Productive Citizens: Factors of depression In Emerging Adults

Productive Citizens: Factors of depression In Emerging Adults

Austin See

University of North Florida

HSC 4730: Public Health Research

Professor Lukens Bull

June 21, 2020

Productive Citizens: Factors of depression In Emerging Adults

Abstract

Mental health has been a reoccurring theme throughout the 2000s as research has found

how influential mental health can be in humans. New studies are continuing to find more

evidence on how mental health plays a role in our every day lives. Continuing with the theme of

mental health, depression in America has come to an all time high, especially those 18-25 years

of age. Studies on depression have shown how depression can cause an emerging adult to skip

important developmental steps and delay or inhibit their ability to join society as a productive

citizen. The cause of depression during this time, is likely linked with many of the stressors that

an emerging adult may face during this period of their life. These stressors include factors such

as race, socioeconomic status, school, work, social media, and more. This discussion is aimed to

review research that may help us understand what and how influences in emerging adults’ lives

may contribute to depression during this influential time. The purpose is to identify and

understand the many influences and the consequences of depression from these factors in later

adulthood.
Productive Citizens: Factors of depression In Emerging Adults

Background

Introduction

Depression is one of the biggest mental health problems in the United States today. This

is especially true for emerging adults as at least 25% have reported symptoms of depression

during this important developmental time in their lives. (Kuwabara, Voorhees, Gollan, &

Alexander, 2007) Although seemingly insignificant, social media is thought to play a role in the

spread of depression in emerging adults as displayed in an article by Ariel Shensa, “Social Media

Use and Depression and Anxiety Symptoms: A Cluster Analysis”, that by using cluster analysis

we can determine that social media has an effect on mental health. (Shensa, Sidani, Dew,

Escobar-Viera, & Primack, 2018) Other factors that may be significant in the development of

depression include school, socioeconomic status, and race. Because of this, it is critical to

establish reliable treatment and assistance in order to lower rates of depression as individuals

begin to integrate into society. With continued high prevalence of depression, especially in

emerging adults, the world continues to ignore its existence as a major health hazard. Further

ignorance and lack of dependable treatment of this disease can become an obstacle to many

people in the future. 

Prevalence

It appears, as society continues to progress, signs and symptoms of depression begin to

become more prevalent. With an estimated 7% of adults being affected by depression in the

United States today, these numbers are not expected to decrease at any time in the near future.

(Shensa, Sidani, Dew, Escobar-Viera, & Primack, 2018) This also does not account for emerging

adults or children, as 25% of emerging adults are estimated to have or experience depression, the

highest prevalence of any age group. (Kuwabara, Voorhees, Gollan, & Alexander, 2007) This
Productive Citizens: Factors of depression In Emerging Adults

means that every 1 in 4 of people you meet (18-25) have depression or have symptoms of

depression. These numbers exclude other mental health issues like symptoms of anxiety which

can be more rampant and just as detrimental as depression. While this may be surprising, when

put under a magnifying glass these numbers begin to make more sense, as during this period of

time there are many factors and stressors that can contribute to the onset of depression in

emerging adults' lives that are less common at any other period.

Factors

This number can be analyzed further, as there are many factors that make depression so

prevalent in this specific age group. In an article authored by Diana Sarokhani, “Prevalence of

Depression among University Students: A Systematic Review and Meta-Analysis Study”, she

found that the prevalence of depression in university students was 33%. (Sarokhani et al., 2013)

In this article, not only did the author survey students, but also took note of their gender and

relationship status, with most of those suffering from depression being male and single. Another

contributing factor to high prevalence of depression during this period is socioeconomic status.

In a study done by Christina Mondi, “Predictors of Depressive Symptoms in Emerging

Adulthood in a Low-Income Urban Cohort”, she found that low socioeconomic status increased

the likelihood of experiencing depression by 15.2% during the ages 18-25. (Mondi, Reynolds, &

Ou, 2017) Combined with the effects of social media use in the article “Online Social

Networking and Mental Health” by Igor Pantc it becomes more understandable of why

depression is so rampant in emerging adults. When a comparative study was done between

university students and sociology economic status, prevalence rose if an individual attended

university and had low economic status.

