Running head: EVIDENCED-BASED
RESEARCH
Evidenced-Based Research: Is St. Johns’s Wort as Effective as Antidepressants in the
treatment of Depression in Adults?
Savetria Nicole Palmer
Walden University
NURS6052, Section 11, Essentials of Evidenced-Based Practice
November 8, 2015
1
EVIDENCED-BASED RESEARCH
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Evidence-based nursing is about applying the best available evidence in to a specific
clinical question. Different clinical questions require evidence from different research designs.
(Complementary and alternative medicines (CAM) are often preferred over conventional
medications because they are available without prescription and because they are assumed to be
safe (Howland, 2010). In light of this new trend in medicine, “nurses are challenged to become
knowledgeable about the uses, limitations, and precautions associated with these new practices
and products.” (Cherry & Jacob, 2013). Nurses can demonstrate leadership in helping
conventional clinical settings integrated CAM therapies into every day practice (Cherry & Jacob,
2013).
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Identifying a Researchable Problem: Asking a Clinical Question
The use of natural remedies does not take the profession of nursing by surprise. It was
Florence Nightingale who first considered an environment of natural healing for patients (Cherry
& Jacob, 2013). According to Cherry and Jacob (2013) nurses should incorporate
complementary and alternative medicine (CAM) into nursing practice. The National Center for
Complementary and Integrative Health (NCCIH) defines CAM as the use of a plethora of
treatment methods that fall outside of the realm of conventional medicine (2015). Most people
use CAM without the knowledge of their physician. While the utilization of CAM is not
contraindicated, it is important that nurses perform a thorough assessment of patients who use
CAM as many of these therapies interact with other medications. Also, nurses should be
knowledgeable of the most up-to-date, evidence-based research, to educate patients about the
appropriateness of the products they use (Cherry & Jacob, 2013). The purpose of this paper is to
identify a researchable clinical issue, formulate background questions and a PICOT question.
This paper will also recognize 10 possible keywords that could be used when conducting a
search of the literature.
Identification of the Problem and the Significance for Nursing Practice
Depression is a mood disorder characterized by perpetual sadness, feelings of
hopelessness and diminished interest in activities that a person used to find pleasurable (Centers
for Disease Control and Prevention (CDC), 2015). Compared with people with illnesses, such as
diabetes, individuals with depression are less successful with interpersonal relationships (i.e.,
social and occupational roles). Depression is a major global issue that if not treated could
potentially become a chronic disease (CDC, 2015).
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There are many medications on the market to treat depression. The most commonly
prescribed type of antidepressants are called selective serotonin reuptake inhibitors (SSRIs)
(Mayo Clinic, 2015). SSRIs work by affecting neurotransmitters in the brain (Mayo Clinic,
2015). Alternatively, many patients opt to use CAM in the treatment of depression. According to
Cherry and Jacob (2013), depression is one of 10 most common conditions for which people use
CAM. One of the most frequent herb used for depression is St. John’s Wort.
The use of CAM presents clinical and legal issues for nursing practice. First, as many
consumers are interested in and use CAM, nurses must become acquainted with cultural factors
that can impact acceptance and use of alternative healing practice (Cherry & Jacob, 2013).
Secondly, legal issues could also arise from the use of CAM. For example, nurses should clarify
which treatment methods fall within the realm of nursing practice (Cherry & Jacob, 2013).
Thirdly, as educators and advocates, nurses must be knowledgeable about the use, benefits, and
side effects of CAM. These issues give rise to researchable the clinical practice question: Is St.
John’s Wort as effective in the treatment of depression in adults.
Background Questions
One of the first steps in evidenced-based research the development of background
questions. Background questions are broad, foundational questions about a clinical issue (Polit &
Beck, 2012). Five questions generated for this research project are:

What is depression?

How can depression be treated?

What complementary alternative treatments (CAMs) are available to treat
depression?

What prescription medications are used in the treatment of depression?
EVIDENCED-BASED RESEARCH

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How effective is CAM versus selective serotonin reuptake inhibitors (SSRIs)
(prescription medication) in the treatment of depression?
In deciding the implementation of evidenced-based research for clinical practice, the
issue of feasibility is considered (Polit & Beck, 2012). Some aspects of feasibility entail concerns
addressing practical interests about the availability of resources, and whether or not nurses will
have rule over the change (Polit & Beck, 2012). Aslam and Emmanuel (2010), advises that the
feasibility of conducting a research project is based on the research question and should be
considered early in the process in order to avert waste of resources and scholarly vitality.
In assessing my research question for feasibility, I considered that fact that as a member
of the largest group of healthcare professionals, I have an opportunity to demonstrate leadership
in the integration of CAM with conventional care (Cherry & Jacob, 2013). Besides this, I
conducted a proof of concept study on my research question by utilizing the Walden Library
database to search for credible, reliable, up-to-date information (Aslam & Emmauel, 2010).
PICO Question
A PICO (Population, Intervention, Comparison, and Outcome) frames a research
question and is divided into four or five variables: Population, Intervention, Comparison, and
Outcome. The following describes each PICO relevant for my research question:
Population- adults with depression
Intervention- St. John’s Wort
Comparison- antidepressants
Outcomes- relief of symptoms
Keywords
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Upon forming a well-worded research question, a literature search and review much be
done. Literature reviews afford synthesis of up-to-date research and scholarly literature (Schmidt
& Brown, 2012). Electronic databases allow researchers to search for reliable information by
using keywords. One type of search query used is a keyword search. Using keywords when
conducting research grants the researcher an opportunity to enter a search term that best
describes it as it is used in database records (Schmidt & Brown, 2012).
Keywords used to research my clinical question are: St. John’s Wort, antidepressants,
effectiveness, symptoms, treatment, CAM, placebo, depression, adults, and therapeutic. These
keywords are closely related to the background and PICO question and produced the most hits in
databases such as PubMed, MedlinePlus, CINAHL and the Cochrane Review.
Literature Review: Alternative Therapies for Depression
Depression is a serious medical and psychological concern for an increasingly
large percentage of the population. Recommended treatments often involve a combination of
some form of prescribed therapy and some type of complimentary alternative medicine (CAM).
One CAM, St. John’s Wort (SJW), has been at the center of debate regarding its ability to treat
depression versus prescribed medications, serotonin reuptake inhibitors (SSRIs).
