1. 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

2. 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 R01MH and supplement R01MH S1 (Alegria)
NIDA Grant R01DA (Duarte)
NIMH Grant R01 MH56401 (Bird) and P20 MD (Canino)
Research assistants Catherine Curtis, Trinidad Rodriguez, and Mitchlery Cardona

3. 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.

4. 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.

5. 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

6. 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

7. 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)

8. 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

9. 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