Understanding Depression: Young Adult Challenges

Chapter 1

1.0 Introduction

Mental health disorders are considered one of the most significant health problems in the world and some of the leading contributors of lived with disabilities (DLL) globally (Vos et al, 2012). Depression, a mental health disorder, has been a significant part of public health problem that is estimated to have at least 18% prevalence in the western world. In fact, World Health Organization (2004) ranked depression as the world’s third burden of disease and third in middle to high income countries. More significantly, according to Gore et al (2011), depression among young adults is considered the leading cause of disability adjusted life globally. Meanwhile, poor mental health is a major problem among young adults that present is different ways including anxiety and depression as well as an increased risk of other mental health disorders such as alcoholism, unemployment and suicidal behavior (Ferguson et al, 2007). Furthermore, Charlson et al (2010) asserts that depression is risk factor for obesity and cardiovascular disease. Against this backdrop, all the health issues associated with depression makes it costly health issue in the society that not only affects the health and well-being of young adults but also affects the social and economic well-being of the patients and their families. This study seeks to unearth existing evidence on the risk factors for depression among young adults as well as how depression affects the lives of young adults. The study will be organized in chapters whereby chapter one will introduce and give a background to the study, chapter two will highlight the research methodologies, chapter three will entail a literature review while chapter 5 provide a discussion of the findings. The last chapter, conclusion, will recap the entire study and give recommendations for practice. The aim of this dissertation is to….(broadly- not your whole aim/objectives), also an overview of each chapter would be useful)

1.1 Defining Depression

Thapar et al (2010) defines depression as symptom specific health impairment that has clinical diagnostic features in adults and young adults. Nonetheless, depression is defined similarly by two main classification (International Classification of Disease, ICD 10 AND American Diagnostic and Statistical manual of mental disorders (DSM-1V) even though DSM-IV makes an exception for children and young adults whereby as opposed to depressed mood, irritable mood is considered an diagnostic symptom (American Psychiatric Association, 1994). However, according to Leaf et al (1996), depression is more often missed in adolescents than in adults possibly because it presents more symptoms of mood reactivity, irritability and fluctuating symptoms. Similarly, depression is more likely to be missed in young adults when there are unexplained physical symptoms, anxiety, eating disorder, decline in academic performance, and substance misuse (Leaf et al, 1996). In some cases, according to Birmaher et al (2004) depression in young adults can be considered an early-onset form of depression in adults because it is strongly linked to later life reoccurrence. It has similar clinical patters and features to that of adults and may be associated with family history of the disorder (Lewinsohn et al, 2003). Nonetheless, the most important difference between depression on young adults and depression in adults is the treatment response, whereby there is a lack of consensus on what constitutes the best practice (Thapar et al 2010). Moreover, depression is more common in prepubertal children that in young adults and adults and differs in terms of prognostic, epidemiological and causative features. The main aim of this study is to explore existing literature on how depression impacts the live young adults.

1.2 Context

1.2.1 Prevalence of Depression

There has been a recent increase in the prevalence of depression among young adults in the recent past within the United Kingdom. For instance, statistics by mental health (2019) indicate a sharp increase in depression among young adults and adults (i.e. people with age of 16 years and above) in 2013 (1.5%) compared to 2014 (19.7%). Statistics by NHS Digital also indicate that one in 12 people in England of ag 5-19 years are diagnosed with emotional disorder, 2.1% among them being depression. Similarly, NHS Digital reports that 16.9% of people age between 17-19 years have a mental a mental disorder, and 4.8% of them are diagnosed with depression. More importantly, women within this age group were found to be twice more likely to have depression (NHS, 2018). A further analysis of statistics indicates that young adults with depression are more likely to harmed by depression. For instance, according to NHS (2018), 46.85% of 17-19-year-old diagnosed with depression are more likely to engage in self-harm women being at the highest risk. This indicates that apart from exposing young adults to serious health harms, depression has greater effects on female young adults. The increasing prevalence of depression among young adults is especially a major concern to health and social care practitioners because that depression has proven to have on the life of young adults. For instance, Vos et al (2012) claims that depression is a significant health challenge to young adults due to its symptomatology such as a feeling of tiredness, significant weight gain or weight loss, suicidal thoughts, drug addiction, and a general lack of motivation. Evidence by Roberts & Povee (2014) also reveal that depression has several social effects on young adults including indulgence in various risk-taking behavior, poor performance at school and social withdrawal. Practitioners are even more concerned with suicide as one of the most dangerous effects of depression among young adults because it is a form of self-harm that causes several other social impacts. Researchers in health and social care have speculate that the increasing prevalence of depression among young adults may be due to the many factors that have proven to be associated with it. For instance, according to Roberts & Povee (2014), depression in young adults is caused by transitioning from one school level to the other, family fights, or even bulling. It would therefore be interesting to find out if the literature review findings similar results as the risk factors for depression among adults (Thapar et al 2010).

1.2.2 Policy

From a policy context, the Public Health England (PHE) bestows upon healthcare practitioners the responsibility of to prevent ill-health and promote the general well-being of both children and adults (Gov.UK). Access to mental health has also been given policy priority by the PHE. The PHE, through its well-being and mental health guidelines requires all health practitioners to take part in mental health promotion and by addressing social risk factors such as extreme stress, domestic violence and poverty that may contribute to depression at an early age (Gov.UK). Furthermore, the PHE’s guidelines on mental illness prevention among children targets child-specific risk factors such as child neglect and sexual assault that may expose children to depression. Currently, PHE indulges in several mental health campaign programs that seek to create awareness among young adults’ bout different mental health issues such as depression. For instance, the Mental Health Awareness Week that is currently being run by PHE seeks to inform the population about mental health especially due to the difficult emotions caused by social restrictions associated with COVID-19 (Pekins, 2020). The program seeks to coordinate both local and national mental health emergency response especially to the mental health challenges caused by COVID-19. This entails providing timely and efficient mental health services and making mental health a priority (Pekins, 2020). Again- more on this- maybe some legislation, current practices- basically where are we at now in terms of this area etc. Therefore, the current study contributes to the PHE policy guideline son mental health by conducting an in-depth empirical evidence evaluation on depression among children. Upon completion, the study will be a significant source of knowledge to both policymakers and health practitioners who would be interested in referring to existing empirical evidence on depression among children.

