A Systematic Review of Mental Health Nursing Needs for Depressed Youth

This literature review investigates the mental health nursing needs of depressed school-going teenagers in England, addressing the rising incidence of depression among this demographic. It focuses on identifying key areas for mental health nurse intervention, examining individual, family, school, and social risk factors contributing to adolescent mental health issues. The review analyzes research articles published between 2010 and 2018 from databases like CINAHL, MEDLINE, PubMed, and PsychINFO, using the GRADE framework to assess the quality of the selected studies. The findings highlight the importance of addressing factors like bullying, low self-esteem, and social isolation to develop effective health promotion programs and provide holistic care, ultimately aiming to improve the mental health and well-being of young people in England. Desklib provides access to this assignment and many other resources to support student learning.

Running head: MENTAL HEALTH NURSING
Mental Health Nursing
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Abstract
The rising incidence of depression among school going youth in London has drawn noteworthy
attention in the recent past. The mental health nursing needs of school going teenagers has been
the topic of research for the present systematic literature review. The paper aims at
understanding the areas where mental health nurses are to intervene immediately for addressing
the concern. The review clearly explains the rationale behind such a systematic review in context
of mental health nursing domain. The findings of the papers have been critically analyzed before
the main findings are presented. The discussion section highlights the implications for practice in
this regard.

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Table of Contents
Introduction......................................................................................................................................3
Methodology and Methods..............................................................................................................6
Findings.........................................................................................................................................10
Discussion......................................................................................................................................17
References......................................................................................................................................21

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Topic: The depressed youth of England: Analyzing mental health nursing needs of school going
teenagers
Introduction
Mental health disorder is a great burden for young people and early adolescence is the
period when mental health issues emerge. Teenagers are prone to adapt unhealthy behaviors like
smoking, drinking and illicit drug use during adolescence and these factors has an impact not
only on their health at that time but also in later life. Recent evident suggest that onset of 50% of
mental disorders is observed in people below the age of 18 years (Das et al. 2016). Among
mental health disorders, major depressive disorder is considered to be one of the leading causes
of disability, morbidity and risk of suicide and the prevalence of the condition in teenagers is
particularly increasing (Roberts 2014). Currently, the prevalence of mental health disorder in
England is also an area of attention for research because recent statistics has showed that mental
illnesses are the leading cause of health related disabilities in children and young people in
England. Children and youth in England are more likely to be engaged in smoking, drug abuse
and alcohol misuse than engaging in educational attainment and employment (Public Health
England 2016). Hence, analyzing the factors predisposing school going teenagers to mental
health risk is important to address the mental health needs of the group.
Review of studies done on risk factors associated with mental illness in adolescent has
given many insights about the possible reason behind rise in mental health disorders in youth.
Different categories of risk factor behind mental health issues in adolescent includes individual
factors, family factors, school factors, drug related factors and social factors. Individual risk in
children includes feelings of low self-esteem, anxiety, loneliness and feelings of worthlessness in

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teenagers (Pinto et al. 2014). In addition, school related factors include experience of bullying,
discrimination and low school performance. Bullying is a serious issue for school-age children
and adolescents as experiences of bullying renders both short term and long-term impact on
mental health of children (McDougall and Vaillancourt 2015). A study investigating about the
outcome of mental health in adolescents with bullying experience has revealed that bullied
school students had higher risk of depression and anxiety during their school years. Bullied
children were also found to have higher chances of psychosocial problems compared to children
who are not bullied. Impact of educational attainment of children due to bullying experience was
also found (Rothon et al. 2011). However, the lack of sensitivity analysis of data affected the
validity of the evidence. Hence, analyzing the role of this factor is essential to determine to
which extent mental health programs for school going adolescent in England can developed.
The above mentioned risk factors all pave the way for social isolation and consequently
development of mental health issues in adolescents. Bullying is just an example of school related
risk factors for mental problems in school going teenagers. Rothon et al. (2011) gave idea of the
impact of bullying on current health outcome and educational attainment in children, however it
underestimated the long term impact of such experience. Sigurdson et al. (2015) suggested that
victims of bullying have internalizing symptoms like that of depression, anxiety and fear or
externalizing symptoms such as tendency to show anger and aggression. This kind of behavior in
the long term compels children to engage in risky and impulsive behavior such as engaging in
criminal activities or engaging in drug abuse. It predispose them to high risk of psychiatric
hospitalization too. However, there might be other causes of depression and anxiety in school
going teenagers too. There is a need to understand the multiple factors involved in risk of mental