It is, therefore, important that medical practitioners research the best available evidence
to prove or disprove SJW’s effectiveness in the treatment of depression. According to Polit and
Beck (2012), after collecting data, researchers must perform a critical summary of research on a
topic or phenomenon to determine validity.
Summary of an Article
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According to Sarris and Kavanagh (2009), in a systematic review of the electronic
databases MEDLINE, CINAHL, the supplement St. John’s Wort was found to be comparably
effective to standard antidepressants for treating mild to moderate depression. St. John’s Wort’s
lower risk of side effects combined with its superiority to a placebo suggests that it should be a
‘first line’ treatment (Sarris & Kavanagh, 2009). Fewer adverse effects were repeated by users of
St. John’s Wort in comparison to both SSRIs (selective serotonin reuptake inhibitors) and older
drugs such as tricyclics.
Supporting Studies
According to a recent qualitative study by Pirotta et al., (2014) of 41 selfidentified users of St. John’s Wort, the alternative herbal medication is used for a variety of
psychological symptoms, including anxiety as well as depression. Many of these symptoms
varied in severity and were self-diagnosed. The ease of using St. John’s Wort (it does not require
a prescription) was one factor in their decision-making. The herbal, apparently all-natural nature
of the supplement gave participants in the study a sense of control over their own health.
Although some were seeking treatment from a counselor, they felt more empowered being able
to regulate the dose themselves. Some participants also believed that St. John’s Wort was safer
than conventional remedies (Pirotta et al., 2014).
Although the Pirotta et al., (2014) study suggests a certain degree of mistrust of
psychopharmacology, even among individuals in counseling, a number of healthcare
professionals have made a case for using the supplement from an economic perspective.
According to Solomon, Ford, Adams, and Graves (2011), a meta-analysis of randomized
controlled trials found the supplement to be more effective than placebos and of comparable
efficacy in treating mild to moderate depression. There are also fewer side effects and adverse
EVIDENCED-BASED RESEARCH
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effects and better compliance; St. John’s Wort is also more cost effective. Patients also seem to
feel more positive about taking the supplement and show greater adherence to and tolerance of a
medication schedule (Solomon et al., 2011). The only risk was found to be interactions with
other medications, specifically if St. John’s Wort was combined with other antidepressants,
which could result in the risk of the patient developing serotonin syndrome due to the fact that
like SSRIs, like St. John’s Wort elevate the level of serotonin in the patient’s brain. Tufanaru
(2014)’s meta-analysis came to similar conclusions regarding the supplement’s efficacy and
benign nature.
Howland (2010), however, notes that while such studies do underline the promise
of St. John’s Wort, there are some inconsistencies in the findings. German studies tend to show
greater benefits from the drug. In a meta-analysis of the efficacy of St. John’s Wort for major
depression versus standard tricyclics, among the recent larger and better-designed studies, only
two of four found SJW effective for major depression and for minor depression when compared
with SSRIs (the antidepressants most commonly prescribed for minor depression in nonpsychiatric, primary care contexts), neither SJW nor citalopram had a significant clinical or
statistical effect when compared with placebo treatment for minor depression, although there
were differences in tolerability, and SJW was not entirely benign (Howland, 2010). There are
some studies that indicate the use of the supplement may be safe for pregnant and breastfeeding
women, which is significant given the prevalence of depression during these life stages.
However, Howland also cited studies that noted in addition to the risks of being combined with
other medications, St. John’s Wort can also interfere with the efficacy of birth control (Howland,
2010).
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Critiquing Research Studies: Qualitative and Quantitative Research
Research is used to answer questions about clinical practice, solve problems, enhance the
quality of patient care, produce new research inquiries and form health policy (Kaplan, 2012). In
confronting questions about clinical practice and policy, practitioners need solid, high-quality,
evidence-based research (Kaplan, 2012).
Summary of an Article
According to the article by Pirotta (et al., 2014) Less like a drug than a drug: The
use of St. John’s Wort among people having depression and/ or anxiety symptoms, qualitative
research can provide valuable insight in terms of how people experience the use of alternative
medicine to treat depression. The study was designed to understand better the meanings users of
St. John’s Wort ascribed to their own actions, versus the meanings ascribed by an outside
authority (Pirotta et al., 2014). The researchers interviewed 41 self-identified sufferers of
depression that had opted to use the alternative herbal remedy of St. John’s Wort rather than
conventional pharmaceutical treatments. The purpose of the study was to determine the rationale
individuals used when they opted for nonconventional remedies. Rather than use the medical
term ‘depression’ alone, the subjects were specifically asked to describe the feelings of
depression, stresses, and the worries that prompted them to use the drug, given that people may
identify their mental health issues in different ways (Pirotta et al., 2014).
Participant’s demographic information was recorded, and their subsequent
responses to three-hour long personal interviews were coded. Interviews were semi-structured to
allow for common themes to emerge, as is typical in the qualitative, grounded theory approach
but participants were also allowed to deviate from the script to give their input. Themes that
emerged included wishing to avoid side effects; the cheapness of the drug; not wishing to
EVIDENCED-BASED RESEARCH
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involve their GP (general practitioner); the ease of obtaining the herb for a self-identified
condition; and its perceived naturalness. Varying degrees of efficacy in the perception of the
users were reported. Patients liked the sense of empowerment using alternative medications gave
them over their health as well as the reduced risk (both perceived and real) of side effects.
Advantages and Disadvantages
A study by Rappaport (et al., 2010) entitled, The treatment of minor depression
with St. John’s Wort or citalopram: Failure to show benefit over placebo, compared both the
effects of the natural alternative, a conventional form of psychopharmacology in the form of the
antidepressant citalopram, and a placebo in a patient population with diagnosed minor
depression. The study took the form of a three-arm, 12 week, randomized clinical trial and
yielded the findings that both the alternative medication and the conventional medication did no
better than the placebo to alleviate the patients’ depressive symptoms.
The quantitative study had an explicitly experimental format because none of the
participants knew what group into which they were placed. Given that alleviation of depressive
symptoms is to some extent subjective, this was critical to assess the efficacy of the experiment.
The study designers also found that while St. John’s Wort and citalopram were no more effective
than a placebo, 60% of patients on these medications reported adverse events versus those on the
placebo, indicating that not only were the treatments not helpful but that the costs outweighed
any benefits (Rappaport et al., 2010). What is so interesting about this study is that it not only
confirms the suspicion of alternative medications held by many conventional practitioners but
also the efficacy even of conventional psychopharmacology (Groopman, 2013).