1.3 Research Aim

Against this background, the main aim of this study is to explore the impact of depression on young adults

1.4 Research Objectives

To identify the risk factors for depression among young adults

To understand the impacts of depression on young adults

This chapter has introduced the study and states what it aims to do. Furthermore, the author has used this chapter to define depression, give statistics on the prevalence of depression among young adults and the implication of depression on well-being of individuals – thereby justifying the need for the study. In `the next chapter, the author discusses the research approaches and methodologies applied to achieve the research objectives. Thus, the chapter will discuss the strategies and methods used in collecting evidence through literature review as well as the databases from which the literature materials were retrieved. The researcher also explains the inclusion and exclusion criteria used to pic various studies for review.

Chapter 2

2.0 Approach

2.1 Introduction

This chapter gives an overview of various research methods, technique sand strategies the author has used to achieve the research objectives. It describes and justifies the research approach, data collection methods, research paradigm, data analysis and techniques used to answer the research questions. The current study seeks to conduct a literature review on the depression among young adults by identifying, critically appraising, analyzing and presenting data from other studies that have explored the same research topic. In social sciences research, depression has remained to be an interesting topic of research to only with regards to depression among the general public but also among specific population groups such as women, men and children and adolescents. Therefore, it is important to use the existing studies to have a deeper understanding of depression as a mental health issue that has various impacts its victims, relatives and the healthcare system. To conduct this literature review, the author has followed a systematic process of identifying, selecting and analyzing existing research evidence as will be highlighted in the subsequent sections of this chapter.

2.2 Research in the context of health and social sciences

Research can be defined as the systematic process of investigation that entails data collection, analysis and interpretation of important information about a phenomenon, through various suitable methodologies to achieve specific objectives set by academic disciplines (Rodgers, et al., 2006). It is conducted on a specific topic with the aim of solving a specific problem within a specific subject area. In the context of health and social sciences, research plays an important role in the society as it helps provide important information regarding specific diseases, the risk factors for such diseases and the specific treatment interventions that can be taken to mitigate those diseases (Roberts & Povee, 2014). Furthermore, through health and social science research, practitioners, academicians and ordinary individuals are made aware of the patterns of care, health costs and the functional abilities specific illnesses for purposes of designing an effective care pathway (Gelder & Daele, 2014). Perhaps the most important component of research in health and social sciences are clinical trials that are mostly used to provide important information regarding clinical trials and effects of newly developed treatment interventions, whereby researchers control for variables that could influence the study results (Logan, 2008). Feedback from clinical trial research are useful in developing drug use protocols diagnostics, medical devices ad vaccines. In any form of enquiry, a researcher can conduct a secondary or primary research. Primary research entails gathering first-hand information from live sources through humanistic methods such as interviews and focus groups while secondary research entails gathering data or information from already existing materials such as books or journals (Happ, 2009). Researchers who use primary research methods are interested in collecting original or new data i.e. first and foremost information about a phenomenon by conducting an in-depth exploration of facts about the object of investigation (Crowe, et al., 2012). While primary research yields first-hand data, its shortcoming is that it may be difficult to conduct because it is time-consuming and requires relatively more resources compared to secondary research (Lopez-Fernandez & Molina-Azorín, 2011). On the flipside, researchers who use secondary research approaches are interested in identifying, analyzing and interpreting existing research (most probably primary research) from readily available resources (Schulze, 2009). The data are already analyzed and interpreted and therefore the researcher just needs to figure out how to constructively use the data to answer their research aims. Using secondary research approaches, the researcher can achieve their research objectives through relatively a cheaper and less time-consuming experience (Wilkins & Woodgate, 2008). Due to the relatively cheap and less time-consuming nature of secondary research, the current study used secondary research approaches to achieve its objectives. This was a literature review-based study that relied on data from secondary sources such as books and journal articles to answer the research questions. The following sections describe the tools, methodologies and approaches that the author relied on to complete the study.

2.3 Research Methodology

2.3.1 Philosophical Perspectives

In the spirit of scientific research, researchers are required to identify and define the kind of research philosophy that their study be based on. According to Wilson (2013), research philosophy refers to the source and nature of knowledge about a phenomenon that inform how data should be collected, analyzed and interpreted. This implies that researchers often make certain assumptions about the sources and nature of knowledge and these assumptions form the basis of the research strategy they adopt (Wilson, 2013). A researcher can either adopt a pragmatic, positivist, realist or interpretivist research philosophy. However, the choice of either of them depends on the practical implications of each. For instance, studies that focus on numbers and facts may take a different research philosophy from those that focus on attitudes, opinions and perspectives. In this regard, the use of interpretivist and positivist research philosophies in either qualitative or quantitative studies have been a subject of great debate among contemporary scholars. Nonetheless, both realism and pragmatism research philosophies have also gained popularity in the recent past. In the current study, the author did not rely on any specific research philosophy because it entails a review of literature from different studies with different research philosophies. The literature review included both qualitative and quantitative studies and therefore its findings were predominantly based on either positivist or interpretivist research philosophy.

2.4 Research methods

2.4.1 Qualitative, quantitative and Mixed methods

A researcher can take three different methods of collecting and analyzing research data namely qualitative, quantitative or mixed methods. Quantitative research methods are mostly used when researchers are interested in testing hypotheses and theories using statistical methods. The data in quantitative methods are mostly expressed in numbers, graphs and tables. On the other hand, qualitative research methods are mostly used when the researcher intends to explore subject data from individuals such as opinions, attitudes and perspectives regarding a phenomenon under investigation. Qualitative and quantitative methods of data collection also differ significantly. For instance, in quantitative data collection methods, the researcher uses closed or multiple-choice surveys, experiments containing both controlled and manipulated variables, content analysis and observations (Roberts, 2014). Contrariwise, qualitative data collection methods include open-ended interviews, focus groups, case studies and other methods that allow the author to gather data on human subjective experience. Thus, as opposed to quantitative data that is often useful when the researcher wants to test or confirm something, qualitative data is useful when the researcher intends to understand something from the perspective of the people experiencing it. Apart from qualitative and quantitative research methods, researchers can also use a mixed method approach, whereby the researcher uses a mix of both qualitative and quantitative approaches to validate the findings made through either of the approaches. For instance, a researcher may start with a survey to find out the general trends about a phenomenon, then use interviews to validate, confirm or refute those trends.

