ORCID Identifier(s)


Graduation Semester and Year




Document Type


Degree Name

Doctor of Philosophy in Social Work


Social Work

First Advisor

Regina T Praetorius


This research study illustrates the overarching syndemic theory, which was used to explain the interconnections of type 2 diabetes, clinical depression, and human suffering among low-income African American outpatients in the southern sector of Dallas TX, USA. The intersections of race, gender, and class were additional variables that were included in this research. Furthermore, this research indicated how poverty, social relationships and other conditions stressed individuals and populations, weakened their natural defenses and caused exposure to disease clusters. I have coined the term D2 S2 to deconstruct the social/syndemic interconnections that interface with diabetes, depression and human suffering. The first dimension in the D2 S2 Model is Diabetes - the chronic blood glucose dysregulating condition. The second dimension is Depression - the biochemical mood disorder, which is often chronic, internalized and untreated. The third and fourth dimensions are Syndemic Suffering - which entails adverse psychological and social conditions encompassing poverty, social relationships and other conditions. The discussion of these four dimensions in this research was illustrated by the personal narratives of six (6) African American outpatients, was shaped by and associated with social, political and economic inequalities, and was escalated by the chronic adversity of diabetes and depression. The D2 S2 Model was developed from the triangulation of the biological, psychosocial and survey data, as well as, through the critical examination of narratives. The narratives indicated that internalized stress and chronic hardships interacted with the self-management of type 2 diabetes and depression. Their narratives indicated that the most frequently occurring themes were physical health problems, mental health problems, occupational problems and economic problems. The research study findings established the value of using narratives in qualitative research and how this methodology provided a vast depth and breadth of knowledge from the information that was gathered. Other findings indicated that psychosocial distress, poverty, and unemployment were major contributing factors vis-à-vis type 2 diabetes, depression and syndemic suffering. The results indicated the benefits of Solution Focused Brief Therapy (SFBT) in the treatment of depression with these outpatients who were living with type 2 diabetes, as evidenced by decreased or stabilized scores on the nine question psychometric screening instrument, the Patient Health Questionnaire-9 © (PHQ-9 ©). Further results indicated that applied syndemic theory was very useful and a “goodness of fit” in addressing the research questions and the intersections of race, gender and class.


Type 2 Diabetes, Depression, Syndemic suffering, Solution Focused Brief Therapy (SFBT), Patient Health Questionnaire-9 (PHQ-9)


Social and Behavioral Sciences | Social Work


Degree granted by The University of Texas at Arlington

Included in

Social Work Commons