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ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3978
STUDY OF DEPRESSION AMONG MEDICAL STUDENTS OF DIFFERENT
PATHIES IN NANDED CITY, MAHARASHTRA.
P. C. Sahu
1
, I. F. Inamdar
2
, Mohammed Ubaidulla
3
, Saleem Tambe
4
, Gadekar R.D
5
, V. K. Sonkar
6
,
M. K. Doibale
7
.
1. Post Graduate Student, Department of Community Medicine, Dr. Shankarrao Chavan Govt. Medical College,
Nanded.
2. Assistant. Professor, Department of Community Medicine, Dr. Shankarrao Chavan Govt. Medical College, Nanded.
3. Assistant. Professor, Department of General Medicine, Dr. Shankarrao Chavan Govt. Medical College, Nanded
4. Assistant. Professor, Department
of Pediatrics, Dr. Shankarrao Chavan Govt. Medical College, Nanded
5. Assistant. Professor, Department of Community Medicine, Dr. Shankarrao Chavan Govt. Medical College, Nanded.
6. Assistant. Professor, Department of Community Medicine, Dr. Shankarrao Chavan Govt. Medical College, Nanded.
7. Professor and Head, Department of Community Medicine, Dr. Shankarrao Chavan Govt. Medical College, Nanded.
CORRESPONDING AUTHOR:
Dr. Inamdar I.F.
I/C Urban health training centre,
Shivajinagar, Nanded 431601.
E-mail: ifinamdar@rediffmail.com
ABSTRACT: BACKGROUND: The goal of medical education is to train knowledgeable, competent and
professional physicians to care for the nation’s sick, advance the science of medicine and promote
public health. It imposes significant psychological stress on medical students, mainly through time
pressure, large amount of new information, excessive working hours and the knowledge that at the
end of their training they will be directly responsible for the health and welfare of others. In this
respect, attention has been paid to stress, health concerns and emotional problems among medical
students. AIM AND OBJECTIVES: 1) To determine prevalence of depression among medical students.
2) To study contributing risk factors for development of depression. MATERIAL AND METHOD: A
Cross sectional study was conducted from June 2012 to Nov 2012 at Dr. Shankarrao Chavan Govt.
Medical College, Nanded and Government Ayurvedic College, Nanded. All the 450 medical students of
both government medical colleges were included in study. Data was collected using pretested semi
structured questionnaire including Becks depression inventory scale. STATISTICAL ANALYSIS: Data
analysed using SPSS version 16. Proportion and Chi square test were used. RESULTS: A total of 421
students participated with response rate of (93.56%). The prevalence of depression according to
Becks Depression Inventory Scale among medical students was (27.08%). Majority (16.63%) had
mild depression followed by (8.08%) with moderate depression, (1.43%) with severe depression and
(0.95%) with very severe depression. There were statistically significant association between type of
depression and faculty of medical science of study subjects (p < 0.05). Year of under-graduation,
religion, parental loss, family h/o chronic illness and h/o unsuccessful love affairs were the factors
significantly associated with depression. (p < 0.05).
CONCLUSIONS: About one fourth of medical students were suffering from mild depression. Along
with academic factors certain socio – demographic and family related factors were significantly
associated with depression among study subjects.
KEY WORDS: Depression, Becks depression inventory scale, Medical students.
ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3979
INTRODUCTION: A depressive disorder is an illness that involves the body, mood, and thoughts. It
affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks
about things.
[1]
Depression is an important health problem due to its prevalence and associated
consequences. The lifetime prevalence of depression ranges between 10 to 21% in population.
[2]
Depression is widespread globally affecting around 151.2 million of the population. It is among the
third most common cause of disability and is anticipated to form the top most cause worldwide by
2030. Worldwide possibility of developing depression is 7- 12 % for men and 20-25 % for women.
These rates are independent of race, education, earnings, or social status.
[3]
Stress, health concerns and emotional problems among medical students has been the
subject of recent research.
[4]
Medical Schools and colleges are recognized as a stressful environment
that often exerts a negative effect on physical health, and psychological well being of the students.
[1]
Students are subjected to different kind of stresses, such as pressure of academics with an
obligation to succeed and an uncertain future. The students also face social, emotional, physical and
family problems which may affect their learning ability and academic performances.
[5]
Perceived
stress is associated with increased levels of depression, drug abuse, relationship difficulties, anxiety
and suicide. Moreover, tired, tense and anxious doctors will not provide as high a quality of care as do
those who do not suffer from these conditions.
[4]
The goal of medical education is to train knowledgeable, competent and professional
physicians to care for the nation’s sick, advance the science of medicine and promote public health.
