Research Proposal- Depression and Obesity

Research Proposal- Depression and Obesity

Title of research: Childhood obesity and prevalence of risk factors for anxiety and depression in Black and Hispanic middle school-age children who attend public school in Flushing, NY.

1.0 Purpose of the study

This study is designed to assess the hypothesis that middle school-age Black and Hispanic children with childhood obesity are at higher risk of getting anxiety and depression. The main objectives include:

To determine whether childhood obesity increases the prevalence of anxiety and depression in middle school-age Black and Hispanic children.

The research question is as follows:

What is the relationship between childhood obesity and the prevalence of anxiety and depression among middle school-age Black and Hispanic children?

2.0 Background

Depression is a menace that is slowly ravaging the world. It has to come to a halt. More than fifty million (19.86% of the population) Americans are mentally ill (Yang et al., 2021). Most of the youth are suffering from depression. Statistics have it that 15.08% of the youths experience a depressive episode over the past year. Actually, more than 2.5 million youths in the US have severe depression (Okca et al., 2018). Multiracial disparities pose a greater risk for non-whites. The major depression rates among Hispanics are 10.8% and 8.7% among blacks (Miller et al., 2019). Multiracial youths are at higher risk of suffering depression. These statistics are quite worrying and saddening. They call on us to take measures against mental illness objectively.

Depression is a mental state whereby an individual has continuous feelings of sadness and loneliness and a lack of motivation to do any task behavioral changes (Wang et al., 2017). Anxiety is when an individual is in a state of constant fearfulness and nervousness. Depression and anxiety are crucial aspects of mental health and well-being. Anxiety and depression have been reported to be among the top causes of death across the world. This is quite worrying. Depression affects all age groups, ranging from adults, the elderly, and the youth.

The symptoms of depression include anxiety, apathy, hopelessness, sadness, guilt, loss of interest in activities, agitation, excessive crying, irritability, social isolation, restlessness, insomnia, and excessive sleeping (Kendller, 2016). Cognitive symptoms include suicidal thoughts and loss of concentration. Other symptoms include weight gain or weight loss and loss of appetite. All these symptoms do not appear at once for one to be diagnosed with depression. Any of the symptoms may indicate depression.

Depression among middle school-aged children is poorly recognized (DeFilippis & Wagner, 2014). Most of these cases are diagnosed at the age of 14 years. The affected may have poor performance in school, maybe socially distant, and even abuse drugs. Most of them might not be aware that they are experiencing depression. A lot of mental awareness has been done in the past year to ensure that people are aware of mental health. However, most of this information on mental health is not taken in with the heaviness it requires. Most people tend to be ignorant of this topic. This explains why the rates of depression have been increasing rapidly in the past years.

There are various factors that can lead to depression in a middle school-aged child. Genetics plays a role in the risks of depression. A history of depression in one’s family predisposes one to getting depression. Some scientists believe that depression is inherited. The mode of inheritance has not been fully understood. In case a member of your family has depression, there is a double likelihood you might get depression. Estimates suggest that depression is approximately 40% determined by genetics (Neale, 2019). There is no clear understanding of how genes cause depression. More studies are ongoing.

Moreover, the death or loss of a loved one might lead an individual into depression. Death or loss brings sadness and grief, which is absolutely normal. Even broken romantic relationships may lead to sadness among middle school children. The feelings of sadness and grief may bring serious symptoms of depression. An individual may feel worthless or useless after loss. This could develop into depression. A person who is grieving may experience poor appetite, loss of interest in activities, and trouble sleeping. These feelings are expected to subside after a while, but if they persist, the grief may turn into depression.

Abuse or traumatic life events may lead to depression. Children who have been abused, either verbally or physically, tend to develop depression. The trauma causes stress to the individual. There are increased levels of cortisol, the stress hormone. Stressful life events are overwhelming, and they cause increased cortisol levels. This triggers depression. Stressful life situations like the financial crisis might lead one to depression. Low socioeconomic status among Hispanics and Blacks might be a big contributor to the increased depression rates. Racial discrimination also causes stress and feelings of low self-esteem, hence depression. Research shows that the multiracial groups living amongst the whites indicate higher rates of depression than those living away from the whites.

Substance use could also cause depression. Drugs such as marijuana and alcohol may cause depressive disorders. Some drugs that are prescribed have been linked to depression. Some examples are anticonvulsants, statins, benzodiazepines, corticosteroids, stimulants and beta blockers.

