|Year : 2018 | Volume
| Issue : 1 | Page : 58-62
Sociodemographic correlates and symptoms of depression, anxiety and stress among a sample of nigerian medical students
AO Coker1, OO Coker2, D Sanni3
1 Department of Behavioural Medicine, Lagos State University College of Medicine, Ikeja, Lagos, Nigeria
2 Medical Department, University of Lagos Medical Centre, University of Lagos, Akoka, Lagos, Nigeria
3 Medical Department, Apex Care Hospital, Ikeja, Lagos, Nigeria
|Date of Web Publication||23-Mar-2018|
Dr. A O Coker
Department of Behavioural Medicine, Lagos State University College of Medicine, Ikeja, Lagos
Source of Support: None, Conflict of Interest: None
Introduction: Previous studies have shown that medical students globally experience various degrees of psychopathologies such as depression, anxiety, and stress while in medical school. Objective: This study aimed at assessing the symptoms of depression, anxiety, and stress in a sample of Nigerian medical students. Materials and Methods: A cross-sectional and descriptive design was adopted for this study. A total of 240 medical students from the second to sixth years studying at the Lagos State University College of Medicine, Lagos, Nigeria were invited to participate in the study. They completed a proforma form that collected their sociodemographic variables and short version of the Depression Anxiety and Stress Scale. Results: A total of 240 medical students participated in the study. The age range was between 25 and 34 years, (mean 25 years; SD = 4.5); 120 (50%) were females and only 9 (3.75%) were married while a large majority of the participants 229 (95.4%) were single. A small number of the participants 9 (3.8%) and 34 (14.2%) smoked cigarettes and consumed alcohol, respectively. The DASS analysis showed that 15 (6.3%), 23 (9.5%), and 148 (61.6%) experienced symptoms of depression, anxiety, and stress, respectively. Conclusion: The study demonstrated that Nigerian medical students also manifested with various symptoms of psychopathology. Nigerian medical students should be taught stress and change management strategies to assist them to cope with the stressful nature of medical training.
Keywords: Anxiety, depression, Lagos, medical students, Nigeria, stress
|How to cite this article:|
Coker A O, Coker O O, Sanni D. Sociodemographic correlates and symptoms of depression, anxiety and stress among a sample of nigerian medical students. Niger J Basic Clin Sci 2018;15:58-62
|How to cite this URL:|
Coker A O, Coker O O, Sanni D. Sociodemographic correlates and symptoms of depression, anxiety and stress among a sample of nigerian medical students. Niger J Basic Clin Sci [serial online] 2018 [cited 2021 Jan 22];15:58-62. Available from: https://www.njbcs.net/text.asp?2018/15/1/58/228370
| Introduction|| |
Medical education has been reported to be demanding and stressful. Previously published studies indicated that medical students experienced various degrees of psychological morbidity such as stress, anxiety, and depression from the onset of medical training.,, The identified etiologies of these psychological distress among medical students include rigorous academic programmes, frequent seminars and in-course assessments, and inability to socialize with other university students., Hence, academic performances of medical students who might be experiencing psychological distress may be limited., Considering this, the prevalence of psychological morbidity such as depression, anxiety, and stress have been documented to be higher among medical students when compared to their age-matched nonmedical colleagues.,,, Published documents showed that the prevalence of psychological and psychiatric morbidity among medical students ranged from 14% to 67%.,,,,,, The literature also showed that medical students' psychological distress could occur at various stages of their medical school training, especially during clinical examination periods.,,, The negative implications those who experience psychological morbidity while in medical school include lower academic performances, reduced self-esteem, lack of confidence, substance and alcohol abuse, low moods, attempted suicide, and suicide.,,,,,,, The literature also noted tha, t if medical students' psychological morbidity are not given early attention by management of medical schools and policy makers, they may probably impact negatively on their future careers as medical doctors and their abilities to serve the society adequately.,,
Despite these scientific revelations about published psychological morbidity of medical students, electronic and manual literature search on studies on psychopathological distress and morbidity among undergraduate medical students in Nigeria showed scanty results., In the same vein, studies on combined psychological distress such as depression, anxiety, and stress were found to be fewer. An important factor in the academic achievement of medical students is the ability to be well-adjusted psychologically while training to become a medical doctor. In developing countries such as Nigeria, the results of a study on psychological morbidity on medical students such as this one may assist in developing psychological interventions for those experiencing psychological distress in medical schools. Therefore, a study on the psychological distress of Nigerian medical student cannot be overemphasized, especially in sub-Saharan Africa. This study was therefore designed to investigate the symptoms of depression, anxiety, and stress among a sample of Nigerian medical students and the relationships between the sociodemographic correlates of the participants and symptoms of depression, anxiety, and stress.
