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OJHAS Vol. 9, Issue 4:
(Oct-Dec, 2010) |
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| Prevalence of Depression Among Medical Students of
a Private Medical College in India |
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Ajit Singh, Department
of Orthopaedics , Rohilkhand Medical College, Bareilly,
Amar Lal, Department of Psychiatry
, Rohilkhand Medical College, Bareilly,
Shekhar, Department of Physiotherapy,
Jaipur College of Physiotherapy, Jaipur. |
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Address For Correspondence |
Department of Orthopaedics,
Rohilkhand Medical College,
Pilibhit
By-pass Road, Bareilly, U.P. 243006.
E-mail:
ajitsingh2409@gmail.com |
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Singh A, Lal A, Shekhar. Prevalence of Depression Among Medical
Students of a Private Medical College in India. Online J Health Allied Scs.
2010;9(4):8 |
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Submitted: Jul 22,
2010; Accepted Dec 27, 2010; Published: Jan 20, 2011 |
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| Abstract: |
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Background: Medical education can contribute to the development
of depression in medical students which may have possible negative academic
and professional consequences. The aims of this study were to explore
the prevalence of depressive symptoms and their relationships to socio-demographic
variables among a cross section of medical students of a private medical
college in India. Methods: A cross-sectional anonymous questionnaire-based survey
was conducted including all students from first to fourth year of a
medical college in India. Beck depression inventory was used to assess
the level of depression with a score of 12 or higher considered depressive.
Additional questions regarding demographic variables were also included
in the survey. Data analysis was done on Epi info version 6. Results: A total of 336 students participated giving a response
rate of 88%. A total of 49.1% students reported depressive symptoms.
It was significantly higher in 1st year (59.3%) and 2nd year (65.6%),
as compared to 3rd (34.4%) and 4th year (37.2%) students
[p<0. 05]. Substance abuse(p<0.0001), first and second year
of study, female sex and language of instruction other than English
at 10+2 level were associated factors for the development of depressive
symptoms [p<0.05]. A significant negative association was also found
between regular exercise and depression (p<0.05). Conclusion:
Depression
may be a significant hidden problem in Indian medical students and mechanisms
to identify and help students with mental health problems should be
seriously considered.
Key Words: Depression; India;
Medical students
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Depression
is highly common and according to WHO by 2020, it would be the
second-most prevalent condition worldwide.(1) There is considerable evidence that rates of depression and suicide
are higher in medical students and that these rates continue to remain
elevated when these students become physicians.(2) Medical students
are a valuable human resource for our future and depression in them
leads to less productivity, reduced quality of life, learning difficulties
and may negatively affect patient care.(3,4) Studies from other parts
of world have shown a high prevalence of depression in medical students
(5-7) but studies on Indian medical students are lacking. India
has one of the largest numbers of medical colleges and medical students
with majority of the students in private medical schools. The present
study was undertaken to determine the prevalence of depression as part
of larger project examining the health of a cross section of medical
students of a private medical college in India and to look for related
demographic characteristics and contributing factors.
The study was
carried in a private medical college in northern India with an annual
intake of 100 MBBS students per year. The study design was reviewed
and approved by the Institutional Ethical Committee. Students from all
four years of the Rohilkhand Medical College, Bareilly were eligible to
participate in this study. A total of 381 medical students participated.
Data was gathered by an anonymous self-reporting questionnaire, which
were distributed separately to each of the four student grades during an
appropriate lecture period, and collected at the end of each session.
Participation in the study was on a voluntary basis and informed consent
was obtained from the students after the aims and objectives of the
study were explained to them. Students identified with clinically
significant depression were offered counseling or appropriate help. The
questionnaire was in the English language, which is the medium of
instruction in all medical colleges in India. Students were instructed
to exclude names and identifying information and questionnaires were
filled using code number. Students were assured that results of survey
will not have any negative repercussions for them. The first section of
the questionnaire focused on demographic items such as age, weight,
height, marital status, year of study, substance use (tobacco; alcohol
consumption; gutkha; sedative-hypnotics and illicit drugs used
in last six months), years to get into medical school after 10+2, medium
of instruction in school prior to medical college, whether they undertook
any regular exercise every week. The degree of depressive symptoms was
measured by Beck Depression Inventory (BDI) which has been used in previous
such studies as a screening tool.(8) It is a 21-item self-administered
instrument, rated on 4-point scale ranging from 0 to 3 and the total
score being 63. A score of 0-16 is considered as normal, 17-20-border
line clinical depression, 21-30 moderate depression, 31-40 severe depression
and over 40 is extreme depression. Score
of 12 and above is taken as depression. Predictive value of the selected
cut-off point, 100% sensitivity, 99% specificity, 0.72 PPV, 1 NPV, and
98% overall diagnostic value [Laasa et al. 2000].(9) BDI was chosen over BDI-II
as it is available free and it can be completed in about ten minutes. Data entry and analysis was done on Epi info
version 6.0. Descriptive analyses were performed to investigate the
distribution of our data.
A total of 336
students returned the fully answered questionnaire,
representing an overall response rate of 88 % after removing badly answered
questionnaires with roughly one-fourth from each year of MBBS class, 63% were males and 37% female students.
Mean age of students was 20.2 years (SD-4.6). About half (49.1%)
of the students had symptoms of depression with 60% of total females
and 42% of total males reported symptoms suggestive of depression
(Table 1). Mild symptoms of depression were found in 64.8% students,
moderate in 27.8% and severe in 7.4% students. It was seen that age,
weight, height, number of years after 10+2 to gain entry in medical
school and dietary habits did not affect the prevalence of depression.
