Dissertations & Theses (Open Access)

Date of Award

Summer 8-2016

Degree Name

Doctor of Philosophy in Nursing (PhD)


Cathy L. Rozmus, PhD, RN - Chair

Second Advisor

Joan Engebretson, DrPH, AHN-BC, RN, FAAN

Third Advisor

Marianne Marcus, Ed.D, RN, FAAN

Fourth Advisor

Rebecca Casarez, PhD, RN



Treatment recidivism, described as frequent unplanned relapse readmissions, is a national problem predominant in adolescents with mental illness with significant socioeconomic consequences. Adolescents living with mental illness are a sub-culture of adolescence, the critical growth period of developmental and social transition from childhood to adulthood. The main triggers of treatment recidivism in this population are not fully understood from previous studies.


The study purpose was to explore treatment recidivism with the following aims:

1. To illuminate treatment recidivism from the perspectives of recidivist adolescents with mental illness.

2. To describe the main factors that contribute to treatment recidivism and how best to minimize them from the perspectives of these adolescents.

3. To describe the interaction of the recidivist adolescents with mental illness with the medical culture.


The design was a focused applied medical ethnography that involved face-to-face interviews of 16 purposively selected recidivist adolescents that met the eligibility criteria who were on inpatient readmission in the study hospital. Individual and group interviews were conducted until data saturation was achieved. Participants also were unobtrusively observed and demographic information was extracted from their medical records. Interview transcripts and other data were organized with NVivo 11 Pro software during data analysis to derive repetitive patterns and themes that revealed the perspectives of the participants.


The 16 participants were near unanimous that the “additional stressors” of problematic parental relations and school bullying were the main triggers of treatment recidivism. They suggested that these main triggers were responsible for treatment recidivism over and above their “routine stressors” of adolescence and mental illness and needed to be addressed to minimize the problem. The participants had a mixed perception of treatment recidivism and described their interaction with the medical culture as mostly positive.


Further research is needed on larger samples to determine the impact of parental relations and school bullying on recidivism in adolescents with mental illness.


5th Advisor: Andrew Harper, MD


Treatment recidivism, Adolescents, Mental illness, Stressors, Non-Compliance, Relapse, Applied medical Ethnography



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