Republic of the Philippines

Naval State University

College of Arts and Sciences
HEALTH SCIENCES DEPARTMENT
Naval, Biliran

Research Proposal

Name of Proponents : Tracy D. Armstrong

Richelle Ann F. Mullon

Adviser : Pearl Irish V. De Paz, DM

Designation : Students and Faculty

College and Department: College of Arts and Sciences

Health Sciences Department

I. Identifying Information

A. Title:

“Level of Anxiety, Fatigue and Depression among Graduating College

Students enrolled in Naval State University”

B. Cooperating Agency: Naval State University

 II. Introduction/ Rationale

Worldwide, an increasing number of students who are pursuing formal

education have been noted. Anxiety, fatigue and depression are some of the

common health issues faced by students while being enrolled in a university. This

may be due to the multiple family and school-related responsibilities as well as the

financial obligations on top of their responsibilities as student. [CITATION CBr06 \l

1033 ].The need to finish the degree becomes compelling because having a

university degree is a primary requirement for social and economic mobility for

lucrative employments. Hence the students are pressured to be able to excel or

graduate in a degree [ CITATION Lee13 \l 1033 ] . Furthermore, the physical and mental

pressure of having multiple responsibilities while enrolled in a formal education can

supplement the possibility of the student to report stress [ CITATION Toe97 \l 1033 ].

Therefore, when stress is faced by the student, the feelings of anxiety and fatigue

may occur and might even lead to depression if unresolved immediately.

According to American Psychological Association, anxiety is as an emotion

characterized by feelings of tension, worried thoughts and physical changes like

increased blood pressure which causes nervousness, fear, apprehension. On the

other hand, fatigue is defined as likely to be weak, exhausted, sleepy, and drowsy or

the physical and mental state of being extremely tired while depression is the feeling

of sadness, feeling down, having a loss of interest or pleasure in daily activities.

Anxiety and fatigue are common symptoms familiar to all of us when facing

stressors. However, if they persist and affect our life substantially, it may lead to

depression.
 The total estimated number of people living with anxiety disorders in the world

is 264 million. This total for 2015 reflects a 14.9% increase since 2005 as a result of

population growth and ageing. Moreover, the proportion of the global population with

depression in 2015 is estimated to be 4.4% and the total number of people living with

depression in the world is 322 million. Nearly half of these people live in the South-

East Asia Region and Western Pacific Region. The total estimated number of people

living with depression increased by 18.4% between 2005 and 2015. This reflects the

overall growth of the global population, as well as a proportionate increase in the age

groups at which depression is more prevalent [CITATION Wor \l 1033 ]. Depression and

other mental health disorder can be prevented when the symptoms are addressed

early and effectively[ CITATION Lee13 \l 1033 ].

In the Philippines, prevention of depression is not common among students.

However, it must be given much attention because of the increasing rates of suicide

among the said population. A strong connection between depression and suicide has

been established in several literatures. Recently, a total of four suicide cases among

students in Naval State University has been recorded. Hence, the sequence of

suicide cases among local students and since little is known about the students’ level

of anxiety, fatigue and depression, the researchers were motivated to propose this

study.

The study will be conducted using the descriptive- correlational research

design and will adopt standardized questionnaires. The results of the study will

become basis of crafting interventions in order for the students to cope up with

anxiety, fatigue and depression thereby improving the mental health of the

graduating students enrolled at universities.

III. Objectives

A. General Objective:

Generally, these study will therefore seek to explore and investigate the

level of anxiety, fatigue and depression among graduating college student

enrolled in Naval State University.

B. Specific Objectives:

Specifically, this study aims:

1. To determine the socio- demographic profile of the respondents as to

their:

1.1 age;

1.2 sex;

1.3 residential location;

1.4 religion;

1.5 educational background;

1.5.1 course;

1.5.2 year Level;

1.5.3 college;

2. To assess the level of anxiety among the respondents;

3. To assess the level of fatigue among the respondents;

4. To assess the severity of depression among the respondents;

5. To test the relationship between the following variables:

 5.1 socio-demographic profile variables and the level of anxiety;

5.2 socio-demographic profile variables and the level of fatigue;

5.3 socio-demographic profile variables and the severity of depression;

5.4 Level of Anxiety and Level of Fatigue;

5.5 Level of Fatigue and Severity of Depression.

6. To craft interventions to cope up with anxiety, fatigue and depression.

Hypothesis:

1. There is no significant relationship between the socio-demographic

profile variables and the level of anxiety of the students;

2. There is no significant relationship between the socio-demographic

profile variables and the level of fatigue;

3. There is no significant relationship between the socio-demographic

profile variables and the severity of depression;

4. There is no significant relationship between the level of anxiety and the

level of fatigue;

5. There is no significant relationship between the level of fatigue and the

Severity of Depression.