Table 2 shows the OR and 95% CI of factors associated with depression
among medical students. Depression was significantly higher in 1st year
and 2nd year students, as compared to 4th year and 3rd years students
(p<0.05). Students with substance abuse were more likely to report
symptoms suggestive of depression (OR=4.34; 95%CI 2.62-7.29). Female students
were more likely to reported symptoms suggestive of depression
as compared to their male counterparts (OR=2.07; 95%CI 1.32-3.27). Similarly,
students facing language problem in their MBBS course because English
not being medium of teaching in 10+2 were more likely to report symptoms
suggestive of depression. On the other hand students who undertook
regular physical exercise were only 0.5 times likely to suffer from
depression.
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Table 1: Cases of depression according to year of study and gender |
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Year
of study |
Number of students |
Depression |
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Male |
Female |
Total |
Male
(%) |
Female
(%) |
Total
(%) |
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1st
year |
58 |
28 |
86 |
30 (58.8) |
21 (41.2) |
51 (59.3) |
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2nd
year |
50 |
32 |
82 |
31 (57.4) |
23 (42.6) |
54 (65.6) |
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3rd
year |
59 |
31 |
90 |
16 (51.6) |
15 (48.4) |
31 (34.4) |
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4th
year |
45 |
33 |
78 |
13 (44.8) |
16 (55.2) |
29 (37.2) |
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Total |
212 |
124 |
336 |
90 (54.5) |
75 (45.5) |
165 (49.1) |
Symptoms suggestive of depression were found in 49.1% of our medical
students which corresponds with prevalence rates found in other
developing countries. A study on undergraduate Chinese medical
students found nearly half of them were depressed with 2% having
severe depression.(10) This percentage is low as compared to the findings of 60%-70% prevalence
of anxiety and depression in medical students of Pakistan.(5,11) Studies
from western world report prevalence rates of depression in the range
of 14–24%.(6,12) Depression was present in 39.9% of students of
a public sector medical college in Mumbai (13), India, which is lower
than our findings. The reason might be the difference of instrument
used to assess depression and also possibly because of the fact that
students of private medical colleges are at increased risk of developing
depression.(14) This may also be due to the different characteristics of each medical
school and its students and teachers. Previous studies had probably
lower rates as students tend to give dishonest responses during such
surveys because of concerns on animosity and potential negative repercussions.(15) We assured
students about anonymosity and encouraged them to give
honest responses which may explain differences in results.
The prevalence
of depressive symptoms was high among newly entered students (1st and 2nd year)
as compared to the senior students. This finding correlates with results of
previous studies.(5,6,12) This could be due to stress of new study environment
and greater degree of work load with obligations to succeed , homesickness as
most of them might live far from home for the first time, change in their
sleeping and eating habits, financial indebtedness, lack of leisure time. A
decrease in symptoms of 3rd and 4th year medical students can be explained by a
gradual adaptation to the environment and the study course.
Female students
were more likely to report symptoms suggestive of depression as compared to male
students which are consistent with western reports.(12) A possible explanation
for this finding is due to the fact that women articulate depressive symptoms,
even very minor ones, more easily then men, and that the excess could actually
be due to this fact as much as to a true expression of greater distress.(16) The
number of female students doing any regular exercise was also very less and this
may also contribute to higher rates of depression among them as regular physical
exercise was negatively correlated with depression (Table 2). Previous research
has shown that leisure activities including physical exercise reduce stress and
depression in students.(17)
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Table 2:
OR and 95% CI of risk factors associated with
depression among medical students. |
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Risk factor |
n |
Odds Ratio |
95% Confidence Interval |
p-value |
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Female sex |
75 |
2.07 |
1.32 - 3.27 |
0.001 |
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1st
year |
51 |
1.74 |
1.05 - 2.87 |
0.029 |
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2nd
year |
55 |
2.66 |
1.58 - 4.53 |
<0.001 |
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Substance
abuse |
76 |
4.34 |
2.62 - 7.29 |
<0.001 |
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Language
problem* |
93 |
1.61 |
1.05 - 2.49 |
0.029 |
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Regular physical
exercise† |
39 |
0.54 |
0.34 - 0.88 |
0.012 |
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* Language
of teaching other than English at 10+2 level before entry in medical
school
† Minimum
30 minutes of exercise on at least three days per week in preceding
six months was considered as having regular exercise.
OR = Odds Ratio,
CI= Confidence Interval
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Students
indulging in substance abuse were four times more likely to report symptoms
suggestive of depression compared to students who did not use substance abuse.
Whether substance abuse is the cause of higher rates of depression or depressed
students self medicate with substance abuse is not clear. Previous studies have
found that a significant number of students consider substance abuse as a coping
mechanism against stress and stress is positively correlated with development of
depression in medical students.(14) Substance abuse in medical students
concurrent with depression is a matter of grave concern and preventive
education and counseling programs in medical curriculum are needed.
There was an
interesting finding in this survey which has not been reported earlier. We found
that students
facing language problem in their MBBS course because English not
being medium of teaching in 10+2 were more likely to report
symptoms suggestive of depression.
A limitation of
this cross-sectional study is inability to draw cause-effect associations
between the studied variables. No data on psychological status of students
before entering medical school and population based data in India are available
to compare our results with general population. One more limitation with anonymous
self reported questionnaires is inaccurate reporting.
Depression may
be a significant hidden problem in Indian medical students and mechanisms to
identify and help students with mental health problems should be seriously
considered. Therefore, an effective system for the prediction of the development
of depression in medical students needs to be developed and interventions aimed
at reducing the incidence of depression needs further research.
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