Health Problem Under Analysis
Cancer was once regarded as a health issue of the elderly, but it is now a significant health concern for younger people. When it comes to women’s health, breast cancer is one of the most serious health problems associated with various psychological and emotional issues. The most prevalent types of treatment include chemotherapy and surgery, which are associated with significant physical and emotional load (Ho, Rohan, Parent, Tager, & McKinley, 2015). It has been found that between 40% and 100% of women undergoing chemotherapy suffer from depression and anxiety (Taso et al., 2014). These patients’ psychological and emotional states have a significant impact on the healing process. Depression is often associated with fatigue, sleep disturbances, and the like, which prevents females from thinking positively and focusing on the treatment and its outcomes. Therefore, it is crucial to explore the major factors associated with the development of depression and, more importantly, to evaluate the existing programs aimed at addressing the issue under discussion. This evaluation will enable researchers and practitioners to come up with effective programs that will become successful solutions to the problem.
|Author, Title, & Year||Authors: |
Würtzen, H., Dalton, S., Elsass, P., Sumbundu, A., Steding-Jensen, M., & Karlsen, R., … Johansen, C.
Ho, S., Rohan, K., Parent, J., Tager, F., & McKinley, P.
Zhou, K., Li, X., Li, J., Liu, M., Dang, S., Wang, D., & Xin, X.
Taso, C., Lin, H., Lin, W., Chen, S., Huang, W., & Chen, S.
Rao, R., Raghuram, N., Nagendra, H., Usharani, M., Gopinath, K., & Diwakar, R., … Rao, N.
|Theoretical or Conceptual Framework||The authors employed cognitive and behavioral theory as well as Buddhist concepts and supportive-expressive therapy.||The cognitive and behavioral theoretical frameworks were employed.||The cognitive-behavioral approach was used due to the focus on females’ behavior and their cognitive processes (perception of music).||The conceptual framework used was associated with the ideas of body-mind connection and meditation.||The cognitive and behavioral conceptual frameworks were used.|
|Design / Method||A population-based randomized control study was carried out to assess the effectiveness of the intervention.||This longitudinal case study was conducted in 2001–2007 and 2005–2011. The participants completed self-report questionnaires.||A randomized controlled trial was the design employed. The control group received nursing care, while the intervention group received the same nursing care along with sessions of progressive muscle relaxation training and music therapy (twice a day).||A randomized controlled trial was used as the method. The intervention group patients received yoga training for over eight weeks. The levels of depression and anxiety in patients were assessed before and four and eight weeks after the end of the intervention.||Randomized controlled study design was used. The intervention group patients received a yoga intervention, while the control group patients received a common supportive-expressive intervention that implied the development of a cooperative and friendly environment.|
|Sample and Sample Size||Participants included 336 females, aged between 18 and 75 years, who had undergone surgery for breast cancer (stage I–III) within 3–18 months.||The participants were 67 postmenopausal females aged between 45 and 70 years treated with surgery and 67 women aged 21–50 who received chemotherapy.||The setting was the breast surgical department of an oncology center in China. Participants comprised 170 females aged between 25 and 65 who had breast cancer and were to have a radical mastectomy.||The participants were females who received treatment at a medical center in Taiwan. There were 60 females aged 20 to 70 who had had breast cancer surgery over one month before the start of the study, never did yoga, and agreed to participate.||A total of 62 females aged 30 to 70 years, diagnosed with breast cancer and who had arranged to undergo breast surgery, participated in the research.|
|Independent and Dependent Variables||Independent variables: |
The major independent variables were the intervention and health conditions of the participants.
The dependent variables:
|The dependent variables: |
The level of depression, sleep disturbances, and fatigue were the dependent variables.
|Independent variables: The major independent variables were health conditions and treatment. |
The dependent variables:
|Independent variables: The independent variables were health conditions and treatment. |
The dependent variables:
|Independent variables: The independent variables were the treatment and health conditions. |
The dependent variables:
|Measurement: Instruments and Tools||The measurements used were the Danish version of the Symptom Checklist -90-r (five-point scales), 20-item Center for Epidemiological Studies-Depression scale.||The following measures were used: Beck Depression Inventory®—Second Edition, Hospital Anxiety, and Depression Scale, Multidimensional Fatigue Symptom Inventory—Short Form, Pittsburgh Sleep Quality Index.||The researchers used the Zung self-rating depression scale and state anxiety inventory.||The following measures were used: profile of mood state (developed by McNair, Lorr, & Droppleman) and brief fatigue inventory (developed by Mendoza and colleagues).||The following measurements were used: Beck’s Depression Inventory and Subjective symptom checklist.|
|Data Analysis||T-tests were the major data analysis tools. The participants completed surveys within 2, 6, and 12 months after the start of the intervention.||Descriptive statistics and path analysis were used to develop associations models. Mplus v 6.11 was used to test the models.||The following statistical tools were used: SPSS 20.0, t-test and chi-square test, and a linear model with univariate analysis.||The researchers used such statistical tools as the SPSS 17.0, descriptive statistics (applied to the analysis of the demographic data), chi-square and t-tests, and ANOVA and Johnson-Neyman method.||Such statistical tools as SPSS 20.0, mean scores, ANCOVA, and simple Pearson correlation were employed.|
|Findings||A medium-to-large impact was identified in the intervention groups 12 months after the start of the program.||The results show that depression, sleep disturbances, and fatigue form a cluster. Fatigue is seen as a preceding symptom that should be properly treated.||The intervention has proved to be effective since patients from the intervention group had a shorter hospital stay (approximately 13 days compared to the 17-day stay of control group patients). The intervention group patients also had lower levels of anxiety and depression (approximately 20 (in the intervention group) compared to 6 in the control group).||After the completion of the intervention, 75% of the participants had lower levels of fatigue compared to the results reported by control-group patients. The intervention did not affect the level of depression.||A decrease in the level of depression was apparent in both groups, but it was more significant in the intervention group after surgery.|
|Strengths / Limitations||Strengths: a large sample, sound measurement, and statistical tools. |
Weaknesses: no attention to ethnicity. Similar programs can be beneficial for patients in other countries.