Apart from depression, obesity is another major challenge in the society. Obesity is the leading cause of death in the world. It is a worldwide crisis of public health concern. The aggregate cost of obesity is $150 billion annually. Approximately a third of all American children are obese.  Research that was done recently indicates that 42 million of the population is obese; by 2025, more than 70 million people will be obese or overweight (Guerrero et al., 2018). The rate of obesity among American children has tripled over the years. The prevalence of obesity among blacks and Hispanics has increased by 120% and by 50% among whites, as a certain study states. There are several factors that contribute to childhood obesity.

Obesity is a leading cause of death globally. A person is termed overweight when their body mass index (BMI) is above 25kg/m² and obese when BMI is above 30kg/m² (Aldolaim, 2019). Obesity predisposes an individual to some comorbid conditions like heart disease, high blood pressure, type 2 diabetes, osteoarthritis, respiratory diseases, and cancers (Subica et al., 2019). Obesity leads to high cholesterol levels in the body. This results in the formation of plaques on blood vessels, which results in high blood pressure. There are joint pains due to the stress that is directed to the joints. Apart from these physical effects of obesity, there are also social and emotional complications.

Physical inactivity is one of the factors that may lead to childhood obesity. Most middle school-age students report spending most of their time watching television, playing video games, and doing homework. This is common among blacks and Hispanics. These are passive activities. They are physically inactive most of the time. Lack of physical exercise causes fats to accumulate in the body hence excessive weight gain (Lee & Yoon, 2018).

Poor diet and nutrition lead to obesity. Intake of food with high calorie levels causes weight gain and obesity (Lee & Yoon, 2018). Most middle school-age Hispanics and blacks report taking fast foods, baked products, and snacks that have high-calorie content. This explains the high prevalence of obesity among them. The low socioeconomic status of Hispanics and Blacks contributes to poor nutrition, as a study stated. They are not able to afford healthy foods, which are more expensive. They live in the surroundings of many supermarkets where cheap fast foods are readily available.

Moreover, psychological factors like stress can contribute to childhood obesity. Academic workload and discrimination in school, among other situations, contribute to the stress of Hispanic children. Some of them might tend to overfeed to relieve the stress. Research by Hase et al. (2017) reports that 17.2% of black and Hispanic middle school-age children are bullied in school. This causes stress that leads to stress eating, hence childhood obesity. The bullying also causes them to feel nervous, fearful, and sad.

Moreover, the influence of media and technology has contributed to childhood obesity (Jordan, 2019). Digital evolution has rendered many to live behind screens hence physical inactivity. There are numerous advertisements on media platforms that advertise very unhealthy lifestyles and foods. This has really influenced the children into eating unhealthy hence the increase of childhood obesity.

Childhood obesity might contribute to depression indirectly (Sagar & Gupta, 2018). Childhood obesity predisposes a child to bullying and social segregation in school. This makes the child feel sad, nervous, and fearful. This contributes to depression. Research shows that there is an increased prevalence of depression among children who are obese (Rao et al., 2020). Moreover, there is an established relationship between obesity and depression prevalence. A research study recently showed a 10.5% prevalence of depression among those who are obese (Williams et al., 2020). This prevalence was among all races. However, the prevalence in the different racial groups has not been defined yet. Studies are ongoing. There is a need to know the prevalence among the different age groups and multiracial groups.

The low socioeconomic status of Hispanics and blacks predisposes them to more stress, anxiety, and depression. Social discrimination explains the increased incidences. There is a need to know the prevalence of depression among Hispanic and black middle school children who are obese. This will ensure that vital measures will be put in place to counter these challenges of public health: depression and childhood mortality.

3.0 Inclusion and Exclusion Criteria

The study population is middle school-aged children who are Hispanics or blacks and attend public school in Flushing, NY. 175 middle school Hispanic and black children will participate in the study.

Inclusion Criteria

Middle school children aged 11-13 years who attend public schools in Flushing. They must be Hispanics or Blacks. Their parents or guardians must give an informed consent to take part in the study.

Exclusion Criteria

Children:

Who are less than 11 years old or older than 12 years, and who are not in middle school.

Who are non-Hispanics or whites?

Attending private schools.

Whose parents or guardians declined to consent to take part in the study?

On antidepressants or antipsychotics, or antidiabetic medication.

4.0 Procedures Involved

The study will be carried out across 25 public schools in Flushing, NY. It will involve distributing questionnaires to students who meet the inclusion criteria. The students will take the questionnaires home to seek consent from their parents or guardians. Once consent is granted, they can answer the questionnaire anywhere. Finally, they will drop the questionnaire at the schools’ clinics, where their weight and height will be measured. The school nurses will help with the weight and height collection.

