The Effects of Sense of Belonging, Social Support, Conflict, and Loneliness on Depression - Essay Example

Anand P.S.Brahmanand ID 5283 Order # 29 September 2006 The Effects of Sense of Belonging, Social Support, Conflict, and Loneliness on Depression by Bonnie Hagerty and Reg Williams, Nursing Research, Jul/Aug 1999 Vol 48, No4 1. Is there a clearly stated purpose of the study Problem statement. Yes. The purpose of the study was clearly stated as to examine the model of effects of the interpersonal phenomena of sense of belonging, social support, loneliness, and conflict on depression, and to describe the predictive value of sense of belonging for depression in the context of other interpersonal phenomenon. Problem statement was not clearly stated but it is reflected as the number of inter personal phenomena affect the depression and the understanding is really complicated. 2. When examining the literature review, review the following: a. Are previous studies and/or theories described Yes. Several studies conducted on the relation of inter personal relations with depression were reviewed. To mention a few, the specific relation between depression and loneliness by Weiss (1974) Bragg (1979), relation between depression and emotional loneliness (Russell, Cutrona, Rose and Yurko, 1984), relation between loneliness and deficits of sense of belonging by Hagerry et al., (1992). b. Are the references current (Number of sources in last 5 years10 years The references are not very recent as far as the time of publication of this research paper is concerned (1999). The most recent reference quoted it self is from 1996. Only five references are mentioned which were published in the last five years. Similarly fifteen references (including the above mentioned five) were mentioned in the last ten years of publication year. c. Is there a clear description about what is known and not known) about the research problem Yes. The author explained that several research studies have been conducted in effect of biological factors on depression. Lot of researchers worked on effect of sense of belonging on depression. Similarly some researchers worked on relation between loneliness and depression. However clarity has not been developed on psychological factors affecting depression. Similarly there has been little research information available on the extent to which the belonging, social support, loneliness and conflict are predictive of depression. 3. Examine the study framework or theoretical perspective. a. Is the framework explicitly expressed or must the reviewer extract the framework from implicit statements in the literature review No. There has been no organized frame work for explicit expression of interconnection of inter personal processes and depression. The literature supporting the implicit expression of interconnection of inter personal processes and depression was reviewed in this research paper. b. Is the framework based on scientific, substantive, or tentative theory The frame work is based on scientific theories. Several researchers have come up with different scientific theories on depression which has formed the base for this frame work. Similarly the statistical path analysis is also a scientifically valid theory which has been used by the author for the present study. c. Does the framework identify, define, and describe relationships among the concepts of interest Yes. It defines the relationships among the concepts of interest i.e. depression and sense of belonging, loneliness and conflict. Path analysis with multiple regression model and correlation has been conducted for better description of relationship among the concepts of interest. d. How is the framework related to the body of knowledge in nursing By predicting the interpersonal theories contribution to depression, nursing will utilize this information for curing psychologically depressed patients effectively. Nursing will control those positive factors affecting the depression and will try to enhance those qualities negatively influencing depression. 4. Are there any research objectives, questions, or hypotheses Yes. The research objectives are as follows: a. To examine the model of effects of the interpersonal phenomena of sense of belonging, social support, loneliness, and conflict on depression, and b. to describe the predictive value of sense of belonging for depression in the context of other interpersonal phenomenon. 5. Identify and describe (conceptually and operationally) the major study variables. Identify the study variables by examining the purpose, the objectives, questions, or hypotheses, and the results section of the research article. Identify the type of each variable (independent, dependent, or research) and define each variable. a. Independent variables: Identify and define conceptually and operationally Type of subject (depressed client or community college student) is taken as independent variable or fixed variable. Age of the client, gender, educational level, annual household income and ethnic background of the clients. Age varied between 21 to 75 years in case of depressed clients and 18-72 in case of community college students. Gender: Women constituted 64.5% and 59% in depressed clients and college students respectively. b. Dependent variables: Identify and define conceptually and operationally Social support, conflict and sense of belonging antecedents were taken as dependent variables. c. Research variables: Identify and define conceptually and operationally Beck Depression Inventory (BDI), Sense of belonging Instrument (SOBI) The revised ULCA Loneliness Scale (RULS) and Interpersonal relationships inventory (IRI) are research variables. BDI (Beck Depression Inventory) is developed by self report measurement of the severity of depression i.e. affective, cognitive, motivational and psychomotor expressions. SOBI-P (Sense of Belonging Instrument - Psychological) and SOBI-A (Sense of Belonging Instrument-Antecedents) were developed by 18 item and 15 item self report measurements scored on 4-point Likert scale ranging from strongly agree to strongly disagree. RULS (Revised UCLA Loneliness Scale) was developed by 20-item self report measure. IRI (Interpersonal Relationships Inventory) has two components. 1. Social support component of IRI was developed by 13-item self report Likert scale. 2. Conflict component of IRI was developed by 13-item self report measurement of Likert scale. GIQ (General Information Questionnaire) was developed by compiling the demographic information about the participants like age, marital status, educational level, gender, annual household income, religious preference and ethnic background. 6. Identify attributes/demographic variables. The age, gender, marital status, education level, annual household income, religious performance and ethnic back ground of the depressed client and community college students are the identified demographic variables. 7. Describe the research design. a. Identify the specific design of the study. A partially ordered path model was developed for conducting this study on effect of sense of belonging, social support, conflict and loneliness on depression. b. Identify the treatment or intervention if appropriate for the type of study conducted. Different subjects having varied levels of interpersonal characteristics such as sense of beloning, social support, conflict and loneliness were measured under some indices such as BDI, SOBI, RULS and IRI are the treatment was given to clients mainly with medication for biological depression. c. How were subjects assigned to groups if groups were studied The subjects were assigned in two main groups: 1. Depressed clients 2. Community college students They were further divided in to two sub groups: A. Based on gender (Male and Female) B. Based on married status (married and Unmarried) d. Were pilot study findings used to design this study If yes, briefly discuss the pilot and the changes made in this study based on the pilot. The pilot project on study of effect of diagnosis for 31 depressed clients was conducted and the data was also collected from 379 community college students. The findings of this pilot study were used to design this study. Two sub groups in both the groups i.e. male and female and married and unmarried were designed for collection of data. 8. Describe the sample and setting. a. Identify inclusion and exclusion sample criteria. Inclusion criteria are : 1.Type of subject 2. Gender : Male / Female 3. Married status : married or single 4. Age: 21-75 (For depressed clients) 18-72 (For community college students) Exclusion sample criteria: Depression factors : 1.Sense of belonging 2.Conflict 3.Loneliness b. Indicate the method used to obtain the sample. The general information questionnaire (GIQ) has been used to collect the sample for demographic characteristics. The data on different variables were fed in to model (path model). c. State the sample size. Indicate if a power analysis was conducted to determine the sample size. The total sample size is 410 and the size of the first sample is 31 for depressed clients and the sample ranged from 21 years to 75 years with Mean sampling age of 38.8 years. Another sample of 379 community college students rabged from 18 to 72 years with a mean sampling age of 26 years. No reference was given for power analysis in determination of sample size. Identify the refusal to participate number and percentage. No reference was given relating to the number of clients refused to participate in the study. d. Identify the characteristics of the sample. The sample is mainly two types. 1. Depressed clients and 2. Community college students and both have variation in their characteristics. For example the range of age for first category is 21-75 years where as it is 18-72 years for the second category. Similarly the percentage of women in higher in the first category (64.5%) than the second category (59%). 51% of the first sample are married where as it is only 32% in case of second category sample. e. Identify the sample mortality (or attrition) number and percentage. The mortality rate was not mentioned in this paper. f. Indicate the type of consent obtained and institutional review board approval. It is mandatory to take consent from the institutional review board. However no reference was provided in this paper relating to this consent from Institutional review board. g. Identify the study setting and indicate if it is appropriate for the study purpose. The study setting included both inpatient wing and out patient wing at a Major Mid western Medical center. The inpatients were treated for major depression and were supplied with questionnaire for answering. The out patients and college students were also distributed the questionnaire. The sample consists of mainly educated group who answer the questions more accurately aiding the perfection of this study. Hence it is more apropriate for the present study. 