2.5 Ethical considerations

Ethical considerations are an important practice on academic research because they define the study’s moral grounds. Furthermore, making ethical considerations in academic research contributes to a general reliability and validity of the study findings (Wilson, 2013). Being a desktop research, the current study did not require any ethical approval from the University’s ethics committee. However, there are several ethical considerations that were made regardless of the study being a desktop research. For instance, measures were taken to eliminate plagiarism by acknowledging the authors of all the materials used in this study. Moreover, the author obeyed all the policies and guidelines regarding use of journal articles as stipulated in the respective online databases.

2.6 Chosen Methodology

In the current study, the researcher conducted a literature review on studies with a variety of research methods. The findings of this study are a culmination of data gathered through qualitative, quantitative and mixed research methodologies applied in the respective studies selected for review. Literature review is a library-based approach research that relies on secondary data to achieve the research objectives (Wilson, 2013). It entails the identification, critically appraising, reviewing and synthesizing data from existing literature materials such as journal articles and books on depression among young children. In recent healthcare research, depression among children has remained an interesting topic of investigation especially considering that earlier research focused much on depression among the general population as opposed to specific demographics such as children. Therefore, it is particularly important to take a focused view of depression by evaluating what existing research say about its causes and impacts on children, as well as how the children cope with it (Wilson, 2013). Fundamentally, literature review is a research approach that facilitates a critical examination of previous empirical research evidence to make conclusion regarding a phenomenon under investigation. It is based on a rigorous search of literature materials and extracting data that may be useful in achieving the current research objectives. Against this backdrop, one of the most significant advantages of literature review as a library based-approach to data collection is its role in promoting evidence-based practice. According to Wilson (2013), evidence-based practice is an approach used by practitioners in health and social care to solve problems by incorporating the best available evidence from patient values, preferences and well-designed studies in making clinical decisions. Therefore, literature review plays a central role in enhancing evidence-base practice because it facilitates san exploration of existing empirical evidence to aid decision making. However, an inherent disadvantage of literature review over empirical studies is that the former relies on secondary data that may have certain limitations too, and thus may not give accurate evidence on the phenomenon under investigation. Further strengths/limitations of a literature review over an empirical study

2.7 Data Collection Methods

2.7.1 Search Strategy

To identify the most recent and up to date research evidence related to depression among young adults, a comprehensive search was conducted on online databases such as MEDLINE, CINAHL, Google Scholar and EBSCO. Electronic search was preferred over physical library search due to the latter options convenience. According to Toomela (2010), online databases facilitate a faster an easier retrieval of journal articles through a simple search compared to searching journal articles in physical library through an offline library catalogue. Furthermore, the databases were selected for their abundance in mental health literature materials that could facilitate a wider scope of reviewed literature (Toomela, 2010). It was also easier to follow and replicate an online search process than an offline one. The study selection process was systematic and rigorous. Each material’s abstract was first read to determine whether they were of interest to the current study or not. The primary goal of a systematic selection process was to ensure that only the most relevant, useful and valid primary research articles were selected for review. The author established inclusion/exclusion criterion that guided the study selection process. Here, the researcher lined up specific characteristics that the studies needed to have to be included in the final list of review. For instance, only the studies published in English language were included for review. This was to eliminate language barrier that would be detrimental to the data interpretation process (Suzuki, et al., 2005). The next inclusion criteria were the year of publication, whereby only studies that had been published in in the year 2010 onwards were included. This ensured that only the up-to-date pieces of evidence were gathered from the reviewed studies. Next, the study only included studies published in full text so that the researcher could fully interpret the evidence from the background of each study to their conclusion. Finally, the researcher only included studies that focused on young adults and not any other population group. The search process was eased by use of search terms such as depression, young adults, therapy, and anxiety. These terms were specifically selected to ensure that the search process yielded a comprehensive result of quality journal articles for final review. Also, the researcher customized the search terms using the Medical Subject Subheading tool (MeSH) to facilitate more accurate search processes. The MeSH tool enables the researcher to link the search terms to predetermined medical subheading within the databases. Furthermore, the search process was aided using Boolean operators (i.e. AND/OR), which facilitate the combination of words to enhance the precision of the search process by incorporating sensitivity and specificity in the search process. For instance, ‘AND’ was used to broaden the search process by combining unrelated search terms while OR was used to narrow the search process by combining related search terms.

2.7.2 Search outcome

The first search process was conducted on EBSCO, whereby 562 journal articles were identified. However, after applying the inclusion/exclusion criteria tit e identified journal articles, only 2 articles were eligible for selection. Thus, the search process sin EBSCO database yielded two journal articles. The next search was conducted on ProQuest database, whereby 667 relevant journal articles were identified. Upon applying the inclusion/exclusion criteria, only two journal articles met the inclusion criteria and were included in the study. The next bit of search was conducted on MEDLINE, whereby an initial search revealed 443 relevant journal articles but only two satisfied the inclusion/exclusion criteria and were included in the study. The six journal articles were then subjected to further screening and critical appraisal before finally being admitted into the study. The following table illustrates the search process

Make sure the table is accurate you need at least 14-15 papers, the results yielded is the total number that were shown, the papers selected are the ones you used. So the table should add up to 14/15papers in total

PRISMA tool illustrating article search process

2.8 Data extraction

For purposes of future reference, the author extracted specific data from each selected journal articles. In doing so, the author gathered data relating to each study’s author (s), country or location of investigation., year of publication, study findings, conclusions, limitations and strengths. Other information of interest was the sample size, and research methods. Upon extracting these kinds of data from each journal article, the researcher systematically synthesized the findings using grounded theory to develop themes for discussions.

2.9 Critical appraisal

The author used the Critical Appraisal Skills Program (CASP) to critically evaluate the quality of each journal article before including them in the review. The CASP too uses a ten-point checklist through which the author evaluated the methodological rigor and the trustworthiness of each journal article before going ahead to review them. Through CASP, the author would tell the quality of each journal article based on three domains namely the findings of the study, the validity of those findings and whether those findings could be applied to a local practice context. Appendix 2 illustrates the CASP results.

Chapter 3

3.0 Literature review

This chapter presents the results of the literature review in terms of the findings of each selected journal articles and how they help achieve the research objectives. It identifies, analyzes, synthesizes and presents the findings of each journal articles in in a thematic format. Where necessary, the themes will be identified and discussed in sections and subsections. Furthermore, during the literature review, the author will consider the differences and similarities of the journal articles under discussion. More importantly, the author will be keen to explore the methodological quality of each journal article to make quality and robustness judgments of each study.