The study design used will be a cross-sectional analytical study design. It is a study design that is used to approve or disapprove assumptions (Danese, 2019). It is also used for population-based surveys to assess the prevalence of a disease. It is a less costly study design that collects data at a specific point in time. It does not involve a lot of time since there is not much follow-up. Many findings and outcomes can be derived from this study design.

Data collection in this study will involve the use of questionnaires. We shall have two teachers from each school. The teachers will help distribute the questionnaires to the children who have met the inclusion criteria. The children will take the questionnaire to their parents or guardians, who will give consent and help them in filling the questionnaire.

The questionnaires capture demographic details such as age, gender, weight, height, residence, and ethnicity of the child. It will also include the level of education of the parents and their income. Moreover, it will include questions on the number of hours spent watching TV or playing video games and the kind of foods taken by the child. It will also involve the Children’s Depression Inventory (CID). This is a tool used to assess and diagnose depression among children from the age of 6 years to around 18 years. It is a modified form of the Beck Depression Inventory that is used for adults. This questionnaire is integrated in a way that assesses the prevalence of depression among obese Hispanic and black middle school children.

After the children, with the help of their parents or guardians, fill the questionnaires, they shall drop them at the school clinic. Their weight and height will be measured by the nurse in charge. These parameters will facilitate the calculation of the BMI. However, the children who will not be granted consent to participate in the study will return the questionnaires to their respective teachers.

This study will run for three months. The timelines are as follows:

Weeks	1	2	3	4	5	6	7	8	9	10	11
Proposal writing
Submission to ethics
Data collection
Data analysis
Report writing
Presentation of results

Filling out the questionnaires will take approximately twenty to 30 minutes.

5.0 Recruitment

The participants of this study will be recruited from the class by the assigned teacher. Teachers know their students well enough; therefore, they are the best options to determine which child meets the inclusion criteria. The teachers will talk to the specific students and issue the questionnaires to them. They will also follow up with their parents to ensure accountability for the issued questionnaires. There will be a reward (a small token) to the participants and teachers to show appreciation. This will motivate all the participants to participate in the research.

6.0 Consent Process

Legally, middle school-age children cannot give consent by themselves. Consent to participate in this study will be gained from parents or guardians. The first page of the questionnaire will involve a consent form which should be signed by the parent or guardian before the survey is completed. This can be done from anywhere, there is no stipulated venue. The consent form will include the scope of the study, the time that will be spent in the study, and a section to state whether one has fully understood what the research involves. It will also include a phrase that allows one to withdraw from the study at any time without offering any explanation. The importance of a consent form is to ensure no coercion to participate in any study. If the parent or guardian requires more explanation, they can reach out to the teacher for further explanation. This will ensure that an informed consent is given.

7.0 Risks to Participants

This study has very minimal risks to the participants if there are any at all. The questionnaire asks participants a number of questions that could, in some circumstances, cause them some degree of distress. The questionnaire will also take some time to fill out. The participants can withdraw from the study at any time, and data collected from them will not be used. The participants can also be withdrawn from the study without their consent when they bring a forged signature of consent.

8.0 Potential Benefits to the Participants

The participants will be able to know their BMI. They will also get a better understanding of depression and childhood obesity and how they are related. At the end of the study, they will be given a small token of appreciation.

9.0 Financial Compensation

This is a self-sponsored study. I will give the participants a non-monetary token at the end when they are submitting the questionnaires. This token will be a packaged gift containing dried raisins and other fruits and an additional leaflet teaching them about childhood obesity and depression. It will also be accompanied by a handmade letter containing affirmations. The teachers shall get 10$ for every completed questionnaire. The participants will incur no cost apart from the time they will spend filling out the questionnaire.

10.0 Provisions to Protect the Privacy Interests of Participants

All the data obtained in this study will be kept strictly confidential. There will be no naming of participants in this study. They will be given codes for identity. Only the data analyst will access the data of this study. The rest of the research team just facilitates the data collection.

11.0 Confidentiality and Data Management

Data in this research involves age, weight, BMI, gender, the income of parents, and the results of the CDI. All this will be obtained through the questionnaire. The questionnaires will be shredded after the data has been stored as an Excel document. The data analyst and the researcher will have access to the data. A specific password will be used to access the data. The data will be analyzed using narrative analysis. Confounding was applied, and explanatory methods were developed. Analysis of qualitative data is quite a fluid process, and it depends on the evaluator and the context of the study.

