|Year : 2017 | Volume
| Issue : 1 | Page : 27-31
Determinants of depression among medical students in two medical schools from South East Nigeria: A screening test
Chinawa Awoere Tamunosiki1, Josephat M Chinawa2, EC Aniwada3, Pius C Manyike4, Ikenna Ndu5, OC Nduaguba5
1 Department of Community Medicine, College of Medicine, Enugu State University Teaching Hospital, Ituku-Ozalla, Enugu State, Nigeria
2 Department of Pediatrics, College of Medicine, University of Nigeria Teaching Hospital, University of Nigeria, Ituku-Ozalla, Enugu State, Nigeria
3 Department of Community Medicine, University of Teaching Hospital, University of , Ituku-Ozalla, Enugu State, Nigeria
4 Department of Paediatrics, Federal Teaching Hospital, Abakiliki, Ebonyi State, Nigeria
5 Department of Pediatrics, Enugu State University Teaching Hospital, Enugu State, Nigeria
|Date of Web Publication||15-Feb-2018|
Josephat M Chinawa
Department of Paediatrics, College of Medicine, University of Nigeria, Enugu Campus, Enugu State
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Objectives: This study aims to assess the susceptibility of depression among clinical students from two medical schools from South East Nigeria, using a screening test questionnaire.
Methods: A total of 352 clinical medical students from two universities were enrolled by simple random sampling. A pretested self-administered depression questionnaire was used to evaluate degrees of depression among the participants.
Result: Out of the 352 students studied, 14 (4%) of the students are susceptible to moderate to severe depression while none are susceptible to mild depression.
Among the students, gender and age were not significantly associated with depression (χ2 = 2.896; P = 0.089). Socioeconomic class of the students was not significantly associated with depression (χ2 = 2.186; P = 0.335).
Conclusion: A relatively low number of medical students are susceptible to depression. Depression among medical students is unaffected by gender, age, and socioeconomic class.
Keywords: Depression, depression questionnaire, medical student, Nigeria
|How to cite this article:|
Tamunosiki CA, Chinawa JM, Aniwada E C, Manyike PC, Ndu I, Nduaguba O C. Determinants of depression among medical students in two medical schools from South East Nigeria: A screening test. Ann Nigerian Med 2017;11:27-31
|How to cite this URL:|
Tamunosiki CA, Chinawa JM, Aniwada E C, Manyike PC, Ndu I, Nduaguba O C. Determinants of depression among medical students in two medical schools from South East Nigeria: A screening test. Ann Nigerian Med [serial online] 2017 [cited 2020 Jan 21];11:27-31. Available from: http://www.anmjournal.com/text.asp?2017/11/1/27/225610
| Introduction|| |
Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings, and sense of well-being. The clinical spectrum of the disease can range from simple sadness to a major depressive or bipolar disorder. People with depressed mood can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable, ashamed, or restless and may lose interest in activities that were once pleasurable, experience loss of appetite or overeating, have problems concentrating, remembering details or making decisions, and may contemplate, attempt or commit suicide.
Depression is a major cause of morbidity worldwide. Lifetime prevalence varies widely, from 3% in Japan to 17% in the US., In most countries, the number of people who would suffer from depression during their lives falls within 8–12% range.,
Prevalence rates of depression among medical students are variable. For instance, Shawaz et al. documented a 51.3% prevalence rates among undergraduate medical students in India. In the same vein, a survey of 2500 students from 7 US medical schools showed about 53% of students with depression. While Thomas et al. noted a prevalence of moderate depression as 14.3%, Basnet et al. in Nepal documented a prevalence of 29.78% among medical students.
Population studies have consistently shown major depression to be about twice as common in women as in men although it is unclear why this is so and whether factors unaccounted for are contributing to this. According to Nauert, a high prevalence toward depressive symptoms was found among medical students, particularly females.
