Doctor
ABSTRACT
Young people in the United States are battling depression in record numbers, reaching an all-time high of 3 million patients in 2015. Researchers are continuing to search for alternative or additional methods than therapy and medications to improve depressive symptoms in teenagers and young adults. Some studies have demonstrated that as possible option in easing depression is physical exercise. In addition to assisting mental health issues, exercise promotes social interaction, physical health, and appearance. However, research has focused primarily on adults and therefore additional studies are needed with focus on the impact of exercise on depression in young people. The purpose of this study is to identify the impact of environmental, socioeconomic, and genetic influences on depression in American youth and to assist in future research on the topic of physical exercise as a therapeutic option. Multiple factors influencing frequency and levels of depression in young American people include gender, family socioeconomic status, race, education, religion, and others. The key research questions are the relationship between physical exercise, genetics, socioeconomic status, and environmental factors with depression in adolescent Americans. A number of different databases will be used to place the information gathered into various categories in a quantitative research design for statistical regression analysis with participants categorized by independent and dependent variables. The research method is a collection of secondary research data. For mental health clinicians to develop effective therapeutic strategies, it is necessary to additional research to address environmental and genetic effects on depression in young people, including the effect of physical exercise.
List of Tables v
Chapter 1: Introduction 1
Background 1
1.2. Problem Statement 4
1.3. Purpose of the Study 4
1.4. Research Questions and Hypothesis 5
1.5. Theoretical Base 6
1.6. Nature of the Study 9
1.7. Conceptual Definitions 10
1.8. Assumptions and Limitations 10
1.9. Delimitations 11
1.10. Significance of the Study 11
1.11. Implications for Social Change 12
1.12. Summary 13
Chapter 2: Literature Review 15
2.1 Introduction 15
2.2 Literature Search Strategy 15
2.3 Theoretical Foundations 16
Chapter 3: Research Method 19
3.1. Introduction 19
3.2. Research Design and Rationale 19
3.3. Research Questions and Hypothesis 20
3.3.1. Research Hypothesis 20
3.3.2. Research Questions 21
3.4. Study Population and Sample Size 21
3.5. Data Methods 22
3.6. Variables 23
3.7. Inclusions and Exclusion Criteria 25
3.8. Data Analysis Plan 25
3.9. Threats to Validity 28
3.10. Threats to Participation Rights 28
3.11. Summary 28
Chapter 4: Results 30
4.1. First Heading 30
Chapter 5: Discussion, Conclusions, and Recommendations 31
5.1. First Heading 31
References 32
Appendix A: Title 40
List of Tables
Chapter 1: Introduction
Background
Depression is considered the most commonly observed mental mood disorder and is defined as an emotional state of intense and persistent sadness (Mutrie, 2000). Episodes of mild sadness are experienced by everyone, but depression consists of long-term periods, endless bad mood, feelings of hopelessness, and a lack of satisfaction. Mood disorders (formerly known as affective disorders) include a wide range in the category of disorders, including the clinical picture of pathological mood and concomitant disorders. Examples of mood disorders are depression, euphoria, and anger (Taylor, 1999). Major mood disorders are common in the general population; patients experience primarily a pathologically persistent and extremely depressed mood that may be alternated with an excessively pathologic euphoric mood, as in the case of bipolar disorder (Reinecke & Davison, 2002). Mood disorders are accompanied by several signs and symptoms that affect all the functional areas (Reinecke & Davison, 2002; Taylor, 1999).
According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) by the American Psychiatric Association, mood disorders are divided into categories of: a) major depressive disorder, b) dysthymic disorder, c) depressive disorder not otherwise specified, d) bipolar disorder, e) cyclothymic disorder, f) bipolar disorder not otherwise specified, g) mood disorder due to a general medical condition, and h) substance-induced mood disorder (American Psychiatric Association, 2000). Today, depression is one of the most common diseases in the mental health sector (Kessler et al., 2003). Marginalized for decades, it has only recently been perceived by both the scientific community and the stakeholders for its propagation range in the societies of the developed and developing countries. The incidence of depression among the entire population around the world is estimated at 350 million people ("Depression," 2016). It is considered the most widespread mental illness in the United States, affecting approximately 40 million adults, about 18 percent of the country’s population (Kessler, Chiu, Demler, & Walters, 2005). In 2014, it was estimated about 15.7 million, or 6.7 percent, of adults in the U.S. have had at least one incidence of major depression in the previous year, while the number of patients at a lifetime risk of experiencing major depression is at approximately seventeen percent (Center for Behavioral Health Statistics and Quality, 2015).