IV. Theoretical/ Conceptual Framework

A. Theoretical Framework

This study is anchored to the Theory of Unpleasant Symptoms (TUOS) helps

to describe the development of multiple symptoms such as anxiety, fatigue and

depression caused by stress due to the completion of academic requirements and

that it can occur at the same time. According to [ CITATION Smi10 \l 1033 ], theories

guide our actions, help us achieve desired results and give evidence to what has

been previously achieved. Specifically, middle range theories are abstract yet are

concrete enough that it provides a link between nursing research and practice. The

theory on unpleasant symptoms was introduced in 1995 as a way for integrating

existing information about a variety of symptoms. [ CITATION Len07 \l 1033 ]

Furthermore, the theory of Unpleasant Symptoms was developed by four

nurse researchers namely Audrey Gift, Renee Milligan, Linda Pugh and Elizabeth

Lenz who shared the same interest in the nature and experience of different

symptoms such as fatigue and dyspnea and in the process of concept and theory

development. The abovementioned nurse researchers collaborated with each other

and conducted several empirical studies and theoretical articles. Frederick Suppe

who is a philosopher of Science and who is also their colleague played an important

role in shaping their understanding of middle range theory and also assisted them in

their theory development. The theoretical assumption of Unpleasant Symptoms

Theory is that multiple symptoms have underlying commonalities which includes the

idea that the said symptoms often occur together [ CITATION Dir09 \l 1033 ].Furthermore,

the theory on unpleasant symptoms is a valuable instrument for nurses as it aids in

crafting individualize interventions that fit the individual needs and unique pattern of

symptoms. That in order to manage the symptoms experienced by the student or

individual, the nursing interventions should include the evaluation of the symptoms

individually and as a whole to understand their interactions. [ CITATION Lop15 \l 1033 ].

Relationships among the individual’s socio-demographic factors, symptoms

experienced and performance outcomes are viewed as reciprocal. For example

severe fatigue and anxiety may lead to depression. When depression occurs, the

individual’s performance is affected and if left untreated may lead also lead the

individual to commit suicide. In this study, the severity of anxiety, fatigue and

depression will be measured among students enrolled in Naval State University.

Anxiety, fatigue and depressions are the unpleasant symptoms or multiple symptoms

that maybe experienced by the respondents. Furthermore, the severity of the

symptoms experienced maybe affected by the sociodemographic profile of the

student. Hence, the relationship of the socio-demographic profile variables will be

tested with the level of anxiety, fatigue and depression among the respondents.

Conceptual Framework

Theory of Unpleasant
Symptoms Profile
age, sex, religion, residential location,
Symptoms, influencing factors
educational background
and performance outcomes.
(Dependent Variables)

Level of Level of Severity of

Anxiety Fatigue Depression

(Independent Variables)

Intervention Scheme to cope up with anxiety,

fatigue and depression

Figure 1. Conceptual Framework of the study

The focus of this study is to assess the level of anxiety, fatigue and

depression among college students of Naval State University. To attain the

objectives underscored by the researcher, the different variables were laid out and

given emphasis, highlighted by the main concepts and constructs derived from

identified theory.

As mentioned in the Unpleasant Symptoms theory, there are two factors that

may affect one’s performance specifically the symptoms experienced and influencing

factors. In the study, the symptoms experienced are anxiety, fatigue and depression

while the influencing factors are the socio-demographic profile variables. This means

that when sever anxiety and fatigue is experienced by the students, depression will

occur and therefore the individual performance may be affected.

As presented in the figure, the researcher will gather the necessary data such

as the socio-demographic profile of the respondents as to their age, sex, residential

location, religion, educational background course, year level and college and also

the level of anxiety, fatigue and depression. Moreover, a two-way arrow will also

determine the association of the socio-demographic profile variables with the level of

anxiety, fatigue and depression. Furthermore, an intervention scheme to increase

the knowledge and improve the attitude and health seeking tendency of the

respondents will be crafted based from the results that will be gathered.

