PBH91001: Mental Health Report on Suicide and Depression in Youths
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This report, prepared by a student, investigates the relationship between depression and suicide in young people. It begins by formulating a PICO question to guide the research, focusing on the impact of perceptions and experiences of depression on suicide outcomes. The report details the methodology used, including the selection of databases (CINAHL, PubMed, and Medline), search terms, and inclusion/exclusion criteria. It outlines the search process, from identification of articles through screening, eligibility assessment, and inclusion, resulting in a final selection of six relevant papers. The discussion section analyzes the selected papers, highlighting the findings of primary research studies and a systematic review, and identifying key factors contributing to suicidality, family influences, and beliefs about suicide. The report concludes by emphasizing the implications of these findings for the design of effective mental health programs for youths. The report is a comprehensive analysis of the topic, providing a detailed overview of the research process and key findings.
Running head: MENTAL HEALTH
Mental health
Name of the student:
Name of the University:
Author’s note
Mental health
Name of the student:
Name of the University:
Author’s note
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1MENTAL HEALTH
Introduction:
This report aims to provide a search strategy and search on database for six published
articles that gives answer to the topic of choice. The topic is related to the issue of suicide and
depression in young people and the main PICO question for the task are as follows:
In young people with depression (P?), what are the impact of perceptions and experience of
depression on suicide and depression outcome?
The significance of the above question is that it has been framed using the PICO format.
The significance of using this format is that it clearly defines the specific population,
intervention, comparison and outcome for a study. Thus, this form of questioning helps to refine
the research question and consider what should be included in the study too (Raich & Skelly,
2013). The above PICO question clearly defines the focus the research.
There are many rationales for investigating about perceptions and experience of
depression and suicide. Firstly, investigating about the topic is important because of high suicide
risks in depressed youths and high rate of depression a major concern for this population. The
report by Australian Institute of Health and Welfare (2016) states that in prevalence of major
depressive disorder is high in young Australian population and this eventually increases the risk
of suicide, suicide ideation and self-harm behaviours. In young people aged 0-14 years, suicide
has become the leading cause of deaths. Thus, investigating the experience of this young people
with depression and suicide ideation may help to identify what factors contribute to depression
and risk of self-harm behaviours. The second rationale for choosing this research question is that
multiple factors increase the risk of depression and exploring the lived experience of these group
of youths may help to understand what interventions are needed to prevent depression and suicde
Introduction:
This report aims to provide a search strategy and search on database for six published
articles that gives answer to the topic of choice. The topic is related to the issue of suicide and
depression in young people and the main PICO question for the task are as follows:
In young people with depression (P?), what are the impact of perceptions and experience of
depression on suicide and depression outcome?
The significance of the above question is that it has been framed using the PICO format.
The significance of using this format is that it clearly defines the specific population,
intervention, comparison and outcome for a study. Thus, this form of questioning helps to refine
the research question and consider what should be included in the study too (Raich & Skelly,
2013). The above PICO question clearly defines the focus the research.
There are many rationales for investigating about perceptions and experience of
depression and suicide. Firstly, investigating about the topic is important because of high suicide
risks in depressed youths and high rate of depression a major concern for this population. The
report by Australian Institute of Health and Welfare (2016) states that in prevalence of major
depressive disorder is high in young Australian population and this eventually increases the risk
of suicide, suicide ideation and self-harm behaviours. In young people aged 0-14 years, suicide
has become the leading cause of deaths. Thus, investigating the experience of this young people
with depression and suicide ideation may help to identify what factors contribute to depression
and risk of self-harm behaviours. The second rationale for choosing this research question is that
multiple factors increase the risk of depression and exploring the lived experience of these group
of youths may help to understand what interventions are needed to prevent depression and suicde
2MENTAL HEALTH
rates. From the concepts of sociological theories, the analysis of perception may help to
understand whether individual behaviour promotes such behaviour or there is connection with
other complex factors too (Geisner et al., 2015).
