The discussion is guided by Colin Rees' (2003) critique framework, which looks into the following parts of the research article: focus of the material, the background presented, the terms of reference, the study design, the data collection method, and ethical considerations. It goes further to include looking into conclusion and recommendations, readability, and finally, its implications to practice. These parts provide for the body of this critique
Focus. The theme of the research article is that there is no relationship between isotretinoin or antibiotic/topic treatments and depression and the patient's quality of life. This article could be filed under the key words: acne therapy, adverse effects, causal relationship, depression, and isotretinoin. The title clearly gives a clue to the focus. Despite its limited number of respondents and other limitations, the study is important to the profession or practice as it can add to the pool of research on the subject.
Background. The study claimed that there have been increasing interests about the possible relationship between isotretinoin therapy and depressive symptoms. It quoted Ault's (1998) study, which estimated that there have been more than two million users of isotretinoin in the United States since 1982. Further, it said, Wysowski et al's (2001) research mentioned that between 1982 and 2000, the Food and Drug Administration (FDA) in the USA had received 431 adverse reaction reports on isotretinoin therapy. These included cases of depression, suicidal ideation, suicide attempts and suicide in patients. Also, Ault (1998) was said to have reported 37 suicides, 110 hospitalized patients and 24 cases of recurring depression on drug re-challenge.
The literature mentioned about gaps in research, hence the undertaking of the study. It said that while the literature pertaining to the efficacy and physical adverse effects of isotretinoin (13-cis-retinoic acid) are widely available, the psychological effects, particularly depression, are not well documented. This was mentioned in the researches done by Mills and Marks (1993), Bigby and Stern (1988), and Hull and Bartel (2000). The research said there are possibilities for association but causal relationship is not established, nor any etiological relationship. Further, it is not clear whether depression is a result of using isotretinoin, or the psychological effect of suffering severe acne or even a combination of both.
No local problems have been laid out, understandably because drug side effects are a worldwide concern and the scope is beyond the locality. The research may have been carried out as "although the possible association between isotretinoin and depression has been known for over 15 years, no causal relationship or etiological mechanisms have been established." (Ault, 1998). There was no theoretical or conceptual framework presented for this case.
Terms of reference. The aim of the research, in the words of the authors, "is to evaluate depressive symptoms and quality of life in acne patients having either isotretinoin or antibiotics/topical treatments." Although there was no hypothesis, the dependent variables are clearly isotretinoin and antibiotic/ topical treatment. On the other hand, the independent variables are depression, quality of life, and acne severity ratings. There were