| Materials and Methods|| |
Design and settings
The study was a descriptive and cross-sectional survey. The study was conducted at the Lagos State University College of Medicine, Ikeja, Lagos, Nigeria.
Medical students from the second year to the sixth year were invited to participate in the study. Written consents were obtained from all participants after they were informed about the aims of study. The participation was entirely on voluntary basis and they were all assured of the confidentiality of the study. Of the total 325 students, 240 agreed to participate in the study giving a response rate of 74%. The study was approved by the Research and Ethics Committee of the College of Medicine.
The recruited participants completed a proforma form that collected their sociodemographic variables that also included whether they used psychoactive substances such as alcohol and nicotine cigarettes. They also completed the short version of the Depression Anxiety and Stress Scale, the DASS-21 item is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety, and stress. Each of the three DASS scales contains 7 items. The depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest or involvement, anhedonia, and inertia; the anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect; while the stress scale is sensitive to levels of chronic nonspecific arousal. Each item on the DASS-21 is scored from 0 (did not apply to me) to 3 (applied to me very much or most of the time). For the depression domain, normal scores range 0–9 while higher scores range from 10 to 28. For the anxiety domain, the normal scores range between 0 and 7, while pathological scores range from 8 to 20 while for the stress domain, the normal scores range 0-14, while the pathological scores range from 15 to 34. The DASS-21 is a short form of the DASS-42, the final score of each domain is multiplied by 2 as recommended by the authors to simulate the full-scale version scores. The DASS was pretested in a selected group of medical students not included in this survey sample for understandability and appropriateness. The DASS was found to be well understood by these selected medical students.
Data was analyzed using the eighteenth version of the IBM Statistical Package for Social Sciences (IBM, SPSS, 18: Ill Chicago). Percentages, means, and standard deviation of nominal variables were determined. Categorical data was compared using Chi-square test. Correlation between the subscales was performed using Pearson's rank correlation coefficient. P value <0.05 was considered significant.
| Results|| |
A total of 240 medical students participated in the study. Their ages ranged between 25 and 34 years, (mean 25 years; SD = 4.5); 120 (50%) were females. A large majority of the participants 229 (95.4%) were single. A small number of the participants 9 (3.8%) and 34 (14.2%) smoked cigarettes and drank alcohol, as shown in [Table 1]. Because the DASS-21 is a short form of the DASS-42, the final score of each domain was multiplied by 2 to simulate the scores of the full-scale version. With regards to the measures of psychopathology with the DASS-21, the participants scored 15 (6.3%), 23 (9.5%), and 148 (61.6%) in depression, anxiety, and stress, respectively. With regards to the scores of the 15 (6.3%) who experienced depression, 9, 3, and 2 and 1 participants manifested with mild, moderate, severe, and extreme severe depression, respectively. The results of the anxiety subscale showed that 23 (9.5%) met the cut-off mark for anxiety. Of the 23 participants who experienced anxiety, 16, 3, 2, and 2 experienced mild, moderate, severe, and extreme severe anxiety, respectively. The findings of the stress subscale showed that 148 (61.6%) participants experienced stress. Of those who experienced stress, 106, 29, 10, and 3 participants experienced mild, moderate, severe, and extreme severe stress, respectively, as shown in [Table 2], [Table 3], [Table 4].