The above PICO question has been developed after revising it several times. Firstly,
PICO format was chosen as it is evidence based technique to frame and answer clinical questions
(Scells et al., 2017).Although PICO format was taken from the beginning to develop a clear and
focussed question, initially the research population taken was people with severe mental illness.
This was revised after interpreting the population group is too broad and selecting specific
disease and age group would give more value to the findings. Thus, the population groups of
youth and mental health disorder of depression was taken because depression is the leading cause
of illness and disability in this age group (World Health Organization, 2019). Hence, taking a
narrowed population group would enhance the value and applicability of research. Initially, there
was confusion regarding the outcome of interest. Depressive symptoms were taken as the
outcome initially. However, as depression and suicide are interconnected, it was finally decided
to take both in the outcome.
Methods:
To start with the process of searching for research literature, the first strategy was to look
for select high quality database. Three databases that were selected for searching articles include
CINAHL, PubMed and Medline. The rationale for selecting these databases is that they all are
high quality and renowned database that publishes research papers in the field of biomedical and
health care literature. PubMed provides free access to MEDLINE and even the possibility to get
access to full text articles. The initial search for papers without any pre-set filters was done in all
rates. From the concepts of sociological theories, the analysis of perception may help to
understand whether individual behaviour promotes such behaviour or there is connection with
other complex factors too (Geisner et al., 2015).
The above PICO question has been developed after revising it several times. Firstly,
PICO format was chosen as it is evidence based technique to frame and answer clinical questions
(Scells et al., 2017).Although PICO format was taken from the beginning to develop a clear and
focussed question, initially the research population taken was people with severe mental illness.
This was revised after interpreting the population group is too broad and selecting specific
disease and age group would give more value to the findings. Thus, the population groups of
youth and mental health disorder of depression was taken because depression is the leading cause
of illness and disability in this age group (World Health Organization, 2019). Hence, taking a
narrowed population group would enhance the value and applicability of research. Initially, there
was confusion regarding the outcome of interest. Depressive symptoms were taken as the
outcome initially. However, as depression and suicide are interconnected, it was finally decided
to take both in the outcome.
Methods:
To start with the process of searching for research literature, the first strategy was to look
for select high quality database. Three databases that were selected for searching articles include
CINAHL, PubMed and Medline. The rationale for selecting these databases is that they all are
high quality and renowned database that publishes research papers in the field of biomedical and
health care literature. PubMed provides free access to MEDLINE and even the possibility to get
access to full text articles. The initial search for papers without any pre-set filters was done in all
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3MENTAL HEALTH
the three databases. The key search terms that were used included ‘depression’, ‘suicide’,
‘youths’, ‘young people’, ‘perception’ and experiences. These search terms were combined
together to ensure that more relevant papers were taken. No filters were applied at this stage.
During search for articles in CINAHL data, advance article searching was used so that
filters could be applied during the search process. The advantage of filter is that it helps to define
certain criteria for research. Search filters are also effective in defining specific criteria for
research and searching for specific subjects (Beale et al., 2019). Thus, search filters were applied
to save time and get reliable research paper. The first filter was applied related to research
publication date by selecting data from 2010 to 2019. Secondly, subject headings were chosen
from advanced search filters to get the most relevant data. Filters were also applied for language
and types of research papers. English language was chosen as the language and full text peer
reviewed articles as the type of source. Moreover, Boolean logic was used to increase the
possibility of getting the most relevant papers related to the research question. The following
table defines how truncations, synonyms and Boolean operators were used in place of each
search terms.
Search terms Synonyms Truncations Boolean operators
Depression Depressive disorder,
major depression,
depressed mood
Depress? Depression OR
depressive disorders
Depression AND
suicide in youths
Suicide Suicidal behaviour,
suicide ideation, self-
harm
Suicid? Suicide or suicidal
ideation
Suicide AND perception
the three databases. The key search terms that were used included ‘depression’, ‘suicide’,
‘youths’, ‘young people’, ‘perception’ and experiences. These search terms were combined
together to ensure that more relevant papers were taken. No filters were applied at this stage.
