ACCOMPLISHING POSITIVITY: DEPRESSION & ADT FOR LATINO MEN WITH PROSTATE CANCER
Background:Studies have resulted in contradictory findings about ADT’s role in exacerbating depression or initiating depression. It could be that radical hormonal changes cause or worsen depression or it could be the overarching context of prostate cancer and the severe side effects ADT engenders. Regardless, men with prostate cancer receiving ADT are at risk of experiencing severe depression that may worsen over time. Men with pre-existing depression are especially at risk for worsening depression while on ADT. Another threat requiring further study is the link between cardiovascular risk, ADT, and depression. It is well documented that men treated with ADT are at increased risk for cardiovascular disease (CVD) and diabetes as a result of metabolic and endocrine changes that accompany ADT. Latino men are under diagnosed with depression and use fewer mental health services than their Caucasian counterparts. Depression is often stigmatized within Latino families.
Methods:We conducted 19 interviews with underserved Latino men taking androgen deprivation therapy to treat prostate cancer. We analyzed the data using grounded theory techniques in Atlas.ti 7. We reviewed clinical notes and quality of life measures for each participant to triangulate findings.
Results:Depressive symptoms emerged as an ongoing issue for the men. Men had poor awareness of what side effects were associated with ADT. Strategies for dealing with depression included controlling emotions, concealing depression, and “being positive” to avoid depression. In this sample, the juxtaposition between the accounts of depressive symptoms and the way the men encouraged themselves and other men to be positive brought to mind the phrase, “grin and bear it.” Men were open to psychotherapy and peer-to-peer counseling. The men’s coping processes and culturally based stigma also contribute to poor identification of serious depression.
Conclusion: These men’s ongoing depressive symptoms and behaviors may be overlooked during treatment for prostate cancer. The links between depression and cardiovascular disease make this issue especially important to address in Latino men receiving ADT. The coping strategy “being positive” needs to be re-evaluated as it can be an avoidant technique. Consistent, accessible and culturally acceptable mental health resources are needed for Latino men with depression. Interventions that include cognitive behavioral therapy and peer-to-peer counseling are culturally acceptable methods to mitigate depression for Latino men with prostate cancer.
Implications for nursing: Nurses can support men by allowing them to feel a variety of emotions and by being advocates for mental health support. Healthcare providers need to be trained to identify diverse ways of explaining depression to better screen Latino men. This is especially true for men who face cultural stigmas around mental health. The issues Latino men face discussing depression may not fit a checklist and may require a broader vocabulary.