DEPRESSION AMONG STUDENTS

Depression among students

Introduction:

Depression among university students is extremely prevalent and widespread problem across the country [1–3]. University students are a special group of people that are enduring a critical transitory period in which they are going from adolescence to adulthood and can be one of the most stressful times in a person’s life. Trying to fit in, maintain good grades, plan for the future, and be away from home often causes anxiety for a lot of students [4]. As a reaction to this stress, some students get depressed. They find that they cannot get themselves together. They may cry all of the time, skip classes, or isolate themselves without realizing they are depressed. Previous studies reported that depression in university students is noted around the world [5–7] and the prevalence seems to be increasing [8]. The average age of onset is also on the decline, making depression a particularly salient problem area for university student populations [8]. Over two-thirds of young people do not talk about or seek help for mental health problems [9]. In Iran, preliminary studies on emotional distress have emerged in recent years including depression in Iranian university. Within the abovementioned background, the aim of this study is to estimate the prevalence of depression among university students using meta-analysis method.

Students’ age and depression :

In terms of students’ age, some studies in particular looked at the relationship between age and depression in students. A study on depression among Malaysian university students pointed out that the prevalence of depression was higher in older students compared to younger students (Shamsuddin et al., 2013). This result also was emphasized in other studies; senior university students have greater rates of depression relative to beginners or first year students (Bostanci et al., 2005; Khawaja & Duncanson, 2008). In contrast, studies in this area (Bayram and Bilgel, 2008; Tomoda et al., 2000) have shown that students in their final year of university have lower levels of depression compared to new students. It is hypothesised that this difference in the above findings might be due to using different samples of students, and different methods of measuring depression. It is somewhat surprising that no relationship was found in this condition. One study indicated that the level of depression in older students is nearly the same as younger students (Lester, 1990). This would indicate there is no significant relationship between a student’s age and the prevalence of depression.

Prevention of depression:

 Depression is one of the most prevalent problems in the mental health of students at different educational levels, such as high school, college and university (Arslan et al., 2009). Previous studies have proposed that psychological morbidity, particularly depression, is a common disorder among students (Adewuya, Ola, Olutayo, Mapayi & Oginni, 2006; Dahlin et al., 2005). Studies of psychological problems encountered by counselling centres revealed that depression was one of the five most common problems among college students. They highlighted that depression accounted for 39% of problems, a higher rate than anxiety, problems with romantic relationships, and the self-esteem of students across different settings (Erdur-Baker, Aberson, Borrow & Draper, 2006; Green, Lowry & Kopta, 2003).

Review Article

 Prevalence of Depression among University Students: A Systematic Review and Meta-Analysis Study:

Diana Sarokhani,1,2 Ali Delpisheh,3,4 Yousef Veisani,1,4 Mohamad Taher Sarokhani,1,5 Rohollah Esmaeli Manesh,6 and Kourosh Sayehmiri4,7 1 Student Research Committee, Ilam University of Medical Science, P.O. Box 69311-57793, Ilam, Iran 2 Department of Computer, Faculty of Engineering, Malayer University, P.O. Box 95863-65719, Hamadan, Iran 3 Department of Clinical Epidemiology, Ilam University of Medical Sciences, P.O. Box 69315-138, Ilam, Iran 4 Psychosocial Injuries Research Center, Ilam University of Medical Science, P.O. Box 69315-138, Ilam, Iran 5 Science and Research Branch, Islamic Azad University, Kermanshah, Iran 6 Eslamabad Payame Noor University, Kermanshah, Iran 7 Social Medicine Department, Medicine Faculty, Ilam University of Medical Sciences, P.O. Box 69315-138, Ilam, Iran Correspondence should be addressed to Mohamad Taher Sarokhani; m taher sarokhani@yahoo.com Received 30 June 2013; Revised 16 August 2013; Accepted 22 August 2013 Academic Editor: Verinder Sharma Copyright © 2013 Diana Sarokhani et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Introduction. Depression is one of the four major diseases in the world and is the most common cause of disability from diseases. The aim of this study is to estimate the prevalence of depression among Iranian university students using meta-analysis method. Materials and Methods. Keyword depression was searched in electronic databases such as PubMed, Scopus, MAGIran, Medlib, and SID. Data was analyzed using meta-analysis (random-effects model). Heterogeneity of studies was assessed using the 𝐼 2 index. Data was analyzed using STATA software Ver.10. Results. In 35 studies conducted in Iran from 1995 to 2012 with sample size of 9743, prevalence of depression in the university students was estimated to be 33% (95% CI: 32–34). The prevalence of depression among boys was estimated to be 28% (95% CI: 26–30), among girls 23% (95% CI: 22–24), single students 39% (95% CI: 37–41), and married students 20% (95% CI: 17–24). Metaregression model showed that the trend of depression among Iranian students was flat. Conclusions. On the whole, depression is common in university students with no preponderance between males and females and in single students is higher than married ones.

