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 Table of Contents  
ORIGINAL ARTICLE
Year : 2021  |  Volume : 28  |  Issue : 3  |  Page : 198-203

Prevalence and factors associated with depression among medical students in Nigeria


1 Department of Family Medicine, Muhammad Abdullahi Wase Teaching Hospital, Kano, Nigeria
2 Department of Public Health, Ministry of Health, Katsina, Nigeria
3 Department of Community Medicine, College of Health Sciences, Bayero University, Kano, Nigeria
4 Department of Psychiatry, College of Health Sciences, Kano, Nigeria

Date of Submission11-Jan-2021
Date of Decision25-Aug-2021
Date of Acceptance27-Aug-2021
Date of Web Publication22-Oct-2021

Correspondence Address:
Dr. Musa Usman Umar
Department of Psychiatry, College of Health Sciences, Bayero University, Kano
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/npmj.npmj_414_21

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  Abstract 


Background: Depression among medical students has been partly attributed to the nature of medical education, and may lead to poor academic and professional adjustment. The objectives of the study were to assess the prevalence of depression and its relationship to socio-demographic and clinical risk factors among medical students of Bayero University in Kano, Nigeria. Methodology: A descriptive cross-sectional study was performed. Two hundred and seventy-nine medical students were selected using a multi-stage sampling technique. The respondents were given a self-reporting questionnaire, which included sociodemographic details and 3-item Oslo Social Support Rating Scale. Depression was assessed using the Mini-International Neuropsychiatric Interview (7.0). Results: The prevalence of depression among medical students was 15.1%. Depression was more in females, <22 years, those at the lower level of study, poor social support, family history of depression and history of depression. After logistic regression, only being female (P = 0.008) and history of depression (P = 0.007) differentiated medical students with depression from those with no depression with odds ratio (OR) of 2.88 (95% confidence interval [CI] = [1.31, 6.33]) and OR of 2.79 (95% CI = [1.33, 5.84]), respectively. There was no association between depression and poor financial state (P = 0.175), self-reported academic performance (P = 0.719) and use of psychoactive substances (P = 0.311). Conclusion: Depression is an important condition among medical students in Nigeria. There is a need to help students with mental health challenges by providing preventive measures, early identification and treatment mechanisms in medical schools in the country.

Keywords: Depression, medical students, Nigeria, prevalence


How to cite this article:
Suraj SS, Umar BI, Gajida AU, Umar MU. Prevalence and factors associated with depression among medical students in Nigeria. Niger Postgrad Med J 2021;28:198-203

How to cite this URL:
Suraj SS, Umar BI, Gajida AU, Umar MU. Prevalence and factors associated with depression among medical students in Nigeria. Niger Postgrad Med J [serial online] 2021 [cited 2021 Dec 1];28:198-203. Available from: https://www.npmj.org/text.asp?2021/28/3/198/328768




  Introduction Top


Depression is a major public health problem with a prevalence of 4.4% in the global population, and 5.4% in the African region.[1] It affects about 322 million people globally. Depression, like in other regions of the world is more common among females (5.9%) compared to males (4.9%) in African.[1] The prevalence of depression in Nigeria is estimated at 3.1%.[2] The total estimated incidence of people living with depression increased worldwide by 49.86%, from 172 million in 1990 to 258 million in 2017, with a notable increase in Western sub-Saharan Africa of 124.42%.[3]

Depression is regarded by the World Health Organisation (WHO) as one of the largest contributors to disability in terms of both years lived with disability (YLD) and disability-adjusted life year.[1] In Africa, it is ranked the second-leading cause of disability, with 7.9% of all YLDs resulting from depression. Here, in Nigeria, it accounts for 7.5% of all YLDs.[4] Globally, individuals with depression are nearly 33 times more likely to commit suicide,[5] while the odds of committing suicide in individuals with depression is about 12 times.[2]