3.1 Risk Factors for depression among young adults

3.1.1 Social Media Use

The use of social media among youth and young adults has been on the rise in the recent past, with unclear information on its impacts on well-being. Consequently, researchers have made attempts to unveil the kind of relationship between social media use and mental wellbeing among young adults and found interesting results worth exploring. For instance, in a recent study by Lin et al (2016), the authors were interested in exploring the existence of any association between social media use and depression among young adults. They selected 1787 young adults of age 19-32 and conducted a survey on how the use of social media impacted on their mental well-being, especially with regards to depression. Using a random digital-address sampling, Lin et al (2016) managed to gather data on self-reported time spent on social media per week using the Pew Internet Research Questionnaire. To measure levels of depression among participants, the study relied on Patient Reported Outcomes Measurement Information System, then analyzed the relationship between the two variables using ordered logistic regression and chi-square test. The results showed that participants within the lower quartile of total time spent on social media experienced lower levels of depression while those with highest quartile levels of time spent on social media had increased odds of depression after controlling for all covariates. Specifically, the study found an odd’s rate of depression of AOR=1.66, 95% CI=1.14–2.42 among those in the higher quartile of social media use per week compared to those in the lower rates of depression. Based on their findings, Lin et al (2016) concluded that social media use is a significant risk factor for depression among young adults. Given the increased use of social media use among across all populations, the authors recommended further studies on the mechanisms of how social media use among young adults causes depression and the remedies that can be taken to prevent this effect. However, there are certain methodological limitations to this study that could affect the generalization of its findings. For instance, the study relied on address-based and digital sampling methods, both which are characterized by data variability and consequently data collection errors (Katz et al. 2017). Therefore, it is not clear whether the selected sample had the ability to give accurate information regarding both their use of social media and levels of depression. Similarly, the study did not execute a complete clinical diagnosis of depression and this affects the study’s ability to provide accurate and reliable data regarding participants’ levels of depression and how the use of social media influences those levels. Nonetheless, the findings of this study have a strength on the account of a large sample population that enabled the development of more accurate mean values (Lin et al. 2016). On the flipside, the use of a relatively larger population sample inhibited the use of ‘gold-standard’ measures of social media use.

3.1.2 Loneliness sand social isolation

Healthy social relationships are an important component to not only young adults but also other population groups including children and adults. In the presence of positive social relationships, individuals are having the necessary social support and guidance that have a positive impact on life and general health and well-being. However, there have been speculations that lack of social relationships characterized by loneliness and social isolation can contribute to poor mental health. Against this backdrop, Mathews et al conducted a study to investigate the relationship between loneliness and poor mental health symptoms – particularly depression, and whether this relationship is mediated by genetic components. The study relied on data from Environmental Risk Longitudinal Twin Study that focuses on age 18 and consisted of 1116 twin children born in England and Wales between 1994 and 1995. Like the study by Lin et al (2016) that relied on participant self-reporting of social media use, Mathews et al (2016) also relied on participant self-reporting of loneliness, social isolation and depressive symptoms. The data was then subjected to a regression analysis to test for how the association between social isolation, loneliness and depression different among the participants. One of the most important methodological precaution taken by Mathew et al (2016) in their study is that they accounted for both environmental and genetic factors, especially considering that the study relied on twin young adults’ participants. The study found a moderate correlation (r = 0.39) between social isolation and depressive symptoms among young adults. This indicated the relationship between the constructs of loneliness and genetic components and how each construct related to depressive symptoms. For instance, Mathew et al (2016) found that both loneliness sand social isolation was almost similarly influenced by genetic compositions at the rate of 40% and 38% for social isolation and loneliness respectively. However, the study found a smaller influence (29%) of genetic composition on depressive symptoms, with the remaining variance (71%) accounting for the non-shared environmental factors. These findings led to the conclusion that while socially isolated young adults do not necessarily experience loneliness, lonely young adults are more likely to be depressed and this is also influenced by the young adult’s genetic composition. Despite the clearly stated results, there are certain methodological limitations that affects the validity and generalizability of their findings. But first, the use of regression analysis to evaluate the correlations between loneliness, social isolation and depression; and how genetic composition influence this relationship presents a powerful methodological strength that improves the validity of this study (Sheets et al. 2017). However, a significant limitation of this study is that like Lin et al (2016) the use of participant self-reporting may have exposed the data to data bias, thus interfering with the credibility of the result. Besides, the generalization of its findings is significantly affected by the fact that the study relied on only 18-year-old participants, and therefore the results might not be applicable to young adults of other age groups.

3.1.3 Genetics and genetical composition

Scientists have for a long time attributed some mental illnesses to individual genetic composition. For instance, in the previously reviewed study by Mathew et al (2016), genetics was found to have an influence on the relationship between loneliness, social isolation and depression. Interestingly, another study selected for review (Needham et al 2016) also explored risk factors for depression and anxiety from the perspective of human genetic composition. In the study, Needham et al (2016), the relationship between telomere length, depression and anxiety in young adults based on the background information that human telomere length has been speculated to have an influence on cumulative exposure to anxiety and depressive disorders. Therefore, the researchers aimed to explore the relationship between depression and telomere length and whether that relationship is moderated using antidepressants, gender or race. Needham et al (2016) relied on data from the UK’s National Health and Nutrition Examination Survey conducted between 1999 and 2002. The authors used quantitative polymerase chain reaction method to measure telomere length in relation to the DNA standards. On the other hand, the authors used the Composite International Diagnostic Inventory to measure the participant’s panic disorder, generalized anxiety disorder and major depression level for the past one year. Upon having measurements for moth variables, the authors used regression analysis to measure the relationship between telomere length and depression as well as anxiety disorders. The results showed that among the female population, individuals with less generalized anxiety disorders or panic disorders had a shorter telomere length compared to those who were less anxious with a difference of β: −0.07, p<0.01. On the other hand, there was no relationship between generalized anxiety disorder, panic disorder and telomere length among the male population (β: 0.08, p>0.05). On the account of respondents that were on antidepressants at the time of the study, those who had major depression had shorter telomeres compared to those who had no major depression (β: −.26, p<.05), even though there was no association between telomere length and major depression among those who were not under antidepressants. Based on the results, the study concluded that telomere length had no association with neither anxiety nor depressive disorders in young adults. While the methodological rigor of this study was somewhat not questionable, there were certain elements of the study that acted as limitations while others acted as strengths. For instance, the study relied on population-based sampling by using data collected by the National Health and Nutritional Examination. This was particularly a strength to the credibility and reliability of the study because it minimized the risk of researcher selection bias that would have been encountered if the study relied on samples selected from the general populations (Needham et al. 2015). However, because the study relied on telomere length as one of its variables, the credibility of the data may have been inaccurate due to the impact of genetical ageing on telomere length. Indeed, the authors failed to account for genetical again as a contravening factor between the variables.