Methodology:

This study protocol is structured in accordance with the Preferred Reporting Items for Systematic reviews and Meta Analyses (PRISMA). The PRISMA contains a 27-item checklist which is aimed at facilitating the development and reporting of robust systematic review protocols [20]. The systematic review was registered on the PROSPERO database (CRD42017064148). Information sources Pub med, Psych INFO, EMBASE and African Index Medicus , BIREME, LILACS, and MEDLINE databases will be searched for studies reporting primary data on common mental disorders (depression and/or anxiety) among students in universities and colleges within LMICs. For this study, LMICs will be defined using the World Bank Country Lending Group list for the year 2017 [21]. Search strategy In light of the paucity of studies in LMICs, no time restrictions will be imposed on the search. Controlled vocabulary terms will be appropriately incorporated for each database. We will use the terms to search for three main concepts namely (1) undergraduate university/college students, (2) prevalence of depression or anxiety, and (3) low- and middle-income countries. A full search strategy for one database is displayed in Appendix 1. Reference lists of retrieved articles will also be examined and additional articles added if they meet the inclusion criteria. Eligibility criteria Studies will be included if they report the prevalence of depression or anxiety among university/college students undertaking undergraduate degree programs. Study types will include descriptive and analytical studies such as cross-sectional and longitudinal studies, case-series analysis, and randomized control trials that include data on prevalence of depression or anxiety. We will include studies in all languages, which will be translated into English. Due to paucity of research on depression or anxiety in most LMICs, the studies will not be excluded based on how they measured depression or anxiety since it is important to understand how these conditions are being measured in different settings.

Data extraction;

Two reviewers will independently screen titles and then abstracts of included articles using a piloted data extraction sheet (Appendix 2). Examples of the type of data that will be extracted include study design, setting, study sample sizes, assessments used for diagnosing depression or anxiety, and prevalence of depression or anxiety. Where there will be doubts on whether a title is relevant, it will be included for retrieval. Reconciliation of disagreements on which article(s) to include will be resolved by discussion and consensus between the two reviewers, or mediation by a third person. Assessment of methodological quality

Assessment of methodological assessment;

 All retrieved papers eligible for selection will undergo an assessment process conducted by two independent reviewers. Standardized critical appraisal tools will be utilized in the quality assessment. In this study, four critical appraisal tools [22] will be used to assess for quality depending on the study design. These are as follows: 1. The Joanna Briggs Institute (JBI) Prevalence Critical Appraisal tool [23] 2. The JBI critical appraisal checklist for randomized control/pseudo-randomized trials 3. The JBI critical appraisal checklist for descriptive/case series 4. The JBI critical appraisal checklist for comparable cohort/case control. These tools were developed primarily for use in systematic reviews. Where there are disagreements between the two reviewers, a third reviewer will be engaged and discussions among the three reviewers will be used to resolve the differences.

Data analysis;

Data analysis and synthesis Meta-analysis of the prevalence of depression and anxiety among university students will be conducted using a random effects model which will generate pooled prevalence with their respsiective 95% CIs. Analyses will be conducted in Stata 14. The results from the review will be summarized and presented in text, Appendix 3, and tables.

Statistical analysis;

The random effects model was used for combining results of studies in meta-analysis. Variance for each study was calculated using the binomial distribution formula. The presence of heterogeneity was determined by the Der Simonian -Laird (DL) approach [12]. Significance level was < 0.05 were considered as statistically significant.

Discussion:

This systematic review will be conducted as the initial step of a longitudinal study on common mental disorders among university students in Zimbabwe. The review aims to explore the prevalence, antecedents, and consequences of depression and anxiety among university students in LMICs. The results from the review will inform and guide health care practitioners and researchers on appropriate and feasible interventions aimed at enhancing the psychological well-being of undergraduate students in resource constrained settings. In this systematic review, we have fully described our search strategy, study selection, data summary, and analysis to allow sensitivity analysis of any aspect of our approach. We have included every study that to our knowledge satisfies our inclusion criteria and employed techniques of estimation that allow integration of studies with high heterogeneity. In situations with high between-study heterogeneity (93.3%), the use of random-effects models is recommended as it produces study weights that primarily reflect the between study variation and thus provides close-to-equal weighting. In the current study, the Beck depression inventory (BDI) has been utilized to detect the prevalence of depression among university students. Although it is not designed for diagnostic purposes, its epidemiologic utility has been evaluated in several studies, which concluded that it is a reliable and valid instrument for detecting depressive disorders in nonclinical populations. Several studies support the BDI’s usefulness in measuring and predicting depression in adolescent samples.

Results: