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ORIGINAL ARTICLE
Year : 2017  |  Volume : 6  |  Issue : 1  |  Page : 1-7

Comparative analysis of depression and its associated risk factors among public and private medical schools students in Karachi, Pakistan: A multicenter study


Department of Community Medicine, Jinnah Sindh Medical University, Karachi, Pakistan

Date of Web Publication17-Jul-2017

Correspondence Address:
Mubashir Zafar
Department of Community Medicine, Jinnah Sindh Medical University, Karachi
Pakistan
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjhs.sjhs_83_16

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  Abstract 

Context: It is estimated that 15.2%–43.8% of depression among medical students worldwide. Subjects and Methods: The purpose of this study was to compare the prevalence of depression and anxiety among the public and private sector. Setting and Design: This cross-sectional study was carried out among the students of private and public sector medical schools using convenient sampling validated “Becks depression scale.” Students of age group between 20 and 25 were included in the study. The dependent variable was depression, and independent variables were age, gender, religion, marital status, father's occupation, ethnicity, and the addiction history of the participants. Statistical Analysis Used: Logistic regression analysis is used to determine the association between depression and sociodemographic statistics. Results: Mean age and standard deviation of students were 23 ± 2 years. In univariate analysis, students suffered 1.8 times in public sector (odds ratio [OR]: 1.185, confidence interval [CI]: 0.537–2.614.), married students were 9.2 times (OR: 9.205, CI: 3.165–26.770), with a past depression history 14.3 times (OR: 14.397, CI: 5.928–34.961), with family history 3.6 times (OR: 3.684, CI: 1.477–9.189), with addiction history 5.4 times (OR: 5.413, CI: 1.729–16.979) and students whose fathers are businessmen were 2.9 times (OR: 2.92, CI: 1.024–5.127) more depressed. On multivariate analysis, only students with a past depression history were significantly 8.3 times more likely to suffer from depression (OR: 8.309, CI: 2.971–23.244). Conclusion: The study identifies that depression is more common in public sector students. This finding helps to develop policies for overcoming these problems which includes easy syllabus for students and providing them career counseling and guidance.

Keywords: Depression, Karachi, medical schools, public-private


How to cite this article:
Zafar M, Rizvi S B, Sheikh L, Nu, Khalid Z, Abbas TG, Waseem S, Khan A, Aijaz S, Akram S, Arshad S, Khalid U, Shahid B, Ahmed S, Aftab M, Usman A, Aslam R. Comparative analysis of depression and its associated risk factors among public and private medical schools students in Karachi, Pakistan: A multicenter study. Saudi J Health Sci 2017;6:1-7

How to cite this URL:
Zafar M, Rizvi S B, Sheikh L, Nu, Khalid Z, Abbas TG, Waseem S, Khan A, Aijaz S, Akram S, Arshad S, Khalid U, Shahid B, Ahmed S, Aftab M, Usman A, Aslam R. Comparative analysis of depression and its associated risk factors among public and private medical schools students in Karachi, Pakistan: A multicenter study. Saudi J Health Sci [serial online] 2017 [cited 2017 Oct 19];6:1-7. Available from: http://www.saudijhealthsci.org/text.asp?2017/6/1/1/210818


  Introduction Top


Depression is a common mental disorder, characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feelings of tiredness, and poor concentration. It involves the body, mood, and thoughts.[1] These symptoms interfere with your daily life routines, the ability to work, sleep, study, eat, and enjoy life. The residence, age, marital status, educational status, the number of diagnosed chronic noncommunicable diseases (heart diseases, diabetic Mellitus, and arthritis), and alcohol drinking are associated risk factors of depression.[2]

Depression has become inevitable with increasing time; it does not only encompass aged people but also undergraduate students, housewives, employees, etc., in its circle. Many researches have been carried out as a study of depression among medical students and several studies have suggested a higher prevalence of depression among medical students than the general population. According to different studies, stress among medical students has been ranging from 12% to 73%.[3],[4]

