|Year : 2019 | Volume
| Issue : 2 | Page : 170-175
Prevalence of depression among health sciences students: Findings from a public university in Malaysia
Abdul Rahman M Fata Nahas1, Ramadan M Elkalmi2, Abdulkareem M Al-Shami1, Tarek M Elsayed3
1 Pharmacy Practice Department, School of Pharmacy, International Islamic University Malaysia, Pahang, Malaysia
2 Department of Pharmacy Practice, Faculty of Pharmacy, Universiti Teknologi MARA, Selangor, Malaysia
3 Pharmaceutics Department, Sinai University, Cairo, Egypt
|Date of Web Publication||26-Apr-2019|
Dr. Abdul Rahman M Fata Nahas
Pharmacy Practice Department, School of Pharmacy, International Islamic University Malaysia, Pahang
Source of Support: None, Conflict of Interest: None
| Abstract|| |
Background: High rates of psychological problems including depression among university students have been reported in various studies around the world. The objectives of this study were to explore the prevalence of depressive disorder, as well as the associated sociodemographic factors (gender, origin, school, and year of study) among health sciences students. Materials and Methods: This cross-sectional study was conducted among 425 students from 5 different schools of health sciences at International Islamic University Malaysia, using the Patient Health Questionaire-9 (PHQ-9). Results: With a response rate of 85.9% (n = 365), the results showed a depressive disorder prevalence of 36.4%. The mean PHQ-9 score of the respondents was 8.10 (SD = 4.9), indicating mild depression severity. A statistically significant association was revealed between gender and severity of depression (P = 0.03), as well as between students’ origin and severity of depression (P = 0.02). Conclusion: The findings indicated high prevalence of depression among undergraduate health sciences students. While providing significant information to students’ affairs department, the study findings suggest the necessity to address depressive disorder in health sciences university students in Malaysia. Future research is needed to confirm these results in larger samples.
Keywords: Cross-sectional study, depression prevalence, health sciences, university students
|How to cite this article:|
Nahas AM, Elkalmi RM, Al-Shami AM, Elsayed TM. Prevalence of depression among health sciences students: Findings from a public university in Malaysia. J Pharm Bioall Sci 2019;11:170-5
|How to cite this URL:|
Nahas AM, Elkalmi RM, Al-Shami AM, Elsayed TM. Prevalence of depression among health sciences students: Findings from a public university in Malaysia. J Pharm Bioall Sci [serial online] 2019 [cited 2019 Nov 15];11:170-5. Available from: http://www.jpbsonline.org/text.asp?2019/11/2/170/257061
| Introduction|| |
Depression is a mental disorder characterized by a low mood state, with significant impaired mental and physical features, causing substantial burden to the society through limiting productivity and everyday activity. Ranked as the 11th greatest source of morbidity in the world, depression impact is unquestionably apparent. In 2015, the World Health Organization estimated a 4.4% global prevalence of depression, which translates into more than 300 million people being affected worldwide, and university students are no exception.
Exploring depressive disorders among university students had riveted the attention of several scholars for few decades.,,, Unfortunately, high rates of depressive disorders had been reported, with an increasing prevalence. It has been reported that the most challenging time that individuals face in life is college life time, as it is considered a critical transitional period; i.e., from adolescence to adulthood, where a lot of pivotal life decisions usually taken during this era.
In addition to depressive disorders, university students, compared to their nonstudying peers, often have higher rates of anxiety and stress disorders, as well as poorer health status.,, All these factors would in turn negatively affect students’ academic performance and impose additional burden to the students’ general health.
On the other hand, a number of studies had reported apparently high rates of depressive disorders among health sciences students,,,, given the complexity of the educational process that those students need to go through. In Malaysia, nearly 2% of the entire population aged 16 years or more had current depression; therefore, several studies had been run to estimate the prevalence of depressive disorders among university students.,,
The first onset of most of the lifetime mental disorders occurs during university age, thus supporting the importance of conducting this study. In fact, the prevalence of depression has been reported to be higher in rural and urban areas compared to metropolitan areas., Many previous studies in Malaysia among university students were conducted in metropolitan cities,,,,, of which findings were not able to be generalized to the urban area. Therefore, this study investigated the prevalence of depression among health sciences students in an urban area in Malaysia.