3.1.4 Chronic Sleep deprivation

Chronic sleep deprivation has been associated with various impacts on human health and well-being across all populations. However, there have been speculations that chronic sleep deprivation among young adults may increase the risk of depression especially among individuals with high risk to mental health issues and sleep deprivation. In this regard, Conklin et al (2018) conducted a population-based study to investigate the relationship between sleep deprivation and gender-based depression among young adults. In short, the authors intended to explore the prospective relationship between levels of depressive symptoms and sleep deprivation among young adults from a gender perspective. To achieve their objectives, Conklin et al (2018) conducted a longitudinal research of 3071 young people from the British Columbia Adolescent Substance Use Survey, a cohort of participants who had two depression measures and three sleep time within one year. The authors estimated gender-specific association between depressive symptomatology changes and chronic sleep deprivation and later conducted a post-estimation analysis to adjust for depression scores for every level of cumulative sleep deprivation. Results indicate that sleep deprivation was associated with an increase in depression scores among young women and no consistent pattern of association between sleep deprivation and depressive symptoms among young men. The study revealed that among the 15% of women who were chronically sleep deprived, 29% of them were depressed. These results led to a conclusion that chronic sleep deprivation can lead to depression among young women. Nonetheless, the generalization of these results is affected by certain methodological limitations that are worth noting. For instance, like other previously reviewed studies, Conklin et al (2018) relied on self-reported sleep deprivation data and this exposed the data to bias. Also, the study generalization is affected by the fact that participants were selected from a specific area and therefore the findings may not apply to the entire population. However, a significant strength of the study is that it relied on longitudinal research design, which is reveals data of people that have been under depression over time.

3.1.5 Parental Death

The death of a child’s parent has been speculated to have several impacts on mental well-being of young adults especially when the child was highly dependent on the parent for life provisions. To confirm this peculation, Fiegelman et al (2017) conducted a longitudinal study on data spanning seven years on the psychosocial and behavioral effects of a young adult’s parental loss. The study was specifically to confirm findings by previous studies that young adults faced psychosocial and behavioral adjustment inabilities after parental death. On of the measurements for psychosocial impacts of parental bereavement was depression, whereby the researcher measured depressive symptoms using a 19-item CES-D scale for the past one year after parental loss. The results indicated that no significant difference in psychosocial adjustment among bereaved young adults and non-bereaved young adults with regards to depression scores. In the end, the study concluded that parental death is a significant risk factor for depression among young adults and that young men are more exposed to the risk of depression compared to young women. However, these findings are subject to certain methodological limitations that are worth mentioning. For instance, the authors mentioned that they did not obtain any consent from the participants to use their data. This raises the ethical nature of the study because using personal data without getting an informed consent from the participant bis tantamount to fraud (Berg et al. 2016). On the flipside, the study has some considerable strengths. For instance, the researchers relied on governmental sites which are considered to have a high validity and less error rates. Furthermore, the longitudinal data allow for a comparison between different forms of depression experienced by the young adults.

3.2 Impacts and Costs of Depression in young adults

The onset of depressive symptoms is linked to various long-term and short-term impacts and costs. Like other metal disorders such as stress and anxiety, depression is associated with costly ramification son developmental transitions among young adults that are worth noting. However, researchers interested in the epidemiology of depression have largely focused on marital stability and timing, occupation, education and childbearing.

3.2.1 Termination of School

Studies by Woodward & Fergusson (2001) have shown a relationship between early onset of depression and other metal disorders and termination of school among young adults. Young adults in secondary schools and college tend to have a difficulty concentrating in school and this may have an impact on the ability to pass exams and transit to next level of education, or may cause them to completely drop out as a result of absenteeism, indiscipline or depression-related addictive behavior such as alcoholism (Woodward & Fergusson, 2001). The impact of depression on education is a significant issue that needs further examination and analysis. Education is an essential necessity for all young adults and therefore it would be important to develop a better understanding of the various factors that influence the relationship between depression and school dropout, so that necessary interventions are taken (Woodward & Fergusson, 2001). This study explores existing research evidence on how depression might impact on young adult’s education and provides necessary recommendations for addressing the issue of depressed young adults dropping out of school. It critically analyses the quality of evidence produced by this study and how the findings apply in real life situation.

3.2.2 Stability and marital status of young adults

A group of researchers interested in understanding the cost of depression have focused on how depression impacts the stability and marital status of young adults. Consequently, there are studies (Breslau et al 2011, Forthofer et al 1996) that highlight how pre-marital mental disorders impact on a young adult’s subsequent marriage and found that individuals with early onset of pre-marital early onset of mental disorders are less likely to get married, even though the studies also show the two variables are either positively associated (Forthofer et al 1996) or unrelated (Breslau et al 2011) with early marriage (i.e. before the age of 18 years), which is associated with a variety of adverse outcomes and also associated with late and on-time marriage, which are known to be associated with several benefits such as social support and financial security. Clearly, there seems to be a complex relationship between mental disorder and marital stability and timing that would be of interest to this study. Therefore, in this study, the author would be interested in analyzing any research evidence on how depression as a mental disorder impacts stability and marital timing among depressed young adults. It would also be interesting to explore whether the evidence highlight a gender difference on marital timing and stability among depressed adults. It would be interesting to explore any existing Some researchers have also explored the possibility of an existing relationship between mental disorder and teen childrearing among young adults. For instance, Dooley & Fielding (1996) conducted a research on the association between mental disorder among adolescents that have given birth and their subsequent childbearing and found that early onset mental disorder is associated with teen childbearing. A further analysis of their findings revealed that the association between mental disorders and increased childbearing was a s a result of increased sexual activity. Therefore, it would be interesting to explore any evidence that indicates depression as one of the mental disorders that predicts increased childbearing among young adults.

