The article represents a study carried out to establish the associations between physical activity and depression and the various contextual variable that maybe know to influence association amongst four main ethnic groups of midlife ladies in the United States. It was conducted through a secondary analysis data acquired from 542 midlife women (Im, E & Chee, 2015). The analysis of the data indicated that there was no correlation between the depressive signs in women and nature of active living and level of physical activity. The depressive symptoms were however discovered to be closely related to occupational, physical activities. Family income was also found to be a strong predictor of the depressive traits amongst women. In developing necessary interventions for the issue of women’s depressive symptoms requires a consideration of physical activity amongst the women.
Research questions and Hypothesis
The study was developed for the purpose of determining the association between physical activity and depression as well as other multiple contextual factors that may be causing these associations amongst the four major groups of midlife in the country (Im et al., 2015). To achieve this objective, the following hypothesis guided the study: The first hypothesis indicated that there is significant difference in depressive symptoms. The next hypothesis indicated that there was an existence of significant racial/ethnic differences in depressive symptoms by menopausal conditions. The third hypothesis indicated that there was an existence of significant associations between physical activity and the depression levels. The fourth hypothesis indicated that physical activity contributed significantly to the prediction of depression scores after taking charge of some specific background characteristics. Some of the background features considered by the research include age, education, marital status, family income, employment, number of children, and their level of articulation (Im et al., 2015). Other characteristics considered include the health conditions such as BMI, general health, disease diagnosis, and the medication provided and the menopausal status. The final hypothesis stipulated that the above-indicated factors make significant contributions to the prediction of depression score amongst the women
From the study, it is clear that the independent variable is the depression symptoms among the women of midlife from four ethnic backgrounds in the United States. The dependent variables for this study included factors such as unique ethical differences, physical activity, menopausal status, background information, and health factors (Im et al., 2015).
Literature and Background of the study
The article offers a background information on the study factors. Depression is noted as being among the most common symptoms experienced by midlife experiencing menopausal transition. At this stage of menopausal transition, women are considered to experience hormonal changes. They also experience the several personal, social, and cultural changes which are in most cases likely to produce negative attitudes among them worries over issues such as sicknesses, reducing femininity, loneliness, and meaningless (Im et al., 2015). Combined, these factors are likely to cause depression issues amongst these women. The literature reviews in this article are comprehensive and cover the following important issues.
One the issue covered in the literature review is the relationship between physical activities, an issue that would be tested further in the current study. Previous studies seem to indicate that engagement in physical activities helps an individual improve mental health benefits to those engaged among the participants. Previous studies have linked physical activity and depression through enhancing the blood flow, release endorphins, and increase the level of epinephrine and epinephrine synthesis. The literature review noted that physical activity had been associated with discharging hostility, reducing the level of emotional tension, as well as tone down the impact of stressful events (Im et al., 2015). In this connection, the literature review points out the gap in the studies reviewed in showing how physical activity affects depression.
Another factor that the literature review covers is of race/ethnicity and considers how this affects physical activity and in turn midlife women’s depressive symptoms. Studies quoted reflects the existence of racial and ethnic differences in engagement in physical activities (Im et al., 2015). In this connection, studies reviewed indicated that white women are more engaged in physical activities as recommended by the Center for Disease Control and Prevention. Women from ethnic minorities were described as being less physically engaged thereby contributing to ill health. The literature review points out that no clear racial/ ethnic difference in physical activity is documented. It also points out the knowledge gap that exists in analyzing to establish the relationship between the level of physical activity engagement and factors indicating depression (Im et al., 2015). The effects of multiple contextual issues have not been actively probed to bring out their effect on physical activity and other depressive symptoms.
The literature review included an analysis of the multiple contextual factors which includes the age, household income, disease status, menopausal stage, and level of acculturation. These factors have been linked to the having some influence on the depression levels among the women. The effects were noted to be high amongst women between the ages of 55 to 64. Individuals with lower income levels are also said to have had a higher prevalence of depression despite the age (Im et al., 2015). Studies have also linked poor health among women with higher rates of depression. There were also some reports that pointed out to how an increase in social support has an inverse relationship with depression level.
The literature reviewed is quite recent with having been published between 2005 and 2013. This helps increase the credibility of the content of the literature review.
Theoretical and conceptual framework
This study is conducted based on a feminist approach as a source of guidance for the analysis. In this approach, the claim put across is that marginalized group could have their power decreased as a result of researchers misusing their studies to offer support to existing androcentric and ethnocentric views and concerns. This approach requires that during the study, the participants’ views, perspectives, opinions, and experiences be highly regarded as opposed to those of the researchers. This theoretical guidance saw the researchers involved in this staff respect the self-reports by women on issues of depression and physical activity (Im et al., 2015). This also guided the study in having a view of using gender as the main influencer of characteristics among women.
Another model used to guide the research is the symptom management model developed by the University of California. This model created a foundation from which the specific objectives and hypothesis were formed. It is a commonly adopted model used for studies engaged in measurement of experiences such as cancer pain, sleep disorders, and menopausal issues (Im et al., 2015). The major domains as prescribed by the model include the person, health & illness, and the environment. These factors are stated as affecting symptom experiences, how they are managed and the excepted outcomes. The model has these concepts broken down into several sub related model. Based on this theoretical model, the study considered the physical activity as the major domain of depression symptoms which were the subdomains. The multiple contextual factors consider in the current study was taken to be the major domain involving other subdomains such as background feature, health and illness and the environment (Im et al., 2015).