During search for articles in CINAHL data, advance article searching was used so that
filters could be applied during the search process. The advantage of filter is that it helps to define
certain criteria for research. Search filters are also effective in defining specific criteria for
research and searching for specific subjects (Beale et al., 2019). Thus, search filters were applied
to save time and get reliable research paper. The first filter was applied related to research
publication date by selecting data from 2010 to 2019. Secondly, subject headings were chosen
from advanced search filters to get the most relevant data. Filters were also applied for language
and types of research papers. English language was chosen as the language and full text peer
reviewed articles as the type of source. Moreover, Boolean logic was used to increase the
possibility of getting the most relevant papers related to the research question. The following
table defines how truncations, synonyms and Boolean operators were used in place of each
search terms.
Search terms Synonyms Truncations Boolean operators
Depression Depressive disorder,
major depression,
depressed mood
Depress? Depression OR
depressive disorders
Depression AND
suicide in youths
Suicide Suicidal behaviour,
suicide ideation, self-
harm
Suicid? Suicide or suicidal
ideation
Suicide AND perception
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4MENTAL HEALTH
of youths
Suicide AND
experience of youths
Perception Experience, beliefs,
opinion
Belie? Depression AND youth
perception
Suicide AND
depression AND youths
In addition, to use of search limiters, inclusion and exclusion criteria for search process
was also developed. The significance of including inclusion criteria is that it helps in designing
high quality research protocols. It enhances clarity during the search process as it defines key
features that are important in a research participants or a study. These decisions have an impact
of external validity of the study too (Patino & Ferreira, 2018). The inclusion criteria for the study
included all studies must have youths with depression as the main sample, all the studies must
give idea about lived experience of depressions and suicidal behaviours and all studies must be
published within the last 10 years. Youths with other severe illness were also excluded to
maintain external validity of the findings.
Results:
There were four stages to the research process namely identification, screening, eligibility
and inclusion. During the identification phase, electronic search for data was done in PubMed,
MEDLINE and CINAHL. The number of articles obtained based on initial search in each
database was as follows:
of youths
Suicide AND
experience of youths
Perception Experience, beliefs,
opinion
Belie? Depression AND youth
perception
Suicide AND
depression AND youths
In addition, to use of search limiters, inclusion and exclusion criteria for search process
was also developed. The significance of including inclusion criteria is that it helps in designing
high quality research protocols. It enhances clarity during the search process as it defines key
features that are important in a research participants or a study. These decisions have an impact
of external validity of the study too (Patino & Ferreira, 2018). The inclusion criteria for the study
included all studies must have youths with depression as the main sample, all the studies must
give idea about lived experience of depressions and suicidal behaviours and all studies must be
published within the last 10 years. Youths with other severe illness were also excluded to
maintain external validity of the findings.
Results:
There were four stages to the research process namely identification, screening, eligibility
and inclusion. During the identification phase, electronic search for data was done in PubMed,
MEDLINE and CINAHL. The number of articles obtained based on initial search in each
database was as follows:
5MENTAL HEALTH
Database No. of articles
CINAHL 55
PubMed 150
MEDLINE 143
The number of articles retrieved for PubMed and MEDLINE was much higher than the other
database because no filters were applied and only search terms were used. Hence, total papers
retrieved after electronic database search included 348. During the next stage of screening, all
papers screening by looking at titles and abstract of each papers and assessing any duplicate
papers. 55 duplicate papers were excluded at this stage. In addition, based on title/abstract
screening of remaining 293 articles, 112 papers were excluded as it had older age group or those
with other types of illness too. The papers which were reporting only about prevalence rate and
no details on their experiences were excluded. Total articles remaining after this stage included
181 papers.