|Strengths: longitudinal design, analysis of factors. |
Weaknesses: quite a small sample, no attention to ethnicity. The findings should be used when developing interventions.
|Strengths: sound measurement and analytical tools. |
Weaknesses: small and quite homogenous sample. The therapy evaluated can be used in a US clinical context.
|Strengths: reliable analytical tools and measurement. |
Weaknesses: small sample. The study is valuable as it proves that yoga can only be a component of an intervention.
|Strengths: appropriate research design, sound measurements, and analytical tools. |
Weaknesses: small sample. The findings prove that yoga can be a part of an intervention.
The health issue under analysis is a depression in females diagnosed with breast cancer. The prevalence of depressive symptoms in females suffering from breast cancer ranges from 4% to almost 60% (Rao et al., 2015). The reviewed articles provide quantitative data regarding the effects that different types of interventions have on depression in the population under consideration, as well as some factors that lead to the development of depression in the target population. The analysis of these studies can help practitioners and scholars develop and assess the effectiveness of interventions aimed at reducing the level of depression in the target population. Only one of the articles was a longitudinal study, while the rest of the sources were randomized controlled trial studies. The cognitive and behavioral approaches were the major conceptual frameworks employed.
Regarding some factors affecting the development of depression and anxiety among females suffering from breast cancer, fatigue, and sleep disturbances are influential predictors of depressive symptoms (Ho et al., 2015). The effectiveness of the different interventions varied in the studies under analysis. For example, Würtzen et al. (2013) claim that an intervention including training on meditation, stress management, yoga, and integration of mindfulness into patients’ everyday life is effective. Zhou et al. (2015) state that an intervention involving training sessions on progressive muscle relaxation and music therapy is effective when treating depression in the target population.
Interestingly, the effectiveness of yoga-based interventions needs further exploration as two studies reviewed to provide quite opposite results. For instance, Taso et al. (2014) note that an intervention involving yoga training had an apparent effect on the level of fatigue, which was reduced after the completion of the intervention, but it had no significant impact on depressive symptoms in the target population. Nevertheless, Rao et al. (2015) emphasize that yoga-based interventions can be effective as the results of their study reveal the positive effects of such an intervention on females’ psychological state.
The studies in question are characterized by high validity and reliability. The researchers used sound measurements and statistical tools. T-tests and chi-square tests were common statistical tools. The authors also tended to use software (such as SPSS or ANOVA). At the same time, the studies in question have certain limitations. First, the sample size is rather small in all the studies. This can hurt the generalizability of data. Moreover, the population was quite homogeneous as females of some ethnicities participated in the studies, and this can also negatively affect the generalizability of the studies.
In conclusion, it is necessary to note that the articles under analysis provide valuable information that can be used in developing and evaluating interventions aimed at decreasing depressive symptoms in females diagnosed with breast cancer. Depression is often associated with other symptoms and health issues that must be addressed. It is also evident that effective interventions can include certain physical training associated with developing stress management skills and mindfulness, as well as music therapy. However, the effects of yoga need further research. It is also necessary to take into account such variables as ethnicity, age, socio-economic status of the participants, and the like, as they can affect the results.
Therefore, further research should address several areas. First, the diverse American society needs the healthcare system that can address different patients’ issues effectively. It is important to implement an in-depth analysis of factors influencing the development of depression including biological, physiological, cultural, socioeconomic, etc. Another direction is associated with the evaluation of various treatment programs used in the clinical setting. Again, considerable attention should be paid to such peculiarities as culture, ethnicity, age, employment, socioeconomic and marital status, and so on. The role of nurses in the implementation process and their preparedness should also be assessed.
Ho, S., Rohan, K., Parent, J., Tager, F., & McKinley, P. (2015). A longitudinal study of depression, fatigue, and sleep disturbances as a symptom cluster in women with breast cancer. Journal of Pain and Symptom Management, 49(4), 707-715.
Rao, R., Raghuram, N., Nagendra, H., Usharani, M., Gopinath, K., & Diwakar, R., … Rao, N. (2015). Effects of an integrated yoga program on self-reported depression scores in breast cancer patients undergoing conventional treatment: A randomized controlled trial. Indian Journal of Palliative Care, 21(2), 174-181.
Taso, C., Lin, H., Lin, W., Chen, S., Huang, W., & Chen, S. (2014). The effect of yoga exercise on improving depression, anxiety, and fatigue in women with breast cancer. Journal of Nursing Research, 22(3), 155-164.
Würtzen, H., Dalton, S., Elsass, P., Sumbundu, A., Steding-Jensen, M., & Karlsen, R., … Johansen, C. (2013). Mindfulness significantly reduces self-reported levels of anxiety and depression: Results of a randomised controlled trial among 336 Danish women treated for stage I–III breast cancer. European Journal of Cancer, 49(6), 1365-1373.
Zhou, K., Li, X., Li, J., Liu, M., Dang, S., Wang, D., & Xin, X. (2015). A clinical randomized controlled trial of music therapy and progressive muscle relaxation training in female breast cancer patients after radical mastectomy: Results on depression, anxiety and length of hospital stay. European Journal of Oncology Nursing, 19(1), 54-59.