promoting strength, resilience and coping strategies.

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