Medical school can impose significant psychological stress on medical students, mainly through time
pressure, large amount of new information, excessive working hours and the knowledge that at the
end of their training they will be directly responsible for the health and welfare of others and their
post matriculation.
[6]
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.
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.
Studies from other parts of world have shown a high prevalence of depression in medical students but
studies on Indian medical students are lacking.
[7]
Hence, there is a need to quantify the depression
and its associated factors among medical students for their counseling and rehabilitation.
AIM & OBJECTIVES:
1) To determine prevalence of depression among medical students.
2) To study risk factors associated with depression among medical students.
MATERIAL AND METHODS:
Study design: cross sectional descriptive study.
Study period: The study was conducted over the period of 5 months during July to November 2012.
Study site and population: Nanded is the second largest urban area in the Marathwada region, after
Aurangabad in Maharashtra state. There are three medical colleges in the Nanded city, Dr.
Shankarrao Chavan Govt. medical College, Govt. Ayurvedic College, and Homeopathic Medical
College, Hospital & Research Centre of which, two medical colleges, Dr. Shankarrao Chavan Govt.
medical College, (MBBS) and Govt. Ayurvedic College, (BAMS) were selected for convenience of data
ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3980
collection. The total student strength of Dr. Shankarrao Chavan Govt. medical College was 250 and
Govt. Ayurvedic College was 200. All 450 undergraduate medical students from first year to final year
and interns in both selected medical colleges were included into the study. In the case of the students
who were absent at the time of first session, mop up round was undertaken to cover the remaining
subjects.
Inclusion criteria: All medical students from first year to final year and internees were included in
the study.
Exclusion criteria: Medical students not giving voluntary consent to participate in the study were
excluded from study.
Data collection: The subjects were clearly told about the aims and objectives of the study. They were
requested to fill the questionnaire with full assurance about the confidentiality and anonymity of
their information. The subjects were assured that the data would be used only for scientific purpose
of the study. Informed consent was obtained from the study subjects. The students were asked to
complete the questionnaire in a class at the end of lecture and returned them to author in the same
session.
A self-administrated questionnaire was utilized including information regarding socio
demographic characteristics, history of psychiatric illness, family history of psychiatric illness,
chronic diseases, parental loss, as well as history of addictions. Information regarding reason of
choosing medical profession and expectation from it was also collected.
The Becks Depression Inventory Scale
[8]
, has been used for screening of depression among
the study population. It is a 21-item self-reported measure, and one of the most widely used
screening instruments for detecting symptoms of depression. It can be administered to assess
normal adults, adolescents, and individuals with psychiatric disorders (>13 years of age). It was
designed to document a variety of depressive symptoms the individual experienced over the
preceding week. Responses to the 21 items are made on a 4-point scale, ranging from 0 to 3 (total
scores can range from 0 to 63).
Study subjects with BDI score 10 and more were classified as depressed and 9 or less were
classified as normal. Depressed individuals were further classified as mild (BDI score 10 – 18),
moderate (BDI score 19 – 29), severe (BDI score 30 – 40) and very severe (BDI score > 40)
Statistical analysis: Data was entered into SPSS 16 software and analyzed using proportions and chi
square test.
RESULTS: A total of 421 students among all 450 students participated in the study with response
rate of (93.56%). Majority 214(50.83%) students were 21 – 24 years age group, 225(53.44%) were
female, 97(23.04%) were internees, 303(71.97%) were Hindu by religion, 333(79.1%) were from
nuclear family. Among 421 students, 191(45.37%) students had father graduate and 154(36.58%)
mother with secondary education, 149(35.39%) belong to socioeconomic class IV. 12(2.85%)
students had parental loss, 09(2.14%) had family h/o psychiatric illness, 39(9.26%) had family h/o
chronic illness, 32(7.6%) were smokers and 33(7.84%) were alcoholic, 42(9.98%) had unsuccessful
love affairs.
The prevalence of depression according to Becks Depression Inventory Scale among medical
students was 114(27.08%). Majority 70(16.63%) had mild depression followed by 34(8.08%) with
moderate depression, 6(1.43%) with severe depression and 4(0.95%) with very severe depression.
ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3981
Among 92 first year medical students, 73(79.35%) had depression. Among 94 second year
medical students 59(62.77%) had depression. Among 92 third year medical students, 30(65.22%)
had depression. Among 97 interns, 72(74.23%) had depression. The proportions of medical students
with depression were significantly associated with years of under graduation. (p < 0.05)
Among 70 medical students with mild depression, 29(41.43) were from Govt. Ayurvedic
Colleges. Among 34 medical students with moderate depression 8(23.53%) were from Govt.