Statistics in respect to the country’s young population make depression the most common mental illness in particular age ranges (Bose, Hedden, Lipari, & Park-Lee, 2016). In 2015, around 3 million adolescents, or twelve percent of the total age group between the ages of 12 to 17, had at least one incidence of major depression in the previous year reaching an all-time high in comparison to the period between 2004-2014; about 8.8 percent of the age group experienced a major depression episode with severe impairment. Major depression episodes presented a higher percentage of female adolescents with 19.5 percent compared to 5.8 percent for males. Of adolescents aged 15, about 16.1 percent reported a major depressive episode and if a teenager had two or more ethnic races in their family, the number was 16.6 percent. Of the number of reported episodes in 12.5 percent of the population, the teens who received treatment numbered 39.3 percent or 1.2 million young people.
The statistics become even more important when it is considered that very often depression is confused with mere feelings of sadness or frustration related to various events from daily life (Barker, 1992). The oversight results in underestimating depression’s seriousness in depressed people who do not realize they suffer from a mental illness. It allows for a cycle to begin, resulting in patients with depression sometimes finding it difficult to recover without the help of specialists within the field of mental health (Graham, 2010).
For many years, experts in the mental-health field have prescribed medication as the primary means to combat depression. Psychomotor therapy is the systematic use of motor skills and of the experiences emanating from them in order to positively influence a patient’s psychomotor personality; the therapy paved the way to the use of alternative practices exclusively or in coordination with psychiatric drugs and is now used frequently to address depression (Knapen et al., 2003). However, in recent years the relationship between mental health and physical exercise has drawn attention to other therapies aside from medications or psychomotor therapy. It is now proven that physical exercise can be very effective in the treatment of depression, which by many is considered to hold superiority over antidepressant medication (Bartholomew, Morisson, & Ciccolo, 2005; Blumenthal et al., 2007;Bodin & Martinsen, 2004; Craft, 2005; Craft & Perna, 2004; Carta et al., 2008; Knapen et al., 2003; Martinsen, Medhus, & Sandvik, 1985; Ossip-Klein et al., 1989; Singh et al., 2005; Singh, Clements, & Fiatarone, 1997; Stein & Motta, 1992). It is believed by many that intense exercise may temporarily reduce depressive symptoms and improve mood, and the relationship between physical activity and depression in most findings reveals contrasting outcomes.
Some studies have addressed the theory that exercise increases the production of serotonin, decreasing depressive symptoms (Craft & Perna, 2004). It has also been proposed that exercise promotes sleep, which has protective brain effects and lowers depression (Uchida et al., 2012). The connections between sleep, serotonin production, and mood encourage additional research on the topic. The rationale behind the choice of the theories is the relationship to the impact of exercise on patient depression, either directly or indirectly. The research questions expand on the theoretical influence of dependent and independent variables on individual reactions of depressed individuals to physical exercise. The theories guide the study approach by dictating the research articles included in the study, and the categories used to investigate influences on the effects of physical exercise on American adolescents. The research builds on previous studies that involved adults, but not adolescents, as there is a gap in that area. There are some inconsistencies among the findings on the effects of physical exercise on depression, and it is hoped the conclusions from this research will assist in promoting a more definitive result.
1.2. Problem Statement
The research problem in the study is a large number of young adults suffering depression in the United States with the possibility of physical exercise as a therapeutic strategy. The purpose of the study is to identify if there is any connection between participating in physical activity and the levels of depression among youth in the United States. The study will evaluate the usefullness of physical exercise in the treatment of patients diagnosed with depression in the 12 to 17 year age group by creating a correlation in study findings. The purpose of this study is to provide more extensive evidence in respect to the link between physical activity and mental well-being of adolescents and youth in the United States. More specifically, the aim is to decipher if there is a connection between participating in some sports activity and the levels of depression among youth in the United States.
1.3. Purpose of the Study
The reason why the research is focused on United States adolescents is that, as presented previously, depression is the most common mental illness among American youth, with present percentages high enough to constitute a stimulus for investigation and research (Bose, Hedden, Lipari, & Park-Lee, 2016). Concurrently, and considering that the current adolescents in the United States are tomorrow’s adults, it can be assumed that today’s depressed adolescents will be tomorrow’s depressed adults, increasing the already high percentage of depressed adults in the country.
Another reason for the study is the fact that in recent years there is evidence indicating that physical activity levels among adolescents and youth in the United States have declined, an issue that is reported as having contributed towards the increase in the rate of mental illness (Biddle & Asare, 2011). More specifically, physical activity seems to be reduced as a child progresses towards adulthood, since adolescents aged 12 to 19 years seem to be less active than the country’s younger populations aged 6 to 11 years. Females also seem to be less physically active than males, while obese adolescents also appear to be less active than the normal-weight youths (Belcher et al., 2010).
