The article,” The Relationship between Symptoms and Stress in Adolescents with Schizophrenia” is authored by Heeyoung Lee and Karen Schepp.The two authors are Psychiatric-Mental Health Nurse Practitioners affiliated to the University of Pittsburgh and the Washington University respectively. This article is a quantitative research that aimed at examining the correlation between symptoms and stress in 40 adolescents suffering from schizophrenia. As such this paper aims at critiquing this article and subsequently addressing the gaps that exist in research and subsequently in the knowledge pertaining to schizophrenia in adolescents. In the pursuit to thoroughly critique this article, the paper will separately focus on the article subsections, including, the title, introduction, methods, data analysis, results and discussion of the results.
One of the points of a good research article is to provide a comprehensive title that reflects the entire aspect of the study ranging from the objective to the target population and ability for the potential reader to easily familiarize with the pertinent tissue under investigation. The title “The relationship between symptoms and stress in adolescents with schizophrenia” has been well formulated to such that the reader identifies the target population (adolescents with schizophrenia) as well as the pertinent (relationship between symptoms and stress). This part of the article defines the authority with which the researchers have approached the topic so that the reader is not tasked with the need to make personal judgments of the intentions of the study from a brief view of the title.
Statement of the problem:
For any research, a thorough investigation of the problem needs to be done so that the researchers can establish the viability of proceeding with the problem as well as define identify the major issues that will be taken into consideration apart from those already described by the title. Lee & Schepp (2009) provide a comprehensive summary of the etiology, epidemiology and physiology of the primary disease in this case schizophrenia. The first five paragraphs and specifically the fourth and fifth provide a pathophysiological analysis of the disease and provide a brief analysis of the importance of investigating the link of the disease symptoms to stress factors in the adolescents population which is also identified as a risk population. Te availability of past longitudinal studies relating to this topics and issue have been mentioned to explain the gap that the study is destined to fill. The gap is identified as “to develop effective self-management strategies for adolescents with schizophrenia” (Lee & Schepp, 2009). The study does not expound on the methods employed addressing the gap but provides an ample background upon which a succeeding section will identify and justify the methods employed in addressing the research problem.
The research does not have any specific research questions stated. However, there is sufficient evidence that provides the researchers the justification to avoid the statement of the research questions. On one hand, the researchers have a stated the topic concisely which then dissipates the absolute need for a stated research questions. Since the title of the research as well as the problem statement section fully addresses the pertinent issue and research gap, there was no further need to provide an open statement of the research question. On the other hand, the study is only focused on one issue and any other issue outside the objective will be regarded as a gap that will be catered for in future research. As such, the objective and problem statement covered for the absence of the research questions.
The literature review section is one of the major strengths of this study. Each of the primary research variables (adolescence schizophrenia, related symptoms and stress) has been handled comprehensively using a host of reliable sources from past studies and literature on schizophrenia. Specifically the study covers the stress and schizophrenia with reliance on research studies and primary data from the year 1992 to 2008. However, data from studies conducted from 2000 to 2008 has been given greater preference to make the study relevant to current demographical settings. The literature review expounds on the problem statement offering a thorough analysis of how past studies have explored the issues being studies and the major setbacks that have been experienced in past research on this issue.
The study employs stress vulnerability model of schizophrenia that has both biological and psychological implications. The model is based on the premise that “vulnerability to developing schizophrenia varies” (Lee & Schepp, 2009). The variation is based on the assumption that the likelihood of presentation or emergence of schizophrenia symptoms at any time is dependent on the individual’s biological vulnerability as well as the magnitude of the encountered stress. This conceptual model helps develop a correlation between the variables of the study and the subsequent objective.
Design and sample:
The study utilized 40 adolescent participants. The study did not undertake collection of primary data but was a secondary analysis of data from an NIMH-funded study that aimed at testing the efficacy of self-management in adolescent suffering from schizophrenia. Therefore, the data used by this research article was adopted from another study, titled, “Self-Management Therapy for Youth with Schizophrenia.”The study had a time setting of 54 weeks. Age of the participants was a major consideration in developing the inclusion criteria. Participants included in this study had to fulfill the following requirements; age (15-19 years), met the DSM-IV-TR (Diagnostic and Statistical Manual of Mental Disorders) and the APA (American Psychiatrists Association) standards for schizophrenia, has a family member who was committed to take place in the study, lived at home with a guardian, parent or a caregiver and continued to take place in the regular treatment plan under the supervision of a healthcare provider.
The sample size was reasonably small to capture the best results. Adolescents present a very large group with various diversities and as such, the sample size was comparatively smaller compared to the size of the adolescent population. As such relevant clinical results may not be reached using this sample size. On the other hand, the duration is pretty long, and attrition rates from the program might be high due to the lengthy period of the study. Considering that this study is not based on primary data, chances of manipulation during analysis are high. However, the inclusion criterion was relevant to the research topic, and the age bracket is acceptable.
Measures included in this study included the demographic data of the participants (captured in the research form that was developed by the researchers) and medication adherence (captured using the Index for medical compliance). Stress level was measured via the Hassles Scale while schizophrenia symptoms were assessed using the ESS (Early Signs and Symptoms Scale).Admittedly, these four measures was pretty relevant to the research topic and objectives.
The study utilized different statistical methods in data analysis including the Cohen’s d, the paired t-tests and the Pearson correlation. Since it was difficult to quantify symptoms, the researchers developed a matrix to correlate stress and symptoms. Although the correlation techniques used in data analysis were relevant to the study, the use of a human-generated matrix could open the entire process to errors. Alternatively, the study could have used rating scales in quantifying symptoms. Rating scales provide numerical values that can easily be used in other correlation techniques.
The results showed no significant relationship between demographic factors such as age and gender and the stress levels. However, there was a significant correlation between rates of hospitalization and the ESS (stress).On the other hand, the finding showed that adolescents with higher levels of stress risk having severe schizophrenia symptoms. These results are in agreement with most clinical studies. Although the analysis of the results in commendable, it can be assumed that since this study is not based on primary data, chances of errors are high. The study relies on secondary data in another study that was not driven by similar objectives and as such carrying forward of the errors of the primary data is assumedly inevitable.
Interpretation of findings:
Interpretation of findings: In practical situations, any discussion of the results should seek to use the results to explain the causes of the phenomenon. The discussion section of this study does not go the extra mile to provide feasible reasons for the apparent lack of correlation between stress and demographic factors. Similarly, this section does not consider personal characteristics of the participants-something that might have influenced the findings. Seemingly, this section does not explain to the reader why the results appeared the way they did. There should be a sound correlating of the research findings and other studies. However, this section does poorly in terms of showing the agreement of the research with other studies.
The primary role of clinical research is to identify gaps in provision of care and subsequently address that gap through evidence-based solutions. This study acknowledges the need to educate parents and adolescents on the need to adopt stress management techniques. The study also recommends additional research to address the areas that were not thoroughly addressed by the research.
Lee, H., & Schepp, K. (2009). The relationship between symptoms and stress in adolescents with schizophrenia. Issues in mental health nursing, 30(12), 736-744.