Advantages and Disadvantages
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It is often debated that qualitative research is not of equal value to quantitative research,
yet both are useful. According to Madrigal and McClain (2012), one outstanding strength of
quantitative research is that it produces data that is descriptive. For example, allowing us to
acquire a snapshot of a user population; however we encounter problems when it comes to the
interpretation of this data. Qualitative studies can provide us details about human behavior,
emotion, and personality characteristics that quantitative studies cannot (Madrigal & McClain,
2012). While qualitative approaches lack the scientific rigor of quantitative studies, they do
provide insight into the thoughts and feelings of the population under scrutiny; this is one of the
primary benefits of qualitative research (Anderson, 2010). In contrast, quantitative studies make
use of the scientific method and are usually required to justify a change in policy, given that the
effect is measurable in a statistically significant fashion.
Translating Evidence
St John’s Wort (SJW) is the most commonly utilized complementary medicine for selftreatment of depression (Knaudt, 1999). It is widely used for medication of self-characterized
anxiety and stress. SJW can be accessed easily with and without the advice of a health
professional. Although there is for its effectiveness in overcoming depression, it also has
potential side-effects. Despite of various side effects, we have limited knowledge about the
consumer’s perspectives on the use of SJW. A study was conducted by Pirotta et al. (2014) in
order to understand how people use SJW for managing worries, stress or depression. In-depth
face-to face interviews were conducted and on the thematical analysation of these interviews it
was founded that participants use it because of perceived benefits associated with the use natural
product, ease obtained by the access of SJW and the perception of safety and effectiveness of
SJW that enable people control over its use. Therefore, the findings of the study showed that
EVIDENCED-BASED RESEARCH
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people use a number of self-care strategies in order to in order to manage mild as well as severe
symptoms of depression and people continue to use the products that they think work most
effectively for them.
Anxiety and mood disorders appear as a significant health related burden on
society. For this purpose, SJW and Kava are the most frequently used herbal medicines for the
treatment of depressive and anxiety disorders. Sarris and Kavanagh (2009) conducted a study for
comprehensive review of SJW and Kava. The main purpose of this study was to review the mode
of action, safety in use, efficacy and in its use of different disorders. A systematic review was
conducted and it was found that evidence support the use of SJW in treating moderate and mild
depression and Kava for treating generalized anxiety. For other disorder limited evidences are
there for the use of St. John’s Wort. It was also evident form the findings that there is no
published human trial for the use of kava in treating affective disorders, or in treating Posttraumatic stress disorder, social phobia, panic disorder or obsessive compulsive disorder. In
scientific terms it can be said that current research evidence only supports herbal medicines in
the treatment of anxiety and depression.
Integrative healthcare holds an important application for nursing practice but, in
order for nurses to fulfill their responsibilities regarding these implications, they need essential
knowledge of complementary and alternative medicines. Also essential knowledge is required to
understand how conventional healthcare and complementary and alternative medicines might
affect each other. The movement of integrative healthcare reflects the sustained use
complementary and alternative medicine among people. The societal trend in regard to clientresponsive health care carries vital implications for the health care professionals to interact with
patients who are showing interest in the complementary and alternative medicine. The inclusion
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of integrative health care in curricula for nurses prepares upcoming nurses for engagement with
the modern client and encourages the focus on the education of nurses (Little, 2013).
For the past few years patients are considered to be consumers of service rather
than just recipients of care. Expectations of patients are increased to receive care that is grounded
in research. For this purpose it is important to educate nurses about evidence based practice
thereby meeting the expectations of the patient. The potential negative outcomes that can be
faced by lack of implementation of evidence based practice is dissatisfied patient and if the
practice go wrong, it can also lead to lack of trust of people on health care providers (Leufer &
Cleary-Holdforth, 2009). Another limitation towards evidence based practice is that there is lack
of funding for conducting evidence based practice which refers to the lack of evidences for
various treatments.
In order to disseminate the evidence based practice it is important to gather the
evidences in support of its effectiveness. After gathering handful evidences, plan a course of
action. The next step in this regard will be engaging appropriate individuals of the organization
for the implementation of EBP. It is important to execute the practice according to the plan and
then evaluate its effectiveness. On a large scale level, this can be done by creating a practical
framework based on the literature on the dissemination of evidence based practice. The main
element in this regard includes close association between disseminating organizer and the
researcher and utilizing marketing principles. Researchers can do this by going through the
evidences available, conducting research, assessing preparedness of the organization, reinvention
and balancing fidelity, evaluation and monitoring and testing the dissemination approaches
(Harris et al., 2012). These steps are important to keep in consideration in order to disseminate
the evidence based practice.
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Summary
Reading these two studies in conjunction is useful given that they demonstrate the
extent to which qualitative versus quantitative research can produce different results. Depression
is a subjective state and feeling better versus not feeling better is to some extent in the eye of the
beholder. Moreover, because of the increased media attention given to depression in recent years,
it can be very tempting for individuals to self-diagnose depression, anxiety, and other
psychological conditions. In the qualitative study under scrutiny, the participants all had engaged
in some degree of self-diagnosis and most concealed the fact that they were taking St. John’s
Wort from their GPs. Self-diagnosis, particularly of a psychological condition, is often unreliable
(Pillay, 2010). Subjectively, according to the interviews, all of the participants had positive
feelings of empowerment over their health. However, there was no comparison group of
individuals suffering depression that had tried other forms of treatment nor was there conclusive
evidence that the participants had clinical levels of depression, versus simply feeling sad or in a
bad mood.
The qualitative study was useful in explaining why patients might seek out
alternative versus conventional therapies. However, the qualitative study could not provide a
reasonable assessment of whether these perceptions were accurate or not. The quantitative study,
on the other hand, explicitly attempted to filter out subjective desires such as having control over
one’s health. It determined that according to excepted psychiatric standards all the participants in
the study were suffering from a diagnosable psychological condition and that unconscious
thoughts and feelings would not influence the final outcome.
From a nurse’s perspective, the qualitative study is a reminder of the types of
priorities individuals have over their mental health, including concerns about side effects, the
EVIDENCED-BASED RESEARCH
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negative perceptions of unnatural treatments, and a desire for control. The quantitative study is
ultimately more useful in the manner in which it calls into question the efficacy of all forms of
chemically-induced treatment for minor versus major depression. Ultimately, for patients not
suffering from major depression, talk therapy may be the more appropriate first recourse of
treatment, given that no antidepressant is without some form of adverse side effect for the
majority of users.
