Individual capacity for self-management

The third contextual determinant related to individual participants’ capacity to self- manage their depression. Notwithstanding the need to address perspectives on age and depression, and to access appropriate support—the other two contextual determinants— individuals require individual capacity for self-management. This capacity comprises ability, choice and expectations, as participants identify, engage and assess which strategies facilitate their efforts to optimise well-being. It also relates to resources such as finances, environment and social support (Yeung et al., 2010).

The self-stuff is that I’m identifying what the issues might be and then using strategies to manage them. When I go to a psychologist, I am there to learn some

strategies to deal with my depression. (Bea, 67 years)

In the current context, personal beliefs related to depression and age, and to the concept of self-management. To illustrate, those who viewed ageing in a positive light were more likely to seek ways to manage their depression that enabled them to optimise their well- being and overall quality of life. Similarly, those who overcame stigma about depression were more likely to maintain their treatment regimen.

I know my default position is one of sadness and slight depression, and accepting that has been one of the greatest difficulties. I think that not accepting that was

at the root of the battle. (Evan, 66 years)

A strong sense of personal autonomy was also associated with improved well-being.

I guess, to a point it’s up to you. If you want to go out there and conquer the

world, well, you will. (Sarah, 71 years)

You determine what you’re going to do with yourself and how others deal with

you. (Amy, 67 years)

It became apparent early in the process of concurrent data collection and analysis151 that participants had a strong interest in and commitment to self-determination and self- management, although they did not necessarily use those exact terms. Known facilitators of self-management were exhibited, including a proactive attitude towards age and

151 _{See 3.3.2.3 (Constant comparative analysis).}

depression, the establishment of short- and long-term strategies, remaining socially engaged and maintaining physical health (Van Grieken et al., 2013).

You know there's something not right and that’s when you either decide you’re going to do something about it or you’re not … it means looking after the

condition I’ve got, which is depression. (Paul, 69 years)

Conversely, the absence of these attributes, coupled with as a sense of futility or hopelessness about ageing with depression, would constitute significant barriers to self- management. Those with the capacity to optimise well-being drew on the resources available to them to facilitate effective self-management. Identification of and engagement with these resources depended largely on each person’s health literacy.

Health literacy comprises individuals’ ability to access, understand and use information in a way that enables them to promote and maintain their health. More specifically, mental health literacy refers to knowledge and beliefs about mental health issues, including risk factors, sources of information and support, and treatment options (Farrer et al., 2008; Jorm, 2000).152

I've looked at websites like beyondblue [a national depression website] and I

think they're tremendous for anyone who's feeling depressed. It's a great

resource to help find your way through some of the rubbish. (Pete, 75 years)

Mental health literacy is associated with early help-seeking, and better recognition and understanding of mental health issues (Farrer et al., 2008). Those with higher levels of mental health literacy are more likely to promote and maintain good mental health (Farrer et al., 2008; Park et al., 2018). For example, concordance with treatment approaches is commonly associated with higher levels of health literacy. Participants reported generally high levels of confidence in their mental health literacy, as they were actively engaged with their treatment for depression. Examples were given of the ways in which information had been sought and accessed, and how that information had served as a prompt to engage with formal services.

I’d probably do all of those things [talk to GP and friends]. But I do use online

things. As long as they are good databases, I use them a lot. (Erica, 70 years)

152 _{See 2.3.3.2 (Help-seeking facilitators).}

The blogs I take with a bit of pinch of salt, but sometimes they’re interesting. I

rely a lot on the medical facilities [websites]. I have asked [my GP] about things

that I’ve seen online and said, “Is that appropriate for me?” And a discussion

has evolved. (Amy, 67 years)

Mental health literacy is essential to effective self-management of depression, as individuals must take responsibility for their day-to-day care (Houle et al., 2013; Lorig et al., 2014). By educating themselves about the symptoms, course, treatment options and lifestyle choices associated with their depression, participants developed their mental health literacy in ways that enabled them to optimise well-being.

6.3

Summary

In this chapter, the context of the study was presented. Three distinctive contextual determinants influenced and moderated—directly and/or indirectly—how the core problem of Struggling to maintain personal identity was experienced by participants:

Perspectives on age and depression influencing help-seeking, Ability to navigate and

access the health care system and Individual capacity for self-management. These

contextual determinants constituted the background against which their experiences took place and provided insight into the setting in which the basic social psychological process occurred.

CHAPTER 7:

Core problem

7.1

Introduction

The basic social psychological problem abstracted from the data153 relates to participants’ sense that they were not treated as individuals as they sought to receive and come to terms with a diagnosis of depression. Consequently, they struggled to maintain a sense of personal identity in their efforts to manage their depression in a way that enabled them to optimise their well-being. In this chapter, a definition of the core problem is followed by an analysis of contributing factors.