Productive Citizens: Factors of depression In Emerging Adults

Affecting Development

Not only is depression more widespread during this time, but this is also a period where

an individual is attempting to join society as a productive adult. Because of this, depression can

halt, delay, or completely skip important development needed for that individual to join society.

This is more thoroughly explained in Sachiko Kuwabara’s study “A Qualitative Exploration of

Depression in Emerging Adulthood: Disorder, Development, and Social Context”. This study

was conducted through a survey of 15 people who have experienced depression or still have

depression during emerging adulthood. It was then separated into themes, of which a main theme

was found of “interruption to identity” in which interviewees explained that during this time of

depression in their lives there was a lack of growth, or, “a time where you don't feel like

yourself”. (Kuwabara, Voorhees, Gollan, & Alexander, 2007) “Prevalence of Depression Among

University Students: A Systematic Review and Meta-Analysis Study” a study done by Diana

Sarokhani also expounds on the possible developmental problems depression can have on a

student at a university. Stating that depression can cause lack of motivation, students with

depression tend to get worse grades greatly affecting them when applying for jobs or continuing

education at a higher level. (Sarokhani et al., 2013)

Treatment

Treatment for emerging adults with depression is either not affordable or non-existent.

This is especially true for those who are low-income or have low socioeconomic status. In a

study done by James January, “Prevalence of depression and anxiety among undergraduate

university students in low- and middle-income countries: a systematic review protocol” January

explains that a major factor of why those with low income or socioeconomic status have

depression is due to the inability to access treatment. (January et al., 2018) Affordable care acts
Productive Citizens: Factors of depression In Emerging Adults

lack inclusivity of treatment of mental health diseases such as anxiety and depression. Sachiko

Kuwabara also explains this in his study “A Qualitative Exploration of Depression in Emerging

Adulthood: Disorder, Development, and Social Context”. In Kuwabara’s study healthcare is one

of the running themes represented across all interviews his study conducted. Finding that

insurance is very limited when dealing with mental health. There is also uncertainty, sigma, and

lack of effective treatments. (Kuwabara, Voorhees, Gollan, & Alexander, 2007) These studies

are just the tip of the iceberg when uncovering the impact of depression in emerging and older

adults in the United States.

Conclusion

When assessing depression in emerging adults there are many factors that contribute to

this mental health issue, not only in emerging adults but also in every age group all over the

world. The main factors for emerging adults specifically being social media, income, and

university/school. These are just some of the many possible problems that can influence an

individual in a negative way leading to mental health issues. In light of these factors and the risk

of skipping developmental queues or even in the worst cases leading to suicide there needs to be

more done in our society to treat those with mental health whether it be making affordable

insurance or changing the social culture to be wary of those with depression. Because of this it

should be a major concern for public health initiatives to lead everyone to a happier more

productive future.
Productive Citizens: Factors of depression In Emerging Adults

Pilot Study and Preliminary Data

During the summer of 2020, research was conducted to understand the link between

social media, SES, race, and university; and depression in emerging adults 18-25. Previously to

this study, numerous studies hinted at the possible link between these factors and mental

diseases. This study has been undergone due to the many hints that one may influence the other.

To collect data on this subject a survey was conducted using the website Qualtrics. The way that

this survey was distributed through word of mouth (text messaging) to collect data on depression

or depressive symptoms and the use of social media. Out of the 20 people who participated in the

survey 100% of them completed the entire survey. Of the responses received from the survey,

15% of participants have never experienced depression or symptoms of depression in their

lifetime. 85% of those participants did experience depression or symptoms during their lifetime.

Of those who have experienced depression or symptoms of depression, showed an increase in the

use of social media in their life. Out of the 20 participants that took the survey 85% of them were

in schooling system (college, grad school, etc). Also, out of the 20 participants in the study 30%

of them deemed social media important enough to affect their personal lives.

Figure 1: This survey, out of the 20 participants that took the survey results showed a 85-15%

ratio of those who have experienced depression or symptoms of depression in their lives.