This study was conducted with two objectives: (1) to explore the prevalence of depression symptoms among health sciences students of a Malaysian university in an urban area and (2) to examine the sociodemographic factors associated with these symptoms.
| Materials and Methods|| |
Design and participants
This was a cross-sectional questionnaire-based study that was conducted at International Islamic University Malaysia (IIUM), Kuantan health campus between October and December 2015. Our target population was all students from five different schools; i.e., School of Medicine (SOM), School of Pharmacy (SOP), School of Dentistry, School of Nursing, and School of Allied Health Sciences. On the basis of the total number of students at these schools, the estimated minimum required sample size was 347 students. However, 425 participants were recruited to allow for the dropout during data collection. The study protocol was approved by the Department of Pharmacy Practice, SOP, IIUM. In addition, all enrolled participants were provided a written informed consent form after the study had been fully explained to them.
In this study, the Patient Health Questionaire-9 (PHQ-9) was adopted to evaluate the presence of depression among our subjects. The PHQ-9 is an easy tool to administer self-report instrument used to determine the presence of depression based on the Diagnostic and Statistical Manual of Mental Disorder, Fourth edition, criteria. The tool consists of nine items, each is based on a four-point scale, ranging from zero to three (i.e., zero: absence of the symptom, one: presence of the symptom over several days, two: presence of the symptom over more than half of the days, and three: presence of the symptom nearly every day). The overall score results range from 0 to 27, in which score of 0–4 represents absence of depression, whereas scores of 5–9, 10–14, 15–19, and 20–27 indicate mild, moderate, moderately severe, and severe depression, respectively. Using a cutoff point of ≥10, the PHQ-9 demonstrated a sensitivity of 88% and a specificity of 88% for the detection of major depression. In this study, we utilized the translated and validated Malay version of PHQ-9. The Malay PHQ-9 was reported to have good sensitivity and specificity for the purpose of research or clinical studies. In addition, the following sociodemographic characteristics were collected: gender, origin, year of study, and type of school.
All analyses were performed using the Statistical Package for Social Sciences version 22.0. To address our research objectives, we ran descriptive and inferential analyses. Frequencies and percentages were provided for description of the study data. Independent sample t test and one-way analysis of variance (ANOVA) test were run for differences testing, whereas Fisher exact test was run for relationship analysis. When P value is <0.05, a statistical analysis was considered significant.
| Results|| |
Of the 425 students who received the questionnaire, 365 (85.9%) responded. Most of the respondents were females (57.3%) and were from urban areas (75.1%). Students’ proportions from different study years were almost equal. The distribution of the respondents was almost the same over the selected schools, except for SOM (16.2%), which was the least. More details on students’ sociodemographics are shown in [Table 1].
In [Table 2], frequencies and percentages of the intensity of depression among the study participants are shown. Only 133 participants reported moderate, moderately severe, or severe depression symptoms, which accounted for a prevalence of depression of 36.4%.
|Table 2: Frequencies and percentages of the intensity of depression among the study participants (N = 365)|
Click here to view
The mean PHQ-9 score of the study sample was (8.10±4.9). As shown in [Table 3], there were no significant differences among different sociodemographic characteristics (genders, origins, year of study, and schools). Nevertheless, males had higher mean PHQ-9 score, as well as students of rural origin (independent sample t tests). One-way ANOVA tests showed that second year students and SOM students had the highest mean PHQ-9 scores.
|Table 3: Differences in Patient Health Questionaire-9 (PHQ-9) scores among different sociodemographic characteristics of study sample (N = 365)|
Click here to view
[Table 4] provides results of relationship tests using Fisher exact test. There was significant association between gender and severity of depression (χ2 = 10.62, P = 0.03). Similarly, a significant association between students’ origin and severity of depression was revealed (χ2 = 11.07, P = 0.02). Both the year of study and type of school had no statistically significant association with the severity of depression (P > 0.05).
