The paradox of the resident experiencing depression: Higher depression, less favorable help-seeking outcome expectations, and lower help-seeking intentions.

BACKGROUND: Medical residents experiencing depression can cause life-threatening harm to themselves and their patients. Treatment is available, but many do not seek help. METHODS: The current set of three studies investigated whether depressive symptomatology in and of itself served as a help-seeking barrier-and whether expectations of help-seeking benefits provided insight into why this occurred. Nine waves of cross-sectional data were collected from medical residents across several different hospitals in the United States. RESULTS: There was a large negative association between levels of depressive symptomatology and help-seeking intentions (H1) in Studies 1 and 3. In Study 2, this association was significant for one of the two help-seeking measures. For all analyses, studies, and measures, there was a large negative association between residents' levels of depressive symptomatology and agreement that seeking help will lead to positive outcomes (H2). Likewise, there was a moderately large indirect effect for all analyses, studies, and measures such that the association between levels of depressive symptomatology and help-seeking intentions occurred through less favorable expectations of help-seeking benefits (H3). Lower agreement of the benefits associated with help-seeking explained between 43 and 65% of depressive symptomatology's negative association with help-seeking intentions across studies. CONCLUSIONS: The current findings indicate that depressive symptomatology itself represents a help-seeking barrier and underscore the importance of help-seeking expectations in explaining why this occurs. If future studies reveal a causal relationship between the perceived benefits of help-seeking and help-seeking intentions, then increasing such expectations could offer a potential path for increasing resident help-seeking.

Caregiving load and pediatric asthma morbidity: conflict matters.

Asthma is one of the most prevalent chronic illnesses among children in the United States and it disproportionately affects members of minority groups living in low-income and urban environments. In these environments, illness-related stressors are often experienced alongside a variety of family and social stressors, and parents may carry significant additional caregiving responsibilities over and above their child's asthma management. Participants in the current study included 23 girls and 22 boys, all diagnosed with asthma and living in low-income, urban neighborhoods; 85% of participants were members of ethnic minority groups. This study utilized a family systems framework to examine links among parents' caregiving responsibilities, parent-child conflict, and asthma morbidity. Caregiving load refers to the number of children and adults for whom the parent endorsed caregiving responsibilities. Two indicators of asthma morbidity were assessed, including asthma-related restrictions in the family's activities and the child's asthma quality of life. The findings of this study suggested a pivotal role of parent-child conflict in predicting children's and families' asthma-related morbidity. Higher levels of parent-child conflict were directly associated with higher levels of family activity restriction. Interestingly, under conditions of high parent-child conflict, higher caregiving load was associated with lower pediatric quality of life, but under conditions of low parent-child conflict, higher caregiving load was associated with higher quality of life. Implications of these findings for asthma treatment programs are discussed.