A systematic review indicates that between 6.0% and 65.5% of medical students have depression.[6] Depression is the leading cause of suicide, resulting in close to 800,000 deaths annually (WHO). Medical students have a higher prevalence of depression compared to the general population,[7],[8] despite similar rates of help-seeking behaviours, which may suggest that there may be under-treatment among them.[8] Several reasons have been given for the failure to seek for treatment. These include fear of having mental health record and its impact on a future career, tight schedules, the stigma associated with accessing mental healthcare services and even fear of perceived unwanted interventions.[7],[8] This consequently, may lead to higher rates of suicidal behaviours among medical students, for which a large multi-institution study reported a prevalence of 11.2% of suicidal ideation.[9],[10] Furthermore, the rates of physician suicide are comparatively high, with rates of 40% and 130% for male and female physicians respectively, which is higher than the general population.[9] This has been attributed to the nature of medical schools, in terms of a long stay in school, rigorous academic pressure, the stress of clinical practice and professional development; and possibly under treatment of psychological disorders in medical students.[9]

Depression among medical students affects their academic performance, clinical practice, and rates of dropout; and may also influence the overall care given to patients as depressed medical students may show less empathy and less willingness to manage chronically ill patients.[7],[8] Previous studies of depression among medical students in Nigeria limited the number of factors associated with the condition assessed and used only self-report instruments.[11],[12],[13] This study is aimed at assessing the prevalence and associated risk factors of depression among medical students in a Nigerian university.


  Methodology Top


Study design and setting

The was a cross-sectional descriptive study of undergraduate medical students of Bayero University, Kano, Nigeria. The data collection was done for 8 weeks from September to November 2018.

Study population

The study population was medical students of Bayero University, Kano. Willing and consenting undergraduate medical students were included in the study while postgraduate students and other students from other departments were excluded. The study assessed 285 students with a 98% response rate (279). Six students declined to continue with the assessment due to either call from their lecturers or other unspecified reasons. Therefore, 279 students information were used for analysis; made up 173 (62%) males and 106 (38%) females with a mean age of 21.75 years (standard deviation [SD] = ±3.25).

Sampling technique

A multi-stage design was used for the study. A stratified sampling design was first used by making sure all the six levels in the faculty of clinical sciences the Bayero University, Kano were included in the study. This is then followed by a systematic sampling method. The total number of medical students in all levels was 715, and a proportionate allocation was used to determine the number of respondents to be selected from each level, using the calculated sample size of 285. The method of selection of students from each level was done by dividing the population of the students in a given class by the total number of medical students in the school and multiplying by the required sample size. The total number of students for the different levels were 141 (100 level), 165 (200 level), 106 (300 level), 93 (400 level), 90 (500 level) and finally 120 (600 level) with the following students selected for each level: 56, 66, 42, 37, 36 and 48, respectively. The sample interval, K was calculated by dividing the total number of students by the desired sample size, giving 3 as the sample interval. In each class, a simple random sampling was then used to select the first student, and thereafter, others students were selected using a sampling interval of 3 till the required number of students were reached per class.

Instruments

  1. Socio-demographic questionnaire: A self-administered socio-demographic and depression variable questionnaire was used to collect information on the age gender, tribe, religion, marital status, etc., The second section captured some risk factors and predictors of depression among the respondents
  2. Oslo 3-item Social Support Scale: The Oslo 3-item Social Support Scale (OSSS-3) was used to determine the social support of the respondents.[14] The instrument provides an assessment of social functioning and can predict individual mental health. It covers a number of areas of social support by measuring the number of people the respondent feels close to, the interest and concern that are shown by others, and the ease of obtaining practical help from others. It has been validated and used in Nigeria.[11],[15] The OSSS-3 was dichotomised into Good and Poor Support; combining those with Moderate and Good Support as Good Support
  3. Mini-International Neuropsychiatric Interview (M.I.N.I.7.0.0): For the diagnosis of depression, the M.I.N.I.7.0.0 was used.[16] The major depressive episode module for diagnosis of depression was interviewer-administered. This M.I.N.I.7.0.0 is a short diagnostic structured interview developed for the assessment and diagnosis of disorders using the Diagnostic and Statistical Manual diagnostic criteria-5 and International Classification of Diseases-10. The Depression Module was used in this work. The first two questions in the depression module of the M.I.N.I.7.0 are screening questions, while the remaining questions confirm the diagnosis of depression, severity, and also determine whether the subject has had at least an episode of depression before. Diagnosis of depression was made when at least one of the screening questions plus any other three in the remaining questions are answered yes. This instrument has been used in Nigerian undergraduate students.[17]