There is a great deal of contradictory evidence on the subject of St. John’s Wort.
On the highest level of the hierarchy of evidence in evaluating research articles, the metaanalyses and systematic reviews of articles from research databases by Saris and Kavanagh
(2009) and Howland (2010) reveal slightly different findings. Saris & Kavanagh (2009) found no
significant difference in efficacy between St. John’s Wort and standard antidepressants and
notably fewer side effects, causing them to make the robust recommendation that the herbal
supplement be the first line of defense in treating depression. Howland (2010), noted in his metaanalysis that not all studies supported the efficacy of St. John’s Wort in comparison to a placebo
and many that did were not of high quality; moreover, St. John’s Wort was not without side
effects and adverse events of its own. A similar meta-analysis specifically from an economic
perspective by Solomon, Ford, Adams, and Graves (2011) took a more moderate perspective,
indicating that the supplement could be used when cost savings and the comfort of the patient
were a consideration; a small qualitative study by Pirotta et al., (2014) also supported that
finding.
The use of CAM is widely used by consumers. Depression is one illness that patients
self-treat with St. John’s Wort, a popular CAM. Healthcare professionals do not discourage the
use of CAM. However, it is important and ethical to educate patients on the risks, benefits and
EVIDENCED-BASED RESEARCH
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efficacy of such therapies. One avenue to ensure that patient’s outcomes are always positive is
through evidenced-based practice research. The innovation of any research question is
determined by a thorough literature search (Aslam & Emmanuel, 2010). The objective of the
literature search is to find out what is known about the topic.
Using the PICO framework, researchers can formulate a researchable clinical question
and from that question, extract keywords to conduct research using reputable databases such as
CINAHL and PubMed. Upon formulating a researchable question the innovation must be
evaluated for feasibility which involved determining whether or not the new concept fits into
clinical practice. (Aslam & Emmanuel, 2010).
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References
Anderson, C. (2010). Presenting and evaluating qualitative research. American Journal of
Pharmaceutical Education, 74 (8): 1-6.
Aslam, S., Emmanuel, P. (2010). Formulating a researchable question: A critical step for
facilitating good clinical research. Indian Journal of Sexually Transmitted
Diseases, 31(1), 47–50. http://doi.org/10.4103/0253-7184.69003
Centers for Disease Conrol and Prevention (CDC) (2015). Depression. Retrieved from
http://www.cdc.gov/mentalhealth/basics/mental-illness/depression.htm
Cherry, B., Jacob, S.R. (2013). Contemporary nursing: Issues, trends, & management (6th Ed.)
St. Louis, MO: Mosby Elselvier.
Groopman, J. (2013). The quackish cult of alternative therapies. The New Republic.
Retrieved from: http://www.newrepublic.com/article/114899/paul-offits-do-youbelieve-magic-reviewed-dangers
Harris, J. R., Cheadle, A., Hannon, P. A., Lichiello, P., Forehand, M., Mahoney, E., ... &
Yarrow, J. (2012). A framework for disseminating evidence-based health promotion
practices. Preventing chronic disease, 9.
Howland, R. H. (2010). Psychopharmacology. Update on St. John's wort. Journal Of
Psychosocial Nursing & Mental Health Services, 48(11), 20-24. doi:10.3928/0279369520100930-99
Kaplan, L. (2012). Reading and critiquing a research article. American Nurse Today
7(10).
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Retrieved from: http://www.americannursetoday.com/reading-and-critiquing-aresearcharticle/
Knaudt, P. R., Connor, K. M., Weisler, R. H., Churchill, L. E., & Davidson, J. R. (1999).
Alternative therapy use by psychiatric outpatients. The Journal of nervous and mental
disease, 187(11), 692-695.
Leufer, T., & Cleary-Holdforth, J. (2009). Evidence-based practice: improving patient
outcomes. Nursing Standard, 23(32), 35.
Little, C. V. (2013). Integrative health care: implications for nursing practice and
education. British Journal of Nursing, 22(20), 1160-1164.
Madrigal, D. & McClain, B. (2012). Strengths and weaknesses of quantitative and qualitative
research. Retrieved from http://www.uxmatters.com/mt/archives/2012/09/strengths-andweaknesses-of-quantitative-and-qualitative-research.php
National Center for Complementary and Integrative Health (NCCIH) (2015). Complementary,
Alternative, or Integrative Health: What’s In a Name? Retrieved from
https://nccih.nih.gov/health/integrative-health
Pillay, S. (2010). The dangers of self-diagnosis. Psychology Today. Retrieved from:
https://www.psychologytoday.com/blog/debunking-myths-the-mind/201005/thedangers-self-diagnosis
Pirotta, M., Willis, K., Carter, M., Forsdike, K. Newton, D. & Gunn, J. (2014). Less like a drug
than a drug.’ The use of St. John’s Wort among people having depression and/ or anxiety
symptoms. Complementary Therapies in Medicine. 22: 870—876.
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Polit, D. F., & Beck, C. T. (2012). Nursing research: Generating and assessing evidence for
nursing practice (Laureate Education, Inc., custom ed.). Philadelphia, PA: Lippincott
Williams & Wilkins.
Rapaport, M. H., Nierenberg, A. A., Howland, R., Dording, C., Schettler, P. J., & Mischoulon,
D. (2011). The treatment of minor depression with St. John's Wort or citalopram: failure
to show benefit over placebo. Journal Of Psychiatric Research, 45(7), 931-941.
doi:10.1016/j.jpsychires.2011.05.001
Sarris, J., & Kavanagh, D. J. (2009). Kava and St. John's Wort: current evidence for use in mood
and anxiety disorders. The Journal of Alternative and Complementary Medicine, 15(8),
827-836
Schmidt, N.A., Brown, J.M. (2012). Evidenced-based practice for nurses: Appraisal and
application of research (2nd Ed.) (Laureate Education, Inc., custom ed.). Sudbury, MA:
Jones & Bartlett Learning.
Solomon, D., Ford. E., Adams, J. & Graves, N. (2011). Potential of St John’s Wort for the
treatment of depression: the economic perspective. Australian and New Zealand Journal of
Psychiatry 2011; 45:123–130.