Other researchers suggest that [1] the prevalence of depression among medical students in public universities has been estimated to be 15.2% in the USA,[5] 21.7% in Malaysia,[6] 24% in the UK,[7] 29.1% in India,[6] and 43.8% in Pakistan.[7] The prevalence of depression among private medical students, however, has been estimated to be 19% in the USA,[8] 49.1% in India,[8] and 60% in Pakistan.[9]

According to different studies, 335 students were assessed for depressive symptoms, and nearly half of them were found to be depressed with 2% having severe depression.[10],[11] Depression was found to be present in 60% and 70% in two different studies of medical and private colleges. The studies also show that there was no difference of gender with regards to the development of depression symptoms.[12],[13]

Medical schools and colleges are recognized as a stressful environment that often exerts a negative effect on the academic performance, physical health, and psychological well-being of the students. A study showed that students affected with these symptoms have a prevalence of 68% of 400 medical students.[14] Retrieving knowledge about the presence of these conditions is important in itself and if found, would need attention.[9],[15] Studies have indicated that the medical students experience the highest degree of pressure from studies. A gender difference regarding stress levels has also been reported, where women reported higher levels of stress than men (crude odds ratio among male:female 7:9).[16],[17]

There was no previous study conducted in Karachi, Pakistan as a comparison between medical students of public and private colleges on an objective of the prevalence of depression. It is a unique multicenter study, providing variations of participants that covers different aspects and highlights diversities of concerned regions. This was done using a self-administered depression questionnaire so that this research proves to be helpful to consider the factors responsible for occurrence and symptoms of depression which leads to an individuals' isolation, self-harm, and even suicide attempts. The motive is to benefit the policy makers and stakeholders to overcome the knowledge gap and develop new interventions for its prevention and take steps on how to eradicate these factors for the betterment of an individual.


  Subjects and Methods Top


Operational definition

The scale used in this study is “Beck's depression scale.” Participants with a cut-off of 20 and above were considered depressed.

Study design

This cross-sectional study was carried out among undergraduates of private and public sector medical schools in Karachi.

Study setting

Four medical schools were selected. Two for each public and private medical school.

Study tool

The study instrument used was a validated questionnaire comprising two sections. Part one was related to sociodemographic characteristics, and part two was related to depression which was assessed by a 21 items questionnaire. It was prepared in English language.

The scale that was used to assess depression level is Beck's Depression Scale. A self-administered questionnaire was utilized. The questionnaire includes Beck Depression Inventory (BDI)-II test which is 21 items self-report, having a four point scale ranging, which ranges from 0 (symptoms not present) to 3 (extreme symptoms). The test requires approximately 5–10 min to finish. Participants with a cut-off of 20 and above were considered depressed. Total score of 20–30 points toward mild mood disturbance, 30–40 indicates moderate clinical depression, and 4060 displays severe depression. The BDI test is broadly recognized and has been verified for concurrent, construct, and content validity. This scale was formerly designed by Aaron T. Beck. In 1961, collating patient's illustration of their symptoms depressed mood, hopelessness, lack of energy, persistent sadness, poor self-esteem, guilt, perception of failure, self-discontent crying irritability, fatigue insomnia decreased appetite, weight loss social withdrawal suicidal thoughts In 1996 the BDI underwent revision as (BDI-II) enhancing its content validity with the aim of focusing on depression symptoms criteria presented by Diagnostic and Statistical Manual of Mental Disorders-IV. Numerous researches concentrating on the psychometric assessment of depression used BDI.[18],[19],[20]

Sample technique

The technique used for sampling was convenient.

Sample size

A sample size of 300 was calculated by the formula:



The sample size was calculated based on the proportion of depression among medical students reported by a previous study.[21],[22] It was estimated using a proportion of depression as 40% at confidence level 95% and bound of error 3%.

Data collection procedure

The administration of each medical school was properly approached, and later each student was individually approached as well. After obtaining their time and identifying their space, the data were collected.

Inclusion criteria

The inclusion criteria were: Age of the participant (20–25 years).