1.4. Research Questions and Hypothesis
The research questions are presented as “What is the relationship between the level of physical activity and diagnosis of depression among youth ages 12 to 17 years in the United States?", “What is the predictive relationship between race, gender, socioeconomic status, religious affiliation, physical activity, and depression in the same population?", and “Is there an impact of physical activity on reducing the level of depression among youth in the United States?"
The hypotheses made, which are to be tested, are explained below.
For the first hypothesis, the null hypothesis (Ho) is to assume there is a bidirectional relationship that exists between physical activity and the level of depression among youth in the United States, while the alternative hypothesis (Ha) is that there is no bidirectional relationship between depression and physical activity among youth in the United States.
For the second hypothesis, the null hypothesis (Ho) is to assume the predicting factors of depression in physically active and non-physically active youth in the United States do affect the depression symptoms exhibited by them, while the alternative hypothesis (Ha) is the predicting factors of depression in physically active and non-physically active youth in the United States do not affect the depression symptoms exhibited by them.
For the third hypothesis, the null hypothesis (Ho) is to assume physical activity has an impact in reducing the level of depression among youth in the United States, while the alternative hypothesis (Ha) is that physical activity has no impact in reducing the level of depression among youth in the United States.
All above hypotheses are to be tested via the interpretation of the results of the regression analysis, the statistical methods and ANCOVA analysis, which will employ data originating from the database sources of PubMed, Google, NCBI, Google Scholar, Medline Plus, and PsychNet.
1.5. Theoretical Base
Concurrently, it has been revealed that only about 25 percent of the country’s young population (i.e. aged between 6 and 15 years of age) exercise at a moderate or vigorous level for a minimum of 60 minutes per day, as suggested by the 2008 Physical Activity Guidelines for American's recommendation. As previously stated, the percentage of young people meeting the above recommendation reduces as their age increases, with girls reducing physical activity levels at a faster pace than boys as years go by, and with the non-white ethnicities of Hispanics, African Americans, and Mexican Americans being more active than their older, female, and Caucasian counterparts (National Physical Activity Plan Alliance, 2014).
On the other hand, as stated previously (Toseeb et al., 2014), sedentary lifestyles seem to be associated with depressive symptoms. The average time spent daily by youth aged 6 to19 years on sedentary activities is 7.1 hours (National Physical Activity Plan Alliance, 2014), while sedentary activities throughout the day were the primary choice for 60.3 percent of the country’s youth (29.2 percent participate in light physical activities, while only 10.6 percent in medium to vigorous physical activities with boys being more physically active than girls (Arundell, Hinkley, Veitch, & Salmon, 2015).
Finally, in the early studies used to determine the levels of physical activities among youths, it was established that vigorous physical activities among mid-adolescent girls fell from 5.9 hours to 4.9 hours weekly, while the respective drop was from 5.1 to 3.5 hours weekly for girls at late adolescent stage. Among boys, the level of physical activities throughout the adolescent stage was 6.5 hours but later declined to 5.1 hours weekly at the late adolescent stage. The levels at boy’s adolescent stage also declined from the previous 15.2 to 11.4 hours weekly. This was mainly attributed to an increase in sedentary activities, and more specifically, to the rise in computer usage. Indicative of this is the fact that girls’ preoccupation with computers increased from 8.8 to 11.1 hours weekly (Nelson, Neumark-Stzainer, Hannan, Sirard, & Story, 2006).
The third reason for the study is that through preliminary research, it has been discovered that there are limited previous studies examining the connection between physical activity and depression explicitly in relation to youth in the United States. Moreover, only one thorough study concerned with the physical activity patterns of adolescents with symptoms of depression in the United States could be retrieved. In this cited study, it was found that United States adolescents with depressive symptoms were engaged in physical activities for fewer hours than their counterparts in other countries, who had regular physical activities (Dentro et al., 2014).
The above data on the physical activity patterns and the previously presented data on depression, when combined with the limited quantity of studies connecting physical activity to depression with respect to United States youth, seem to enhance the need for further examination of the precise nature of the link between physical activity and mental well-being of adolescents in the United States, which is the purpose of the present research.