The risk of major depression is increased with neurological conditions such as stroke, Parkinson's disease, or multiple sclerosis and during the 1st year after childbirth., Other risk factors identified include a family history of depression and poor school performance. Social status has been reported to be inversely related to the prevalence of depression as studies have reported that those in lower socioeconomic class are more likely to be depressed.
Studies on depression among medical students are few and have shown high level of depression among medical students.,,, Moreover, studies done on depression in this setting did not address the degree of depression such as mild, moderate, or severe.
Moreover, a careful search also showed that the work done by the above authors ,,, was not principally among clinical medical students.
This study aims at finding out various degrees of depression among clinical medical students and the influence of sociodemographic variables on depression among medical students in South East Nigeria.
| Methods|| |
The study was carried out among clinical medical students from two medical schools in South East Nigeria. There are seven medical schools in South East Nigeria. The clinical medical students' population of these schools cuts across the various socioeconomic strata in Nigeria.
The study was carried out among medical students in University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu and Ebonyi State University Teaching Hospital, Abakaliki, all in South East Nigeria.
A pretested self-administered depression questionnaire (a screening tool) was used for this study. The questionnaire is a 30-item scale. It has a dichotomous response options which are YES and NO. A score of 1 or zero is assigned to some Yes response while a score of zero or 1 is also assigned to some NO response [Appendix 1]. The scores are computed and rated as shown below:
- 0-9 points: No depression
- 10-19 points: Mild to Moderate depression
- 20-30 points: Moderate to Severe depression.
Medical student sampling
Medical students in 4th and 5th year from University of Nigeria and Ebonyi State University were selected from the five medical schools in South East Nigeria by simple random sampling method. The medical students who met inclusion criteria were consecutively recruited into the study. The medical schools were selected by listing all the medical schools in South East Nigeria, and selecting two medical schools using simple random sampling.
The questionnaires were completed by the medical students after the purpose of the study was explained. Confidentiality was assured by informing the respondents not to write their names on the questionnaires. Three hundred and fifty-two medical students were recruited from Enugu and Ebonyi States. Their age and socioeconomic class were obtained. Socioeconomic class was ascertained using the socioeconomic classification by Oyedeji.
The minimum sample size required for this study was calculated using the following formula:
N = Z 2 P (I − P)/D 2
Where Z (i.e., the level of significance) = 1.96; P = Prevalence of children with depression., D = Tolerable error (0.05).
Using the formula above, we determined a minimum sample size of 206 patients. In anticipation of a 15% rate of attrition, the minimum sample size for our study is 270.
Oral informed consent was obtained from the medical students before embarking on the work.
Statistical analysis was with Statistical Package for Social Sciences version 19 (Chicago, IL, USA). Chi-square test was used to test for statistical association of categorical variables. Age was not normally distributed. All reported P values are 2-sided and values <0.05 were assumed as significant.
| Result|| |
The mean (standard deviation) age of the students was 24.11 (4.85) years. Of the 352 students studied, 173 (49.1%) were female while 179 (50.9%) were male, giving a male:female ratio of 1:1.
Two hundred and thirty-eight (67.6%) of the study population were from the upper socioeconomic class; 53 (15.1%) from the middle socioeconomic class while 61 (17.3%) were from the lower socioeconomic class [Table 1].
Out of the 352 students studied, 14 clinical medical students have moderate to severe depression with an overall prevalence of 4% while none had mild depression [Table 2].
Among the clinical students, gender and age were not significantly associated with occurrence of depression (χ2 = 2.896; P = 0.089). Socioeconomic class of the students was not significantly associated with depression (χ2 = 2.186; P = 0.335) [Table 3].
|Table 3: Associations between sociodemographics of students and depression (n=352)|
Click here to view
The prevalence of moderate to severe depression among clinical medical students from University of Nigeria Teaching Hospital, Enugu, is 2.8% while that among medical students from Ebonyi State University is 5%. This is however not statistically significant (χ2 = 1.043; P = 0.307) [Table 4].