V. Methodology

A. Research Design

The study will be a descriptive- correlational research design. A standardized

survey questionnaire such as the 21-item Beck Anxiety Inventory, 9-item Brief

Fatigue Inventory of The University of Texas M. D. Anderson Cancer Center and 11-

ITEM Kutcher Adolescent Depression Scale: KADS-11. The study aims to determine
the socio-demographic profile, the level of anxiety, fatigue and depression among

the college students of Naval State University. Furthermore, the study aims to

correlate the socio-demographic profile variables with the level of anxiety, fatigue

and depression.

B. Research Locale

The study will be conducted at Naval State University. The researchers

choose the University as the locale of the study because it is the only academic

institution of higher learning in the province of Biliran. The researchers believed that

there is a need to assess the level of anxiety, fatigue and depression among the

college students since they are very prone to face mental health problems due to

stress in orderto comply with the academic requirements.

Naval State University is mandated to provide advanced education, higher

technological, professional instruction and training in the fields of arts and sciences,

education, agriculture, fishery, forestry, maritime education, information and

communications technology, engineering, tourism and other related fields of study. It

is also mandated to undertake research and extension services, and provide

progressive leadership in its areas of specialization. It is composed of two

campuses: the main campus and Biliran campus. Under the main campus, is

composed of six colleges namely: Arts and Sciences, Maritime Education, Industrial,

Information, and Communication Technology, Engineering, Education and the

Graduate School.

C. Research Instrument

To obtain the needed knowledge all questions indicated on the statement of

the problem, the researcher will use of a standardized questionnaire such as the 21-
item Beck Anxiety Inventory[ CITATION Bec01 \l 1033 ] and the 9- item Brief Fatigue

Inventory [ CITATION The \l 1033 ] and 11-ITEM Kutcher Adolescent Depression Scale:

KADS-11.[ CITATION LeB02 \l 1033 ] The questionnaire will be comprised with the

following parts: 1) Respondents Socio-demographic profile (i.e. name, age, sex,

residential location, religion and educational background, personal experience and

prior exposure; 2) A twenty-one item scale to assess the level of anxiety; 3) A nine

item scale questionnaire to assess the level if fatigue; 4) an eleven- item

questionnaire to assess the severity of depression among the respondents.

D. Target Respondents

The respondents of the study will include the college graduating students of

Naval State University-Main campus. A total of 50 respondents per college will be

utilized as the respondents using purposive sampling. Purposive sampling is used by

a researcher to subjectively select participants based on what he or she thinks will

be representative of the population[CITATION Pol101 \l 1033 ].

Below are the inclusive criteria of the respondents:

1. Must be 18 years old and above;

2. He or she must be officially enrolled for the school year 2018-2019 at any

year level in order to ascertain the research question are answered accordingly;

3. Must be a regular student which means he or she must have a full

academic load of the year level enrolled;

4. Must be a graduating student on March 2019.

5. He or she must be willing to participate in the study.

The exclusion criteria are those not mentioned in the inclusion criteria and those

students who refuse to participate in the study will be excluded.

E. Data Collection

The data will be collected as follows: First, a transmittal letter will be

forwarded to the different offices such as to the University President, Research

Services Office Director, Dean of the College of Arts and Sciences, Chairperson of

the Health Sciences Office, Health Sciences Research Coordinator and the deans

of the seven colleges of the university in order to seek permission and approval to

conduct the study entitled “ Level of Anxiety, fatigue and depression among

graduating college students in Naval State University. Moreover, ethics clearance

will be sought from University Ethics Committee. After the approval, the list of

qualified respondents will be obtained from the Registrar’s office and from the list the

respondents will be randomly selected.

The study and the questionnaire will be carefully explained to the participants

of the study. Prior to the data collection, participants will be asked to sign the

informed consent to indicate their voluntary decision in participating the actual study.

The self- administered questionnaire will then be given to the participants. The

questionnaire of the participants will include the cover letter, informed consent, the

socio-demographic profile, a twenty-one item scale to assess the level of anxiety, a

nine item scale questionnaire to assess the level if fatigue and the an eleven- item

questionnaire to assess the severity of depression among the respondents.