Procedure

The study was approved by the Ethics Committee of the College of Health Sciences, Bayero University, Kano in September 2018 (BUK/CHS/REC/VII/49). Permission was obtained from the Dean of Students of the University. Each selected student was given a consent form which was filled in the class. Students with diagnoses of depression were later referred to the University Clinic. The self-administered part of the questionnaire was given to each student by research assistants. The MINI 7.0 was administered either in the library or the garden close to the students' classrooms during their free period after the students had filled their self-administered questionnaires in the classrooms. Privacy was maintained during the interview. The MINI 7.0 interview was conducted by SSS. On average, all the stages of the data collection for each participant took 10–15 min.

Data analysis

The data that were collected was analysed using the statistical software SPSS version 20 (IBM Cooperation, Armonk, New York, USA). The result obtained was presented in the form of tables and charts using Microsoft excel. Descriptive statistics were used for categorical variables. The Chi-square test was used in assessing significant differences between the depression and various variables. Variables found to be associated with depression were further placed into the logistic regression equation. In all analyses, the P = 0.05 was used as statistically significant with a 95% confidence interval (CI).


  Results Top


The mean age of the respondents was 21.75 ± 3.25 years. The population was made of 62% (173) male. Up to 95% (265) of the population were single. Level 200 students have the highest number at 23.7% (66) among the respondents, followed by level 100 students at 19.4% (54), level 600 students 17.2% (48), level 300 students 13.6% (38), level 400 students 13.3% (37) and level 500 students 12.6% (36) in that order [Table 1].
Table 1: Socio-demographic characteristics of the participants

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Prevalence of depression

In this sample of medical students, the prevalence of depression was 15.1% (CI 8.1, 22.1). Based on severity, the prevalence of mild, moderate and severe depression was 5.4%, 6.8% and 2.9%, respectively. The prevalence of depression in females was 23.6%, while that of males was 9.8% with a female-to-male ratio of 2.4:1 and this difference was statistically significant (χ2 = 9.729, P = 0.002) [Table 2].
Table 2: Socio-demographic and clinical variables associated with depression

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Socio-demographic factors associated with depression

The mean age of the respondent with depression was 20.48 (SD ± 2.45) which was lower than the mean age for students that were not depressed at 21.97 (SD ± 3.32). This difference was found to be statistically significant (t-test = 3.316; P = 0.006). Medical students aged 21 and below had more depression at 20.1% compared to those >21 years with 8.8% and this difference was also statistically significant (χ2 = 6.92; P = 0.008). Females were more likely to have depression at 23.6% compared to males with 9.8% and this difference was statistically significant (χ2 = 9.73; P = 0.002). In terms of marital status, the single medical student had more depression, 15.4% while married individuals were 7.7%, but this difference was not statistically significant. Pre-clinical students were more likely to have depression at 18.5% compared with clinical students at 10.7%, but the difference was not statistically significant. However based on levels, students in years 2 and 3 had more students with depression compared to other levels, and the difference was statistically significant (χ2 = 19.74; P = 0.001). Poor social support was significantly associated with depression at 30.3%, moderate at 13.7% and good at 12.5% (χ2 = 6.88; P = 0.032). Living with a family or not was statistically significant (15.4% vs. 12.1%, P = 0.616).