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ill for teenagers and analyze the interaction between those factors to understand mental health
needs of adolescents.
Just like teenage pregnancy, prevalence of depression in school going teenagers has also
become great public health issue for England. To facilitate development of effective health
promotion program for children before they develop mental illness, there is a need to effectively
identify and interpret association between different risk factors and it role in long term risk of
mental health problem in adolescents (Swartz, Hariri and Williamson 2017). Previous research
has covered about risk factors separately, however the association between family and social
factor or other factor has not been covered. Hence, the main is to explore the factors behind high
number of depressed youth in England and find out factors present in their life that predispose
them to risk of developing mental health issues. By conducting systematic search on depressed
school going school going teenagers, the associated between different risk factors can be
effectively analyzed. This in turn will help to identify and analyze mental health nursing needs
for the population group too.
The main research question for the task is ‘What are the mental health nursing needs for
depressed youth of England. By means of systematic review of relevant research articles,
relevant research article related to the study objective will be selected. The evaluation of the each
paper in terms of research question and critical framework, useful information can be obtained
regarding ways to improve mental health of teenagers in England. Research in this area is also
significant because data obtained from the research will help to target not only just school
children, but also other social support groups that are a necessary part of their life. This will
facilitate the delivery of holistic care and realization of a healthy and productive youth
population in England.

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Methodology and Methods
Literature review strategy:
To retrieve relevant research articles specific to the research question, the strategy is to
analyze research articles published between the years 2010 to 2018. This has been done to ensure
that updated information is retrieved regarding performance and preparedness of the health care
system of England to tackle the issue. Research articles were mainly retrieved from databases
like CINAHL, MEDLNE, PubMed and PsychINFO. The rational for selecting these databases is
that all of them are renowned databases that published research articles in the area of health
science. For instance, PubMed published wide range of biomedical literature and all of them are
peer-reviewed articles thus promoting the trustworthiness and credibility of research evidence
(Ncbi.nlm.nih.gov 2018). Secondly, PsychINFO is also a relevant database for this systematic
review as it is the most trust library for literature in behavioral and social science. As depression
is an area that affects behavioral as well as social outcome for children, searching research article
from this database can yield useful result. Ensuring the credibility of research evidence is a
necessary criteria in research to save time and promote effective analysis of research data. This is
also important because outcome of this research would pave for evidence based health care in
England and integration of the information in health care practice (Gopalakrishnan and
Ganeshkumar 2013).
Apart from focus on selection of research from specific data bases and limiting the search
to certain date range, another important search strategy for the selection of articles for this
systematic review was the use of relevant search terms. The key search term for this systematic
review included ‘depression in teenagers of UK’, ‘depression in school going teenagers in UK’
and ‘mental health problem in school going teenagers of UK’. These were the primary research

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terms used in MEDLINE, CINAHL and PsychINFO. Use of Boolean operators like ‘AND’ and
‘OR’ futher refind the search process. Combination of keywords related to research question and
Boolean operators helped to get specific research article.
Types of evidence to be considered
As the main is to get answers related to mental health issues in youth of England and
identify mental health needs of the population, the search strategy is to include both qualitative
and quantitative research studies. Qualitative research studies can give descriptive information
related to mental health needs of youth in England, whereas quantitative research studies can
give idea about trends and extent to which certain risk factors increase risk of depression and
demand of mental health for school going teenagers. Based on this criteria, studies using cross-
sectional research design, randomized controlled trial, systematic review and mixed methods
study were analyzed. The preference has been given to primary research articles first and
secondary research articles were selected if it gave comprehensive data related to research
question.
Inclusion/exclusion criteria
The following were the inclusion criteria to identify relevant articles related to the
research question:
 The search was designed to obtain descriptive and statistical data on the problem of
depression in adolescent children of England. Hence, both quantitative and qualitative
research articles were taken for systematic review
 All research articles conducting research in clinical, community or school setting of UK
was considered for the research