Moreover, confidentiality will be provided and participants will be assured that

anonymity will be ascertained by referring them to their respective number. Answers

to completed questionnaire and test scores will be recorded, tallied and will be kept

in a safe place while waiting for completed data entry and analysis.
F. Data processing and analysis

The raw data gathered will be analyzed. The data on the socio-demographic

factors will be described using the frequency and percentage formula. The level of

anxiety will be derived from the the 21-item Beck Anxiety Inventory, the level of

fatigue will be derived from the 9- item Brief Fatigue Inventory of The University of

Texas M. D. Anderson Cancer Center and the severity of depression will be derived

from the 11-item Kutcher Adolescent Depression Scale. Moreover, the presence or

absence of the relationship between the variables will also be determined using the

Chi-square test at 0.05 level of significance. Meanwhile, the relationship between the

level of fatigue, anxiety and the depression will be tested by assessing the strength

of the Spearman’s Rho correlations at a 0.05 level of significance.

The data will be encoded in Microsoft Excel and will be analyzed using the IBM

Statistical Package for Social Sciences.

G. Ethical considerations

The respondents of the research will be provided with informed consents

indicating the purpose of the research, the potential benefits and harm of the

research towards them and ensure their complete anonymity throughout the

research. The researcher will address issues such as honestly, objectivity, respect,

for intellectual properly, social responsibility, confidentiality, non-discrimination and

others.

VI. Time Frame

July – Research Proposal Approval

August – Questionnaire/ Tool and Data Collection

 September – Data Analysis and Finalization

October – Defense (3rd week)

VII. Budgetary Requirements

1. Supplies and Materials P1,000.00

2. Book bind P 2,000.00

3. Printing P 1,000.00

4. Miscellaneous P 1,000.00

P 5,000.00
 References

American Psychological Association. (n.d.). Psychology Topics: Anxiety. Retrieved July 10,
2018, from http://www.apa.org/topics/anxiety/index.aspx
Beck, A. T., Steer, R. A., & Brown, G. K. (2001). The Fourteenth Mental Measurements
Yearbook.
Brus, C. (2006). Seeking balance in graduate school: A realistic expectation or dangerous
dilemma? New Directions for Student Services, 31-35.
Dirsken, S., Belyea, M., & Epstein, D. (2009). Fatigue- Based Subgroups of Breast Cancer
Survivors with Insomia. Cancer Nursing, 404-411.
LeBlanc, J., Almudevar, A., Brooks, S., & Kutcher, S. (2002). Screening for Adolescent
Depression:Comparison of the Kutcher Adolescent Depression Scale with the Beck
Depression Inventory,. Journal of Child and Adolescent Psychopharmacology.
Lee, R., Sta. Maria, M., Estanislao, S., & Rodriguez, C. (2013). Factors associated with
Depressive Symptoms among Filipino University Students. PLOS Journals.
Lenz, E., Pugh, L., Milligan, R., Gift, A., & Suppe, F. (2007). The middle- range theory of
unpleasant symptoms: An update. Advance Nursing Science, 14-27.
Lopes- Junior, L., de Omena Bomfim, E., Nascimento, L. P.-d.-S., & Lima, G. d. (2015).
Theory of Unpleasant Symptoms: Support for the management of symptoms in
children and adolescents with cancer. Revista gaucha Enfermagem, 109-112.
Polit, D., & Beck, C. (2010). Essentials of Nursing Research. Lippincott Williams & Wilkins.
Smith, M., & Parker, M. (2010). Nursing Theories and Nursing Practice.Nursing Theory and
the discipline of nursing. Philadelphia: Davies.
The University of Texas M. D. Anderson Cancer Center. (n.d.).
Toews, J., Lockyer, J., Dobson, D., Simpson, E., K, B., Brenneis, F., & Cohen, G. (1997). An
anaylysis of stress among medical students, residents and graduate students at four
Canadian schools of Medicine. Academic Medicine, 997-1002.
World Health Organization. (2017). Depression and other forms of Mental Disorders. Global
Health Estimates. Geneva.
Yeap, R., & Low, W. Y. (2009). Mental health knowledge, attitude and help-seeking
tendency: a Malaysian context . Sinagapore Medical Journal.