Exclusion criteria

The students who were already diagnosed and treated for any psychological disorder or any comorbid were excluded from the study. All those who did not give their consent were also excluded from the study.

Variables

The dependent variable is depression and the independent variable were age, gender, religion, marital status, father's occupation, ethnicity, and the addiction history of the participants.

Data analysis

Data were entered into EpiData version 3 and analyzed in SPSS version 20. Frequencies, mean, deviation and standard deviation were calculated for quantitative variables, and proportions were calculated in qualitative variables. The association between dependent and independent variables was determined through regression analysis. In regression analysis, univariate and multivariate analysis to see the association between dependent and independent variables.

Ethical consideration

Informed written consent was obtained before study from the parent and target medical institutes. The participants were assured confidentiality and given the option to participate in the study without any further questions and implications. Institutional ethical clearance was obtained.

There was no conflict of interest among stakeholders.


  Results Top


Of 300 medical students, 27.3% were males, and 72.7% were female students. Mean age of students was 23 years and SD was ±2 years, 5.7% were married, 11% had past depression history, and 5.3% had family history of depression [Table 1].
Table 1: Sociodemographic characteristics of study participants (n=300)

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In public sector medical school, 9.7% of students were found to suffer from depression. Depression was more common in female students (9.6%) than males (7.3%). It was significantly higher in the age group 20–23 years (9.3%) than the age group 24–25 years (5.3%). Depression was more common in Urdu speaking (9.7%) and married students (41.2%). It was higher in people with past depression history (42.4%), family history of depression (22.2%), and addiction history (31.2%) [Table 2].
Table 2: Comparison of sociodemographic characteristics between normal and depressed study participants

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In univariate analysis, married students were 9 times more likely to suffer from depression (odds ratio [OR]: 9.205, confidence interval [CI]: 3.165–26.770), students with a past depression history were 14 times more likely to suffer from depression (OR: 14.397, CI: 5.928–34.961), students with family history were 3.6 times more likely to suffer from depression (OR: 3.684, CI: 1.477–9.189), students with an addiction history were 5 times more likely to suffer from depression (OR: 5.413, CI: 1.729–16.979) and students whose father had been working as a businessman were significantly 2.9 times more likely to suffer from depression (OR: 2.92, CI: 1.024–5.127) [Table 3].
Table 3: Association between sociodemographic characteristics of study participants and depression (univariate analysis)

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On multivariate analysis, students with a past depression history of at least 6 months were significantly 8.3 times more likely to suffer from depression (OR: 8.309, CI: 2.971–23.244), whereas no significant association of other sociodemographic characteristics with depression was observed in multivariate analysis [Table 4].
Table 4: Association between sociodemographic characteristics of study participants and depression (multivariate analysis)

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In public sector medical school, 9.7% were found to suffer from depression. In private sector medical school, 8.3% were found to suffer from depression [Figure 1].
Figure 1: Comparison of depression between students of public and private sector medical schools

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In public sector medical school, 20% of students aged 24–25, 36% with a past depression history, 33% with an addiction history and 11% with a sound financial background were found to be depressed [Figure 2].
Figure 2: Risk factors associated with depression in public medical schools

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In private sector medical school, 11% of students aged 20–23, 51% with a past depression history, 21% with an addiction history and 17% with a sound financial background were found to be depressed [Figure 3].
Figure 3: Risk factors associated with depression in private medical schools

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  Discussion Top


In this research study, it was found that the public sector medical school students are comparatively more depressed than the students of private sector medical schools. The major causes of depression in the research are mostly related to the female gender, younger age group, financial constraints, married individuals, past depression history, family history of depression and family problems, and an addiction history. These causes of depression are consistent with the findings of our research study as well.

We found out that depression is more common in public (government) based medical institutions (OR: 1.185, CI: 0.537–2.614) as compared to private medical institutions through our research study. In previous studies, the depression among the students of public medical students has been estimated to be 15.2% in the USA,[23] 24% in the UK,[7] 29.1% in India,[8] and 43.8% in Pakistan,[9] which is consistent with the findings of this study. This is related to a number of factors which may include age, gender, marital status, and a past depression history.