The prevalence difference in depression among medical students from the two medical schools is not associated with their socioeconomic class and age (χ2 = 1.718; P = 0.424) [Table 5].
| Discussion|| |
Medical career, due to its heavy curriculum, demands great concentration, commitment, and discipline from students; this heightens when the students start their clinical postings; in this light, some of the students cannot cope with this didactic syllabus, which consequently alters their mental and physical state. It has been reported that stress, anxiety, and depression experienced by medical students throughout their school year may pose some problems such as low academic performance.,
The overall prevalence of moderate to severe depression in the study population was 4% while that no student had mild depression. This finding is similar to that of Fábio et al. who documented the prevalence of moderate to severe depression among medical students as 4.2%. However, Fabio's work was not among clinical students. Although the prevalence of depression varies widely, the prevalence of depression among medical students in this study was within the range of earlier studies., Furthermore, only very few studies classify depression into mild, moderate, and severe. This may account for very high prevalence in some of their findings. For instance, a study on similar topic in Nigeria done over a decade ago showed a very high prevalence rate of 23.3%. In addition, prevalence studies among medical students in India and in the USA showed a prevalence rate of 51.3% and 53%, respectively. Though failure to classify depression could contribute to this variation in prevalence rate, however, improving trends in the standard of living and questionnaire used may also contribute to this difference.
When we compared the prevalence of depression among medical students from the two universities under study, those students from University of Nigeria Teaching Hospital, Enugu, had a prevalence of 2.8% while that among medical students from Ebonyi State University was 5% with no statistical significance. Socioeconomic class and age differences were not able to delineate the reason for these differences. However, the former university medical school with a lower prevalence had about five times the number of lecturers when compared to the later medical school with a prevalence of 5%. Fewer lecturers and facilities may increase the workload and pressure of teaching among these medical students; this may make the understanding of the subject cumbersome and burdensome thus leading to stress and depression in the long run.
The prevalence of depression in this study is lower when compared to the prevalence of 5.2% obtained in general population. However, this finding was refuted by Dahlin et al. and Ibrahim et al. who in their separate studies noted a higher prevalence of depression in general population.
Prevalence rate obtained in this study is also <17.3% noted by Aguocha et al. among resident doctors. Aniebue et al. also noted similar trend.
We noted no link between socioeconomic class and prevalence of depression among medical students. It is pertinent to know that low socioeconomic status (SES) is generally associated with high psychiatric morbidity and poorer access to health care. However, among psychiatric disorders, depression shows a more controversial association with SES. Studies carried out on 51 prevalence studies and five incidence studies indicated that association of SES and prevalence of depression is variable.
We noted in this study that female medical students were more depressed than their male counterpart although this was not statistically significant. Similar findings have been reported by other studies., Although determinants of gender differences in depressive disorders are far from being established, gender-specific risk factors for common mental disorders that disproportionately affect women include gender-based violence, socioeconomic disadvantage, low or subordinate social status and rank and unremitting responsibility for the care of others., Sarah et al. however noted a male predominance in their study. The reason for female preponderance to depression in the adolescent age group has been attributed to differences in coping styles or hormonal changes during puberty.
We noted no association between age and prevalence of depression. This was also corroborated by Jadoon et al. who noted that age, marital status, locality, and total family income did not significantly affect the prevalence of depression among medical students.
| Conclusion|| |
The prevalence of depression among medical students in South East Nigeria is 4%. Age and socioeconomic class are not significantly associated with depression.
We acknowledge our participants, the medical students who made out time to respond to our questionnaire.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
American Psychiatric Association. DSM-5 Diagnostic and Statistical Manual of Mental Disorders. 5th
ed. Obtainable from dsm.psychiatryonline.org/doi/.../appi.books.9780890425596>. [Last accessed on 2017 Jul 17].