While not directly stated, the most appropriate research design for this study is the causal design. In causal designs, the aim of the study is normally in creating an understanding of a phenomenal and how it is affected by various factors. In this study, the phenomenal under study is the depression as affected by the level of physical activity among women from different ethnic groups. This type of research design helps the researcher in having a deeper understanding of the occurrences in the society and establishing a causal link between the parameters under study (Im et al., 2015). The study can be replicated in a different setting. It is also a highly likable research design with greater confidence due to higher internal validity. This comes from the systematic subject selection and fair representation of the groups under study.
Population and sample
For this study, the sample was acquired from internet communities and groups in the US. The method of sampling used was quota sampling set out by race/ethnicity and SES. This lead to the selection of 542 women selected from four main racial groups (Im et al., 2015). The sample included 157 non-Hispanic, 127 Hispanic, 135 Non-Hispanic African Americans, and 123 Non-Hispanic Asians (Im et al., 2015). The inclusion criteria for the study is indicated. It considered women had to be midlife between the ages of 40-60 years, fit enough to take part in some form of physical activity, with ability to read and write in English, with internet access and of racial identity either Non-Hispanic white, Hispanic, Non-Hispanic African American, or Non-Hispanic Asian (Im et al, 2015)
The sample size was determined using the Cohen Statistical Power Analysis. This formula considers the significance level, effect size, desired power, and estimated variance and sample size. The main advantage of this method is that it optimizes on the sample size thereby avoiding cases of lack of enough participants. This method, therefore, helps overcome the situation on inconclusive inference-making. This makes the sample to be more representative of the sample.
Method and results
Measurement of the results for this study included; questions on background characteristics, questions related to health and menopausal status, Kaiser Physical Activity Survey, and Depression Index for Midlife Women (Im et al., 2015). The background information of the participants was captured using the questions on ages, education, marital status, employment, family income and a number of children. Measurements of the perceived health and menopausal status were done through five questions that sought to establish body weight and height, perceived general health, diagnosed diseases and medicine, and menstrual cycle patterns. The physical activity was measured using KPAS. This scale is made up of four subscales that include; caregiving index, occupational index, active living index, and sports/exercise index. Each of these uses a 5-point Likert-type scale. Depression was using DIMW scale adapted from the Midlife Women’s Symptom Index. The DIMW scale contains 17 items that measure the signs and symptoms.
Data collection procedures included a web-based sample selection criteria. On the project website, a potential respondent was informed of their informed consent and required to indicate their inclusion criteria. Only those who satisfied the inclusion criteria of age, mobility, literacy, access to the internet, and ethnicity. The respondents were required to fill their details on the internet survey page. The data confidentiality was maintained, and data was only accessible to the research team.
The data were subjected to statistical analysis using SPSS. The analysis involved descriptive analytics that sought to establish the frequencies, percentages, mean, range and standard deviation. Hypothesis 1-3 were analyzed by the use of chi-square tests, ANOVA, two way-ANOVA, correlation, and multiple regression (Im et al., 2015).
The results of this study were presented in the form of tables and narrative. This combination is effective as it offers the results in a summarized format and a narrative to expound on the results presented. Some background information indicated that the average age was 49.04 years, mean BMI was 29.42, acculturation level was 4.49, 68% of respondents were married, 77.1% employed 16.45% had low income while 45.9% were in the post-menopausal stage (Im et al., 2015).
The discussion of the results breaks down to address the study hypothesis one by one. From the study, it was established that there existed significant racial/ethnic differences in depressive symptoms faced by the women in menopause transition stage. It was also established that their menopausal transition cases biological and psychosocial changes that made these women get new depressive symptoms that they did not earlier experience. A significant association between physical activity and depressive symptoms was found to exist but varied according to the nature of the physical activity (Im et al., 2015).
The article identifies the limitations associated with carrying out of a secondary analysis of gathered through Internet Survey Data. One of the limitation is that the respondents may be highly educated, married and employed whereas a quota sampling was adopted. The participants forming part of the sample may not be a true reflection of the major/ethnic groups (Im et al., 2015). This puts a limit into the level in which the results may be generalized. The used of self-reporting reducing the attainment of objective validation of these self-reports.
Based on the research findings, suggestions for future studies have been shown. The researchers are prompted to carry out more analysis on specific racial/ ethnic differences in depression signs that women undergoing menopausal stage experience. Due to some inconsistencies in data on racial difference, more in-depth research needs to be carried to gain more insights (Im et al., 2015). While the evidence from this study indicate that increasing physical activity among the women would help improve their depression symptoms, there is a need for more research to specifically point out the types of physical activities needed for this. This will help inform on the development of mental promotion programs to help the women with depression.
The nature of sampling techniques and sample size helps indicate the generalizability of the results, and they can thus be applied across the field of nursing. This may be the creation of a mental health promotion program that would help the midlife women deal with the depression symptoms. The nurses will also be better informed on the need to deal with poor health among the midlife women as one of the ways of reducing the rate of depression significantly.
Im, E.-O. H., & Chee, W. (2015). Physical Activity and Deprssive Symptoms in Four Ethnic Groups of Midlife WOmen. Western Journal of Nursing Research, 746-766.
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