The third stage was the eligibility stage and at this stage full text eligibility of papers was
assessed using the inclusion and exclusion criteria. Overall 175 papers were excluded because of
the following reasons:
The sample size in these articles did not matched the age groups
The study sample had other several illness apart from depression
The study explored the effect of an intervention and did not explored experiences
The study focused on other outcomes like social support
Database No. of articles
CINAHL 55
PubMed 150
MEDLINE 143
The number of articles retrieved for PubMed and MEDLINE was much higher than the other
database because no filters were applied and only search terms were used. Hence, total papers
retrieved after electronic database search included 348. During the next stage of screening, all
papers screening by looking at titles and abstract of each papers and assessing any duplicate
papers. 55 duplicate papers were excluded at this stage. In addition, based on title/abstract
screening of remaining 293 articles, 112 papers were excluded as it had older age group or those
with other types of illness too. The papers which were reporting only about prevalence rate and
no details on their experiences were excluded. Total articles remaining after this stage included
181 papers.
The third stage was the eligibility stage and at this stage full text eligibility of papers was
assessed using the inclusion and exclusion criteria. Overall 175 papers were excluded because of
the following reasons:
The sample size in these articles did not matched the age groups
The study sample had other several illness apart from depression
The study explored the effect of an intervention and did not explored experiences
The study focused on other outcomes like social support
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6MENTAL HEALTH
Records identified through electronic database search in MEDLINE,
CINAHL and PubMed
(n = 348)
Records after duplicates removed
(n = 55 )
Records screened
(n = 293)
Records excluded
(n = 112 )
Full-text articles assessed for
eligibility
(n = 181 )
Studies included in the
review
(n = 6 )
Full-text articles
excluded, with
reasons
(n = 175 )
Thus, the final list of papers that were ultimately selected for the review included 6
papers. The above flow chart below gives a summary of the overall search process:
Figure 1: Summary of the search process at each stage
Records identified through electronic database search in MEDLINE,
CINAHL and PubMed
(n = 348)
Records after duplicates removed
(n = 55 )
Records screened
(n = 293)
Records excluded
(n = 112 )
Full-text articles assessed for
eligibility
(n = 181 )
Studies included in the
review
(n = 6 )
Full-text articles
excluded, with
reasons
(n = 175 )
Thus, the final list of papers that were ultimately selected for the review included 6
papers. The above flow chart below gives a summary of the overall search process:
Figure 1: Summary of the search process at each stage
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7MENTAL HEALTH
Discussion:
Total six papers were found to give answer to the research question. Out of six papers,
five papers were primary research papers and one paper was a systematic review paper. Out of
five primary research papers, the study by Issakainen (2015) used qualitative approach to
investigate about young people’s view of communicating their depression. In relation to the
research question, this paper informed regarding the youths view about resources taken to seek
support on depression. This paper is relevant however it does not explore much about factors
contributing to risk. Hence, this is not considered the best research evidence. The second paper
by Geisner et al. (2015) was a qualitative study that explored college student’s perception of
depressed mood. The study assessed symptoms of depression and feelings of sadness, depression
and suicide ideation. The study mainly revealed underestimation of depression among male
students and over-estimation of the prevalence of suicidal ideation. The study gave idea about
intensity of feelings. However, this again is not best evidence as it does not fully explores causes
and factors contributing to depression. The study by Holley (2015) and Lesniak (2010)
investigated about the lived experience of adolescent who engage in self-harm behaviour. These
two studies revealed that child trauma, feeling abandoned and ashamed resulted in such
behaviours. However, the gap in this paper is that it has certain biases such as selection bias.
