This study was conducted at a community public mental health center in Korea. A purposive sampling was used to recruit Korean women suffering from depression. The sample is made up of housewives who come to the health center to get counseling on their depression. The inclusion criteria were: (1) 40- to 64-year-old Korean women, (2) a 7 or higher score in the Korean version of the 21-item Hamilton Rating Scale for Depression[21], and (3) the ability to communicate freely and the willingness to travel to the designated interview place. Twelve women who met the sample criteria were recruited.

The participants were recruited at the outpatient clinic in the public mental health care center. Flyers that described the study recruitment were posted on the bulletin board and displayed on the tables in the waiting area. The researchers explained the purpose and the procedure of the study to the individuals who volunteered to participate in the study, and obtained their consent to participate in the study and to the audio taping of their interviews. The participants were informed that participating in this study was voluntary; they could refuse to answer any of the questions that made them uncomfortable, and could withdraw anytime they wanted to, without a penalty. The confidentiality of their identity and responses was reinforced by informing them that all the information obtained from the study would be kept in a locked cabinet in the Principal Investigator's office and that only the researchers involved in this study could access it. The interviews were conducted in a public health center's consultation office for the privacy and comfort of the participants.

The data were collected between April 1 and September 30, 2012 mainly from in-depth interviews of the individual participants using semi-structured questions to guide the direction of the interviews. The questions were as follows: (1) When do you feel most depressed in your everyday life?; (2) How do you feel when you are depressed?; (3) What do you think of depression?; (4) What do you do when you are depressed?; and (5) How does depression affect your life? Additionally, open-ended questions and spontaneous questions were used during the interviews, as deemed appropriate.

Each participant was informed that the interview would last for an hour, but more time was given to participants who needed more time to finish their stories. During each interview, the researcher took notes on the content of each session, the responses of the individual participants, and the investigator's reflections on the interview. All the interviews were digital voice recording and transcribed verbatim to computer-based files by the researchers. The participants' demographic data--their age, education, income, employment, marital status, and religion--were also collected. The data collection was continued while the data analysis was in progress, such as theoretical sampling for comparing. Each participant was interviewed three to four times to complete the data collection. Once the researchers determined that the concepts were saturated and additional information was redundant, the data collection was terminated.

Using the grounded theory methodology[19], the data analysis began with a review of the verbatim transcripts by all researchers separately to ensure accuracy. The data analysis consisted of: (1) open coding, to generate the codes by examining the data sets word by word and line by line, and then comparing the generated codes to develop categories; (2) axial coding, which connected the developed categories from the open coding using a coding scheme that involved conditions, contexts, action/interaction strategies, and consequences; and (3) selective coding, in which a theoretical model was constructed from the categories by identifying a basic social psychological process that represented a central phenomenon around which all the other categories were anchored.

The transcribed data from each case were first analyzed by the individual researchers, and then comparatively analyzed with the data generated by the two other researchers. To ensure a parsimonious model, the three researchers and another researcher revisited the schematic six months after its initial creation to verify that all core categories, subcategories, and their connections were appropriately and accurately placed in their simplest form.

The rigor of a qualitative study must demonstrate the scientific trustworthiness of the study. According to Lincoln and Guba[22], to prove scientific trustworthiness, criteria must be established, including credibility, dependability, confirmability, and transferability. In this study, credibility was established by immersion and "member checking," as suggested by Lincoln and Guba [22]. Three of the researches who worked on this research have published doctoral dissertation on grounded theory Methodology and another researcher have published her paper on Ethnography in international journal, and another researcher has worked on qualitative of research in her Ph.D program. The researcher designated to perform the first step of the analysis was immersed in the theoretical sampling data by repeatedly listening to the audio recordings, and all the researchers performed the "member checking" with the participants at the end of each interview to ensure the credibility of the data. The second researcher, an expert in grounded theory research, verified the coding from each transcript and theory development throughout the comparative analysis. Moreover, the Korean language was used during the analysis to ensure accuracy, as the study was conducted in Korean. Then the final results of the study were translated into English during the writing process by the corresponding author, who is bilingual (English and Korean), and who brought out the meanings of the words rather than translating them literally. Dependability is how the research process is made open and accountable with the use of record-keeping[22]. In this study, dependability was supported by the cumulative records of (1) the written analysis, (2) the minutes of the research meetings, and (3) the e-mail correspondence of the researchers. Confirmability is the ability of a researcher to remain objective and neutral., and to disclose preconceived ideas or perspectives a priori[22]. To support confirmability, the researchers were self-reflective and cognizant of their relationships among themselves and with the participants, and understood that their actions and reactions during the interviews might affect the participants' responses. The field notes and the observation of the participants during the interviews were additional resources for the enhancement of the confirmability of the study. Finally, transferability is the ability of the researchers to provide a detailed and in-depth picture of specific circumstances of the study so that others can use the findings in a different context[22]. To ensure transferability in this study, the data collection was continued until the data were saturated and the theoretical model surfaced. Additionally, a literature review was conducted to theoretical sensitivity into Korean women with depression and their symptom manifestations and expressions. The two key informants confirmed the result.

Twelve participants aged 40~64 (mean age, 56.5) participated in and completed this study. Majority of them (83%) indicated that their monthly income was less than 1,000 US dollars, and that 33% of them were Protestant, 17% Catholic, and 17% Buddhist, and that 33% had no religion. Also, majority (10) of the participants received mental health care services, and two participants who did not receive any treatment acknowledged while participating in the study that they would need and benefit from mental health care services.

The researchers conceptualized the central phenomenon of the Korean house wives' life with depression as a symbolic image of "living in an empty shell," which represents the basic socio-psychological process composed of the four phases of experience with depression. The data suggested that the three phases were:(1) feeling like one is vanishing into thin air,(2) becoming an empty shell, and (3) searching for the meaning of life and phase.(4) fulfilling of an empty shell(Figure 1).

In this first phase, the participants experienced depression as suffering through difficult life, physical and emotional pain and they ended up giving everything up through seeing themselves as non-existent, and avoiding confrontation. During this period, the participants described different their experience of depression according to duration of depression through age, number of family's death experience and status of marriage, also cling to family such as disappointment with family, husband or child. Disappointment mostly with their family members was very serious. Because they felt that no one truly understood their suffering due to the non-visibility of their illness. Eventually, as seemingly vanishing into thin air. These experiences were tangibly expressed in the following statements.

The participants described their perception of their lives in this second stage, which progresses from the first stage, as being spun around by overwhelming force with a sense of powerlessness and entream frustration, and their perception of themselves as an empty hollow shell. They described themselves as being swept away by depression, with no sense of meaning of life, no hope, no strength, and no self, and as eventually facing death. The following statements described those experiences.

In third phase, the participants redefined their lives with depression and their relationship with their surroundings, and gradually started to move from nothingness to seeing a light from their inner darkness as an empty shell, and to experiencing moments of hope and power of life. This was a turning point from their inner hollowness to regaining their lives. So the participants started to have some passive desire and others more active desire to live. The intervening conditions in this stage started with the participants' acceptance of help from others, including from their family, friends, and professionals, through the use of the collaborative approach between the participants and others and the encouragement of their help-seeking using available support and resources. Followed by acknowledge of problems through recognizing own problems, understanding of families. Once they showed desire to live, they were able to motivate themselves through positive thinking, confidence building, and productive action.

Once they started to motivate themselves to have a better life, the consequences were recovery of self through self-awareness, finding themselves and discovering their purpose in life, and being recognized by others. The participants described this phase of their experience as searching for meaning in life. The following statements illustrate these shifts.