|Table 1: Sociodemographic variables and mean DASS-21 scores of the participants|
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|Table 2: Frequency distribution in depression scores among the participants (n=240)|
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|Table 3: Frequency distribution in anxiety scores among the participants (n=240)|
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|Table 4: Frequency distribution in stress scores among the participants (n=240)|
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When the levels of psychopathology among the various years of the participants were compared, the second-year students scored higher in the measures of depression. Likewise, the sixth-year students had higher scores in the anxiety domain while the second-year students had the highest levels in the stress domain, as shown in [Table 5]. [Table 6] showed moderate-to-strong positive correlations between the three dependent subdomains of the DASS-21 (depression, anxiety, and stress). When the participants were further grouped into three different groups into sex, age, and faculties where they receive lectures; comparatively, the male participants experienced depression than the female participants. Participants in the age bracket 23–28 years also experienced depression more than those in the age bracket 29–34 and according to their faculties, the preclinical students experienced depression more than their clinical counterparts. However, none of the associations were statistically significant. With regards to the anxiety scores of the participants, male participants experienced more anxiety than their female counterparts. The participants in the age bracket 23–28 years experienced anxiety more than those in the age bracket 29–34 years and according to their faculties, the clinical students experienced anxiety slightly than those in the preclinical faculty. There were no statistically significant relationships among their anxiety levels. The stress scores of the participants showed that female participants experienced more stress than males. The participants in the age bracket 23–28 years experienced more stress than those in the age bracket 29–34 years, and according to their faculties, clinical students experienced higher stress than those in the preclinical faculty. However, there were no statistically significant relationships among their stress scores, as shown in [Table 7].
|Table 5: Overall means scores of the participants from second to sixth year|
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|Table 6: The correlation between the subscales of Depression Anxiety and Stress Scales|
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|Table 7: Association of demographic variables as risk factors of depression, anxiety and stress among participants|
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| Discussion|| |
This study aimed at determining the rates of depression, anxiety, and stress among a sample of Nigerian medical students. The results of this study showed that 6.3%, 9.5%, and 61.6% participants experienced depression, anxiety, and stress, respectively. With regards to our result on depression, the result was not in agreement with results from other studies. The prevalence of depression among medical students from previous studies ranged from 14% to 30%.,,, The probable reasons why our sample had low scores in the depression subdomain could due to the fact that the medical hostel is very close to the medical college, thus, students do not have to travel far to get to school. It can also be assumed that most of the participants come from affluent families and likely received adequate moral and financial support from their parents. Published evidence also indicated that financial problems and travelling between medical school and home were factors that caused psychological distress for students.,,, The friendly atmosphere of the medical college and cordial rapport between students and lecturers could be another reason for the low levels of depression among the surveyed students.
The result of the anxiety scores showed that 9.5% of the participants experienced anxiety. This finding was also not in agreement with most published studies. The reported rates of anxiety among undergraduate medical students ranged from 15.5% to 67%.,,,,, Previous published studies showed that higher levels of anxiety in medical students could negatively impact on academic achievements.,,, In this light, highly-anxious medical students may also find it difficult to cope with academic performance. However, the reasons for low level of anxiety among our study group could be due to the above-mentioned explanations with regards to depression. Nonetheless, the results of the stress domain showed that 61.6% of the participants experienced stress. This finding was, however, in consonance with findings from other workers.,,,, The possible explanation for this high rate of stress among our participants could be due to long study hours, frequent continuous assessments and assignments, difficult examinations, relationship problems, homesickness, high societal and parental expectations, loneliness, and lack of social life.
With regards to gender, contrary to findings from other workers, in this study, male participants had higher scores in the subscales of depression and anxiety. While some studies found some significant relationship between gender and psychopathology,, others did not find any significant difference., The students aged 23–28 years scored higher in the subscales of depression, anxiety, and stress when compared to older students. This could be due to less experience, difficulty in coping with life changes, work overload, fear of failing, and time management issues younger student experience., Nonetheless, this study did not find any statistical significant associations between the sociodemographic variables and the subscales of depression, anxiety, and stress with regards to age differences.
