Discussion: Searching Databases NURS 6052

In the treatment of pediatric depression, how does the use psychotherapy or play therapy in combination with pharmacologic treatment compare to the use of therapy alone affect PT outcome within 6 months of diagnosis?

The first search I tried was “treatment of childhood depression” and over 800 articles were found as a potential match.  The first three articles were relevant to my PICO(T) question but not exactly what I was looking for.  The search results after the first three were more specific to certain conditions such as childhood trauma and childhood cancer.  While these would be interesting to read, they will not help me answer my question.  I realized I needed to use more specific keywords in order to generate articles that relate more to my personal question of interest. To do this, I attempted to add the Boolean operator “and” and changed my search term to “pharmacologic treatment of childhood depression and play therapy.”  Unfortunately, I was completely unsuccessful and honestly was reminded that my greatest struggle of graduate school this far is my struggle when it comes to finding research and journal articles.  Thankfully, this week’s discussion post will be a helpful opportunity for me to practice and learn from fellow students. After my moment of frustration, I decided to give a new search term a try.  Again, using Boolen operators I changed the search to read “depression in children AND pharmacologic treatment OR play therapy.”  To my amazement, over 19,000 results were found and after digging through them I found several articles that would be helpful to me in my quest to answer my PICO(T) question.

The first article I read was Psychological treatments for depression in pre‑adolescent children (12 years and younger): systematic review and meta‑analysis of randomized controlled trials.  This article was from the database ESBCO Discovery service.  This article was helpful because it is a systematic review of 2,822 abstract and 124 full-text articles about the treatment of depression in the pediatric population (Forti-Buratti, Saikia, Wilkinson, and Ramchandani, 2016). This one article used Medline, PsycINFO, EMBASE, and Web of Knowledge databases to find relevant articles and studies.  This is incredibly helpful to me as I begin exploring treatment options to answer my PICO(T) question because they have done much of the searching for me.

The next article that I found helpful in my quest was from the Social Sciences Citation Index database. In this article, Understanding the Impact of Treatment on the Dimensions of Childhood Depression, the authors examined three clinical trials in which 269 patients were given a placebo and 261 patients were given the drug Fluoxetine (Isa, Bernstein, Trivedi, Mayes, Kennard, and Emslie, 2017).  The researchers used the Childhood Depression Rating Scale-Revised (CDRS-R) to develop a score to track the effectiveness of treatment for the children.  The overall finding is while both groups did see improvement in their scores over time, the group taking the Fluoxetine had much greater improvement in a faster amount of time.

Increasing the rigor and effectiveness of search criteria will be a process of continual learning.   In the article 7 steps to the perfect PICO search, Kathy Jensen recommends changing the natural language in the question into subjects’ descriptions, headings, or synonyms.  In my case, trying to different ways of saying pediatric depression was helpful in yielding different results.  Using the term depression in children actually seemed to be more effective than childhood depression and pediatric depression. It is interesting that something that is seemingly so simple can have a major impact on a student’s ability to find what they need when searching for articles.  Learning to restate search criteria and keywords will be essential to my growth as a student and as a PMHNP based on evidence-based practice. While much more research would need to draw a final conclusion for my PICO(T) question, this opportunity to search multiple databases is certainly helpful in making progress towards understanding the best methods of treating depression in childhood.

References

Isa, A., Bernstein, I., Trivedi, M., Mayes, T., Kennard, B., & Emslie, G. (n.d.). Understanding the Impact of Treatment on the Dimensions of Childhood Depression. JOURNAL OF CHILD AND ADOLESCENT PSYCHOPHARMACOLOGY, 27(2), 160–166. https://doi-org.ezp.waldenulibrary.org/10.1089/cap.2015.0023

Jenson, Kathy. Seven Steps to the Perfect PICO Search. 9 Jan. 2018, health.ebsco.com/blog/article/seven-steps-to-the-perfect-pico-search.

Melnyk, B. M., Fineout-Overholt, E., Stillwell, S. B., & Williamson, K. M. (2009). Evidence-based practice: step by step: igniting a spirit of inquiry: an essential foundation for evidence-based practice. The American Journal of Nursing, 109(11), 49–52.