References

Akca, S. O., Yuncu, O., & Aydin, Z. (2018). Mental status and suicide probability of young people: A cross-sectional study. Revista da Associação Médica Brasileira, 64(1), 32-40. https://doi.org/10.1590/1806-9282.64.01.32

Aldolaim, S. (2019). Parental perceptions of childhood obesity: Systematic literature review. Journal of Childhood Obesity, 04(01). https://doi.org/10.36648/2572-5394.4.1.70

Danese, A. (2019). Annual research review: Rethinking childhood trauma‐new research directions for measurement, study design, and analytical strategies. Journal of Child Psychology and Psychiatry, 61(3), 236-250. https://doi.org/10.1111/jcpp.13160

DeFilippis, M., & Wagner, K. D. (2014). Management of treatment-resistant depression in children and adolescents. Pediatric drugs, 16(5), 353–361. https://doi.org/10.1007/s40272-014-0088-y

Guerrero, A. D., Mao, C., Fuller, B., Bridges, M., Franke, T., & Kuo, A. A. (2018). Racial and ethnic disparities in early childhood obesity: Growth trajectories in body mass index. Journal of Racial and Ethnic Health Disparities, 3(1), 129-137. https://doi.org/10.1007/s40615-015-0122-y

Hase, C. N., Goldberg, S. B., Smith, D., Stuck, A., & Campain, J. (2017). Impacts of traditional bullying and cyberbullying on the mental health of middle school and high school students. Psychology in the Schools, 52(6), 607-617. https://doi.org/10.1002/pits.21841

Jordan, A. B. (2019). The role of media in childhood obesity. Global Perspectives on Childhood Obesity, 421-428. https://doi.org/10.1016/b978-0-12-812840-4.00033-5

Kendler, K. S. (2016). The phenomenology of major depression and the representativeness and nature of DSM criteria. American Journal of Psychiatry, 173(8), 771-780. https://doi.org/10.1176/appi.ajp.2016.15121509

Lee, E. Y., & Yoon, K. H. (2018). Epidemic obesity in children and adolescents: risk factors and prevention. Frontiers of medicine, 12(6), 658–666. https://doi.org/10.1007/s11684-018-0640-1

Miller, B., Rocks, S., Catalina, S., Zemaitis, N., Daniels, K., & Londono, J. (2019). The missing link in contemporary health disparities research: A profile of the mental and self-rated health of multiracial young adults. Health Sociology Review, 28(2), 209-227. https://doi.org/10.1080/14461242.2019.1607524

Neale, B. (2019). Faculty opinions recommendation of genome-wide association analyses identify 44 risk variants and refine the genetic architecture of major depression. Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature. https://doi.org/10.3410/f.733105041.793567849

Rao, W. W., Zong, Q. Q., Zhang, J. W., An, F. R., Jackson, T., Ungvari, G. S., Xiang, Y., Su, Y. Y., D’Arcy, C., & Xiang, Y. T. (2020). Obesity increases the risk of depression in children and adolescents: Results from a systematic review and meta-analysis. Journal of Affective Disorders, 267, 78–85. https://doi.org/10.1016/j.jad.2020.01.154

Sagar, R., & Gupta, T. (2018). Psychological Aspects of Obesity in Children and Adolescents. Indian journal of pediatrics, 85(7), 554–559. https://doi.org/10.1007/s12098-017-2539-2

Subica, A. M., Agarwal, N., Sullivan, J. G., & Link, B. G. (2017). Obesity and associated health disparities among understudied multiracial, Pacific Islander, and American Indian adults. Obesity, 25(12), 2128-2136. https://doi.org/10.1002/oby.21954

Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W., Zhu, Y., Chen, C., Zhong, X., Liu, Z., Wang, D., & Lin, H. (2017). Prevalence of depression and depressive symptoms among outpatients: a systematic review and meta-analysis. BMJ open, 7(8), e017173. https://doi.org/10.1136/bmjopen-2017-017173

Williams, E. P., Mesidor, M., Winters, K., Dubbert, P. M., & Wyatt, S. B. (2020). Overweight and obesity: Prevalence, consequences, and causes of a growing public health problem. Current Obesity Reports, 4(3), 363-370. https://doi.org/10.1007/s13679-015-0169-4

Yang, X., Fang, Y., Chen, H., Zhang, T., Yin, X., Man, J., Yang, L., & Lu, M. (2021). Global, regional and national burden of anxiety disorders from 1990 to 2019: Results from the global burden of disease study 2019. Epidemiology and Psychiatric Sciences, 30. https://doi.org/10.1017/

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Research Projects: Each student must develop a proposal for a research project that could practically be executed or that the student will execute. Your proposal will begin with an initial topic and then progress to a draft IRB submission (the Template can be found in Appendix B). To facilitate revisions, students will receive feedback. Then, the student will revise and submit the final IRB proposal (10 pages double-spaced, including references and excluding the cover page and attachments such as data collection tools).