An element that appears to have been neglected in current literature is information on the magnitude and statistical significance of the relationships between physical activity and depression in American youth. There is a great need to understand the nature of this association. The primary assumption is that the association is linear, which implies that a change in one variable leads to either a negative or positive effect on the other variable. However, there is a need to understand whether the association is positive or negative. This will pave the way to drawing conclusions on whether an increase in physical activity will result in a decrease or increase, and at what levels and in what context in the levels of depression. Secondly, there is a need to understand whether this association is weak, moderate, or strong on either side of the linear equation. This information is important because it offers guidance on the level of interventions required, their urgency and the importance of the intervention. Finally, there is a need to properly interpret the determined statistical significance for the association in view of the possibility of type-1 and type-2 error. It is noted that “cause and effect studies” of this nature should demonstrate strong internal and external validity. An understanding of the statistical significance contributes to acknowledging whether the hypotheses upon which the study is based are correct or incorrect.
1.6. Nature of the Study
For the purposes of this study, a framework based on a study by Jerstad et al., (2010) which states that a bidirectional relationship between physical activity and depression indeed exists, is adopted. The same concept was later strengthened by Stavrakakis, de Jonge, Ormel, & Oldehinkel (2012) and Bursnall (2014) in which both studies concluded that in an actual sense, the bidirectional association between physical activity and general depressive symptoms is two-way. Azevedo Da Silva et al. (2012) and Steinmo, Hagger-Johnson, & Shahab (2014) also suggested that there is indeed a bidirectional relationship between physical activity and depression.
This framework will be used for this study to identify independent, dependent and covariant variables to make the study a true experiment. While investigating the relationship, other studies and data records from secondary resources having this kind of framework will be examined. The secondary data will be collected from database sources to determine the relationship between depression and physical activity or inactivity among youths.
Ethical considerations will be taken to ensure an effective and meaningful research that demonstrates integrity in the secondary data collection. Compliance to all ethical concerns, such as consent, privacy, confidentiality and adequate communication will in all cases be adopted (Curtis & Jonathan, 2013).
Apart from the above, it is also stressed that this dissertation is to be carried out in a manner that ensures plagiarism will not take place under any circumstance, that the studies of all authors used will be properly referenced, as well as used accurately without misinterpretations, and with the ultimate aim to achieve the fundamental objectives of the dissertation (Zhang, 2015).
Regression analysis, different statistical methods, and ANCOVA analysis will be used to answers the two research questions of this quantitative study.
1.7. Conceptual Definitions
The following terms arre used operationally in this study:
Physical Activity. Categorized as sedentary, light, medium, and vigorous activities.
Depression. Long-lasting periods of time with endless bad mood, feelings of hopelessness, and a lack of satisfaction (Mutrie, 2000).
Adolescents. Young people aged 12 to 17 years.
1.8. Assumptions and Limitations
Though physical activity may be identified as having a bidirectional association with depression, the positive implications of this relation may not be observed due to other barriers, such as youths having unstructured life and health modification concepts, low motivation in taking part in physical activities, and deficient knowledge about the kinds of physical activities needed to change their perceptions about the benefits of the latter (Rogerson, Murphy, Bird, & Morris, 2012).
1.9. Delimitations
The study will be narrowed to include only American children ages 12 to 17 years participating in studied published in credible journals within the last 14 years.
1.10. Significance of the Study
The significance of this study lies in the fact that it is aimed at enhancing understanding of the association between physical activity and depression among the youth in the United States by addressing the gaps in research, as well as providing further evidence on a topic for which limited studies seem to have been so far undertaken. Consequently, this research result may serve as the basis for future investigation at a country level, as well as a preliminary database on which future data may be compiled to substantiate the claim that physical activity is indeed beneficial to dealing with depression levels of the country’s youth. If the above claim is proven false, this study may constitute the stimulus for additional future research to support the variables that have been presented in this study.
At a more practical level, this dissertation’s outcomes are expected to highlight the need for introducing public health programs in American schools to the need to explicitly address mental health problems, including depression, of American youth. The confirmation that increased physical activity levels or that specific physical activity programs have positive effects in reducing levels of depression among youths may be used by education policymakers, who will then be able to incorporate and maintain proper physical education programs in the school curriculum to lower the prevalence of depression among the country’s youth.
Finally, positive identification of this relationship can also be used as evidence to advocate the adoption of physical activities among the general public in order to reduce the disturbing increase of depressive symptom trends witnessed in relation to the country’s adults by initiating an education program for adolescents and adults in order to deliver insights on the beneficial effects of physical activities on their mental and physical health. It should not be neglected that, as today’s adolescents and youth are tomorrow’s adults, by providing these adolescents and youth with proper exercise at an early stage, attitude in respect to the physical activity will be associated with mental health and this attitude continue into adulthood, leading to healthier future adults both mentally and physically through a depression prevention approach.
