The Edinburg Depression Scale as a Tool for Depression Screening - Research Proposal Example

Dissertation Proposal Introduction Depression is one of the most debilitating problems for both the mother and child after. The accurate measurement of levels of depression is therefore important if it is to be detected and treated especially in post-partum units. In Saudi Arabia, this has traditionally not been the case, with little research being done on attitudes of care teams towards the use of depression measurement scales in post-partum units. Significance of the Problem Depression that is left untreated has negative effects on the health of the mother and child. This is why screening takes on greater significance within the typical post-partum unit. The Edinburg Depression Scale (EDS) is one of the most common scales in the world for such screening. Such tools, however, only work in situations where there is a lot of attitudinal investment on the part of the healthcare practitioners. Since screening is an important first step, it is important to investigate the attitudes of nurses towards this screening tool in the post-partum units of Saudi Arabian hospitals. This fits into the larger context of tackling the issue of post-partum depression in a country where admittedly not much research has gone into the subject. Problem Statement Researchers have found that the introduction of any new systems to be used in treatment ca be challenging, and that the effect of this complexity depends on how well the healthcare teams adapt to this change (Alkadi, 2016). Even when practitioners understand the importance of techniques or tools, poor attitudes still arise, especially when it comes to perceptions of usefulness (Sinha & Shetty, 2015). In Saudi Arabia, considering the fact that there have been very few studies even on the prevalence of post-partum depression, there is an important gap to be filled through research and discourse on matters of depression and attitudes especially of healthcare teams (Al-Modayfer et. al., 2015). This paper will therefore look into the attitudes of healthcare teams towards the introduction of EDS into healthcare teams in the post-partum units in Saudi Arabian hospitals. It will do so by answering the following research questions. Research questions and Hypothesis Research question 1: What are the attitudes of multidisciplinary teams to the introduction of EDS to postpartum units in the hospitals of Saudi Arabia? Hypothesis 1: Negative attitudes towards the EDS result in negative health outcomes within the post-partum unit Hypothesis 2: Attitudes towards the use of EDS in the measurement of post-partum depression in Saudi Arabia are negative Literature Review EDS is one of the most common screening techniques across the world. When it was first introduced ad validated, it was for women in the post-natal period. Basically, it is a scale with 10 items that relate to the cognitive affective symptoms of depression rather than the somatic symptoms, which have been identified as possibly misleading in this context (Cox, et al., 1987). Every item is scored on a 4 point scale from 0-3, with the total possible score of 30. It is a relatively simple test that takes approximately 5 minutes to complete. It has, however over the past few years expanded in scope, with researchers validating it in other clinical populations. It has been used in people with poor physical health, been useful in palliative care and in Parkinson disease (Baillon, et al., 2014). According to surveys, post-partum depression remains one of the most common psychological health problems among women, with an approximate global prevalence rate of between 10 and 15 percent (Alharbi & Abdulghani, 2014). It is because of this that depression screening has emerged as an important part of the care process in postpartum units. The Edinburg Depression Scale therefore emerges as an important part of this process. In fact, it has been identified as a valid and useful instrument, one that can potentially be self-completed for people that suffer from depression (Baillon, et al., 2014). Still, even with the perceived usefulness of EDS in various clinical settings, there is still a large possibility of a negative attitude towards it (Al-Modayfer et. al., 2015). This comes from the various barriers towards the proper and continued use of such tools in the screening of depression. Studies have found three main types of barriers: system barriers, patient-centered barriers and physician centered barriers. In this context, the paper will mainly focus on the physician centered barriers, which include time constraints, insufficient knowledge, competing demands and the fear of liability (Gjerdingen & Yawn, 2007). There is not enough research on the use of EDS in Saudi Arabia, or the attitudes of care teams towards its adoption. There are several reasons why this research therefore closes a significant gap. While research in North America, Europe, Japan and Australia places prevalence of post-partum depression at approximately 13 percent, the rates in Araba women were much higher. In the United Arab Emirates, for instance, the prevalence rates were 22 percent, while in Lebanon the rates were 21 percent (Green, et al., 2006). Research has also placed the prevalence rates in Saudi Arabia at an approximate 17 percent, still higher than global averages (Alasoom & Koura, 2014). It is also important to look into the general attitudes of Saudi Arabians towards mental health and treatment. For a long time in the past, the mental health treatment setup was little or non-existent. Researchers have identified several reasons for this, including the focus on God’s will as the reason for people getting sick or recovering (Koenig, et al., 2014). Other issues, especially for mental healthcare teams is the legal aspect, where the