Percentage of 18-25 who have

experienced depression

100
80
60
40
20
0
Yes No
Productive Citizens: Factors of depression In Emerging Adults

Figure 2: Participants were also asked to document how much time they thought they spend on

social media daily. The graph shows 14 out of 20 participants marked 2+ hours of social media

every day. Blue: 4+ hours Orange: 2-3 Grey: 30 minutes to 1-hour Yellow: None

Hours of Social Media Daily

1 2 3 4

Figure 3: Shows participants that recorded if social media affects them directly in some way,

such as it being essential for them (income or otherwise). Out of the 20 that answered, 30%

answered that social media directly affects them.

Affects Personal Life Directly

16
14
12
10
8
6
4
2
0
yes no
Productive Citizens: Factors of depression In Emerging Adults

Research Methods

The purpose of this study is to determine the prevalence of depression and understand the

factors that contribute to the onset of depression in emerging adults. To accomplish this goal,

Austin See, the principal investigator (PI), has selected multiple experienced personnel to assist

in this study. One of the personnel, Professor Lukens Bull, MPH, will be assisting the PI in

guaranteeing the ethical conduct of this study, along with tasks like recruitment, collection of

data, and analysis of results. Included in the personnel will be Dr. XXX, a Psychiatrist who

specializes specifically in the diagnosis of mental health in children and young adults. Also, on

the team will be a data coordinator, who will be responsible for all data collected, this includes

analysis and the insurance of the accuracy of the data.

This study is specifically directed at emerging adults ages 18-25 who have depression,

with data taken on race, social status, social media use, and other factors that may influence

depression in this stage of life. This study will be conducted in Orange County, Orlando, Florida.

This specific county was selected due to a high number of college students, as school is a likely

factor for those who develop depression during these ages. Those who may participate in this

study must be 18-25, it is not required that they must have depression or symptoms of

depression, this is to gain the most accurate data possible based on those who can give the best

and most reliable data on depression during this developmental age. This study will consist of

300 participants who will be asked to take a survey. This will be distributed through convenience

sampling; this is due to the ability to access a wider range of diverse people and will only be

taken by those who are willing to participate in the study. The study will be posted on social

media websites also in boards and classrooms at the University of Central Florida. It is important
Productive Citizens: Factors of depression In Emerging Adults

10

to attain a diverse variety of people, so efforts will be made to offer the study to as many groups

of people as possible.

The type of study conducted will be a cross sectional, this is to compare factors with rates

of depression in emerging adults. Those with depression or symptoms of depression will be in

one group and those without depression or symptoms of depression will be in another group.

They will then be compared by questions on the survey pertaining to factors that may increase or

decrease the prevalence of depression in emerging adults. The purpose of this is to understand

the influence that the factors have on the prevalence of depression in emerging adults. We should

see in this study that those with depression will have a higher rate of confirmation on certain

factors than those without depression. The higher the confirmation rate over the group without

depressive symptoms the more of an influence that factor is on depression during this

developmental period.

The survey that will be used will be a revised version of the survey made for class but

will be based on many of the questions asked in that same survey. The data will be sorted into

categories and analyzed from the personnel on the team. The main purpose is to isolate specific

factors that highly contribute to depression in emerging adults to have a better grasp of what the

main causes of mental health problems at this stage in life. The data will then be sorted into a

table to be compared and analyzed. The only problems expected during this study is the

possibility of misinformation during the survey. This happens through the way that the survey is

being distributed. Participants can lie about their age or experiences that they have had with

depression, this causes skewed results, the combat this, there is a high participant count to offset

any misinformation.
Productive Citizens: Factors of depression In Emerging Adults

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Data Analysis

In the research study “How does social media, race, SES, and university contribute to

depression in emerging adults?” multiple variables will be examined using SAS 9.4. An analysis

must be undergone to understand the distribution of data. Because of the sample size all variables

will be normally distributed. The outcome variable will be scored overall through questions

involving school, race, depression, and social media. All of these areas will be analyzed

individually and will be normally distributed. Question 6: “Are you currently in school?” of the

survey will be analyzed as a continuous variable. Lastly, an analysis will be done to understand

the differences and influences of multiple variables and their impacts on mental health including

school, race, socioeconomic status, and social media.

