Critical Analysis Of Qualitative Research On Depression

Methodology

Critical Examination Of Research Rigour From Qualitative Literature

Major depressive disorder or depression is a mood disorder that is primarily characterized by a persistent low mood, a loss of interest in pleasurable activities and a feeling of sadness. In other words, it can be defined as a state of aversion and low mood that most often creates a negative impact on the behaviour, thoughts, feelings, and wellbeing of the affected person (Chukhraev, Vladimirov, Zukow, Chukhraiyeva & Levkovskaya, 2017). There are different forms of depression namely, persistent depressive disorder, postpartum depression, seasonal affective disorder, and psychotic depression. There is mounting evidence to support the alterations that occur in different regions of the brain upon the onset of depression (Schmaal et al., 2016). Depression has been found to create an impact on the personal relationships, work life, eating habits, sleep patterns and overall functioning of a person (Fried, Epskamp, Nesse, Tuerlinckx & Borsboom, 2016). Furthermore, depression also makes people ruminate and preoccupies over feelings and thoughts of inappropriate guilt, worthlessness, and regret. The report aims to critically appraise three qualitative articles on depression, in order to assess their strength, rigour, and weaknesses.  

The aim of the research was to explore the views of participants suffering from depression on a behavioural activation treatment that was based on use of smartphones. Ly et al., (2015) selected a qualitative follow-up as the main methodological agenda. Follow-up studies have been found to enhance the meaningfulness and interpretability of already existing data. The authors employed a strategic selection strategy for recruiting 12 person who had earlier participated in the original quantitative study, via advertisements and mass media. Interviews were the primary data collection method that were further analysed in the form of specific data patterns or themes namely, treatment, commitment and absence of important components.

Follow-up procedures are most often conducted simultaneously with a research. However, conducting the follow-up study afterwards was also an accurate methodological approach since their key benefits can be attributed to an increase in the overall efficiency of a research study. Furthermore, conduction of a follow-up study also helps in fulfilling research promises, reviewing fresh developments and ensuring that all project milestones are met accordingly (Pathak et al., 2015). These factors establish the appropriateness of the research design. Although the sampling method was accurate in recruitment of most participants who had earlier been enrolled in the research, the data collection method had some discrepancies. Interviews have been identified as major data collection methods since they facilitate the process of obtaining in depth information about the perceptions, opinions and feelings of participants, since they allow the incorporation of detailed questions. Another advantage of conducting interviews was that they assist in gaining a high response rate.

Results and Discussion

However, the interview was conducted over telephone, that prevented asking questions of complex natures (Lewis, 2015). Furthermore, the body language of the participants cannot be assessed during telephonic conversations, thereby preventing proper understanding of the responses. This might have accounted to a lack of reliability of the findings (Farooq & de Villiers, 2017). Although the researchers allowed the patients to present their opinions, they did so after six months of receiving the treatment, which had the potential of recall bias due to inaccuracy or incomplete recollections of the past experiences or events by the participants (Stone, Shiffman & Shields, 2016). Moreover, small sample size is often associated with less accurate results since they get decreasingly demonstrative of the total patient population (Malterud, Siersma & Guassora, 2016). This in turn also affected reliability of the interview results that resulted in increased variability, which also contributed to a bias. Another major disadvantage of the study was that it was related to voluntary response bias that is intricately linked with small sample size.

Boggs et al., (2014) conducted the study with the aim of determining the experiences of participants subjected to Mindful Mood Balance (MMB), a web-based intervention, for reducing depressive symptoms. The authors based their research on MBCT that has been identified as an essential approach for lessening the depression severity and avoiding relapse of the mental disorder (Gu, Strauss, Bond & Cavanagh, 2015). The participants were selected from behavioural medical settings and primary care units, based on their ability to meet certain pre-determined inclusion criteria. The study design was based upon interviews that focused on different areas such as, MMB website components, ways by which it hindered or facilitated home practises, clarity, quantity, and quality, among others. Data analysis was performed by organising the interview responses into four themes.