psychiatrist was held personally responsible if they discharged a mentally ill patient who then went on to cause harm to other people or themselves (Koenig, et al., 2014). Presently, even though there is a lot of promise with regards to the potential for development of mental healthcare especially for high risk populations like women in the post-natal period, it has to be grounded in research. According to the world health organization, depression is set to be the second major cause of disability by the year 2020 (Al-Qadhi, et al., 2014). Method Participants A total of 50 participants from 2 hospitals participated in the research process to measure their attitudes towards EDS as a depression screening tool. The participants were chosen based on several factors. Every participant must have been a part of a care team or philosophy that made use of care teams. Secondly, every participant must have been on a facility that had post-partum depression screening and treatment/consideration as part of their post-natal care or follow up process. Finally, the participants were only chosen from hospitals that made it either an option or compulsory to use EDS as a tool. Every one of the participants had either used the EDS at least once in the past month or were actively using it in their daily post-natal care activities. Measures To measure or evaluate practitioner attitudes towards the use of EDS, the researchers used a questionnaire adapted from The Leeds Attitude to Concordance (LATCon) scale. This is a scale that was developed in 2001 to assess the patient and practitioner attitudes towards concordance. The researchers developed an attitudinal Likert scale on 20 items (Knapp, et al., 2009). The LATCon and LATCon II scales have been used in various settings, covering different populations and healthcare situations, and has been translated in various languages for easier adaptation. This is testament to its high validity and reliability. Research Design The researcher used the survey research design to gather information about the attitudes of the practitioners towards the use of EDS. Survey research is the use of standardized questionnaires and interviews to collect data about participants, their views, thoughts, preferences and behaviors (Bhattacharjee, 2012). All the 50 participants received a standardized questionnaire with the Likert scale helping to operationalize the various variables in use. The use of the questionnaire design was especially useful considering the bulk of the results the researcher would have to sort through, and the time constraints for the participants, who were taking time off their busy schedules to participate in the process. Procedures Every participant in the process received the questionnaire via mail, completed it and sent it back. Every participant was promised the chance to win a holiday through a lottery which they entered when they agreed to participate in the study. The researcher followed up with the participants through phone calls and emails, and was able to answer questions about the nature of the survey and how to fill in questions. Responses were collected and the results tallied after a two week period. There were 80 participants targeted but only 50 were included in the final tally for various reasons. The 30 excluded were non-respondents, those that changed their minds for various reasons, including time constraints, fear of possible repercussions and personal/religious reasons. Data Analysis The research questions and hypotheses were as follows. Research question 1: What are the attitudes of multidisciplinary teams to the introduction of EDS to postpartum units in the hospitals of Saudi Arabia? Hypothesis 1: Negative attitudes towards the EDS result in negative health outcomes within the post-partum unit Hypothesis 2: Attitudes towards the use of EDS in the measurement of post-partum depression in Saudi Arabia are negative To measure the attitudes and present them quantitatively, the researchers used the Likert scale, with items scored as follows: 0, strongly disagree; 1, disagree; 2, agree; 3, strongly agree. The alpha levels to test significance will be 95 percent. Results Majority of the participants were female, with 18 male and 32 female respondents. The mean age was 35.1 years old, and the median age 33.5. Statistical Analysis In general, the data showed that attitudes towards use of EDS were skewed towards being negative. Attribute Number male 18 female 32 total 50 mean 35.1 median 33.5 Discussion While EDS is an excellent tool for depression screening, the results show that due to various barriers, attitudes towards its use in the Saudi Arabian context are generally affected negatively. The practitioners, for instance, have to deal with time constraints, the need to prioritize other elements of care in post-partum situations, patients suffering from stigma and not wanting to acknowledge depression, negative societal attitudes and the legal liability aspects. This therefore affects the likelihood of depression being accurately identified and diagnosed, and eventually affects the health outcomes. This is consistent with the literature and general trends in dealing with mental health in Saudi Arabia. Limitations One of the biggest limitations was the fact that this research was self-administered and a rigid questionnaire. First, there were no ways through which the researcher could gauge the truthfulness of the responses. Secondly, the rigid nature of the questionnaire makes it difficult to provide contextual information. Recommendations for Future Research The researcher only looked at the attitudes of the healthcare teams in as much as they are affected by various barriers. A possible future direction of research could be on the influence of system barriers to the use of EDS in the larger healthcare system. References Read More