Mixed methods in the context of a longitudinal study of depression and anxiety Kiara Alvarez, PhD Instructor, Harvard Medical School Disparities Research Unit, Massachusetts General Hospital 7/13/2017

Acknowledgments Study PIs: Margarita Alegría, PhD, Glorisa Canino, PhD, Cristiane Duarte, PhD Ben Cook, PhD, Dharma Cortés, PhD and Sarah Mayorga-Gallo, PhD MGH, NYSPI/Columbia, and UPR study teams Funders NIMH Grant R01MH098374 and supplement R01MH098374- 03S1 (Alegria) NIDA Grant R01DA033172 (Duarte) NIMH Grant R01 MH56401 (Bird) and P20 MD000537-01 (Canino) Research assistants Catherine Curtis, Trinidad Rodriguez, and Mitchlery Cardona

Effects of Social Context, Culture and Minority Status on Depression and Anxiety (NIMH R01) Longitudinal study design (4 waves of data of ~2,000 youth interviewed in two sites (one as majority and one as minority): enables us to use variation across sites to examine causal mechanism of minority/majority status in MDD Our study includes a wide range of environmental, social, family, and individual level measures associated with MDD and DAS (depression and anxiety symptoms) to identify if and how experiences of minority status augment risk for these negative outcomes.

Mixed Methods Study Aims By conducting in-depth qualitative interviews and ethnographic observations, we aim to: deepen our understanding of the quantitative findings, assess the accuracy of our interpretations, and further explain the subjective experience of living as a minority/majority for Latino young adults.

Research questions and process How do social and structural characteristics of neighborhoods impact the day to day experience of residents? How do these vary, if at all, by neighborhood and by site? Neighborhood selection based on high/low DAS Participant recruitment Ethnographic observations Interviews Ethnographic Observations

Neighborhood Selection Using data collected from wave 4, we identified 8 census block groups (4 in PR, 4 in NY). Blocks represented both high and low rates of DAS. Process for selecting block groups: Merged census data with survey data Estimated multilevel linear regression models for each site, with individuals nested within census block groups Selected neighborhoods based on predicted depression and anxiety rates as well as consideration of neighborhood characteristics

Participant recruitment Semi-structured interviews were conducted with 5 eligible participants per census block. 41 interviews (21 in PR, 20 in NY). Two approaches to recruitment used simultaneously: Recruiting participants already involved in quantitative study Snowball sampling of participants with similar demographics (18-29 yo Puerto Rican young adults)

Data collection Semi structured interview guide Neighborhood advantages and stressors Insider/outsider experiences Group membership perceptions Reaction to preliminary quantitative findings Research assistant interviewers completed ethnographic field notes of their experiences in the four neighborhoods, including: Observation of structural characteristics and social interactions Informal interaction with neighborhood residents

Examples of emerging themes Social support in childhood Quantitative data: importance of childhood peer relationships in reducing psychological distress in young adulthood Qualitative data: informal mentoring leading to social interaction opportunities for youth Rapidly changing neighborhoods Quantitative data: Unexpectedly high numbers of movers South Bronx: gentrification displacing residents PR: financial crisis and migration to the mainland