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 The criteria for selection of articles was that it must be published between 2010 to 2018
 The most specific criteria was selecting articles that targeted school going adolescent
population for research.
 Another relevant criterion was the discussion only on depression or mental health issues
in youth and no other physical illness in adolescents.
The exclusion criteria for the systematic review included the following:
 Research articles published before 2010 were excluded.
 Research articles done with adults or those aged above 18 years were excluded
 Research articles done in other country apart from UK was excluded
Critical framework to be used:
The quality of the final selected articles has been evaluated by the use GRADE (Grading
of Recommendations, Assessment, Development and Evaluation) rating system framework for
this review. This framework analyzes research article on basis of parameters such as study
limitations, consistency, directness, precision, publication bias and quality (Balshem et al. 2011).
Data extraction:
The strategy for analysis and extraction of research data included two step processes. The
first process was to use screen articles by the review of title and abstract. Based on this strategy,
a total of 30 articles were found to be relevant to the research questions. The full text review of
these articles was done in the next phase. The eligibility criteria for inclusion of the study were
that it should match all the inclusion criteria mentioned above. At this stage, type of study
design, results of the study and outcome measures were analyzed. Hence, a total of 45 articles

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were found relevant as per the research question and topic of the systematic review. After review
of abstract, a total of 30 articles were found eligible for the review. Finally, based on full test
review of articles, a total of 10 articles were critically analyzed for this systematic review. The
following is the flow diagram for searching the articles.
No. of articles identified through data base
search (n=45)
No. of articles found after removal of
duplicates and irrelevant articles (n=30)
No. of records screened by reviewing abstract
(n=30)
Articles excluded
(n=15)
Full text articles assessed for eligibility
(n=20)
Studies included for systematic review (n=10)

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Findings
The present section of the paper summarizes the findings of the research papers included
in the study. Each study has been assessed critically, and the key points of the papers have been
presented. The papers throw light on the research question to address it adequately.
Pitchforth et al. (2017) studied mental health and well-being trends among young people
and children in the UK. As per the researchers, there is a growing concern about the wellbeing
and mental health of young people and children in the UK. This has led to increased demands for
referrals to mental health services, counselling services and admissions for self-harm. The
researchers carried out an investigation of the trends in mental and physical health outcomes
through a national health study. Data were collected from 34 surveys carried out in England,
Wales and Scotland. Seven outcome indicators were under scrutiny. The study indicated that the
prevalence of self-reported mental health condition increased considerably, almost six fold, over
the last two decades. The findings reinforce the urgent need of considering the factors that lead
to poor mental health status among children in the UK.
Kidger et al. (2014) studied self-reported school experience of children in South West
England in relation to predictors of self-harm and mental health. The researchers had opined that
different aspects of school life among adolescents are associated with poor mental health status
and a higher risk of self-harm. However, existing literature did not consider prospective studies.
To bridge the gap in the literature, members of the Avon Longitudinal Study of Parents and
Children (ALSPAC) birth cohort were required to complete postal surveys of school experiences
aged 14, and self-harm behaviour aged 16. Examination was done to understand the relationship
between school experiences and related self-harm with the help of multivariable logistic
regression models. The school experiences studied were feeling connected to the school,

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enjoyment of school and perception of teachers as fair. The study indicated that self harm in
children aged 16 years had a clear association with earlier perceptions of school which mainly
encompassed strangled relationship with others and poor acceptance by others
(OR=2.43[1.76,3.35] and OR=2.69[2.16,3.35]. The study concluded that when students feel
unconnected with the environment in school or were unhappy due to unfair treatment of teachers,
chances of self-harm were more. Assessment of the perceptions of the school would act as a tool
for understanding preventable interventions for self-harm. The study had a limitation that the
outcome and exposure measures were self-reported.
Bullying and mental health problems in school going children have been well
documented in the literature. Rothon et al. (2011) carried out a prospective study to the extent to
which bullying can have an impact on mental health status of school going children, and the
usefulness of social support to buffer the negative effect on children. The researchers considered
as a representative multiethnic sample of adolescents who attended East London secondary
schools covering three different boroughs. The study indicated that adolescents who are bullied
have fewer chances of achieving academic success as compared to those who are not bullied.
These children also had the tendency to suffer from depressive symptoms. Social support when
given to this population had been effective in the promotion of good mental health. The finding
that drew considerable attention is that support from family and peers were not sufficient in
protecting adolescents from mental health challenges, indicating the need of support from
nursing professionals. The study had a key limitation that the key measures of the study were
self-reported.
Stewart-Brown et al. (2011) pointed out that the last two decades had marked an
augmented interest in the arena of mental health issues of children. The researchers from the UK