9. Describe the measurement instrument used in the study with the following guidelines: a. Identify the type of each measurement strategy (i.e. Likert scale, visual analog scale, physiological Measure, questionnaire, observation, or interview). Likert scale and questionnaire were mainly used as measurement strategies. SOBI-P, SOBI-A, RULS and IRI are self report measures scored on Likert scale. GIQ has been used for collection of demographic information. Identify the level of measurement (nominal, ordinal, interval/ratio) achieved by each measurement strategy. In case of BDI there is an ordinal level of measurement i.e. the extent of depression imply a rank order a. Affective b. Cognitive c. Motivational and d. Psychomotor expressions In case of SOBI-P and SOBI-A 4-point likert scale reflects an interval level of measurement where the variables are given numbers and ranks but the interval between the two numbers will be same. In case of other instruments such as RULS and IRI also interval level of measurement in the form of likert scale is found. c. Discuss how the instrument was developed or purpose of use. BDI (Beck Depression Inventory) is developed by self report measurement of the severity of depression i.e. affective, cognitive, motivational and psychomotor expressions. SOBI-P (Sense of Belonging Instrument - Psychological) and SOBI-A (Sense of Belonging Instrument-Antecedents) were developed by 18 item and 15 item self report measurements scored on 4-point Likert scale ranging from strongly agree to strongly disagree. RULS (Revised UCLA Loneliness Scale) was developed by 20-item self report measure. IRI (Interpersonal Relationships Inventory) has two components. 1. Social support component of IRI was developed by 13-item self report Likert scale. 2. Conflict component of IRI was developed by 13-item self report measurement of Likert scale. GIQ (General Information Questionnaire) was developed by compiling the demographic information about the participants like age, marital status, educational level, gender, annual household income, religious preference and ethnic background. d. Report the reliability of each instrument from previous studies and the current study. BDI has good to excellent reliability SOBI-P and SOBI-A has test reliability of 0.84 and 0.66 respectively. RULS has strong reliability with alpha value of 0.93 IRI-social support has strong reliability with alpha value of 0.93. IRI-conflict has good reliability with an alpha value of 0.87. e. Report the validity of each instrument from previous studies and the current study. BDI has strong concurrent validity and has significant correlation with number of other measures of depression. Construct validity was found with SOBI-P and SOBI-A. RULS was reported to have construct, concurrent and discriminant validity according to the previous results (Russel, Pepian and Cutrona, 1980). IRI-social support has content and construct validity (Tilden et. Al., 1990) and IRI-conflict also has content and construct validity (Tilden et. al., 1990). 10. Describe the procedures for data collection. a. If appropriate, identify the intervention protocol. While formulating the questionnaires for data collection the intervention protocol is important to collect the relevant data from the clients and screen the symptoms in such a manner that the treatment for depression would be more effective. Clients with more extent of depression can be screened through this for effective treatment. b. Detail how the data were collected. The data were collected by using General Information Questionnaire (GIQ). Inpatient clients submitted the questionnaire by email or was collected by the researchers. Out patient clients who were invited by posted advertisements and psychotherapist referrals submitted their questionnaire by mail. Community college students who were invited through class room interaction and posted announcement submitted their qustionnaire directly to the researchers. 11. Describe the statistical analyses used, if any. a. List the statistical procedures used to describe the sample. Step wise multiple regression model and correlation and normal distribution studies were used as statistical tools. b. Was the level of significance or alpha identified and if so, indicate what it was (.05, .01, or .001). Beta (is a type-II error and the probability that a statistical test will generate a false negative error) was identified (alpha is a type-I error). The model between interpersonal experiences and depression has shown a Beta value of -0.04. The Beta value for the relationship between social support and depression was also 0.04. Complete the table below with the analysis techniques conducted in the study: 1) Identify the focus (description, relationships, or differences) of each analysis technique. 2) List the statistical procedures. 3) List the statistics. 4) Identify specific results. 