Kawasky and Groh Article Critique


The article by Kwasky & Groh (2014) is about how self-efficacy and Vitamin D can be employed in predicting and preventing depression in young women. The critical appraisal will look at how the authors used the literature review, research problem, theoretical framework, research variables and research design. Both researchers are qualified and experienced in the field of health behavior. Andrea N. Kwasky is a licensed nurse practitioner specialized in nurse practitioner, psychiatry and mental health. She has more than 12 years of experience in varied fields and over 17 research articles in topics such as health economics, self-efficacy, and depression. Carla J. Groh is professor in the University of Detroit Mercy, at the School of McAuley School of Nursing. She has skills and experience in areas such as depression, mental health, nurse anesthetists, personality and relationships. She is associated with over 25 research articles. The two authors have the prerequisite experience and skill to undertake research on mental health and associated strategies. The title of the research article is concise and clear as it describes the research design – longitudinal study, research problem – depression, research population – young women and the research solution – Vitamin D and self-efficacy. The research abstract has all the constituent parts of a research paper, which include introduction, problem statement, methodology, results/findings and conclusion. The abstract is sufficient, as the reader can understand what the paper entails and they can choose whether to proceed in reading the entire article or not. 

Literature Review

The clinical problem that prompted the study is the high risk of young adult women for developing depression, anxiety and co-morbid substance abuse. Women have a higher risk of getting depressive disorders than men, and in addition, younger women are at more risk to be depressed than women from any other age group. Therefore, if the symptoms of depression amongst the young women is left undetected and treated, this population is likely to face serious challenges including suicide. The authors provided statistics to support the significance of the problem by indicating a high prevalence rate of 8.5% of major depressive episode for women compared to men. 

The issue is significant in the nursing profession as interventions and strategies are required to reduce the prevalence rate of depression among young women. The nursing fraternity has the burden to research and implement effective prevention and treatment strategies that will assist this population to live a quality life. 

The major topics discussed in the literature review include the relationship between Vitamin D and depression and the relationship between self-efficacy and depression/mental illnesses. It is important to note that most of the studies did not focus on the target population –young women, but on a general but related population such as women and different age groups. The literature review cited some current resources such as Gallup (2013) and Guy et al., (2013). In addition, the research mentioned some ongoing studies such as Nielson et al. (2011). The literature review employed both primary and secondary sources. Example of primary of a primary source used in the study is U.S. Department of Agriculture and Agriculture Research Service (2010). A majority of the other sources were secondary sources. 

The authors critically analyzed the studies cited in the literature review as they identified the research method, outcomes and limitations. For instance, the study by MinhuTu et al. (2011) found that individuals with higher Vitamin D levels are at a lower risk for depressive symptoms. The study had two limitations: the first one is the age samples were significantly older than the young adult women and secondly, the authors could not find the causal relationship between vitamin D and depressive symptoms. Mentioning such limitations assists the reader or information user to understand how to use the study and the areas of further research. 

Research Problem, Purpose, Research Question/Hypothesis

The research problem is the high prevalence rate of depressive episodes among young adult women and the lack of effective strategies to detect and treat the disorder. Furthermore, there are dire consequences of the disorder is undetected and untreated in this population. The purpose of the study is twofold: to conduct a longitudinal study examining the relationship between Vitamin D levels and depression in young adult women, and collect data on self-efficacy to determine if there is a relationship between self-efficacy, depression and Vitamin D. The research purpose clearly describes the need to fill a gap that exists in the nursing knowledge, which is lack of significant evidence in the relationship between Vitamin D, self-efficacy and depression symptoms in young adult women. The research question is: Is there a relationship between vitamin D levels, depression scores, and coping self-efficacy scores in young adult women over three points in time? The authors of the study poses the following hypothesis: self-efficacy and Vitamin D levels can predict and prevent depression. The research hypothesis is derived from the research problem, as there is a need to establish if there is a significant relationship between Vitamin D, self-efficacy and depression. The research purpose was explicitly stated as well as the research hypothesis. 


Theoretical Framework

The theoretical framework employed in the study was guided by the hypothesis of the study that is aforementioned. The theoretical formwork also informed the use of the longitudinal study as there was a need to determine the impact of Vitamin D on depression during different seasons. The theoretical framework used in the study is rather vague as the major focus is on the research variables, while there is little consideration on the structure. The theoretical framework in the study is implicit. There is no diagram used to represent the theoretical framework in the study. The theoretical framework is linked to the research variables as both studies on Vitamin D and self-efficacy described and explained concepts about the relationship with depressive disorders together with the assumptions and limitations. The authors did not make any theoretical propositions, either implicitly or explicitly. 


The research variables for the study are Vitamin D, self-efficacy and depression. The independent variables are Vitamin D and self-efficacy while the dependent variable is depression. Depression was measures using two tools. One tool measured depression using a 4-point scale i.e. from not at all to nearly every day. The second tool measured minimal depression, mild depression, moderate depression and severe depression. Self-efficacy was measured based on the ability to cope with challenges and threats based on three scores: cannot do at all, moderately certain can do and certain can do. Vitamin D was measured using serum 25(OH) D levels. The conceptual definitions are consistent with the operational definitions. For instance, self-efficacy is conceptually a measure of self-management and the scale measured the individuals’ ability to cope with challenges and threats. The demographic variables measured in the study include age, race, and health status.

Research Design

The research employed a correlational longitudinal study; it was conducted over three seasons i.e. September, January and April. The design was appropriate for the study as it was meant to determine the correlation between the variables as well as the relationship during different period. The design was appropriate in answering the research question as Pearson’s correlations was employed to determine the correlation between vitamin D and depression and an ANOVA was conducted was undertaken to determine the differences across the three data collection points.

The procedure involved recruiting the participants using flyers around the campus, use of social media and university organizations. Eligible participants included (1) aged 18 to 24 years; (2) able to read and write English; (3) able to sign informed consent; and (4) willing to complete the surveys and have their vitamin D levels drawn via finger stick at three points in time during the academic year. There were three data collection points and the students spent utmost 40 minutes. The participants completed the self-administered BDI-II, PHQ-9, CSES, health/demographic questionnaire, and had their vitamin D collected via finger stick. The participants were compensated for their involvement.

It is possible to replicate the study using the study procedure as the method of recruiting the participants is simplistic as well as the eligibility criteria. In addition, the self-administered questionnaires are readily available for public use. The method used to collect vitamin D from participants using the finger stick is method anyone can be trained on and master within days. 

The researchers found that coping strategies might mediate the effect between low vitamin D levels and depression scores. This mediating effect was not controlled in the study. The authors did not mention any threats to the design validity. The research had three limits. Firstly, the population was not population based but self-selected (comprised of students from a particular university). Secondly, the mean vitamin D levels over the three data collection points were within, or close to the recommended vitamin D level of 30 ng/ml. Thirdly, these three limitations – participant homogeneity, not depressed and sufficient vitamin D levels, limit generalizability to other populations, particularly young women of other races and ethnicities and those who are depressed.


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