3.2.3 Unemployment

Other researchers have also explored depression among young adults a from a socio-economic perspective. Whereas the association between depression and unemployment is well-known, most studies have only explored the impact of unemployment on depression and not depression as a risk factor for job loss (Dooley & Fielding 1996). However, in a recent study by Kawakami et al (2013), the researchers explore the latter relationship and found that depression may be a risk factor to job loss in the sense that mental disorder at time of completing school may be predictive of work inability and unemployment. However, this relationship was only found to be possible in high income countries. Therefore, firs, it would be interesting to explore any evidence on depression as a risk factor for job loss in other countries apart from low- and medium-income countries or evidence indicating that depression can contribute to job loss among young adults. Untreated depression has serious effects on individuals, their families and the public health sector. From an individual perspective, depression can cause serious long impacts that affect various aspects of an individual’s life even though it is both preventable and treatable (Luby, et al., 2009). For instance, research by Luby, et al., (2009) identify suicide as one of the most significant outcomes of depression among young adults. Untreated depression can contribute to negative thoughts especially when the individual is trying to figure out a way out of the depressive situation (Birkeland, et al., 2005). Therefore, it is important to understand how depressive thoughts can contribute to suicidal behavior and the necessary interventions that can be taken to mitigate them.

3.2.4 Addictive behavior

Depression has also been associated to unhealthy addictive behavior such as alcoholism. For instance, Maurer (2012) explains that because depressive symptoms hardly go away and instead worsen with time, people often resort to addictive behavior such as self-medication, alcoholism and smoking to alleviate the symptoms. Unfortunately, according to Maurer (2012) such habits only worsen the problem. Moreover, when depression is combined with addition, individuals are exposed to more risk of suicidal behavior. There is a need to establish the link between depression and suicidal behavior especially considering the emotional and socio-economic impacts of suicides on the victim’s families (Maurer, 2012). In this study, suicide as an effect of depression is explored in depth, with specific focus on the events that led up to a depressed individual’s decision to take their lives and the necessary interventions that can be taken to prevent that decision-process. The study identified and analyzed existing research evidence on suicide as an impact of depression among young adults, as well as the measures for preventing suicide among depressed adults. Existing research has also established a link between depression and self-injury among young adults. According to research by Pratt & Brody (2008), young adults often resort to self-inflicted injury in attempt to cope with depression through methods such as burning or cutting. While some individuals reportedly do not intend to harm themselves, such behaviors are life-threatening and may result in accidental deaths (Pratt & Brody, 2008). This highlights the need for further evidence on the role of depression in self-injury, with a clear understanding of why young adults resort to pain-inflicting behavior when they feel depressed.

Chapter 4

4.0 Discussion

This study has demonstrated different risk factors for depression among young adults all which have been backed by concrete empirical research evidence. For instance, one of the studies reviewed herein found a strong association between social media use and depression among a sample of young adults. Thus, it is possible to extrapolate that increased social media use can lead to increased levels of depression. Indeed, these results tie back to several other studies that have linked social media use with reduced subjective moods, life satisfaction and a sense of wellbeing (Krosset al 2013 & Chou et al 2012). Furthermore, studies by Burke et al (2010) found that passive use of social media as oppose to active communication is associated with decreased social capital as well as an increase in social isolation. This can be explained by the fact that during passive social media use, individuals are exposed to idealized peer representations that cause a distorted belief and feelings of envy among the users against others (Krasnova et al, 1998). The envious feelings can lead to a loss of self-worth and consequently depression. Individuals’ mood may also be affected by the feeling that by engaging in passive social media use, they are not doing anything meaningful (Sagioglou et al, 2014). In fact, the increased time spent by younger adults on the internet, and specifically on social media has led to the proposals by a section of psychologists to propose that ‘internet addiction’ be included as one of the psychiatric conditions that are associated with depression ( WHO, 2015; Morrison & Gore, 2010). Similarly, there is a possibility that increased use of social media expose young adults to the risk of cyber bullying which may also contribute to greater levels of depression (Pew Research Center, 2007). Regardless of the nature of association between social media use and depression, the findings of this literature review should be of significant interest to public health practitioners and clinicians in many ways. For instance, according to recommendations by National Institute of Health and Care Excellence (NICE, 2015), clinicians should evaluate whether a depressed individual has been engaging in excess social media use and thereby being a contributory factor to their mood dysregulation. Furthermore, social media can be used to reduce stigmatization of depressed individuals and early detection of depression through individuals’ posts and comments (Moreno et al, 2011). Because social media has become an integral component of human interaction, practitioners who interact with depressed young adults should advise on the importance of finding a balance between positive social media use and how to eliminate potentially harmful use. On the same note, the findings on the association between excess social media use and depression among young adults suggest that public health practitioners can use social media platforms as important platforms for screening possibly depressed individuals and disseminate targeted sensitization programs regarding how to deal with depression. Disseminating sensitization messages about depression can help reduce excessive use of social media aby making them aware of how it is associated with depression.

This study has also explored the concepts of loneliness and social isolation based on a national representative longitudinal data. Based on this data, evidence show that socially isolated young adults experience loneliness and are more likely to experience depression that those who are not socially isolated. This finding implies that developing social relationship has more positive impacts on young adults’ mental health and well-being compared to subjective feelings of connectedness. Given these results, this study supports suggestions by other studies (VanderWeele et al, 2011) that developing interventions o address loneliness among young adults can help reduce depressive symptoms among this population. Because loneliness can be experienced even without isolation, little results can be achieved by simply increasing an individual’s social contacts. Similar observations were made by a meta-analysis of interventions for depressive symptoms, which found that developing interventions for negative social cognitions can be more effective in addressing loneliness compared to interventions meant to address social contact (Masi et al, 2011).On a broader perspective, practitioners should consider relationship-base interventions such as interpersonal therapy that are more effective in addressing depressive symptoms (Mufson et al 1999). The findings that social isolation and loneliness are a risk factor for depression among young adults enlighten on the relationship between mental health and social connections. While loneliness and social isolation are two related constructs, practitioners should not practice them interchangeably because lonely people are likely to develop depressive symptoms regardless of the social support they get (NICE, 2015).