Dissemination of Findings

Once the research is complete, the research team will then publish the findings in one or

more peer reviewed journals. The results that the research team has found will then be presented

at a national convention, aimed at public health officials and organizations. These results will

also be taken to nearby Jacksonville communities and be available in the University of North

Florida system. Due to this research being focused on emerging adults ages 18-25 who are likely

in college or have higher education, this information will be critical to colleges and universities.

The researchers in this study will create a presentation video that will be used to share the

findings.
 Productive Citizens: Factors of depression In Emerging Adults

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References

January, J., Madhombiro, M., Chipamaunga, S., Ray, S., Chingono, A., & Abas, M. (2018). Prevalence

of depression and anxiety among undergraduate university students in low- and middle-income

countries: A systematic review protocol. Systematic Reviews,7(1). doi:10.1186/s13643-018-

0723-8

Kuwabara, S. A., Voorhees, B. W., Gollan, J. K., & Alexander, G. C. (2007). A qualitative exploration

of depression in emerging adulthood: Disorder, development, and social context. General

Hospital Psychiatry,29(4), 317-324. doi:10.1016/j.genhosppsych.2007.04.001

Mondi, C. F., Reynolds, A. J., & Ou, S. (2017). Predictors of depressive symptoms in emerging

adulthood in a low-income urban cohort. Journal of Applied Developmental Psychology,50, 45-

59. doi:10.1016/j.appdev.2017.03.009

Pantic, I. (2014). Online Social Networking and Mental Health. Cyberpsychology, Behavior, and Social

Networking,17(10), 652-657. doi:10.1089/cyber.2014.0070

Sarokhani, D., Delpisheh, A., Veisani, Y., Sarokhani, M. T., Manesh, R. E., & Sayehmiri, K. (2013).

Prevalence of Depression among University Students: A Systematic Review and Meta-Analysis

Study. Depression Research and Treatment,2013, 1-7. doi:10.1155/2013/373857

Shensa, A., Sidani, J. E., Dew, M. A., Escobar-Viera, C. G., & Primack, B. A. (2018). Social Media Use

and Depression and Anxiety Symptoms: A Cluster Analysis. American Journal of Health

Behavior,42(2), 116-128. doi:10.5993/ajhb.42.2.11

Productive Citizens: Factors of depression In Emerging Adults

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Appendix
A: Pilot Study Survey
http://unf.co1.qualtrics.com/jfe/form/SV_0I0Qb30sVRiSVc9
B: Pilot Study Codebook

# Variable Name Question From Survey Answer Categories Variable Type

1 Progress Progress 100 Numeric
2 Duration (in seconds) Duration (in seconds) 20-3417 Numeric
3 Q1 I am 18-25. yes Text
Do you now or have you in the
past experienced depression or
4 Q2 symptoms of depression? yes, no Text
30 minutes-1
hours, 2-3 hours,
How long do you use social 4+ hours, I do not
5 Q3 media platforms daily? use social media Time
In your experience how does
social media make you feel about
6 Q4 yourself? Short Response Text
Daily, Yearly,
How often do you post on social Monthly, Once a
7 Q5 media? week, Never Time
8 Q6 Are you currently in school? yes, no Text
Does social media have a direct
9 Q7 effect on your personal life? yes, no Text
How would you describe your
10 Q8 attachment to social media? Short Response Text
11 Q9 Do you have a significant other? yes, no Text

White, Black, or
African American,
American Indian or
Alaska Native,
Choose one or more races that Asian, Native
you consider yourself to be: - Hawaiian or Pacific
12 Q10 Selected Choice Islander, Other Text
Productive Citizens: Factors of depression In Emerging Adults

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C: Human Subjects
Human Subjects

The study that we are conducting is titled: “How does social media, race, SES, and

university contribute to depression in emerging adults”. The purpose of this study is to find and

understand the correlation between social media, race, SES, and university; and depression

during emerging adulthood (18-25). It is also, to understand the impact mental health has on

emerging adults into later adulthood due to factors such as social media. To acquire data on this

subject our staff conducted a survey asking those who are 18-25 questions on their experiences

with social media and the effects social media may have had on their wellbeing. Because the

study that we are sending out is a survey, we will not be seeking IRB approval for this study.