5) Provide specific probability value (p= ) in a table as shown next. Path analysis model Positive or negative Beta value T tvalue P value Relation between interpersonal experiences and depression Both -0.04 0.79 0.43 Relation between social support and depression Negative -0.04 0.84 0.40 Purpose of Analysis Statistical Procedure Statistic Result Probability (p) : It will give the percentage value of probability at which the statistical significance between two variables is erroneous or invalid. Difference between males & females on blood pressure t-test t 3.75 p = .04 The difference in t value for blood pressure between male and female is significant with 4 % level of significance i.e 4 % chance for error. Difference between treatment & comparison groups on wt. loss Analysis of Variance F 5.79 p = .009 It indicates that there is a strong significance between treatment and comparison groups in terms of weight loss as the probability of error is only 0.9%. Relationship of pain perception & anxiety for adolescents Pearson Correlation r 0.56 p = .03 Frankly speaking the correlation coefficient value of 0.56 does not give much clarity as far as the relationship between pain perception and anxiety are concerned. The value of r should be atleast 0.6 or above to confirm the correlation. In terms of level of significance i.e. p value of 0.03, the accuracy of significance will be strong as the error percentage probability is only 3 %. 12. Describe the researcher's interpretation of findings. The findings can be summarized from the present study as follows: a. Variables in the form of interpersonal characteristics studied in this paper explained 64 % of the variance of depression which is quite appreciable. b. The type of the subject influenced the depression to a higher extent followed by psychological sense of belonging and loneliness. c. Social support affected other inter personal characteristics affecting depression but it had no direct effect on depression. d. Conflict has negatively affected the psychological sense of belonging which affects the depression significantly. 13. What study limitations were identified by the researcher The main limitation noticed in this study is that the depressed clients were mainly treated with medication for biological depressions such as sleeplessness but not with the interpersonal therapy. Even then the psychological sense of belonging has shown higher correlation with depression. This value or effect would have been more accurate had the clients treated with psychological therapy. The reason for non correlation between social support and depression was due to the fact that the depression was measured in the form of BDI which reflects mainly biological, affective, behavioural and cognitive symptoms. This could have been a more integrated measurement instrument for getting better accuracy. 14. How did the researcher generalize the findings Majority of the findings of this study are in conformity with the previous research results and hence the researcher has generalized some findings as follows: The influence of psychological sense of belonging on depression was also reported by Hagerty et al., 1996 (Low sense of belonging is correlated with strong extent of depression. Similarly the correlation between conflict and depression was revealed by the researcher in this study which is in tune with the findings of other researchers (Coyne & Bolger, 1990: Pitula & Daugherry, 1995). The lack of direct effect of social support on depression as revealed by the present study was supported by buffering theory of social support (Cohen and Wills, 1985). 15. What were the implications of the findings for nursing The results of the present study helped the researchers in nursing in coming up with better treatment and diagnosis for client suffering from depression. For example, the earlier course of diagnosis used to concentrate much on biological ways of depression treatment which was not very effective. Now the course of treatment is more integrated with incorporation of psychological ways as suggested by this study. As reported by the present study depression is mainly caused by low psychological sense of belonging, higher loneliness and higher conflict. Hence the nursing field concentrates on controlling factors of loneliness and conflict and motivational factors for psychological sense of belonging. 16. What suggestions for further study were identified There is a lot of scope and necessity to study the characteristics and predictors of sense of belonging and its role in positive interpersonal experience and mental health. Major studies were done on biological effects of depression where as very little research information is available on characteristics of interpersonal experiences affecting depression and identifying the prediction of each variable contributing depression. For getting better clarity on this aspect, intensification of more studies on same line have to be replicated. 17. Is the description of the study sufficiently clear to replication Yes. There is enough clarity in the methodology and results studied under this research paper. Standard measurement techniques were employed and optimum statistical tools were exercised and only necessity at this point of time is to intensify this study through replications. Read More