Out of six papers, two best research evidences have been identified. The first is a primary
research study by Orri et al. (2014) which used qualitative approach to assess attempted suicides
by adolescent and young adults. The result gave many ideas about events leading to suicide. For
Discussion:
Total six papers were found to give answer to the research question. Out of six papers,
five papers were primary research papers and one paper was a systematic review paper. Out of
five primary research papers, the study by Issakainen (2015) used qualitative approach to
investigate about young people’s view of communicating their depression. In relation to the
research question, this paper informed regarding the youths view about resources taken to seek
support on depression. This paper is relevant however it does not explore much about factors
contributing to risk. Hence, this is not considered the best research evidence. The second paper
by Geisner et al. (2015) was a qualitative study that explored college student’s perception of
depressed mood. The study assessed symptoms of depression and feelings of sadness, depression
and suicide ideation. The study mainly revealed underestimation of depression among male
students and over-estimation of the prevalence of suicidal ideation. The study gave idea about
intensity of feelings. However, this again is not best evidence as it does not fully explores causes
and factors contributing to depression. The study by Holley (2015) and Lesniak (2010)
investigated about the lived experience of adolescent who engage in self-harm behaviour. These
two studies revealed that child trauma, feeling abandoned and ashamed resulted in such
behaviours. However, the gap in this paper is that it has certain biases such as selection bias.
Out of six papers, two best research evidences have been identified. The first is a primary
research study by Orri et al. (2014) which used qualitative approach to assess attempted suicides
by adolescent and young adults. The result gave many ideas about events leading to suicide. For
8MENTAL HEALTH
some it was a way to free oneself from intolerable condition and for some it occurs because of
poor interpersonal relationship, communicative issues and feelings of revenge. Continued period
of depression was also associated with high suicide ideation. Thus, by the use of thematic
approach and detailed narration, this study shows what factors engage youth in such behaviour.
Moreover, systematic review by Grimmond et al. (2019) has been identified as the best study as
it used systematic review as a research method which comes under top level in evidence
hierarchy and by getting the same results from multiple studies; this study enhances the
generalizability of the findings. The key findings of this review were that it gave in-depth details
regarding factors contributing to suicidality, family influences and beliefs about suicide. It gives
implications to design effective mental health programs for youths.
some it was a way to free oneself from intolerable condition and for some it occurs because of
poor interpersonal relationship, communicative issues and feelings of revenge. Continued period
of depression was also associated with high suicide ideation. Thus, by the use of thematic
approach and detailed narration, this study shows what factors engage youth in such behaviour.
Moreover, systematic review by Grimmond et al. (2019) has been identified as the best study as
it used systematic review as a research method which comes under top level in evidence
hierarchy and by getting the same results from multiple studies; this study enhances the
generalizability of the findings. The key findings of this review were that it gave in-depth details
regarding factors contributing to suicidality, family influences and beliefs about suicide. It gives
implications to design effective mental health programs for youths.
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9MENTAL HEALTH
References:
Australian Institute of Health and Welfare (2016). Mental health of Australia’s young people and
adolescents. Retrieved from: https://www.aihw.gov.au/getmedia/42e2f292-4ebb-4e8d-
944c-32c014ad2796/ah16-5-5-mental-health-australias-young-people-
adolescents.pdf.aspx
Beale, S., Duffy, S., Glanville, J., Lefebvre, C., Wright, D., McCool, R., ... & Smith, L. (2014).
Choosing and using methodological search filters: searchers' views. Health Information
& Libraries Journal, 31(2), 133-147.
Geisner, I. M., Kirk, J. L., Mittmann, A. J., Kilmer, J. R., & Larimer, M. E. (2015). College
students’ perceptions of depressed mood: Exploring accuracy and
associations. Professional psychology: research and practice, 46(5), 375.
Geisner, I. M., Kirk, J. L., Mittmann, A. J., Kilmer, J. R., & Larimer, M. E. (2015). College
students’ perceptions of depressed mood: Exploring accuracy and
associations. Professional psychology: research and practice, 46(5), 375.
Grimmond, J., Kornhaber, R., Visentin, D., & Cleary, M. (2019). A qualitative systematic review
of experiences and perceptions of youth suicide. PloS one, 14(6).
Holley, E. E. (2015). The lived experience of adolescents who engage in nonsuicidal self-
injury (Doctoral dissertation, Antioch University).