|Table 4: Comparisons of sociodemographic characteristics with the severity of depression among the study participants (N = 365)|
Click here to view
| Discussion|| |
This study focused on the prevalence of depression and the severity of its symptoms of undergraduate health sciences students. The mean PHQ-9 score was in the mild severity range (8.10±4.9). We also found that the respondents predominately reported mild depression (38.6%), followed by moderate depression (26.0%). Our findings concurred with those reported in previous studies,,, which found that depression mean score was of mild severity in their samples of university students.
On the other hand, we reported a considerably high prevalence of depression (36.4%) that was higher than a study in Malaysia conducted by Islam et al., in which 30% of their sample (N = 1017) from metropolitan university had depression. It is worth mentioning that PHQ-9 is not a diagnostic tool; however, it is important to note that depression of moderate severity or more needs attention from concerned health authorities. Two preceding studies reported much higher depression prevalence rates as they were run among medical students, who are known to have more complex and heavy-loaded curriculum., Our study included students from medical and other health sciences; this might in part explain the lower prevalence of depression in our sample, yet the highest mean PHQ-9 score was reported by medical students (8.97±5.6), although it was not significant.
We revealed that males had higher mean PHQ-9 score compared to females, although it was not significant. The same findings were obtained from various studies using other survey tools among university students, in which no significant difference in depression mean scores according to gender was revealed., In contrast, Bayram and Bilgel reported several studies that found higher depression rates among females compared to males. In our study, females had higher rates of severe level of depression. Previous studies reported an increased prevalence of depression among females owing to, for instance, the more sensitivity to interpersonal relationships, as well as hormonal changes.
No significant difference in mean PHQ-9 score according to the year of study was reported. However, second year students had the highest mean score. Similar results were obtained in other few studies,,, where fresh entrant students reported a higher score of depression compared to seniors. In fact, the risk to confront depression increases as higher education is commenced. Moreover, second year students would face more complex curriculum compared to first year students. In the contrary, Bostanci et al. found that depression severity correlated with the year of study. We found that most of our sample with a severe level of depression was from year four. It might be that as medical students approach the graduation, more concerns arise regarding their future career, especially if one accounts for the high rate of youth unemployment (10.8%) compared to headline unemployment (3.4%) as reported by Malaysian authorities in 2017.
In our study, we found a significant relationship between students’ origin and severity of symptoms. Most of students from urban areas were more likely to report depressive symptoms of various severities. These results are corroborated in two previous studies., Urbanization is known to affect individuals’ lifestyle with its reduced sunlight exposure and time spent with family, in addition to lesser exercising resulting in higher rates of obesity. All these aspects might increase the risk for stress and depression. In contrast, Probst et al. documented a higher prevalence of depression in residents of rural areas compared to urban areas in the United States, possibly due to different population characteristics.
Although our study showed no significant difference in the mean PHQ-9 score among different schools, medical students reported the highest mean PHQ-9 score. It is known that medical schools are stressful environments for their students. Indeed, the prolonged study hours, emotional challenges of becoming health carers, as well as the high workload impose a substantial burden on those group of students., This in turn would increase their risk to confront depression at certain point in their academic life.
Unlike previous studies in Malaysia, this study was focusing on students of health sciences in urban area. However, findings from our study should be comprehended while considering its limitations. First, as the study sample represented only IIUM students, this findings from our study cannot be generalized to other universities in Malaysia. Second, because depression is perceived as being a stigma, it could be underreported by respondents.
| Conclusions|| |
More than one-third of IIUM health sciences students accounted for the prevalence of depression in our study. This provides credence that university students of health sciences are at increased risk for depression. Therefore, there is a need to develop efficient screening, counselling, and prevention programs, in addition to treatment services to control this disorder among these future health care providers.
