CLR

The type of the paper included: controlled trials (n =5)

A PICo format is adopted to assist in searching for the right information, as it breaks the study question in an easy-to-understand way (Kang et al., 2019). PICo question provides keywords and phrases for searching the right study literature for the study. The PICo for this project is “Among youths and adolescents with depression  (P), what are the self-care strategies  (I), compared to no intervention  (C ), that are effective in reducing emotional distress  (O)?” The population for the study is young people diagnosed with depression, and the intervention is self-care strategies like relaxation, naturopathy, and medication. The comparison is no intervention, while reducing distress is the outcome. The format allows the researcher to extract detailed literature for the study subject thoroughly.

Results

           The final set included 12 study articles published between 2019 and 2023; three were conducted in Australia, one in Uganda, two in Iran, four in the United States, one in Syria, and one in China. The research articles reflected on various self-care strategies to reduce emotional distress among young adults and adolescents. The participants' demographics were reported in all twelve study articles. The articles balanced gender in their sampling. Male young adults are the most affected by emotional distress compared to females in the majority of the studies. The twelve selected study articles included five controlled trials, three randomized controls, and four cross-sectional studies.

Table 2. Results Table

Six articles were guided by framework, model, or theory, with some study articles using more than theories. This is substantial because theories, models, and frameworks justify developing a hypothesis and pragmatically examining the relationship among concepts and variables. Four different data collections were used, with some articles using two or more data collection methods. Three study articles conducted interviews; two used focus groups, six utilized questionnaires, and one used surveys. Twenty-three instruments were used to measure mental distress levels, depression, and self-care strategies. Likert scales were utilized to examine how subjects rated their response to statements: The scales are used to gather participants' feelings, opinions, and attitudes on self-care interventions (Dye et al., 2020). The responses are assigned scores and measured subsequently.

The analysis of most articles showed an attitude among adolescents to seek assistance in their social networks and rely on other self-care strategies to reduce emotional distress (Farshi et al., 2020). The resources and actions adolescents utilize are summarized into ten groups and grouped into four main areas for four analytical purposes. The first significant area involves resources for reinforcing adolescents individually in their life cycle phase, in that their objective is maintaining personal autonomy to resolve conflict. Some socialization of problems with friends was established as the primary motive for emotional stress; thus, distress may originate from the social context, and solutions can only come from the context.

The second area involves parents and teachers who provide particular support in the form of unconditional love, expressed through parenting to young adults during self-care (Reiszadeh et al., 2022). Attention from parents and teachers entails that adolescents are accompanied into their future. The area can include a girlfriend-boyfriend relationship because it provides trust and affection as support to cope with adverse situations. The third area concerns taking mental distress beyond close social networks, directing stress caused by the unfortunate case in a spot, physical activity, and conversation with close and trusted relatives (Reiszadeh et al., 2022). The last identified area outlines self-care approaches that connect the adolescent's external and internal worlds through artistic and sensory expression.

Eight of the twelve studies believe adolescents express concern about maintaining self-control and personal autonomy when looking for assistance with emotional distress. The perspective comes when they consider seeking solutions to their problem themselves and within themselves (Tonsing & Tonsing, 2022). For adolescents, this represents maintaining individuality and strengthening. Among young people, mobilizing personal resources take varying connotations. Some young adults express the need to move and act themselves, believing that no one else can assist them out of their situation. Others seek to empty their distress to acquire the desired happiness from within themselves. One article utilizes the silence metaphor to describe this internalization process of addressing emotional distress (Tonsing & Tonsing, 2022). The article believes that when an individual experiences silence and breaks away from all noise backgrounds, such an individual realizes their situation and is aware of areas of change or improvement. Being silent assist people in becoming alone with themselves, creating room to solve their distress. This intervention can be utilized anytime and place where one wants. Writing is found to be another self-care strategy some adolescents use to determine the internal communication process to express their personal experiences. The young adult can write things down and see the best way to react.

Adolescents feel they can only depend on themselves when their mental health worsens. In most cases, young adults tend to ask for assistance from others when they cannot resolve their distressing issue with their resources or have no option (Nguyen et al., 2021). Additionally, interventions for addressing adversity situations may go beyond personal resources. As times pass, young adults cannot live with their problems; therefore, they can share their experiences. When adolescents opt to come out of themselves, they socialize in a friendship context, where distress originates for most young people. Encouraging and talking to others is among the primary resources young people can use to face the adverse situation. Adolescents consider their friends the primary psychological source in daily life, especially during distressing situations (Ren et al., 2021). Some of the activities young adults share with their friends include watching movies, walking, and having coffee, all of which help them let off steam, seek understanding, and grow trust. Friends play a critical role in cheering them up and assisting them in regaining confidence and overcoming emotional distress.

The presence of individuals close to the adolescents' adult world, their knowledge, unconditional love, and trust places them as a critical support resource for adolescents facing emotional distress (Cho, 2021). For some young adults, sports serve as a way to expand their social networks and establish support outside of family and friendship circles (Bang & Park, 2020). Team sports bring a sense of belonging and identity, eventually boosting adolescents' self-esteem (Bruno et al., 2021). Other self-care strategies identified in some study articles include artistic, creative, and sensory activities like music and reflexology.

Discussion

The two articles provide a critical summary of the effectiveness of self-care interventions in dealing with distress, especially among young adults and adolescents. The majority of the studies demonstrate different self-care resources adolescents and young adults can utilize to cope with situations of anxiety and depressive distress. Three studies, Farshi et al. (2020), Shrestha et al. (2021), and Reiszadeh et al. (2022, show ten main resources categorized into four areas covering various levels and possible therapeutic pathways adolescents take, depending on whether they suffer from self-perceived distress, formal diagnosis, and control group case.