The researchers were accurate in recognising the role of mindfulness-based cognitive therapy that has gained attention as an effective psychotherapeutic approach, originally developed for the treatment and management of symptoms associated with depression. Although the recruitment costs and efforts were low, adoption of a homogenous sampling model was not accurate since it failed to produce an estimate of a generalizable target population. One probable disadvantage of recruiting Kaiser Permanente Colorado members was that it might have led to over-representation of that group. It was also associated with an inherent bias of likely being unrepresentative of the target population being studied (Etikan, Musa & Alkassim, 2016). Interviews have been identified to confer a range of potential advantages such as, quick collection of research responses, sufficient audience for collecting representative sample, and presence of a personal touch. Moreover, the data collection method was also cost-effective, when compared to in-person interviews. Despite the advantages, telephonic interviews are often negatively received by respondents, and result in a failure to understand the feelings and expressions of the participants (Hofisi, Hofisi & Mago, 2014).

Strength and Weaknesses of Studies

Another drawback of the study can be attributed to failure of the researchers in obtaining feedback from the non-completers, except one, thereby contributing to representativeness bias. Furthermore, collection of feedback shortly after implementation of the MMB program, thereby resulting in a failure to establish the credibility of the findings in the long run. Conducting an interview of the participants during a follow-up period of three or four months was an essential prerequisite in establishing credibility of the findings. This would have helped in determining or monitoring success of the MMB program in the long run.

The study was conducted by Kingstone et al., (2017) to discover the views and perceptions of third sector workers and older adults about depression and anxiety, with the aim of designing a community-based psychosocial intervention. The researchers employed the use of semi-structured interviews that was conducted among participants who were recruited by the process of purposive sampling. Upon conducting the interview, the responses were transcribed verbatim and categorised into different themes namely, the different types of loss, personal burden of mental illness, courage and encouragement, group activity values and self-worth, among others.

One major advantage of the research was that the authors were successful in addressing a clearly focused question related to depression and anxiety among older people. This was consistent with other findings that have established a correlation between chronic stress and depression among adult people (Klainin-Yobas, Oo, Suzanne Yew & Lau, 2015). The procedure of purposive sampling was advantageous owing to the fact that it assisted the researchers in reaching the target sample at a rapid pace and usually encompasses a wide array of sampling techniques such as, homogenous sampling, expert sampling, and critical case sampling (Palinkas et al., 2015). However, major drawbacks of the sample recruitment procedure were related to its increased risk to researcher bias. Since the sampling was based on the researchers, it might have resulted in bias, thereby reducing the validity of the data (Robinson, 2014). In addition, it also resulted in a difficulty in defending the overall representativeness of the selected sample. Semi-structured interviews have been found particularly useful in qualitative research due to the fact that they allow generation of huge amount of data in details, are reliable and can be analysed easily.  

However, since the interviews largely depended on the skills of the researchers and their articulacy of the participants, there might have been some discrepancy in the responses (Kallio, Pietilä, Johnson & Kangasniemi, 2016). Furthermore, the researchers are also prone to demonstrate unconscious cues or signals that guide participants from providing answers that are expected of them. Another major disadvantage of the data collection technique can be attributed to its difficulty in analysing qualitative information. This might have also contributed to a lack of validity due to the lack of way to determine the authenticity of the responses (Leung, 2015). Absence of a male perspective was directly responsible for a bias in the results, thereby restricting the generalisation of the findings.

Conclusion

Conclusion

To conclude, the research questions were adequately addressed by the researchers in all the three studies. However, the major weakness of all the researches was in the data collection and sampling procedure. Sampling commonly refers to the way by which a representative group is selected from a larger population that is being investigated.  Thus, samples comprise of a group of individuals who participate in an investigation. However, the methods employed by all the researchers had the potential of contributing to a sampling bias. This is referred to as a situation where the representative population is collected in a manner that some people of the target population show a reduced likelihood of being included, when compared to others.

Two essential steps that could have been taken in order to prevent such bias are (a) avoiding convenience or purposive sampling, and (b) ensuring that the target population was defined properly (Roulston & Shelton, 2015). Another drawback was related to data collection over telephonic interviews in two of the studies, which if replaced by focus groups or direct structured interviews, would have prevented bias in the responses, by facilitating more direct personal interaction. The article by Kingstone et al., (2017) is a good piece of evidence as it addressed the essential components required for formulation of a psychosocial intervention. Hence, all the studies providing an insight into different aspects of depressive disorder. 

References

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Chukhraev, N., Vladimirov, A., Zukow, W., Chukhraiyeva, O., & Levkovskaya, V. (2017). Combined physiotherapy of anxiety and depression disorders in dorsopathy patients. Journal of Physical Education and Sport, 17(1), 414. DOI:10.7752/jpes.2017.01061

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