The authors are greatly thankful to the third year students group from School of Pharmacy at International Islamic University Malaysia who participated in data collection of this study.
Financial support and sponsorship
This research was funded in part by Research Initiative Grant Scheme (RIGS 17-005-0580) from International Islamic University Malaysia (IIUM).
Conflicts of interest
There are no conflicts of interest.
| References|| |
Panza F, Frisardi V, Capurso C, D’Introno A, Colacicco AM, Imbimbo BP, et al
. Late-life depression, mild cognitive impairment, and dementia: Possible continuum? Am J Geriatr Psychiatry 2010;18:98-116.
Hu TW. The economic burden of depression and reimbursement policy in the Asia Pacific region. Australas Psychiatry 2004;12 (Suppl):S11-5.
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al
. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: A systematic analysis for the global burden of disease study 2010. Lancet 2012;380:2197-223.
World Health Organization. Depression and other common mental disorders. Global Health Estimates 2017. [cited 2019 Mar 2]. Available from: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf?sequence=1 .
Nezu AM, Nezu CM, Nezu VA. Depression, general distress, and causal attributions among university students. J Abnorm Psychol 1986;95:184-6.
Hogg JA, Deffenbacher JL. A comparison of cognitive and interpersonal-process group therapies in the treatment of depression among college students. J Couns Psychol 1988;35:304.
Abramson LY, Alloy LB, Hogan ME, Whitehouse WG, Cornette M, Akhavan S, et al
. Suicidality and cognitive vulnerability to depression among college students: A prospective study. J Adolesc 1998;21:473-87.
Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol 2008;43:667-72.
Chen L, Wang L, Qiu XH, Yang XX, Qiao ZX, Yang YJ, et al
. Depression among Chinese university students: Prevalence and socio-demographic correlates. PLoS One 2013;8:e58379.
Radeef AS, Faisal GG, Ali SM, Ismail MM. Source of stressors and emotional disturbances among undergraduate science students in Malaysia. IJMRHS 2014;3:401-10.
Hysenbegasi A, Hass SL, Rowland CR. The impact of depression on the academic productivity of university students. J Ment Health Policy Econ 2005;8:145-51.
Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y. Prevalence of depression, anxiety and their associated factors among medical students in Karachi, Pakistan. J Pak Med Assoc 2006;56:583-6.
Yusoff MS. Associations of pass-fail outcomes with psychological health of first-year medical students in a Malaysian medical school. Sultan Qaboos Univ Med J 2013;13:107-14.
Yusoff MSB, Rahim AFA, Yaacob MJ. Prevalence and sources of stress among Universiti Sains Malaysia medical students. MJMS 2010;17:30-7.
Quince TA, Wood DF, Parker RA, Benson J. Prevalence and persistence of depression among undergraduate medical students: A longitudinal study at one UK medical school. BMJ Open 2012;2:e001519.
Ministry of Health, Malaysia. Malaysian Mental Healthcare Performance. Technical report 2016. [cited 2019 Mar 02]. Available from: http://www.moh.gov.my/index.php/file_manager/dl_item/554756755a584a6961585268626938794d4445334c30786863473979595734765457567564474673494 5686c5957783061474e68636d5567554756795a6d3979625746 7559325567556d567762334a30494449774d5459756347526d.
Shamsuddin K, Fadzil F, Ismail WS, Shah SA, Omar K, Muhammad NA, et al
. Correlates of depression, anxiety and stress among Malaysian university students. Asian J Psychiatr 2013;6:318-23.
Mohd Sidik S, Rampal L, Kaneson N. Prevalence of emotional disorders among medical students in a Malaysian university. Asia Pac Fam Med 2003;2:213-17.
Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry 2005;62:593-602.
Brooks E, Novins DK, Thomas D, Jiang L, Nagamoto HT, Dailey N, et al
. Personal characteristics affecting veterans’ use of services for posttraumatic stress disorder. Psychiatr Serv 2012;63:862-7.