1.11. Implications for Social Change
If the results of this research prove that indeed physical activity has a positive, bidirectional association with depression in youth in the United States, then the social implications are expected to be important. In particular, the results may be used to suggest physical activity both as a preventative and intervention method for the reduction of the current and future levels of depression among young people throughout the country. In this way, United States society will realize fewer depressed young people, who will have two important aspects to their mental and physical health. First, they will be physically healthier, especially since physical activity has been associated with the reduction of low-density lipoproteins and the increase of high-density lipoproteins, improved glucose metabolism, increased strength, and the reduction of body lesions (Sothern, Loftin, Suskind, Udall, & Blecker, 1999). Second, mental health is characterized by improved personalities, since physical activity is associated with self-discipline, teamwork, fair competition and altruism. Exercising with other people strengthens the attitudes of rivalry and cooperation, helping the adolescent to respond in the same way to defeat and victory by recognizing their potential mistakes. Positive competition assists in creating a positive self-image (Desha, Ziviani, Nicholson, Martin, & Darnell, 2007). However, the positive social implications do not stop there, since by providing society with less depressed, healthier, and improved personalities in young people in the United States, the potential of providing society with less depressed, healthier, and adults with improved personalities to the United States of the future increases.
1.12. Summary
The incidences of depression in the population of American youth ages 12 to 17 years are recognized as a significant problem for the mental health community. The pressures on achieving in multiple areas, the impact of social media, and a society promoting permissive child-rearing places stress on young people in the United States not previously experienced. Possible contributions of physical activity to fighting depression have not been studied sufficiently in teenagers and young adults. It is anticipated the research conducted in this paper will add to the available knowledge of the topic and promote additional studies to assist in developing definitive answers concerning the effects of physical exercise on depression among young people in the United States. It is possible adolescent patients may be able to decrease or eliminate the need for drug therapy through the effective application of physical exercise. Medications for depression have side effects and a social stigma for young people in America; if exercise has the ability to improve mood and promote physical health and sleep, this could be of significant importance for the care of adolescent depression. By decreasing the incidence of adolescent depression in America, health care costs may be lowered, family relationships may be improved, the social adjustment might result in better adjustment and quality of relationships, and educational progress may increase with subsequent satisfactory careers and levels of mental health.
Chapter 2: Literature Review
2.1 Introduction
There are a large number of sources available on the relationship between physical activity and depression. The bulk of the sources for the literature search are expected to be secondary sources. The challenge will be to find studies with all the participant data required for inclusion in this research. In addition, extrapolation from adult studies in certain areas may be required lacking sufficient research in some areas.
2.2 Literature Search Strategy
A number of different databases will be used to place the information gathered into categories in a quantitative research design for statistical regression analysis with participants categorized by independent and dependent variables. The search engines used to include PubMed, Google, NCBI, Google Scholar, Medline Plus, and PsychNet. Data from published reports from reliable government websites such as National Institute of Mental Health and Centers for Disease Control and Prevention, as well as health organization websites will also be included.
Keywords to be used will include exercise and depression, depression in adolescents, serotonin production in depression, sleep patterns in depression, exercise and mood, treatments for depression, DSM-IV definition of depression, and psychomotor therapy programs. The articles will be rated for the inclusion of the study based on research conducted within the last 14 years with references to original studies in secondary articles. Publications will include books and peer-reviewed and credible journals such as Psychology of Sport and Exercise, BMC Medicine, Medicine & Science in Sports & Exercise, and Journal of Sport and Exercise Psychology. The websites used for current statistical information will include the Center for Behavioral Health Statistics and Quality, United Nations University, and the World Health Organization, among others. Books, newsletters, periodicals and journals that provide relevant evidence on the subject matter in this study, and video documentaries may serve as additional sources of information on the subject of physical activity and depression. .
2.3 Theoretical foundation.
Especially in the case of adolescents, several studies have shown the beneficial effect on physical activity on depression. An example is a study conducted on teens from 15 to 18 years of age, showing adolescents participating in sports activities experienced fewer feelings of boredom, frustration, and general depression; they also smoked fewer cigarettes, used marijuana less often, and followed a healthier diet than those not actively involved in some kind of sport (Baumert, Henderson, & Thompson, 1998). However, research has found a negative relationship between depression and physical activity in adults (Dopp, Mooney, Armitage, & King, 2012; Tomson, Pangrazi, Friedman, & Hutchison, 2003; Wiles, Haase, Lawlor, Ness, & Lewis, 2012). Additional research of the association between depression and physical activity is needed explicitly for adolescents, although in recent years there have been a few studies focused on the investigation of the link between physical activity and depression among youths.