From a genetic perspective, this study has found evidence on the direct relationship between anxiety and depressive symptoms and telomere length. Whereas this relationship was found not to vary across different races and ethnicities, a past year generalized anxiety disorder and depression was found to be associated with telomere length among women. An important piece of information revealed in the course of the literature review is the information on the lack of relationship between anxiety and depressive symptoms and telomere length in samples of different races. While several other studies have relied on exclusively one ethnic community, existing evidence by (Breslau et al, 2006) and (Needham et al, 2013) reveal that there are varying risk of both telomere length and psychopathology across different ethnicities and therefore there is a need to evaluate whether the relationship between telomere length and depression among young adults vary across different ethnicities. Whereas the reviewed evidence in this study suggest no ethnic difference in the association between depression and anxiety disorders and telomere length, more studies in this relationship should be conducted, especially on a diversity of ethnicities. Nonetheless, the reviewed evidence herein reveal that severe depressive symptoms can emanate from telomere length and can be treated by either in a clinical setting or through psychotropic medications. However, practitioners should also note that severe psychopathology may also not be associated with telomere length, and this indicates the importance of proper diagnosis of depressive symptoms in terms of its causes. This study has also reviewed evidence confirming that sleep deprivation is a risk factor for depression and gender mediates this relationship. While the study could not find a direct relationship between sleep deprivation due to the design of the reviewed study, several other pieces of research have confirmed this relationship among young adults. However, despite the findings, it is important to note that there are several other factors that might mediate the relationship between sleep deprivation and depression among women, including environmental and biological development factors. For instance, the transition from childhood to adolescence has been identified to be associated with high risk of depression (Franceschi, 2007). This is potentially because both hormonal and neurological changes not only reduce the total duration of sleep but also change sleep stages and timings from deeper stage to lighter stages and from day to evening chronotype. This implies that practitioners should target this group of individuals and address these changes in patters when developing and implementing guidelines and remedies for depression among young adults. Similarly, puberty is characterized by emotional and cognitive changes whereby an individual becomes more responsive to socio-emotional context at a time when they have not yet developed good neural executive functioning for pulse inhibition (Fitzpatrick et al, 2011). This immature brain development could expose young adults to more depressive symptoms, with young women displaying higher levels of and earlier onset of depression than men (Epel et al, 2009). These differentials in depression levels are important to mental health practitioners because they reveal the nee for targeted and customized interventions in young men and women. Practitioners also need to be aware of environmental factors that influence young people’s experience of depression including school term start times, lack of physical activity engagement, and alcohol consumption among others. These factors should be incorporated in the development and implementation of various interventions targeted at addressing depression among young adults. The review has also found evidence that depression among young adults can be caused by death of a parent. Evidence supporting this finding also reveal that young adults encounter adjustment problems when they lose one or two parents and this is characterized by increased depression, decreased self-esteem, increased risk to child delinquency and criminal behavior, and decreased academic performance. The evidence herein on loss of a parent as a risk factor for depression among young adults reveals more details on the transitioning and adjustments made by young adults once they lose their parents. By tracking the sample population through seven years of their lives since the loss of a parent, the reviewed evidence show that at some point after the loss, there are new patterns of the association between parental loss and depression (with an exception of girls), whereby most of the adjustment problems had disappeared by the age of 26 and consequently their use of drugs, suicidality, mental health service use, and other components of psychosocial adjustments were similar to those of the non-bereaved. These results imply that bereaved young adults may adopt to their loss after some time and thus practitioners addressing depression among bereaved young adults should consider the time factor to recovery.

Solutions to parental loss-related depression should also consider the fact that the young adults may experience long-lasting socio-economic disadvantages especially if those parents were their main providers. This implies that the bereaved may experience more depression due to the lack of several other life needs such as utility or credit services. They face additional financial problems because they must live independently from their parents compared to their unbereaved counterparts. Therefore, when developing interventions for depression, health and social care workers should consider the various socio-economic risks the young adults face upon losing their parents even as they use conventional ways of treating depression. This may entail delivering addressing the socio-economic needs through the creation of employment opportunities and other social support to enhance their welfare. As more evidence emerge on the association between parental death and depression among young adults, it is also clear that upon the death of their parents, they may face conflicts and frustrations from their relatives or among siblings. Such conflicts might emerge due conflicts over wealth and property especially in cases where the parents leave no will. This calls for the establishment of legal and regulatory procedures for settling disputes among young adults upon parental death as a strategy to eliminate conflicts and consequently anxiety or depression. In conclusion, this chapter has discussed the study findings on the risk factors and impacts of depression among young adults. The study has developed an understanding of the findings by synthesizing the findings and comparing them with the findings of other studies. The next chapter entails several conclusions that can be made from the study findings. Besides, it contains an analysis of the implications of the findings to normal practice as well as some recommendations for future studies.

4.1 Strengths and limitations of the study

Like any other literature review study, this study has various strengths and limitations that may affect how its findings are applied and generalized. Regarding the strengths, the findings and conclusions of this study have been made with a wide range of evidence from different studies with different methodological background. Thus, the findings are more reliable than the findings that could be derived from a single study. Secondly, the conclusions in this study have been made after a sound analysis of existing research gaps, open research questions from previous studies and existing research gaps that are yet to be addressed. While the study might not have addressed all the research gaps, it makes more contributions to what is already known about the study topic. More importantly, this study has identified more research gaps and made suggestions for future research. On the flip side, the literature review methodology approach taken by this study was less rigorous than other types of literature review approaches such as systematic literature reviews. Furthermore, the findings of this study are compiled from the findings of a variety of other studies that have their respective methodological limitations and thus its findings are only valid to extent that those respective study’s findings are valid.

Chapter 5

5.0 Conclusion and Recommendations

This study has reviewed empirical data on the relationship between depression and social media use in a large representative sample of young adults. With the increasing prevalence of social media use and the substantial jump in mortality and morbidity associated with depression, the results of a positive relationship between depression and social media use in adults has important implications for future research and practice. For instance, future research should conduct a finer evaluation and assessment of the context and content of the relationship between social media use and depression should be conducted to enhance practitioner’s ability to develop better interventions for depression. From a practice point of view, researchers and practitioners should collaborate on identifying different strategies and means of using social media as a platform for launching different interventions for depression among young adults. Some of the prospect strategies can be launching social media campaigns against the misuse and abuse of social media, especially against behavior that are likely to cause depression such as trolling and bullying. These findings also point to the need for stricter Facebook regulatory policies that curtail social media-based abusive behaviors such as bullying that may case depression. This study has also unearthed the connection between mental health and social connection. From a clinical practice point of view, the reviewed empirical findings on the relationship between depression, loneliness and social isolation clearly reveals what practitioners should target when dealing with depression in young adults. Based on these findings, it is clearer that young adults’ engagement in social activities is not only important for their social capital but also their mental health. These findings not only reveal the need for social participation among young adults but also the need for effective tactics and strategies for addressing social loneliness and isolation among young adults.