Probst JC, Laditka SB, Moore CG, Harun N, Powell MP, Baxley EG. Rural-urban differences in depression prevalence: Implications for family medicine. Fam Med 2006;38:653-60.
Masron T, Yaakob U, Ayob NM, Mokhtar AS. Population and spatial distribution of urbanisation in Peninsular Malaysia 1957-2000. Geografia-Malaysian Journal of Society and Space 2012;8:620-9.
Kroenke K, Spitzer RL, Williams JB. The PHQ-9: Validity of a brief depression severity measure. J Gen Intern Med 2001;16:606-13.
Sidik SM, Arroll B, Goodyear-Smith F. Validation of the GAD-7 (Malay version) among women attending a primary care clinic in Malaysia. J Prim Health Care 2012;4:5-11, A1.
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]
Rada RE, Johnson-Leong C. Stress, burnout, anxiety and depression among dentists. J Am Dent Assoc 2004;135: 788-94.
Islam MA, Low WY, Tong WT, Yuen CW, Abdullah A. Factors associated with depression among University Students in Malaysia: A cross-sectional study. KnE Life Sciences 2018;4:415-27.
Aboalshamat K, Hou XY, Strodl E. Psychological well-being status among medical and dental students in Makkah, Saudi Arabia: A cross-sectional study. Med Teach 2015;37 (Suppl 1):S75-81.
Grant K, Marsh P, Syniar G, Williams M, Addlesperger E, Kinzler MH, et al
. Gender differences in rates of depression among undergraduates: Measurement matters. J Adolesc 2002;25:613-7.
Bostanci M, Ozdel O, Oguzhanoglu NK, Ozdel L, Ergin A, Ergin N, et al
. Depressive symptomatology among university students in Denizli, Turkey: Prevalence and sociodemographic correlates. Croat Med J 2005;46:96-100.
Albert PR. Why is depression more prevalent in women? J Psychiatry Neurosci 2015;40:219-21.
Dyson R, Renk K. Freshmen adaptation to university life: Depressive symptoms, stress, and coping. J Clin Psychol 2006;62:1231-44.
Hafen M Jr, Reisbig AM, White MB, Rush BR. Predictors of depression and anxiety in first-year veterinary students: A preliminary report. J Vet Med Educ 2006;33:432-40.
Royal College of Psychiatrists. The mental health of students in higher education. London: Council Report CR166, 2011. [cited 2019 Mar 04]. Available from: https://www.rcpsych.ac.uk/docs/default-source/improving-care/better-mh-policy/college-reports/college-report-cr166.pdf?sfvrsn=d5fa2c24_2.
Dahlin M, Joneborg N, Runeson B. Stress and depression among medical students: A cross-sectional study. Med Educ 2005;39:594-604.
The Star online. Young and jobless in Malaysia [2018 Aug 6; cited 2018 Nov 13]. Available from: https://www.thestar.com.my/ business/business-news/2018/08/06/young-and-jobless-in-malaysia/#UOKV2QgTIo0q3y8H.99.
Wang JL. Rural-urban differences in the prevalence of major depression and associated impairment. Soc Psychiatry Psychiatr Epidemiol 2004;39:19-25.
Sundquist K, Frank G, Sundquist J. Urbanisation and incidence of psychosis and depression: Follow-up study of 4.4 million women and men in Sweden. Br J Psychiatry 2004;184:293-8.
Hidaka BH. Depression as a disease of modernity: explanations for increasing prevalence. J Affect Disord 2012;140:205-14.
Puthran R, Zhang MW, Tam WW, Ho RC. Prevalence of depression amongst medical students: A meta-analysis. Med Educ 2016;50:456-68.
Rosenthal JM, Okie S. White coat, mood indigo–depression in medical school. N Engl J Med 2005;353:1085-8.
Barney LJ, Griffiths KM, Jorm AF, Christensen H. Stigma about depression and its impact on help-seeking intentions. Aust N Z J Psychiatry 2006;40:51-4.
[Table 1], [Table 2], [Table 3], [Table 4]