Of the studies specifically for American youth, the results are contradictory. A study was conducted on a total of 2,951 adolescents participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), which revealed that teens with designated levels of physical activity had a decreased possibility of exhibiting depressive symptoms (Wiles, Haase, Lawlor, Ness, & Lewis, 2012). However, the study also showed that although a total set of physical activity per day (tertiles: ≤270 min; >270–326.6 min; ≥326.7 min) was associated with depressive symptoms, moderate to vigorous physical activity (15 min per a day) was not independently linked to improvement (Wiles et al., 2012).Another study conducted with a total of 2,789 participants aged 11 to12 and 13 to14 showed similar results (Rothon et al., 2010). The study concluded the possibility of depressive symptoms was reduced by approximately eight percent for every hour added to the weekly exercising pattern of both boys and girls.
A study by Brown, Pearson, Braithwaite, Brown, and Biddle (2013) was based on a series of previous English language studies originating from different scientific databases; it suggested that physical activity interventions, especially when combined with education, or interventions with a more methodological approach, when related to explicit participant characteristics had the most positive impact on depression. However, the study also stressed that the improvement of depressive symptoms depended highly on participant education on physical activity program implementation.
In contrast, there are studies reporting no association between physical activity and depression among young people. According to a study by Johnson et al. (2008), it was determined that there was no relationship between physical activity and depressive symptoms in the 1,397 participants consisting of 12-year-old girls other than a limited inverse relationship between sedentary activity and depressive symptoms. Similarly, a study conducted with a total of 736 participants around the age of 14.5 years concluded there is no relationship between the levels of physical activity of 14-year-olds and depressive outcomes in a follow-up at the age of 17 years (Toseeb et al., 2014). Therefore, the link between physical activity and depression requires more research to be either verified or refuted.
Chapter 3: Research Method
3.1. Introduction
The research focus in on the relationship between physical activity and depression in American youth aged 12 to 17 years. The study will evaluate the usefullness of physical exercise in the treatment of patients diagnosed with depression in the 12 to 17 year age group by creating a correlation in study findings. The purpose of this study is to provide more extensive evidence in respect to the link between physical activity and mental well-being of adolescents in the United States. The research questions are presented as “What is the relationship between the level of physical activity and diagnosis of depression among youth ages 12 to 17 years in the United States?", “What is the predictive relationship between race, gender, socioeconomic status, religious affiliation, physical activity, and depression in the same population?", and “Is there an impact of physical activity on reducing the level of depression among youth in the United States?" The hypothesis is that physical activity has a bidirectional affect on depression in American adolescents ages 12 to 17 years.
This chapter presents the research design and why it was chosen, the hypotheses to be addressed by the study, the research questions to be investigated, data method, inclusion and exclusion criteria, variables, data analysis plan, threats to the validity of the study, and threats to the rights of the participants.
3.2. Research Design and Rationale
The proposed research design is quantitative with the research method as a collection of secondary research data. The regression data analysis will be conducted using the Statistical Package for Social Sciences. The implications for social change are to contribute and promote research into the use of physical exercise to reduce depression in Americans in the age group of 12 to 17 years.
The research study will be centered on quantitative research to understand and validate the hypothesis stating that there is a bidirectional relationship between physical activity and depression among youth in the United States. The quantitative research design is used to confirm a hypothesis employing numbers and statistics that are gathered through tools such as questionnaires, is highly structured and planned, and are documented using objective language.
3.3. Research Questions and Hypothesis
3.3.1. Research Hypothesis: The hypotheses made, which are to be tested are explained below.
For the first hypothesis, the null hypothesis (Ho) is to assume there is a bidirectional relationship that exists between physical activity and the level of depression among youth in the United States, while the alternative hypothesis (Ha) is that there is no bidirectional relationship between depression and physical activity among youth in the United States.
For the second hypothesis, the null hypothesis (Ho) is to assume the predicting factors of depression in physically active and non-physically active youth in the United States do affect the depression symptoms exhibited by them, while the alternative hypothesis (Ha) is the predicting factors of depression in physically active and non-physically active youth in the United States do not affect the depression symptoms exhibited by them.
For the third hypothesis, the null hypothesis (Ho) is to assume physical activity has an impact in reducing the level of depression among youth in the United States, while the alternative hypothesis (Ha) is that physical activity has no impact in reducing the level of depression among youth in the United States.
All above hypotheses are to be tested via the interpretation of the results of the regression analysis, the statistical methods and ANCOVA analysis, which will employ data originating from the database sources of PubMed, Google, NCBI, Google Scholar, Medline Plus, and PsychNet.