Cash RE. Depression in Children and Adolescents: Information for Parents and Educators, National Association of School Psychologists 2004;1:1-4. Obtainable from https://www.amazon.com/
Depression... Child-Parents.../14422. [Last accessed on 2017 Jul 17].
World Health Organization. The World Health Report 2001: Mental Health: New Understanding. New Hope: World Health Organization; 2001.
Andrade L, Caraveo-Anduaga JJ, Berglund P, Bijl RV, De Graaf R, Vollebergh W, et al.
The epidemiology of major depressive episodes: Results from the International Consortium of Psychiatric Epidemiology (ICPE) Surveys. Int J Methods Psychiatr Res 2003;12:3-21.
Iqbal S, Gupta S, Venkatarao E. Stress, anxiety and depression among medical undergraduate students and their socio-demographic correlates. Indian J Med Res 2015;141:354-7.
] [Full text]
Dyrbye LN, Thomas MR, Massie FS, Power DV, Eacker A, Harper W, et al.
Burnout and suicidal ideation among U.S. medical students. Ann Intern Med 2008;149:334-41.
Schwenk TL, Davis L, Wimsatt LA. Depression, stigma, and suicidal ideation in medical students. JAMA 2010;304:1181-90.
Basnet B, Jaiswal M, Adhikari B, Shyangwa PM. Depression among undergraduate medical students. Kathmandu Univ Med J (KUMJ) 2012;10:56-9.
Amoran O, Lawoyin T, Lasebikan V. Prevalence of depression among adults in Oyo State, Nigeria: A comparative study of rural and urban communities. Aust J Rural Health 2007;15:211-5.
Oyedeji GA. Socio-economic classification. In: Araoye MO, editor. Class Research Methodology with Statistics for Health and Social Sciences. 1st
ed. Ilorin: Nathadox Publishers; 2004. p. 115-20.
Fouilloux C, Barragán V, Ortiz S, Jaimes A, Urrutia M, Guevara R. Síntomas depresivos rendimiento académico en estudiantes de medicina. Salud Ment 2013;36:59-65.
Omigbodun OO, Odukogbe AT, Omigbodun AO, Yusuf OB, Bella TT, Olayemi O. Stressors and psychological symptoms in students of medicine and allied health professions in Nigeria. Soc Psychiatry Psychiatr Epidemiol 2006;41:415-21.
Tabalipa FO, de Souza MF, Pfützenreuter G, Lima VC, Traebert E. Prevalence of anxiety and depression among medical students. Rev Bras Educ Méd 2015;39:388-94.
Aniebue PN, Onyema GO. Prevalence of depressive symptoms among Nigerian medical undergraduates. Trop Doct 2008;38:157-8.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39:594-604.
Ibrahim AK, Kelly SJ, Adams CE, Glazebrook C. A systematic review of studies of depression prevalence in university students. J Psychiatr Res 2013;47:391-400.
Aguocha GU, Onyeama GM, Bakare MO, Igwe MN. Prevalence of depression among resident doctors in a teaching hospital, South East Nigeria. Int J Clin Psychiatry 2015;3:1-5.
Lorant V, Deliège D, Eaton W, Robert A, Philippot P, Ansseau M. Socioeconomic inequalities in depression: A meta-analysis. Am J Epidemiol 2003;157:98-112.
Piccinelli M, Wilkinson G. Gender differences in depression. Critical review. Br J Psychiatry 2000;177:486-92.
Naushad S, Farooqui W, Sharma S, Rani M, Singh R, Verma S. Study of proportion and determinants of depression among college students in Mangalore city. Niger Med J 2014;55:156-60.
] [Full text]
Angold A, Costello EJ, Erkanli A, Worthman CM. Pubertal changes in hormone levels and depression in girls. Psychol Med 1999;29:1043-53.
Jadoon NA, Yaqoob R, Raza A, Shehzad MA, Zeshan SC. Anxiety and depression among medical students: A cross-sectional study. J Pak Med Assoc 2010;60:699-702.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]