Clinical variables associated with depression

Medical students who have a family history of depression were more likely to have depression at 32% compared to those that do not have at 13.4% [Table 2]. The difference was statistically significant (χ2 = 6.17; P = 0.013). Furthermore, those with history of depression were presently more likely to have depression at 27.4% when compared to those that did not report history of depression at 10.7% [Table 2]. This difference was statistically significant (χ2 = 11.78, P = 0.001). Medical students with depression reported a higher percentage of those that used psychoactive substances when compared to those that did not have depression [Table 3]. This difference though was not statistically significant. Recent stressful life-event within the last 12 months and seeing medical training as stressful were not associated with the diagnosis of depression [Table 2].
Table 3: Regression analysis of factors associated with depression

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After regression analysis only gender with odds ratio, OR of 2.88 (P = 0.008; at 95%, [CI]: [1.21, 6.33) and history of depression with OR of 2.79 (P = 0.007; CI= [1.33, 5.84] differentiated students with depression from those with no depression. Age of individual, level of study, social support level and family history of depression did not show association on logistic regression.


  Discussion Top


The prevalence of depression among medical students in this study was similar to a number of studies.[18],[19],[20] The study among US medical students reported a prevalence of 16.4%,[20] similar to 16.2% among 1068 medical students in a public medical school in Mexico.[19] In this study, the prevalence was higher when compared to some other studies, including the prevalence of 6.6% reported in clinical students in the United Kingdom[21] and 3.4 in first-year German medical students.[22] Still, other studies have reported a higher prevalence of 58.1%,[23] 38.1%,[24] and 39.7%.[25] However, two recent meta-analyses reported a prevalence of between 27.2% and 28%.[9],[26] The reason for these varied prevalence rates could be the differences in diagnostic criteria and cut-off points, use of diagnostic versus screening instruments and the use of self-report scales that vary significantly in their sensitivity and specificity for detecting depression.[26],[27] This can be illustrated by a study in the same medical school that used a screening instrument that reported a prevalence of 57.3%.[11] Furthermore, the heterogeneity and cultural influences of different populations and medical course structure could influence the self-reporting of depression.[9] Notwithstanding, the prevalence of 15.1% in this study is above the prevalence of 8.3% reported by Adewuya et al. among Nigerian university students,[17] and still much higher than the Nigerian Survey of Mental Health and Well-being that found a prevalence of 3.3% among the general population.[28] These two studies also used diagnostic instruments.

Females were more likely to be depressed than males in this study. This finding is consistent with findings from Egypt,[29] Brazil[30] and from a systematic review by Mao et al.[31] However, many studies did not find any significant association between gender and depression among medical students.[13],[32] Other studies have reported significantly more male prevalence of depression.[33],[34]

Those in years 3 and 4 had more prevalence of depression, with the trend increasing from 100 level to 200 and peaking at 400 level. Unlike other studies that reported the prevalence of depression is significantly highest among medical students in year 1 and subsequent decreases with increasing levels.[9] Our findings could be attributed to the nature of the course structure of medicine in the university, with students introduced to only core science courses at 100 level and then from 200 level, the students start basic medical sciences and subsequently clinical sciences. A longitudinal study reported that the prevalence of depression increases significantly in medical students from pre-medical training to a period of medical training.[35]

Another factor found to be significantly associated with depression was a prior history of depressive illness. This is consistent with the findings of some studies.[36],[37] The impact of social support was also noted to have a significant association with depression among the studied medical students. Respondents that reported poor social support are more likely to be depressed compared to those that reported moderate and good social support. This is in keeping with the positive effect of social support as a health promotive factor in various life situations and gives buffers to the untoward effects of stressors that any individual may be going through.[11]

In this study, variables that might be related to depression, such as physical activity, duration of sleep, personal efficacy and personality were not assessed. It is a single centre study and therefore could not be generalised though fairly the few studies from the country reported a high prevalence of depression. Although a cross-sectional study, this study utilised a diagnostic instrument in the diagnosis of depression and did emphasise the need for such studies as recommended in a recent meta-analysis that reported of the 167 studies, all but 1 used a self-report instrument.[26]


  Conclusion Top


The prevalence of depression among the participants is 15.1% and is higher than the one observed in the general population. Medical students are at an increased risk of having depression, due to the nature of their academic schedules. Factors associated with depression in this study include age, sex, family history of depression, prior history of depression, social support and year in medical school.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
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