Ayurvedic Colleges. Among 6 severely depressed medical students 5(83.33%) Govt. Ayurvedic
College. The proportion of medical students with different grade of depression was significantly
associated with faculty of medical sciences. (p < 0.05)
There was no significant association between age, sex, socioeconomic status, parental
education, family history of psychiatric illness, history of smoking and history of alcohol intake by
medical students with depression.
Among 303 Hindu medical students, 69(22.77%) had depression while among 69 Muslim
medical students 27(39.13%) had depression. The proportion of medical students with depression
was significantly associated with their religion. Among 409 medical students with no parental loss,
107(26.16%) had depression and among 12 medical students with parental loss, 7(58.33%) were
depressed. The proportions of medical students with depression were significantly associated with
history of parental loss. Among 39 medical students with family history of chronic illness,
16(41.03%) had depression while among 382 medical students with no family history of chronic
illness, 98(25.65%) had depression. The proportions of medical students with depression were
significantly associated with family history of chronic illness. Among 41 medical students with
unsuccessful love affairs, 18(43.9%) had depression while among 379 medical students with no
unsuccessful love affairs, 96(25.33%) had depression. The proportions of medical students with
depression were significantly associated with history of unsuccessful love affairs.
Most common reason behind choosing medical profession among medical student was ideal
of being doctor 291(69.12%). Most common expectation of students from medical profession was
occupational satisfaction 226(53.68%).
DISCUSSION: Medical institutions have long been recognized as involving numerous stressors that
can affect the well-being of students. As per the Becks Depression Inventory Scale, the present study
reveals prevalence of depression among medical students as 27.08%. This prevalence seems to be
high among medical students, which tends to affect not only their academic performances but also all
aspects of health; the similar findings were also noted by N. Karaoglu et. al.(29.3%)
[6]
, Surabhi Sidana
et. al. (21.5%)
[9]
and F. Rab et. al. (19.5%)
[10]
, while Yoolwon Jeong et. al. (37.1%)
[11]
, A.K. Khuwaja et.
al. (39%)
[13]
reported still higher prevalence than the present study.
Majority of the students i.e. 70(16.63%) had mild depression followed by 34(8.08%) with
moderate depression and 6(1.43%) with severe depression. In study conducted by Thomas L.
Schwenk et. al.
[14]
51.29% had no depression, 29.5% had mild depression and 14.26% had moderate
to severe depression. The depression level in medical students is increased during academic
examination and the label “academic examination stress” covers a wide range of situations that may
have very different psychological consequences. On the contrary, Aisha Yusuf et. al.
[3]
found that
40.12% medical students had no depression, while 38.95% had mild and 20.93% had moderate
ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3982
depression. Ajit singh et. al.
[15]
found 64.8% medical students with mild depression, 27.8% with
moderate and 7.4% with severe depression.
The proportions of medical students with depression were significantly associated with
years of under graduation. Stress levels increase as students advance in their medical college years.
According to our study, there was a higher rate of depression among 2
nd
and final year medical
students compared with 1st to 3rd year students. Higher levels of stress have also been reported in
the study of S. N. Bazami Inam et. al.
[16]
, Surabhi Sidana et. al.
[9]
, S.N.B. Inam et. al.
[17]
, while F. Rab
[10]
found no significant association between depression and year of under graduation.
In our study we correlated certain risk factors such as age, gender, year of study, substance
abuse, depression in family In present study, there was no significant association between age, sex,
socioeconomic status, parental education, family history of psychiatric illness, history of smoking and
history of alcohol intake by medical students with depression. Similar results were noted by Ajit singh
et. al.
[15]
, Numan Arif et. al.
[18]
, and Yoolwon Jeong et. al.
[11]
Surabhi Sidana et. al.
[9]
while Thomas L.
Schwenk et. al.
[14]
, N. Karoglu et. al.
[6]
, A.K. Khuwaja et. al.
[13]
found significant association between
sex of medical students and depression.
In present study, there was significant association between religion, history of parental loss,
family history of chronic illness and depression among medical students. Similar results were seen in
the study conducted by Aisha Yusuf et. al.
[3]
who found significant association between religion of
medical students and depression. F. Rab et. al.
[10]
and Muhammad S. Khan et. al.
[1]
found significant
association between history of parental loss and depression. Muhammad S. Khan et. al.
[1]
also found
significant association between family history of chronic illness and depression.
The most common reason behind choosing medical profession as a career among medical
student was ideal of being doctor i.e. 291(69.12%). The most common expectation of students from
medical profession was occupational satisfaction i.e. 226(53.68%). In contrast, N. Karagolu et. al.