Young adults are more likely to be affected as compared to older adults.[1] The age group of 20–23 years (OR: 0.545, CI: 0.070–4.248) is more affected than the age group of 24–25-year-old students according to this research study. Another study stated poor quality work by medical students aged 20–22 years (OR: 0.81, CI: 0.53–1.23).[9] The findings of this research study are consistent with it. Different reasons are associated with it such as school pressure, peer pressure, family problems, sense of loss, self-doubt, high expectations, etc.

Females of all age groups are more commonly affected as compared to males.[16],[17] We found in our study that females (OR: 0.741, CI: 0.288–1.906) are a more depressed group than the males. This was also stated in certain previous studies (OR: 2.05, CI: 1.42–2.95),[9] the findings of which are contradicted with that of this study. This could be because the majority of the study participants in our study belonged to the female gender and so it is not comparable to the previous studies. It is clear that females, particularly those belonging to the middle and lower classes of our society, are faced with much higher social, cultural, and economic pressures. This is further attenuated by the lack of proper facilities (social, medical/maternal).

In addition to the above aspect, it is commonly seen that married women are more depressed.[24] They suffer a greater amount of depression as compared to the unmarried individuals. In our research study, married students (OR: 9.205, CI: 3.165–26.770) were more affected than the unmarried ones. These findings are consistent with the findings of previous studies (OR: 2.52).[25] There are various factors behind this such as financial stress, parenthood, exhaustion, challenging in-laws, miscommunication, work stress, and others.

In terms of the type of life events, it is seen that depressed patients experience significantly higher proportion of life events related to the death of a family member, personal health related events, bereavement, interpersonal, and social events.[26] Students with depression history (OR: 14.397, CI: 5.928–34.961), and family history (OR: 3.684, CI: 1.477–9.189) were found to be more depressed than the students without such history in our research study. This finding is also consistent with the previous studies (past depression history OR: 1.8–2.3; 95% CIs: 1.05–4.02)[27] and (family history OR: 4.4).[28]

Other factors such as smoking, drug abuse, and primary metabolic disorder are likely to be present in almost every society. Participants with an addiction history (OR: 5.413, CI: 1.729–16.979) were more depressed than those without such history according to our study. This has also been stated in previous studies (OR = 1.454) based on suicide and drug abuse,[29] consistent with the findings of this study. These are mostly associated with the socioeconomic factors of an individual and therefore mainly prevail in the ones with the poor economic background.

Subjects with poor economic background and poor nutritional status are more depressed than their financially sound counterparts.[30] Financially, sound (OR: 2.152, CI: 0.863–5.368) were found to be more depressed than the salary person in our study. This aspect was also discussed by a number of researchers based on their study of slums and poor (OR [low and high groups, respectively], 5.4–6.9).[31] The findings of this study contradict with that of the previous studies. This could be because of the increasing communication gap among the family members, spending a little time with them due to busy life styles and the family issues arising in the result.

The solution to above-mentioned factors is based on individual's own capability of dealing with it. Overcoming the reason behind depression mainly depends on the person's social and physical environment and how one copes with it. One of the necessities to overcome depression is the financial support. The stakeholders should get involved to make it possible. There is also a need for large-scale studies to eradicate depression as much as possible from the society. Avoiding alcohol, cigarettes, and drugs is another way to overcome depression on an individual level.

The strength of this study is that in contrast to most of the previous studies, we compared the depression rate among the students of the public and private sector medical schools. This study also determines the associated factors of depression in the study participants which includes their age, gender, marital status, depression and family history. At the same times, this study is limited because of the time constraint, lack of resources, and the small sample size. Is also does not determine the causal factors which are associated with depression.


  Conclusion Top


The study identified that depression is more common in public colleges among married females in their early twenties of low socioeconomic status and with depression history. There is an urgent need to combat depression, the integrated action is required by different stakeholders.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
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    Figures

  [Figure 1], [Figure 2], [Figure 3]
 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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