Tufanaru, C. (2014). Depression (adults): St. John's Wort (hypericum perforatum). The Joanna
Briggs Institute. Retrieved fromhttp://ovidsp.tx.ovid.com.ezp.waldenulibrary.org/sp3.17.0a/ovidweb.cgi?&S=LAJJFPGBDGDDAPPANCJKLFMCFJJMAA00&Link+Set=
S.sh.39%7c1%7csl_19
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Critique Template for a Qualitative Study
NURS 6052
Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or
Mixed Methods Studies (due by Day 7 of Week 7)
Date: October 18, 2015
Your name: Savetria Palmer
Article reference (in APA style):
Pirotta, M., Willis, K., Carter, M., Forsdike, K., Newton, D., & Gunn, J. (2014). 'Less
like a drug than a drug': The use of St John's wort among people who selfidentify as having depression and/or anxiety symptoms. Complementary
Therapies In Medicine, 22(5), 870-876 7p. doi:10.1016/j.ctim.2014.07.007
URL:
http://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/detail/detail?vid=4&sid=
f715b9ed-51bb-44eb-bd65467498468ca1%40sessionmgr4003&hid=4106&bdata=JnNjb3BlPXNpdGU%3d#AN
=103856329&db=rzh
What is a critique? Simply stated, a critique is a critical analysis
undertaken for some purpose. Nurses critique research for three main
reasons: to improve their practice, to broaden their understanding, and to
provide a base for the conduct of a study.
When the purpose is to improve practice, nurses must give special
consideration to questions such as these:


Are the research findings appropriate to my practice setting and
situation?
What further research or pilot studies need to be done, if any, before
incorporating findings into practice to assure both safety and
EVIDENCED-BASED RESEARCH

21
effectiveness?
How might a proposed change in practice trigger changes in other
aspects of practice?
To help you synthesize your learning throughout this course and prepare you
to utilize research in your practice, you will be critiquing a qualitative, quantitative,
or mixed-methods research study of your choice.
If the article is unavailable in a full-text version through the Walden
University Library, you must e-mail the article as a PDF or Word
attachment to your Instructor.
QUALITATIVE RESEARCH CRITIQUE
1. Research Issue and Purpose
What is the research question or issue of the referenced study? What is its
purpose? (Sometimes ONLY the purpose is stated clearly and the question must be
inferred from the introductory discussion of the purpose.)
How and why do people use St. John’s Wort (SJW) for management of selfidentified depression stress or worries?
2. Researcher Pre-understandings
Does the article include a discussion of the researcher’s pre-understandings?
What does the article disclose about the researcher’s professional and personal
perspectives on the research problem?
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The researchers state that there is little known about consumer perspectives
on the use of SJW. No professional and personal perspectives on the research
problem were given.
3. Literature Review
What is the quality of the literature review? Is the literature review current,
relevant? Is there evidence that the author critiqued the literature or merely
reported it without critique? Is there an integrated summary of the current
knowledge base regarding the research problem, or does the literature review
contain opinion or anecdotal articles without any synthesis or summary of the
whole? (Sometimes the literature review is incorporated into the introductory
section without being explicitly identified.)
The author reported one Cochrane systematic review without critique in this
study.
4. Theoretical or Conceptual Framework
Is a theoretical or conceptual framework identified? If so, what is it? Is it a
nursing framework or one drawn from another discipline? (Sometimes there is no
explicitly identified theoretical or conceptual framework; in addition, many
“nursing” research studies draw on a “borrowed” framework, e.g., stress, medical
pathology, etc.)
No theoretical or conceptual framework identified.
5. Participants
EVIDENCED-BASED RESEARCH
23
Who were the participants? Is the setting or study group adequately
described? Is the setting appropriate for the research question? What type of
sampling strategy was used? Was it appropriate? Was the sample size adequate?
Did the researcher stipulate that information redundancy was achieved?
The participants were people aged 18 and over, with current or recent
experience of using SJW for the treatment of depression, stress, or worries. Faceto-face interviews were conducted in a place and time of the participant’s choosing
A purposeful sampling strategy was used to recruit 41 people (30 females and 11
male), aged 18 and over, who self- identified as having used SJW for depression
stress or worries from a community in Melbourne, Australia. The sample size was
adequate for this study. The research did report that recruitment ceased when
ongoing analysis indicated that there was a range of gender and ages, and no new
experiences or opinions were being reported.
Protection of Human Research Participants
What steps were taken to protect human research subjects?
The project was approved by the University of Melbourne Human Research
Ethics Committee. As the topic related to mental health, a protocol was developed
for participants showing distress and participants were advised about sources of
help if needed.
6. Research Design
What was the design of the study? If the design was modeled from previous
research or pilot studies, please describe.
A qualitative design, focusing on understanding the reasons for SJW use.
EVIDENCED-BASED RESEARCH
24
7. Data Collection/Generation Methods
What methods were used for data collection/generation? Was triangulation
used?
Participants were recruited using advertisements placed in health food shops,
pharmacies, naturopathy and medical clinics, in University staff and student
newsletters, and well known social networking sites
8. Credibility
Were the generated data credible? Explain your reasons.
The data generated is not credible because while the researchers obtained a
diverse sample, in terms of demographic and experience of SJW, participants were
self-selected which may have led to a sample with more favorable SJW experiences.
9. Data Analysis
What methods were used for data analysis? What evidence was provided that
the researcher’s analysis was accurate and replicable?
Interviews were transcribed in full and then coded (tagging of text relating to
each expressed idea) using NVivo 9 software. The coded text was examined to
identify similarities and differences in the ideas expressed, and from the patterns in
the data that became evident, key themes were generated about how and why
participants used SJW. This use of coding is evidence that the data is accurate.
EVIDENCED-BASED RESEARCH
10.
25
Findings
What were the findings?
Three themes emerged as to why participants used SJW-ease of access of
SJW, perceptions of effectiveness and safety of SJW enabling control over its use,
and the perceived benefits of using a natural product. Generally, participants did
not reserve use of SJW only for mild depression symptoms.
11.
Discussion of Findings
Was the discussion of findings related to the framework? Were those the
expected findings? Were they consistent with previous studies? Were serendipitous
(i.e., accidental) findings described?
12.
Limitations
Did the researcher report limitations of the study? (Limitations are
acknowledgments of internal characteristics of the study that may help explain
insignificant and other unexpected findings, and more importantly, indicate those
groups to whom the findings CANNOT be generalized or applied. It is a fact that all
studies must be limited in some way; not all of the issues involved in a problem
situation can be studied all at once.)
13.
Implications
Are the conclusions and implications drawn by the author warranted by the
study findings? (Sometimes researchers will seem to ignore findings that don’t
confirm their expectations as they interpret the meaning of their study findings.)
EVIDENCED-BASED RESEARCH
26
The author did not draw any conclusions. However, the author did state that
the finding support earlier reported studies and provide new insights particularly via
the diversity of the sample, the inclusion of men’s views and the clear illustration of
different types of use (occasional, intermittent and regular).
14.
Recommendations
Does the author offer legitimate recommendations for further research? Is
the description of the study sufficiently clear and complete to allow replication of
the study? (Sometimes researchers’ recommendations seem to come from “left
field” rather than following obviously from the discussion of findings. If a research
problem is truly significant, the results need to be confirmed with additional
research; in addition, if a reader wishes to design a study using a different sample
or correcting flaws in the original study, a complete description is necessary.)
The author cited that the study was small, but some findings about how
gender shapes SJW use may be indicative and worthy of further study.
15.
Research Utilization in Your Practice
How might this research inform your practice? Are the research findings
appropriate to your practice setting and situation? What further research or pilot
studies need to be done, if any, before incorporating findings into practice to assure
both safety and effectiveness? How might the utilization of this research trigger
changes in other aspects of practice?
This research gives insight to nursing practice in that it speaks to the
preferences of patients in choosing natural versus prescription medication for
depression. As nurses, we have to be advocates for our patients and what they
perceive as best for them.
Critique Template for a Qualitative Study
EVIDENCED-BASED RESEARCH
27
NURS 6052
Week 6 Assignment: Application: Critiquing Quantitative, Qualitative, or
Mixed Methods Studies (due by Day 7 of Week 7)
Date: 18Oct2015
Your name: Savetria Palmer
Article reference (in APA style):
Pirotta, M., Willis, K., Carter, M., Forsdike, K., Newton, D., & Gunn, J. (2014). 'Less
like a drug than a drug': The use of St John's wort among people who selfidentify as having depression and/or anxiety symptoms. Complementary
Therapies In Medicine, 22(5), 870-876 7p. doi:10.1016/j.ctim.2014.07.007
URL:
http://web.a.ebscohost.com.ezp.waldenulibrary.org/ehost/detail/detail?vid=4&sid=
f715b9ed-51bb-44eb-bd65467498468ca1%40sessionmgr4003&hid=4106&bdata=JnNjb3BlPXNpdGU%3d#AN
=103856329&db=rzh
What is a critique? Simply stated, a critique is a critical analysis
undertaken for some purpose. Nurses critique research for three main
reasons: to improve their practice, to broaden their understanding, and to
provide a base for the conduct of a study.
When the purpose is to improve practice, nurses must give special
consideration to questions such as these:



Are the research findings appropriate to my practice setting and
situation?
What further research or pilot studies need to be done, if any, before
incorporating findings into practice to assure both safety and
effectiveness?
How might a proposed change in practice trigger changes in other
aspects of practice?
EVIDENCED-BASED RESEARCH
28
To help you synthesize your learning throughout this course and prepare you
to utilize research in your practice, you will be critiquing a qualitative, quantitative,
or mixed-methods research study of your choice.
If the article is unavailable in a full-text version through the Walden
University Library, you must e-mail the article as a PDF or Word
attachment to your Instructor.
QUALITATIVE RESEARCH CRITIQUE
16.
Research Issue and Purpose
What is the research question or issue of the referenced study? What is its
purpose? (Sometimes ONLY the purpose is stated clearly and the question must be
inferred from the introductory discussion of the purpose.)
How and why do people use St. John’s Wort (SJW) for management of selfidentified depression stress or worries?
17.
Researcher Pre-understandings
Does the article include a discussion of the researcher’s pre-understandings?
What does the article disclose about the researcher’s professional and personal
perspectives on the research problem?
EVIDENCED-BASED RESEARCH
29
The researchers state that there is little known about consumer perspectives
on the use of SJW. No professional and personal perspectives on the research
problem were given.
18.
Literature Review
What is the quality of the literature review? Is the literature review current,
relevant? Is there evidence that the author critiqued the literature or merely
reported it without critique? Is there an integrated summary of the current
knowledge base regarding the research problem, or does the literature review
contain opinion or anecdotal articles without any synthesis or summary of the
whole? (Sometimes the literature review is incorporated into the introductory
section without being explicitly identified.)
The author reported one Cochrane systematic review without critique in this
study.
19.
Theoretical or Conceptual Framework
Is a theoretical or conceptual framework identified? If so, what is it? Is it a
nursing framework or one drawn from another discipline? (Sometimes there is no
explicitly identified theoretical or conceptual framework; in addition, many
“nursing” research studies draw on a “borrowed” framework, e.g., stress, medical
pathology, etc.)
No theoretical or conceptual framework identified.
20.
Participants
EVIDENCED-BASED RESEARCH
30
Who were the participants? Is the setting or study group adequately
described? Is the setting appropriate for the research question? What type of
sampling strategy was used? Was it appropriate? Was the sample size adequate?
Did the researcher stipulate that information redundancy was achieved?
The participants were people aged 18 and over, with current or recent
experience of using SJW for the treatment of depression, stress, or worries. Faceto-face interviews were conducted in a place and time of the participant’s choosing
A purposeful sampling strategy was used to recruit 41 people (30 females and 11
male), aged 18 and over, who self- identified as having used SJW for depression
stress or worries from a community in Melbourne, Australia. The sample size was
adequate for this study. The research did report that recruitment ceased when
ongoing analysis indicated that there was a range of gender and ages, and no new
experiences or opinions were being reported.
Protection of Human Research Participants
What steps were taken to protect human research subjects?
The project was approved by the University of Melbourne Human Research
Ethics Committee. As the topic related to mental health, a protocol was developed
for participants showing distress and participants were advised about sources of
help if needed.
21.
Research Design
What was the design of the study? If the design was modeled from previous
research or pilot studies, please describe.
EVIDENCED-BASED RESEARCH
31
A qualitative design, focusing on understanding the reasons for SJW use.
22.
Data Collection/Generation Methods
What methods were used for data collection/generation? Was triangulation
used?
Participants were recruited using advertisements placed in health food shops,
pharmacies, naturopathy and medical clinics, in University staff and student
newsletters, and well known social networking sites
23.
Credibility
Were the generated data credible? Explain your reasons.
The data generated is not credible because while the researchers obtained a
diverse sample, in terms of demographic and experience of SJW, participants were
self-selected which may have led to a sample with more favorable SJW experiences.
24.