Those who can participate in the study if they wish to do so, must be 18-25 years old.

Every race, and gender will be included. This study will also target those who are or are not in a

higher academic learning system. This is to understand if university also influences mental health

during this important timeframe. The reason why we are excluding those who are not 18-25 is

due to the inability to answer our questions with the more knowledge of how they felt when they

were this specific age. Many of the questions are specifically for people who are currently 18-25

years old.  No incentives will be offered to participate in this study. To reach out to as much of

the emerging adult community, this survey will be posted on school boards and in places that are

accessible to as many people as possible. No children will be used in this study.

Productive Citizens: Factors of depression In Emerging Adults

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Ethnic Categories
Hispanic or
Not Hispanic or Latino Total
Latino
Femal
Racial Categories Male/Female Male/Female Male
e
American Indian/Alaskan Native 10/10 10/10 20 20 40
Asian 10/10 10/10 20 20 40
Native Hawaiian or other Pacific
10/10 10/10 20 20 40
Islander
African American/Black 10/10 10/10 20 20 40
White 10/10 10/10 20 20 40
More than one race 10/10 10/10 20 20 40
Total 120 120 120 120 240

D: Consent

INFORMED CONSENT FORM

to Participate in Research, and

AUTHORIZATION
to Collect, Use, and Disclose Protected Health Information (PHI)

Title of this study:

Researchers:

You are being asked to participate in a research study.

Before you agree to take part in this study, Austin See

or his/her representative will tell you:

 Why the study is being done and what will happen to you if you take part in the
study: This study is being undergone for the purpose of understanding depression
in emerging adults with the possible correlation to social media, university, gender,
and race. The purpose is to understand factors that contribute to depression in
emerging adults and understand the effects that prevent emerging adults from
entering society. For this study, participants will be asked to complete a survey, if
at any time the participant does not wish to take or complete the survey they may
stop without any penalty. With this survey, participants will remain anonymous,
except that we ask you for your age, gender, and race. If you choose to take part
in this study, you will answer the questions asked under any time frame and may
Productive Citizens: Factors of depression In Emerging Adults

16

stop the survey, and not participate in this study, if you wish, at any time. Upon
completion of this survey your answers will be sent to a database where they will
be stored, sorted, and analyzed.

 How long you will be in the study: The survey is designed to only take 5 minutes,
you may take as much time as needed, and if at any point you wish to no longer
continue you may without repercussions. Once the survey is complete, that is the
end of your participation in this study. You will not be asked or required to
participate in this study any further.

 How many people will be in the study: This study will be distributed across the
Orlando area, we are looking for at least 240 participants to take part in the
study. If more than 240 participants take part in the study, their responses will
also be stored, sorted, and analyzed.

 The possible foreseeable risks, discomforts, and benefits of this research: The
participant may feel uncomfortable answering some of the questions that are
presented during the survey, if at any time you do not wish to continue, you may
do so without repercussion. Taking this survey may benefit you by understanding
some of the possible feelings social media, or other may have on your mental
health.

 Alternatives to being in the study: If you do not wish to take part in this study, but
you do wish to help, you may distribute this survey to acquaintances you may
know in the area that are 18-25 years of age.

 How your study records will be maintained and who will have access: Once you
complete our survey, it will then be sent to a database where it will be stored,
sorted, and analyzed. Only the researchers and those assigned to analyzing the
database will have access to the information.

 If it will cost you anything to take part in this study: It will not cost you anything to
take this survey, this survey is free and participation is optional.

 When or if you may be told about new findings which may affect your willingness
to keep taking part in this study: This study will only publish the findings when
complete. You will not be told about the findings until the study is officially
published.
Productive Citizens: Factors of depression In Emerging Adults

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If you agree to participate in this study, you will be given a signed copy of this
document.

You may contact Austin See at (888) 888-8888 at any time if you have questions about
the research or if you think that you have been hurt by the research.