References (minimum 15 references–within 10 years are preferred).

For learning, the student is required to review and cite ONLY research or review articles available in PubMed/Medline or PubMed Central. This will ease your process of finding abbreviated journal names for citation, as PubMed provides official abbreviations of journal names. Books, websites, newspapers, and other materials are not allowed to be cited due to the fact that these materials are not evaluated through the blind peer review process.

Format:

1.0 Purpose of the Study:

Describe the purpose and specific aims. State the research questions and hypotheses to be tested.

2.0 Background / Literature Review / Rationale for the study:

Describe the relevant current context of the study and gaps in current knowledge.

Provide the scientific or scholarly background for, rationale for, and significance of the research based on the existing literature and how it will add to existing knowledge.

Add relevant references at the end of the protocol (not at the end of this section).

3.0 Inclusion and exclusion criteria:

Briefly describe the total number of participants and the criteria (such as age, gender, language, etc.) that define who will be included or excluded in your study sample.

Indicate specifically whether you will include or exclude any special populations:

Adults unable to consent

Individuals who are not yet adults (minors): infants, children, teenagers

Pregnant women (where the activities of the research may affect the pregnancy or the fetus.)

Prisoners or other detained individuals.

4.0 Procedures Involved:

Describe the setting of the study, including all locations where research procedures will be performed.

Describe the study design, including the rationale.

Provide a description of all research procedures and activities.

Describe the study timelines, including the duration of an individual participant’s participation in the study and the overall anticipated duration of the project.

Describe the actual source records or measures that will be used to collect data about participants. (Attach all data collection tools).

5.0 Recruitment:

Describe when, where, and how potential participants will be recruited.

Describe the types of strategies and materials that will be used to recruit participants.

6.0 Consent Process:

If obtaining consent using a written consent document, describe:

Where the consent process will take place.

The details of the consent process including:

The role of the individuals listed in the application as being involved in the consent process.

The amount of time that will be devoted to the consent discussion.

Steps that will be taken to minimize the possibility of coercion or undue influence.

Steps that will be taken to ensure the participants’ understanding.

7.0 Risks to Participants:

List the reasonably foreseeable risks, discomforts, hazards, or inconveniences related the participants’ participation in the research. Describe the probability, magnitude, duration, and reversibility of the risks.

Consider physical, psychological, social, legal, and economic risks as well as community or group harms.

If applicable, describe risks to others who are not participants.

Withdrawal of Participants:

Describe anticipated circumstances under which participants will be withdrawn from the research without their consent.

Describe procedures that will be followed when participants withdraw from the research, including withdrawal from some but not procedures with continued data collection.

1. 1. Describe the use of data after withdrawal.

8.0 Potential Benefits to Participants:

Describe the potential benefits that individual participants may experience from taking part in the research. Describe also the probability, magnitude, and duration of the potential benefits.

Indicate if there is no direct benefit to participants. Do not include benefits to society or others.

9.0 Financial Compensation:

Describe any financial compensation that will be provided to participants. Include how much money or what gifts will be provided and for what activities.

Include whether compensation will be prorated if there are multiple research activities or if a participant withdraws from the study before finishing.

Describe any costs that participants may be responsible for because of participation in the research.

10.0 Provisions to Protect the Privacy Interests of Participants:

Describe the steps that will be taken to protect participants’ privacy interests throughout the research activities.

Indicate who is on the research team and how the research team is permitted to access any sources of information about the participants.

11.0 Confidentiality and Data Management:

Describe how data will be handled study-wide, including:

What information will be included as data? “Data” includes all information collected in the conduct of the research, such as but not limited to consent, surveys, interview notes, audio or video recordings, photographs, notes of observations, field notes, etc.

Where and how will data (or specimens) be stored? How will data be transported from the point of collection to where they will be stored?

How long will the data or specimens be stored? (Note: IRB policy is 7 years after the completion of the study. However, there are circumstances when other time frames may apply.)

Who will have access to the stored data or specimens?

Describe the steps that will be taken to secure the data (e.g., training, authorization of access, password protection, encryption, physical controls, certificates of confidentiality, and separation of identifiers and data) during storage, use, and transmission.

Describe the data analysis plan, including any statistical procedures applicable.