3.3.2. Research Questions: The theories proposed include how physical exercise promotes serotonin production, effective sleep patterns, and mood enhancement dictates the research questions under investigation. The research questions that guide this dissertation’s purpose are:
What is the relationship between the level of physical activity and diagnosis of depression among youth ages 12 to 17 tears in the United States?
What is the predictive relationship between race, socioeconomic status, religious affiliation, gender, physical activity, and depression in the same population?
Is there physical activity impact in reducing the level of depression among youth in the United States?
3.4. Study Population
The study population will include American adolescents aged 12 to 17 that were participants in research published within the last 14 years.
3.5. Data Methods
The data used for this research will be the results of previous studies and will be collected from different national databases in the United States. Data on the physical activity levels and depression levels of the given population related to aging, ethnicity, gender, family income level, and religious affiliation will originate from the Centers for Disease Control (CDC) and Prevention database. A bidirectional association approach to complete data collection and analysis will be employed; with this method, one influence may impact another and the analysis procedure will attempt to make any correlations between one influence on the other.
Instances and previous studies will be reviewed to gain more understanding concerning the relationship between physical activity and depression in American youth. The secondary data includes physical activity intervention programs implemented previously, combining the results of the quantitative research with the findings of the existing studies presented in the studies to validate if there is a bidirectional relationship between physical activity and depression among American youth.
The data used for this research relies on primary source, making this study a secondary source. Sources used will include books, magazines, journals, reports and publications, articles, and documents related to the topic of this research. Extensive use of the National Center for Biotechnology Information’s (NCBI) database will take place since a preliminary investigation of the database has shown there are a large number of articles related to the topic of this research. Data will also originate from published reports from reliable government websites such as the National Institute of Mental Health, the Substance Abuse and Mental Health Services Administration, the Center for Behavioral Health Statistics and Quality, and the Centers for Disease Control and Prevention, as well as health organization’s websites such as the World Health Association (WHO).
3.6. Variables
The dominant variables for the study are the physical activity of the youths and their depression levels. Answering the research questions requires the determination and measurement of the variables of the study. For this study, the independent variable will be the levels of physical activities among youths in the United States. The dependent variable is the depression and/or associated symptoms reported among the study participants. On the other hand, the covariates in this study are the ethnic backgrounds of the participants, gender, income levels of families, and religious affiliations. The classifications are based upon the intensity of the physical activities in which each participant is involved and how that relates to lifestyles. The categorization is based on the allocation of time in terms of hours spent at various daily activities. The product of the two variables will then be divided by the total hours per day to determine the mean physical activity level. Young people will be categorized as light activity or sedentary lifestyles with a physical activity level of between 1.40 and 1.69 (Food and Agricultural Organization, n.d).
Dependent Variable Independent Variables Covariants Levels of Depression Level of Physical Activity Gender Ethnicity Socioeconomic Status Religious Affiliations
Classifications are based on the intensity of physical activity, type involved, and the relationship to lifestyle. The categorization is based upon the allocation of time in terms of hours spent at various daily activities. The product of the two primary variables will be divided by the total hours per day to determine the mean Physical Activity Level (PAL). The covariants will include gender, ethnicity, socioeconomic status, and religious affiliations. Gender, religious affiliation, and ethnicity will require a specific designation without variation, they will be considered as discrete variables. For instance, the participants will be classified as Hispanic, Caucasian, African-American, Asian, or Other. However, socioeconomic status may have the participant placed into a range of income levels, such as “Less than $10,000 annual income” or $10,000 to $25,000 annual income”.
Rational subgrouping will be used as the sampling strategy to place measurements into meaningful groups for statistical evaluation. The goal is to decrease the possibility of variations. The adolescents are categorized in the light activity or sedentary lifestyles when they present a PAL value with PAL value described as a person’s Total Energy Expenditure (TEE) in the 24-hour period divided by their Basal Metabolic Rate (BMR) of between 1.40 and 1.69. The adolescents in the moderately active or active lifestyle category have a PAL value of between 1.70 and 1.99, while young people classified in the vigorously active lifestyles category will have a PAL value of between 2.00 and 2.40 (United Nations University, WHO, FAO, 2004).
The data for both the dependent and independent variables will originate from primary data reported from a database source. The data is expected to contain information on the physical activity of the subjects such as the amount of time they had been spending exercising over a 24-hour period. The researcher will then use the secondary data to determine the PAL value for each subject and classify the subjects under their respective categories.