You may contact the Institutional Review Board at the University of Mid-Florida Health
Science Center at (999) 999-9999 if you have questions about your rights as a research
subject or what to do if you are injured.

You may choose not to be in this study or you may quit being in the study at any time
and there will be no penalty and no loss of any benefits you are entitled to.
If you agree to participate in this study, Austin See will create, collect, and use private
information about you and your health. This information is called protected health
information or PHI. In order to do this, the Principal Investigator needs your authorization.

More specifically, the following information may be collected, used, and shared with
others:

 (List)
This information will be stored in locked filing cabinets or in secure computer servers with
security passwords.
Your PHI may be collected, used, and shared with others for the following study-related
purpose(s):
 To determine
Once this information is collected, it becomes part of the research record for this study.
Only certain people have the legal right to collect, use and share your research records,
and they will protect the privacy and security of these records to the extent the law allows.
These people include:

 the study Principal Investigator, and research staff associated with this project.
 other professionals at the University that provide study-related treatment or
procedures
Productive Citizens: Factors of depression In Emerging Adults

18

 University of Mid-Florida Institutional Review Board (IRB; an IRB is a group of

people who are responsible for looking after the rights and welfare of people
taking part in research).

Your PHI may be shared with:

 Sponsor
 United States and foreign governmental agencies who are responsible for
overseeing research, such as the Food and Drug Administration, the Department
of Health and Human Services, and the Office of Human Research Protections

 Government agencies who are responsible for overseeing public health concerns
such as the Centers for Disease Control and federal, state and local health
departments

Otherwise, your research records will not be released without your permission unless
required by law or a court order. It is possible that once this information is shared with
authorized persons, it could be shared by the persons or agencies who receive it and it
would no longer be protected by the federal medical privacy law.

Your PHI will be used and shared with others until the end of the study (or alternative).

Once this research study is completed, any information that could identify you might be
removed from any identifiable private information or identifiable biospecimens collected
and that, after such removal, the information or biospecimens could be used for future
research studies or distributed to another investigator for future research studies without
additional informed consent from you or your legally authorized representative.

You are not required to sign this consent and authorization to allow researchers to collect,
use and share your PHI. Your refusal to sign will not affect your treatment, payment,
enrollment, or eligibility for any benefits outside this research study. However, you cannot
participate in this research unless you sign this consent and authorization.
You have the right to review and copy your protected health information. However, we
can make this available only after the study is finished.
You can revoke your authorization at any time before, during, or after your participation in
this study. If you revoke it, no new information will be collected about you, but information
that was already collected may still be used and shared with others if the researchers
have relied on it to complete the research. You can revoke your authorization by giving a
written request with your signature on it to the Principal Investigator.
Productive Citizens: Factors of depression In Emerging Adults

19

Signing this document means that the research study, including the above information,
has been described to you orally and/or that you have read this document, and you
voluntarily agree to take part.

________________________________ ______________
Signature of Person Obtaining Consent Date

________________________________ ______________
Consent and Authorization of Patient Date
Productive Citizens: Factors of depression In Emerging Adults

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E: Budget and Timeline

Personnel Salary Benefits % time Total

Austin See 10,000 5,000 Full 15,000
Dr. XXX 10,000 5,000 Part 15,000
Dr. XXX 10,000 5,000 Part 15,000
Dr. XXX 10,000 5,000 Part 15,000
Other Expenses ---
Equipment and 100
Supplies

Communications ---

Travel 2,000

Other costs F&A 29,808

Total Direct Costs 42,100

Total Indirect 29,808
Costs

Total Requested 71,908 20,000 91,908

Productive Citizens: Factors of depression In Emerging Adults

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Activity Sep Oc No De Ja Fe Marc Apri Ma Jun Jul Aug

t t v c n b h l y e y
Research and download ---
supporting documents
Read and understand ---
literature of documents
Create hypothesis ---
Create goals and aim ---
Draft research methods ---
for paper
Organize and store data ---
Analyze data/make tables ---
Draft results ---
Draft introduction and ---
discussion
Revise and --- ---
submit/present