References:
Australian Institute of Health and Welfare (2016). Mental health of Australia’s young people and
adolescents. Retrieved from: https://www.aihw.gov.au/getmedia/42e2f292-4ebb-4e8d-
944c-32c014ad2796/ah16-5-5-mental-health-australias-young-people-
adolescents.pdf.aspx
Beale, S., Duffy, S., Glanville, J., Lefebvre, C., Wright, D., McCool, R., ... & Smith, L. (2014).
Choosing and using methodological search filters: searchers' views. Health Information
& Libraries Journal, 31(2), 133-147.
Geisner, I. M., Kirk, J. L., Mittmann, A. J., Kilmer, J. R., & Larimer, M. E. (2015). College
students’ perceptions of depressed mood: Exploring accuracy and
associations. Professional psychology: research and practice, 46(5), 375.
Geisner, I. M., Kirk, J. L., Mittmann, A. J., Kilmer, J. R., & Larimer, M. E. (2015). College
students’ perceptions of depressed mood: Exploring accuracy and
associations. Professional psychology: research and practice, 46(5), 375.
Grimmond, J., Kornhaber, R., Visentin, D., & Cleary, M. (2019). A qualitative systematic review
of experiences and perceptions of youth suicide. PloS one, 14(6).
Holley, E. E. (2015). The lived experience of adolescents who engage in nonsuicidal self-
injury (Doctoral dissertation, Antioch University).
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10MENTAL HEALTH
Issakainen, M. (2015). Young people's views of communicating their depression. International
Journal of Adolescence and Youth, 20(1), 86-99.
Lesniak, R. G. (2010). The lived experience of adolescent females who self-injure by cutting.
Adv Emerg Nurs J,; 32 (2): 137-47.
Orri, M., Paduanello, M., Lachal, J., Falissard, B., Sibeoni, J., & Revah-Levy, A. (2014).
Qualitative approach to attempted suicide by adolescents and young adults: the
(neglected) role of revenge. PLoS One, 9(5).
Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies:
definitions and why they matter. Jornal Brasileiro de Pneumologia, 44(2), 84-84.
Raich, A. L., & Skelly, A. C. (2013). Asking the right question: specifying your study
question. Evidence-based spine-care journal, 4(02), 068-071.
Scells, H., Zuccon, G., Koopman, B., Deacon, A., Azzopardi, L., & Geva, S. (2017, November).
Integrating the framing of clinical questions via PICO into the retrieval of medical
literature for systematic reviews. In Proceedings of the 2017 ACM on Conference on
Information and Knowledge Management (pp. 2291-2294).
World Health Organization (2019). Adolescent mental health. Retrieved from:
https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
Issakainen, M. (2015). Young people's views of communicating their depression. International
Journal of Adolescence and Youth, 20(1), 86-99.
Lesniak, R. G. (2010). The lived experience of adolescent females who self-injure by cutting.
Adv Emerg Nurs J,; 32 (2): 137-47.
Orri, M., Paduanello, M., Lachal, J., Falissard, B., Sibeoni, J., & Revah-Levy, A. (2014).
Qualitative approach to attempted suicide by adolescents and young adults: the
(neglected) role of revenge. PLoS One, 9(5).
Patino, C. M., & Ferreira, J. C. (2018). Inclusion and exclusion criteria in research studies:
definitions and why they matter. Jornal Brasileiro de Pneumologia, 44(2), 84-84.
Raich, A. L., & Skelly, A. C. (2013). Asking the right question: specifying your study
question. Evidence-based spine-care journal, 4(02), 068-071.
Scells, H., Zuccon, G., Koopman, B., Deacon, A., Azzopardi, L., & Geva, S. (2017, November).
Integrating the framing of clinical questions via PICO into the retrieval of medical
literature for systematic reviews. In Proceedings of the 2017 ACM on Conference on
Information and Knowledge Management (pp. 2291-2294).
World Health Organization (2019). Adolescent mental health. Retrieved from:
https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
11MENTAL HEALTH
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