Critical Appraisal of a Literature Review on Sleep and Depression

This report presents a critical appraisal of a literature review and meta-analysis by Gee et al. (2019), which investigates the effectiveness of non-pharmacological interventions for sleep problems in reducing depression symptoms. The review followed a PROSPERO protocol and included randomized controlled trials. The methodology involved searching electronic databases like CINAHL, CENTRAL, PsycINFO, and Medline using specific search terms and limiters. The PRISMA flow chart was used to outline the article selection process, including inclusion and exclusion criteria. The included studies were assessed for bias using the Cochrane collaboration's risk of bias tool. The findings were summarized in a tabular format and a forest plot. The report highlights the strengths of the review, such as the proper synthesis of the data and the discussion of clinical implications, as well as a lack of detailed level of evidence description. The review concluded that sleep interventions can be effective in reducing depression symptoms, emphasizing the potential cost-effectiveness of this approach. The report provides a detailed analysis of the review's structure, methodology, and conclusions, offering valuable insights into the relationship between sleep interventions and depression.

Running head: CRITICAL APPRAISAL
CRITICAL APPRAISAL
Name of the Student
Name of the University
Author note

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Q1. The purpose of this review is to determine the effectiveness of the non-pharmacological
interventions of sleeping issues in reduction of the depression symptoms (Gee et al., 2019).
Hence, the review has been focused on non-pharmacological interventions of sleeping issues that
reduce negative symptoms of depression of a person.
Q2. The review has been developed with the consideration of the PROSPERO protocol of the
literature review (Crd.york.ac.uk, 2020). The authors mentioned the registry in the PROSPERO
protocol for the search strategy of the research process.
Q3. The review is focused on the randomised control trial based papers. There total of five
inclusion criteria for the articles to be reviewed in this paper. The inclusion criteria are as
follows:
1. Randomised control trial
2. Sleep improving non-pharmacological intervention is the intervention chosen for the studies.
3. The trial is included with a control group which is not provided with sleep improving
interventions.
4. Depression symptoms of the participants have been measured with a specific and validated
instrument.
5. The articles are published in the English language in peer-reviewed journals (Gee et al., 2019).
Q4. The review process has been conducted on the randomised control trial based studies.
Hence, the studies have been included in the review are randomised control trial focused on sleep
intervention and relationship with depression reduction of the participants.
Q5. The study has been conducted based on the electronic database search strategy. The articles
have been searched from electronic databases. The databases used here are CINAHL,
CENTRAL, PsycINFO and Medline (Gee et al., 2019).

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Q6. The search terms used for finding the articles are effective. It has been seen that the search
terms are focused on sleep disorders and the effects of this factor. Also are related to the
intervention focused on the reduction of the depressive conditions. Hence, it can be stated that
the search terms are suitable for the purpose of this study (Grames et al., 2019).
Q7. The limiters used for the search are focused on limiting or narrowing the search to the
clinical trials for the chosen topic and also the English language based papers. The limiters are
focused on narrowing down the search to the identification of the articles with clinical trials or
the randomised control trials and also the English language (Gee et al., 2019).
Q8. In the study, the authors developed the PRISMA flow chart to highlight the identification,
screening, exclusion and inclusion of the articles for the meta-analysis purpose. The PRISMA
flow chart showed the identification of the articles with the proper emphasis of the process that is
the identification by database search and hand search. The PRISMA also identifies the exclusion
factors of the articles and the factors are duplicate articles, improper title and abstract, full-text
unavailability, control condition designed to improve sleep only, no measurement of depression,
intervention is focused on sleep improvement and other reasons. After exclusion and inclusion of
remaining articles, the PRISMA also identified two more factors for the exclusion of several
articles. Finally, the number of chosen articles for the meta-analysis has been highlighted.
According to Tam, Lo and Khalechelvam (2017), a PRISMA should be included with all the
search factors and the inclusion and exclusion criteria of the articles for a specific study. Hence,
as per McInnes et al. (2018), it can be found that the PRISMA flow chart developed by the
authors highlighted every aspect including the identification, screening, and eligibility
assessment and inclusion and exclusion criteria and it is a proper PRISMA flow chart.

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Q9. It has been seen that the study has been focused on the determination of depression and sleep
improvement intervention. Thus, the randomised control trials selected for the meta-analysis has
been assessed for the bias identification by the Cochrane collaboration's risk of bias tool, which
is a critical appraisal tool. According to Sterne et al. (2019), this tool appraises the articles with
consideration of five main domains such as selection, performance, attrition, reporting, and other
and these domains are rated by high, low or unclear judgemental factors. Based on the views of
Whiting et al. (2016), this critical appraisal tool is appropriate in this study as this study is
targeting the randomised trial controls and this tool is used for analysing the biases of the
randomised control trials.
Q10. The study has described the included articles in a summarised tabular format. The table is
included with the entire study author names, country of the articles, study population description,
intervention used in the articles, the measurement of the outcomes in both descriptive manner
and statistical manner. However, the summary table does not comprise the study type as the
articles chosen for the meta-analysis are predominantly randomised control trials. Hence, based
on the characteristics of the summary table it can be found that the authors developed a proper
summarised version of the data and other details of the articles chosen and used for the study
(McShane & Böckenholt, 2017).
Q11. The exclusion criteria of the articles have been described in the PRISMA flow chart
developed in the study. However, there is no table found in the article that lists excluded studies
and describes the specific reasons for the exclusion of those studies. Hence, it can be stated that
the exclusion of the studies has not been mentioned in the article with specific reasons in any
tabular format.

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Q12. The data of the articles have been placed in the table as the Forest plot. The data than
described descriptively in the discussion section of the article. The process of synthesis of the
data has been seen to be done with consideration of the meta-regression process. The narrative
explanation of the data based outcomes of the included studies has been seen in the article
(Correll et al., 2018). Thus, it can be stated that the data representation or the abstract is in a
tabular format of Forest plot and the synthesis has been done with the consideration of the meta-
regression process and explained in narrative or descriptive way in the discussion section of the
article.
Q13. According to Cooper, Hedges and Valentine (2019), the articles chosen for the study have
been developed a proper synthesis of the data found. Synthesis and analysis of the context of the
sleep improvement intervention for the depression reduction have been properly critiqued with
the consideration of the opinions of other authors as well. Moreover, the limitations of the study
have also been mentioned in the article.
Q14. The level of evidence has not been properly described in the article. However, the article
described a lack of item missing in some evidence. Based on the type of the study and the
reviewed article character it can be stated that the level one evidence is included in the review as
there are more randomised control trials is reviewed with similar outcomes (Saltzman et al.,
2017).
Q15. The article also described the effective clinical implication of the study results. The article
described that there is a presence of stigma regarding mental health issues. However, the results
of the articles showed that sleep intervention could reduce the effect of depression. Moreover, it
has also been found that the sleeping disorder, along with depression, affected patients after
receiving sleep intervention showed significant improvement of the depression and sleep

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disorder conditions. Hence, it can be stated that sleep intervention can be very much effective for
depression reduction, and it is cost-effective in comparison to other interventions as well (Gee et
al., 2019).

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