3.7. Inclusion and Exclusion Criteria
Inclusion data includes ethnicity, religion, gender, ages between 12 and 17 years, familial history of depression, information regarding family socioeconomic status, and publication within the last 14 years. Exclusion data is lack of data on any of the inclusion requirements and ages younger than 12 and older than 17 years at the time of data collection. If the source includes a longitudinal study in which the participant reaches the age of 17 prior to the end of the data collection period, he or she will be excluded.
3.8. Data Analysis Plan
Dependent Variable Independent Variables Covariants Levels of Depression Level of Physical Activity Gender Ethnicity Socioeconomic Status Religious Affiliation
Regression analysis examines the association between variables by validating the unexpected outcome of one variable to another ("Chapter 13," 2016). It calculates the quantitative impact of one fundamental variable on another. The analysis of the data will be performed using the Statistical Package for Social Sciences. This researcher will employ various statistical tests such as t-tests to determine the significance to the differences between the means of various variables, descriptive statistics to present measures of central tendency for the data, and main statistical tests that are central to answering the research question about the correlation.
The dependent variable in this study is the depression symptoms reported by the participants due to their activity or inactivity in physical activities. The depression symptoms included in the dependent variable will include: 1) frequency of decreased pleasure in activities, 2) frequency of feeling depressed, 3) frequency of problems with falling asleep, staying asleep, or sleeping too much, 4) frequency of feeling tired, 5) frequency of poor appetite or overeating, 6) frequency of feeling bad about oneself, 7) frequency of having trouble with concentration, 8) frequency of moving or speaking so slowly other people notice, 9) frequency of suicidal thoughts of thoughts of hurting oneself, and 10) how difficult are the problems depression causes at work, home, or with other people. In this respect, the Pearson moment correlation coefficient will be examined to determine the nature of the association by investigating whether the linear association between the variables is positive or negative. The Pearson moment correlation will also help determine the magnitude of the association. The output of the Pearson moment correlation, when performed using the Statistical Package for Social Sciences, includes the data to be used in determining the statistical significance of the association between physical activity and depression. After the relationship between the independent and dependent variables has been developed categorically, the covariate will be used to measure their effect on the dependent variable.
The analysis of covariance (ANCOVA) analysis for this study is used to interpret how results are obtained and the nature of the conclusions that will be drawn from the study. It will allow this researcher to compare one variable in two or more groups in order to take into account the variability of other variables. This type of analysis combines either one-way or two-way analysis of variance with linear regression. ANCOVA analysis is relevant for this study in that there are four covariances that may influence the dependent variable. The analysis will only affect the research design and not the research model, thus not influencing the final conclusions. The ANCOVA analysis will be used to test the significance to the differences between the groups of variables. The study adds control factors of one or multiple covariates to observe how they influence the scores of the relationship between independent and dependent variables. Depression levels among American youth are observed when other personal characteristics are integrated. The covariate under consideration for this study is a phenomenon of interest since the researcher suspects that they will affect the dependent variable when the independent variable is controlled.
Logistic Regression Analysis is a statistical method used to analyze dichotomous response data that may prove effective in determining influence of the independent variables that are categorized as discrete (Chatterjee & Price, 2012). The analysis incorporates one or more numeric covariate. It also compares two or more groups of variables by adjusting the background factors, otherwise known as the covariate measures. The Logistic Regression Analysis is different from ANCOVA analysis in that it uses numeric response measures while utilizing portions based on binomial responses such as survival and success rates (Roberts, Rao & Kumar, 1987). It will be used to measure if physical activity intervention programs are applicable to adolescents possessing various backgrounds. It will seek to establish if such factors affect the outcomes of the physical activity clinical interventions in reducing depression if present among American youth from different ethnic groups, religion, and gender.
3.9. Threats to Validity
Brown (2006) present five criteria to determine the validity of a literature review: 1) purpose, 2) scope, 3) authority, 4) audience, and 5) format. In order to maintain the validity of this study, all five criteria will be taken into account and addressed during the entire process of the research.
3.10. Threats to Participant’s Rights
The identities of participants in the studies reviewed and included in this research will not be disclosed by the published literature. The studies must indicate that the participants gave informed consent to taking part in each study. This protects the participants’ rights to privacy and protection from harm.
3.11. Summary
The research method for this study on the relationship between physical activity, depression, and co-variant influences on American youth ages 12 to 17 years will rely on secondary data from published studies in credible journals, books, and other sources. The research study will be centered on quantitative research to understand and validate the hypothesis stating that there is a bidirectional relationship between physical activity and depression among youth in the United States.
Chapter 4. Results
4.1 First Heading
Chapter 5: Discussion, Conclusions, and Recommendations
5.1 First Heading.
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Appendix A: Title of Appendix