The adolescents' narrative shows the experience of distress as their fault and responsibility. Most participants expressed their ability to resolve emotional distress through their resources. Self-care strategies for reducing distress ranges from sociability expressed relationship with parents, families, friends, and older adults, to individuality, group membership like drama, sports, and bands, or even other self-care intervention like meditation, relaxation, and laughter (Gibson & Trnka, 2020). Additionally, young adults can rely on homeopathy, naturopath, and reflexology (Cowie & Myers, 2021). The adolescents' self-sufficiency perception reinforces the use of different lay resources.

Most articles agree that young adults prefer seeking assistance from family and friends to cope with distressing events. The findings confirm the findings of other studies that discussing or talking with a close friend or maintaining contact with social networks helps young adults reduce depressive symptoms. Some articles, however, consider the conviction by young people that they can resolve mental health problems on their own as a severe hindrance to seeking professional assistance. Other studies believe that young adults prefer support networks because they are easy and readily available. Additionally, the interventions reduced the risk of stigmatization experienced when seeking professional help from health facilities and professionals. Adolescents see family and social networks as another link between the adult and the immediate world (Bang et al., 2020). Moreover, young people rely on networks to establish suitable care and attention consistent with their lay strategies of problem-solving and personal autonomy.

The young people’s choice of lay care approaches should be seen as a social reality that brings an understanding of how young people cope with distressing situations (Wickström & Lindholm, 2020). The frequency with which the adolescents refer to terms like understanding, presence, and trust to describe the relationship or expect from parents, friends, teachers, or relatives show such to be desirable characteristics in the person with whom the young adults share their stress. Additionally, this demonstrates the need for adolescents to establish an intersubjective and dialogic encounters with one another to regain their mental health. The articles show to reveal this relationship as grounded on the peace of mind and understanding to express their pain.

Young adults expect to be listened to and given emotional support and let them talk without hurting their autonomy and self-esteem. The emphasis from the young adults on “being there” show how much they value their local-subjective world in handling emotional distress. Moreover, one article articles describe brief mindfulness as effective in improving sleep quality and reducing depression (Downie et al., 2021). Mindfulness and meditation have been relied upon for stress management in various settings, including workplaces, hospitals, and personal levels, during distressful events. According to Farshi et al. (2020), self-care enhances the quality of life and anxiety among women suffering from endometriosis. Most self-care strategies, including regular physical exercise, can greatly enhance an individual’s mood and mental health (Butler et al., 2019). Eating healthy foods such as fruits and vegetables and staying hydrated can boost one’s well-being. Additionally, Chen et al. (2022), self-care confidence and social connectedness improve emotional well-being among young adults, who greatly value the role played by parents, teachers, friends, and relatives in relieving the distress they get during their lifetime.

All the twelve studies selected for the project used scientific research methodology and complied with the necessary ethical standards for the studies. Strict adherence to the research guidelines and methods guarantees valid, reliable, and widely generalizable study findings that correctly reflect the reality of the population from which the sample is drawn (Bruno et al., 2021). However, some articles used a small sample size which can affect the results' generalizability. But generally, the study findings remarkably confirmed and agreed with past findings. The findings can form a strong literature foundation for future research on the effectiveness of self-care strategies in addressing emotional distress. Additionally, the provided evidence in the studies can serve as a base for developing effective evidence-based practice (EBP) interventions to address different nursing and healthcare problems.

Conclusion

Emotional distress is a prevalent mental health concern in adolescence and young adults because they are at a critical phase in constructing social and personal identities. Adolescents are vulnerable to anxiety, depression, and negative moods and tend to have negative attitudes toward seeking professional assistance. Various lay care strategies outside the professional care boundaries can help address youths' emotional distress. These strategies can include social support, self-care, informal care, or self-help, all of which cover a broad range of practices. Moreover, studies find spirituality, structured routine, and creative activities as important in reducing emotional distress. The population for the study is young people diagnosed with depression, and the intervention is self-care strategies like relaxation, naturopathy, and medication. The comparison is no intervention, while reducing distress is the outcome. The self-care strategies are to be compared to no intervention to measure their effectiveness in reducing emotional distress among adolescents and young adults suffering from depression.

The research used the Academic Search Planner, CINAHL, MedLine, ProQuest, and Scopus electronic databases CINAHL and Search Premier electronic databases that are accessible through the university’s library to conduct a systematic literature search. The final set included 12 study articles published between 2019 and 2023; three were conducted in Australia, one in Uganda, two in Iran, four in the United States, one in Syria, and one in China. The twelve selected study articles included five controlled trials, three randomized controls, and four cross-sectional studies. The analysis of most articles shows an attitude among adolescents to seek assistance in their social networks and rely on other self-care strategies as an option to reduce emotional distress. The resources and actions adolescents utilize are summarized into ten groups and grouped into four main areas for four analytical purposes. The first significant area involves resources for reinforcing adolescents individually in their life cycle phase. The second area involves parents and teachers who provide particular support in the form of unconditional love, expressed through parenting to young adults during the process of self-care. The third area concerns taking mental distress beyond close social networks, directing stress caused by the distressing situation in a spot, physical activity, and conversation with close and trusted relatives. The last identified area outlines self-care approaches that connect the adolescent’s external and internal worlds through artistic and sensory expression. All the twelve studies selected for the project used scientific research methodology and complied with the necessary ethical standards for the studies. However, some articles used a small sample size which can affect the results' generalizability. Generally, the study findings greatly confirmed and agreed with past study findings. The findings can form a strong literature foundation for future research on the effectiveness of self-care strategies in addressing emotional distress.

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