5.1 Recommendations for Practice

Practitioners have the responsibility for not only addressing depression in young adults but also offering solutions in a manner that does not create an opportunity for stigmatization and further depression. This implies that when treating depression among young adults, practitioners should consider strategies such as confidential emotional support through focused programs aimed at sensitizing the victims on how to avoid depression. The results also call for better solutions for loneliness and depression among young adults that can add value to the society. For instance, community organizations should consider involving young adults in community service or other activities that can add value to the community while keeping them engaged with colleagues. Engaging in community service activities create an opportunity for the young adults develop new friend sand expand their social networks. This study has also explored the connection between genetics and depression. One of the reviewed studies had empirical evidence on the positive relationship between telomere length and depression. While these positive findings were associated with various methodological issues related to sample design and study selection, the findings make significant contribution to the diagnosis and management of depression in young adults by revealing that depressive symptoms in young adults is associated with longer telomere lengths in young adults. Nonetheless, these findings confirm yet again that the relationship between depression and genetics is complex and still need further research. A key aspect of care that practitioners should consider is informing the youth that having a genetic predisposition to depression does not mean that they will get it. Another possible implication of this finding is that genetics may influence how well the treatment intervention works for patients because some genes may determine how the body absorb, uses and excrete antidepressants. However, more research is needed on how telomere length may affect the young adults’ use of antidepressants. This literature review study has also revealed strong empirical evidence to show that there is a gender-specific relationship between sleep deprivation and depression among the young adults’ population. However, more research is required in this finding because the reviewed evidence only reveled an association between chronic sleep deprivation and increase depression among young. Future studies should consider young men and the gender differential between the two genders. Moreover, future efforts by public health practitioners to promote the mental health or young adults should consider various strategies that can address young women’s sleep deprivation.

5.1 Reflection

The most important insight I have gained from this study is that young adults are at a high risk of mental health issues such as depression that have both long-term and short-term effects on their health and well-being. A possible implication of this realization is that the incident o depression among young adults can be caused by a complex interplay between environmental, biological, and lifestyle factors. This realization is important to me in two major ways. First, it informs me that when diagnosing a patient for depression, the diagnosis process must consider the patients’ environmental, biological and lifestyle factors for depression. Secondly, I have learned the importance of developing a comprehensive treatment intervention for depression that considers the three dimensions of risk factors for depression among adults. This new insight will change the way I diagnose and treat young adults with depression symptoms because I now have a better understanding of the complex interplay between environmental, biological and lifestyle risk factors for depression among them.

References

Birkeland, R., Thompson, J. K. & Phares, V., 2005. Adolescent Motherhood and Postpartum Depression. Journal of Clinical Child and Adolescent Psychology, , 34(2), pp. 292-300.

Breslau, J., Aguilar-Gaxiola, S., Kendler, K.S., Su, M., Williams. D., Kessler, R.C. 2006. Specifying race-ethnic differences in risk for psychiatric disorder in a USA national sample. Psychol Med;36(1):57–68. [PMC free article] [PubMed] [Google Scholar]

Crowe, M., Sheppard, L. & Sheppard, L., 2012. Mind mapping research methods. Quality & Quantity, , 46(5), pp. 1493-1504.

Epel, E., Merkin, S.S., Cawthon, R., Blackburn, E.H., Adler, N.E., Pletcher, M.J., et al. 2009. The rate of telomere shortening predicts mortality from cardiovascular disease in elderly men. Aging;1(1):81–8. [PMC free article] [PubMed] [Google Scholar]

Franceschi, C. 2007. Inflammaging as a major characteristic of old people: can it be prevented or cured? Nutr Rev.;65(12 Pt 2):S173–6. [PubMed] [Google Scholar]

Fitzpatrick, A.L., Kronmal RA, Kimura M, Gardner JP, Psaty BM, Jenny NS, et al. 2011. Leukocyte telomere length and mortality in the Cardiovascular Health Study. J Gerontol A Biol Sci Med Sci;66(4):421–9. [PMC free article] [PubMed] [Google Scholar]

Happ, M. B., 2009. Mixed Methods in Gerontological Research: Do the Qualitative and Quantitative Data “Touch”?. Research in Gerontological Nursing, , 2(2), pp. 122-127.

Lopez-Fernandez, O. & Molina-Azorín, J. F., 2011. The use of mixed methods research in interdisciplinary educational journals. International Journal of Multiple Research Approaches, , 5(2), pp. 269-283.

Maurer, D. M., 2012. Screening for depression.. American Family Physician, , 85(2), pp. 139-144.

ME, T., 2006. Depression and sleep: pathophysiology and treatment. Dialogues in Clinical Neuroscience, , 8(2), p. 217–226.

Masi. C. M., Chen HY, Hawkley, C., Cacioppo T. 2011. A meta-analysis of interventions to reduce loneliness. Pers Soc Psychol Rev ;15(3):219–266. doi: 10.1177/1088868310377394. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

Roberts, J. M., 2014. Critical Realism, Dialectics, and Qualitative Research Methods†. Journal for The Theory of Social Behaviour, , 44(1), pp. 1-23.

Schulze, S., 2009. Teaching Research Methods in a Distance Education Context: Concerns and Challenges.. South African journal of higher education, , 23(5), pp. 992-1008.

Sagioglou, C., Greitemeyer T. 2014. Facebook’s emotional consequences: Why Facebook causes a decrease in mood and why people still use it. Comput Human Behav.;35:359–63.

Wilkins, K. L. & Woodgate, R. L., 2008. Designing a Mixed Methods Study in Pediatric Oncology Nursing Research. Journal of Pediatric Oncology Nursing, , 25(1), pp. 24-33.

Zikmund, W. G., Babin, B. J., Jon C. Carr, J. C. & Griffin Business Research Methods, M., . Business Research Methods (with Qualtrics Printed Access Card) 9th Edition. ed. (): South-Western College Pub;.