[6]
found that majority of women (49%) chosen medical profession for occupational guarantee and
expect prestige (71%) from medical profession. Study claims that the main “filter” which defines
who will enter medical school, is not the medical college admission process but rather an
individual’s decision to apply for admission Medical faculty preference is the first sign of desire for
medicine.
CONCLUSION: About one fourth of medical students were suffering from depression. Majority had
mild depression. Along with academic factors certain socio – demographic and family related factors
were significantly associated with depression among study subjects.
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ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3983
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ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3984
Table 1: Socio-demographic profile of study subjects: (n = 421)
Characteristics No of students (%)
169(40.14)
21 – 24 214(50.83)
25 – 28 38(9.03)
Sex Female 225(53.44)
Male 196(46.56)
Yrs of under graduation
1
st
yr 92(21.85)
2
nd
yr 94(22.33)
3
rd
yr 92(21.85)
4
th
yr 46(10.93)
Internee 97(23.04)
Religion
Buddhist 39(9.26)
Hindu 303(71.97)
Muslim 69(16.39)
Others 10(2.38)
Type of family
Nuclear 333(79.1)
Three generation
26(6.18)
Joint 62(14.73)
Table 2: Prevalence of depression among medical students (n = 421)
Type of depression No. of medical students (%)
No depression (0 – 9) 307(72.92)
Mild depression (10 – 18) 70(16.63)
Moderate depression (19 – 29) 34(8.08)
Severe depression (30 – 40) 06(1.43)
Very severe depression ( > 40) 04(0.95)
Total 421(100)
Table 3: Association between type of depression and f aculty of medical education (n = 421)
(BDI Scale)
Types of depression BAMS (%) MBBS (%) Total (%)
Mild (10 – 18) 41(58.57) 29(41.43) 70(100)
Moderate (19 – 29) 08(23.53) 26(76.47) 34(100)
Severe (30 – 40) 05(83.33) 01(16.67) 06(100)
Very severe (> 40) 02(50) 02(50) 04(100)
Total 56(49.12) 58(50.88) 114(100)
(χ² = 14.22, df = 3, p = 0.0026)
ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3985
Table 4: Association between year of under graduation and depression among medical
students
Year of under graduation Depression Total (%)
Present Absent
I 19(20.65) 73(79.35) 92(100)
II 35(37.23) 59(62.77) 94(100)
III 19 (20.65) 73(79.35) 92(100)
IV 16(34.78) 30(65.22) 46(100)
Internee 25(25.77) 72(74.23) 97(100)
Total 114(27.08) 307(72.92) 421(100)
(χ² – 10.22, df – 4, p – 0.0368)
Table 5: Socio demographic risk factors for depression (n = 421)
Risk factors Depression (BDI score) P value
Absent (≤ 9) Present (≥ 10)
Course BAMS 130(69.89) 56(30.11) 0.2134
MBBS 177(75.32) 58(24.68)
Age (yrs) 17 – 20 122(72.19) 47(27.81) 0.2568
21 – 24 153(71.50) 61(28.50)
>25 32(84.21) 6(15.79)
Sex Female 162(72) 63(28) 0.6484
Male 145(73.98) 51(26.02)
Religion Buddha 24(61.54) 15(38.46) 0.0146
Hindu 234(77.23) 69(22.77)
Muslim 42(60.87) 27(39.13)
Other 07(70) 03(30)
Post graduate 7(53.85) 6(46.15)
Parental loss Yes 5(41.67) 7(58.33) 0.01
No 302(73.84) 107(26.16)
Family h/o psychiatric
illness
Yes 4(44.44) 5(55.56) 0.0520
No 303(73.18) 109(26.32)
Family h/o chronic illness
Yes 23(58.97) 16(41.03) 0.03
No 284(74.35) 98(25.65)
Unsuccessful Love affairs Yes 24(56.1) 18(43.9) 0.0153
No 283(74.67) 96(25.33)
ORIGINAL ARTICLE
Journal of Evolution of Medical and Dental Sciences/ Volume 2/ Issue 22/ June 3, 2013
Page 3986
Table 6: Distribution of reasons behind choosing medical profession (n = 421)
Reasons of choosing medical education No. of students (%)
Occupational guarantee 127(30.17)
External pressure 29(6.89)
Ideal of being doctor 291(69.12)
(Multiple responses)
Table 7: Distribution of students as per their expectations from medical profession (n = 421)
Expectation from medical education No. of students (%)
Prestige 151(35.87)
Better economy 99(23.52)
Occupational satisfaction 226(53.68)