Data Analysis
What methods were used for data analysis? What evidence was provided that
the researcher’s analysis was accurate and replicable?
Interviews were transcribed in full and then coded (tagging of text relating to
each expressed idea) using NVivo 9 software. The coded text was examined to
identify similarities and differences in the ideas expressed, and from the patterns in
the data that became evident, key themes were generated about how and why
participants used SJW. This use of coding is evidence that the data is accurate.
EVIDENCED-BASED RESEARCH
25.
32
Findings
What were the findings?
Three themes emerged as to why participants used SJW-ease of access of
SJW, perceptions of effectiveness and safety of SJW enabling control over its use,
and the perceived benefits of using a natural product. Generally, participants did
not reserve use of SJW only for mild depression symptoms.
26.
Discussion of Findings
Was the discussion of findings related to the framework? Were those the
expected findings? Were they consistent with previous studies? Were serendipitous
(i.e., accidental) findings described?
27.
Limitations
Did the researcher report limitations of the study? (Limitations are
acknowledgments of internal characteristics of the study that may help explain
insignificant and other unexpected findings, and more importantly, indicate those
groups to whom the findings CANNOT be generalized or applied. It is a fact that all
studies must be limited in some way; not all of the issues involved in a problem
situation can be studied all at once.)
28.
Implications
Are the conclusions and implications drawn by the author warranted by the
study findings? (Sometimes researchers will seem to ignore findings that don’t
confirm their expectations as they interpret the meaning of their study findings.)
EVIDENCED-BASED RESEARCH
33
The author did not draw any conclusions. However, the author did state that
the finding support earlier reported studies and provide new insights particularly via
the diversity of the sample, the inclusion of men’s views and the clear illustration of
different types of use (occasional, intermittent and regular).
29.
Recommendations
Does the author offer legitimate recommendations for further research? Is
the description of the study sufficiently clear and complete to allow replication of
the study? (Sometimes researchers’ recommendations seem to come from “left
field” rather than following obviously from the discussion of findings. If a research
problem is truly significant, the results need to be confirmed with additional
research; in addition, if a reader wishes to design a study using a different sample
or correcting flaws in the original study, a complete description is necessary.)
The author cited that the study was small, but some findings about how
gender shapes SJW use may be indicative and worthy of further study.
30.
Research Utilization in Your Practice
How might this research inform your practice? Are the research findings
appropriate to your practice setting and situation? What further research or pilot
studies need to be done, if any, before incorporating findings into practice to assure
both safety and effectiveness? How might the utilization of this research trigger
changes in other aspects of practice?
This research gives insight to nursing practice in that it speaks to the
preferences of patients in choosing natural versus prescription medication for
depression. As nurses, we have to be advocates for our patients and what they
perceive as best for them.
EVIDENCED-BASED RESEARCH
34
Walden University M.S. in Nursing
Formative Evaluation Criteria for Applications and Formal Papers
Categories and Criteria
Points
QUALITY OF WORK SUBMITTED - 35 Possible Points
1. The extent to which work meets the assigned criteria and work reflects graduate level critical and
analytic thinking
(0-30 Points)
Assignment exceeds expectations. All topics are addressed with a minimum of 75%
25-30
containing exceptional breadth and depth about each of the assignment topics.
Assignment meets expectations. All topics are addressed with a minimum of 50%
20-24
containing good breadth and depth about each of the assignment topics.
Assignment meets most of the expectations. One required topic is either not
16-19
addressed or inadequately addressed.
Assignment superficially meets some of the expectations. Two or more required
topics are either not addressed or inadequately addressed.
0-15
2. Purpose of the paper is clear
(0-5 Points)
A clear and comprehensive purpose statement is provided which delineates all
5
required criteria.
Purpose of the assignment is stated, yet is brief and not descriptive.
4
Purpose of the assignment is vague.
1-3
No purpose statement was provided.
0
ASSIMILATION AND SYNTHESIS OF IDEAS - 50 Possible Points
The extent to which the work reflects the student’s ability to1. Understand and interpret the assignment’s key concepts
(0-10 Points)
Demonstrates the ability to critically appraise and intellectually explore key concepts.
9-10
Demonstrates a clear understanding of key concepts.
8
Shows some degree of understanding of key concepts.
5-7
Shows a lack of understanding of key concepts, deviates from topics.
0-4
2. Apply and integrate material in course resources (i.e. video, required readings, and textbook) and
credible outside resources
(0-20 Points)
Demonstrates and applies exceptional support of major points and integrates 2 or
15-20
more credible outside sources, in addition to 3-4 course resources to support point of
view.
Integrates specific information from 1 credible outside resource and 3 to 4 course
10-14
resources to support major points and point of view.
Minimally includes and integrates specific information from 2-3 resources to support
3-9
major points and point of view.
Includes and integrates specific information from 0 to 1 resource to support major
0-2
points and point of view.
3. Synthesize (combines various components or different ideas into a new whole) material in course
resources (i.e. video, required readings, and textbook) by comparing different points of view and
highlighting similarities, differences, and connections.
(0-20 Points)
Synthesizes and justifies (defends, explains, validates, confirms) information
18-20
gleaned from sources to support major points presented. Applies meaning to the
field of advanced nursing practice.
Summarizes information gleaned from sources to support major points, but does not 16-17
synthesize.
Identifies but does not interpret or apply concepts, and/or strategies correctly; ideas
14-15
unclear and/or underdeveloped.
Rarely or does not interpret, apply, and synthesize concepts, and/or strategies.
0-13
EVIDENCED-BASED RESEARCH
35
WRITTEN EXPRESSION AND FORMATTING - 15 Possible Points
1. Paragraph and Sentence Structure: Paragraphs make clear points that support well developed
ideas, flow logically, and demonstrate continuity of ideas. Sentences are clearly structured and
carefully focused--neither long and rambling nor short and lacking substance.
(0-5
Points)
Paragraphs and sentences follow writing standards.
5
Paragraphs and sentences follow writing standards 80% of the time.
4
Paragraphs and sentences follow writing standards 70% of the time.
3
Paragraphs and sentences follow writing standards < 70% of the time.
0-2
2. English writing standards: Correct grammar, mechanics, and proper punctuation
(0-5 Points)
Uses correct grammar, spelling, and punctuation with no errors.
5
Contains a few (1-2) grammar, spelling, and punctuation errors.
4
Contains several (3-4) grammar, spelling, and punctuation errors.
3
Contains many (≥ 5) grammar, spelling, and punctuation errors that interfere with the
0-2
reader’s understanding.
3. The paper follows correct APA format for title page, headings, font, spacing, margins, indentations,
page numbers, running head, parenthetical/in-text citations, and reference list
(0-5 Points)
Uses correct APA format with no errors.
5
Contains a few (1-2) APA format errors.
4
Contains several (3-4) APA format errors.
3
Contains many (≥ 5) APA format errors.
0-2
Total Points for Assignment:
Please copy and paste this rubric table at the end of all Application Assignments in order for your
assignment to be graded.
Guidance for Application Assignments:
Application Assignments require a title page, introduction, body of the paper, conclusion, and reference
page. The title page needs to follows APA style and includes a title, student name, course number and
section, and date. An abstract is not required. APA style headings are to be used appropriately to
separate and organize sections of the paper. The use of direct quotes is discouraged and should only be
used when the source material uses language that is particularly striking or notable. The introduction
should provide an overview of the topic, the purpose of the paper, and topics that will be addressed. The
body of the paper needs to address all required topics. The conclusion ought to provide closure for the
reader, synthesize the content, and tie everything together to help clarify the main points of the paper.
The reference page should include all references cited in the assignment in correct APA format.. Some
course assignments may require the use of more than 2 credible outside resources. In these cases, the
minimum outside sources specified in the instructions for the assignment will be applied in the grading of
these course assignments. Credible sources include scholarly peer-reviewed journal articles, evidence
based resources, and professional (.org), educational (.edu), and government websites (.gov).
Commercial websites (.com) are not considered credible sources. Please note: When selecting articles
for course assignments, you are advised (unless you are referencing seminal information) to focus on
work published within the past five years.
Late Policies:
Assignments submitted late without prior agreement of the Instructor, outside of an emergency absence,
or in violation of agreements for late submission, will receive a grade reduction for the Assignment
amounting to a 20% point loss. After 5 days, the Assignment will not be graded. Students should be
aware that late Assignments may not receive the same level of written feedback as do Assignments
submitted on time.
Running head: EVIDENCED-BASED RESEARCH
Citation
Type of
Study
1
Setti
ng
Key
Concepts/Variables
Findings
Hierarchy
of Evidence Level
Design
Type
Framework/
Theory
(Pirotta et al.,
2014)
Type of
Study:
Qualitative
Study
Design
Type:
Pilot study
Framework/
Theory:
None
mentioned
(Sarris &
Karanagh,2009)
Type of
Study:
Quantitative
Design
Type:
Systematic
Review
Framework/
Theory:
None
mentioned
A
community in
Melbourne,
Australia. Indepth faceto-face
interviews
were
conducted.
Interviews
were taped,
transcribed
and analyzed
thematically
A
systematic
review was
conducted
using the
electronic
databases
MEDLINE,
CINAHL, and
The
Coch
rane
database
Concepts:
Consumer
pespectives
Independent
Variable:
n/a
Dependent
Variable:
n/a
Controlled
Variable:
n/a
Concepts:
Efficacy
Independent
Variable:
n/a
Dependent
Variable:
n/a
Controlled
Variable:
n/a
Three themes emerged
as to why participants used St.
John’s Wort (SJW) — ease of
access of SJW,perceptions of
effectiveness and safety of SJW
enabling control over its use, and
the perceivedbenefits of using a
natural product. Generally,
participants did not reserve use of
SJW only formild depressive
symptoms. While there is often a
preference for more natural
approaches like SJW,people
experiment and continue to use
what they perceive is most
effective for them
Current evidence
supports the use of SJW in
treating mild–moderate
depression, and for kava in
treatment of generalized
anxiety. In respect to the other
disorders, only weak preliminary
evidence exists for use
of SJW in SAD. Currently
there is no published human trial
on use of kava in affective
disorders, or in OCD,
PTSD, PD, or SP. These
disorders constitute potential
applications that warrant
exploration.
Level 6
Level 1
EVIDENCED-BASED RESEARCH
Citation
Study
Design
37
Setti
ng
Key
Concepts/Variables
Findings
Type
Hierarch
y of Evidence
Level
Framework/
Theory
(Howland,
2010)
Type of
Study:
Quantitative
Study
Design
Type:
Randomized
Control Trial (RCT)
Framework/
Theory:
None
mentioned
(Kasper et al.,
2010)
Type of
Study:
Quantitative
Study
Design
Type:
Literature
Review
A
metaanalysis of a
12-week RCT
and safety
study
comparing
SJW, the
antidepressant
(Celexa), a
and placebo
as treatment
for
depression
was
conducted at
General
Hospital in
Boston,
Cedars-Sinai
Medical
Center
A
total of 31
RCT using
meta-anylysis
were
reviewed to
determine the
efficacy of
SJW in the
Concepts:Effi
cacy
Independent
Variable:
SJW or
Celexa
Dependent
Variable:
Depression
Controlled
Variable:
Placebo
Group
Concepts:Effi
cacy
Independent
Variable:
n/a
The study found that the
efficacy of St. John’s Wort for
major depression versus standard
tricyclics, among the recent larger
and better-designed studies, only
two of four found SJW effective
for major depression and for
minor depression when compared
with SSRIs (the antidepressants
most commonly prescribed for
minor depression in nonpsychiatric, primary care
contexts), neither SJW nor
citalopram had a significant
clinical or statistical effect when
compared with placebo treatment
for minor depression, although
there were differences in
tolerability, and SJW was not
entirely benign
Level 2
The trials of Hypericum
extract and other
antidepressants, including
selective serotonin reuptake
inhibitors (SSRIs),
provide support for
Hypericum extract efficacy.
However, since the constituents
of Hypericum
Level 2
EVIDENCED-BASED RESEARCH
Framework/
38
treatment of
depression
Theory:
None
mentioned
Dependent
Variable:
n/a
Controlled
Variable:
extract differ between the
individual manufacturers, the
efficacy cannot be extrapolated
from
one extract to another. In
this review,
n/a
(Tufanaru,
2014)
Type of
Study:
Quantitative
Design
Type:
Evidence
Summary
Framework/
Theory:
A
combination
of 40
systematic
reviews and
metaanalysis that
reached
conclusions
about the
efficacy of
SJW for the
treatment of
depression
Concepts:
Efficacy
Independent
Variable:
Dependent
Variable:
Controlled
Variable:
SJW is an evidencedbased complimentary alternative
medication in the treatment of
depression.
Level 1
1
1