Regarding how the participants coped with stress of medical school, the findings of this study also showed that they indulged in psychoactive substances such as alcohol and nicotine cigarettes. The results showed that 3.8% smoked nicotine cigarettes and 14.2% drank alcohol. Previous reports also indicated that persistent stressors in medical schools may make students develop bad coping skills with negative long-term consequences such as use and abuse of psychoactive substances such as nicotine, alcohol, hypnotics, and analgesics, which were found to be counterproductive and may aggravate experienced psychological distress., The use or abuse of psychoactive substances could also be due to the magnitude of academic work in medical schools, academic pressure to score high grades, zero tolerance of faults during clinical practice, perfectionist clinical standards, and demanding nature of medical training generally make medical students to have reduced social life.,, Published evidence indicated that, if these psychopathological conditions among students are not detected early, they could affect students throughout their medical training and may eventually negatively impact on quality patient care as graduate doctors.,, High prevalence of psychological disturbance among medical students should be given desired attention by healthcare providers and policymakers to make policies to provide proper counselling services and psychoeducation in medical schools.,,
This study is not without its limitations. These limitations include the use of homogeneous sample of medical students from one university. However, the psycho-socio-economic conditions of one medical school in Lagos can be compared to other medical schools in Nigeria. The DASS-21 is a self-report instrument which could lead to bias or under-reporting. The generalizability of the results of this study should be limited. Nonetheless, it is suggested that large prospective multicentred studies be carried out to identify and intervene in issues of psychological distress in medical schools.
| Conclusion|| |
Training as a medical doctor is highly stressful. This study also showed that the surveyed medical students experienced various degrees of depression, anxiety and stress. Therefore, it is suggested that healthcare providers and policy makers should make policies to provide proper counselling services and psychoeducation in medical schools. Medical students should also be taught stress and change management strategies to assist them in coping with the stressful nature of medical training and as future medical doctors.
The authors did not receive any financial support from anybody or organisation.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Yusoff MS, Abdul Rahim AF, Baba AA, Ismail SB, Mat Pa MN, Esa AR. Prevalence and associated factors of stress, anxiety and depression among prospective medical students. Asian J Psychiatry 2013;6:128-33.
Yaqoob R, Raza A, Shelizad MA, Zesshan SC. Anxiety and depression among medical students; a cross-sectional study. J Pak Med Assoc 2010;60:699-702.
Chatterjee C, Mandal PJ, Mallik S, Manna N, Sardar JC, Dasupta S. A study on medical distress among MBBS students in a medical college, Kolkata, India. Ann Trop Med Public Health 2012;5:453-7. [Full text]
Yusoff MSB. Effects of a brief stress reduction intervention on medical students' depression, anxiety and stress levels during stressful period. Asian J Psychiatry 2011;12:71-84.
Mackenzie S, Wiegel JR, Mundt, Brown D, Saewyc E, Heiligenstein E, et al
. Depression and Suicide Ideation among Students Accessing Campus Health Care. Am J Orthopsychiatry 2011;81:101-7.
Schwenk TL, Lindsay D, Leslie AW. Depression, stigma, and suicidal ideation in medical students. JAMA 2010;304:1181-90.
Inam SB. Anxiety and Depression among Students of a Medical College in Saudi Arabia. Int J Health Sci 2007;1:295-300.
Benbassat J, Baumal R, Chan S, Nirel N. Sources of distress during medical training and clinical practice: Suggestions for reducing their impact. Med Teacher 2011;33:486-90.
Aniebue PN, Onyema GO. Prevalence of depressive symptoms among Nigerian medical undergraduates. Trop Doct 2008;38:157-8.
Ofili AN, Oriaifo I, Okungbowa E, Eze EU. Stress and psychological health of medical students in a Nigerian university. Niger J Clin Pract 2009;12:128-33.
Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales 2nd
ed. Sydney: Pscyhology Foundation; 1995.
Lovibond PF, Lovibond SH. The structure of negative emotional states: Comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories. Behav Res Ther 1995;33:335-43.
Yusoff MSB. Psychometric Properties of the Depression Anxiety Stress Scale in a Sample of Medical Degree Applicants. International Med J 2013;20:295-300.
Baykan Z, Zacar M, Cetinkaya F. Depression, anxiety and stress among last-year student at Erciyes University medical school. Acad Psychiatry 2012;36:64-8.
Yusoff MBS, Rahum AFA, Yaacob MJ. Prevalence and sources of stress among University Sains Malaysia medical students. Malysian J Med Sci 2010;17:30-7.
Jadoon NA, Yagoob R, Raza A, Shehzad MA, Zeshan SC. Anxiety and depression among medical students: A cross-sectional study. J Pak Med Assoc 2010;60:699-702.
Abdulghani HM, Alkanhal AA, Mahmooud ES, Ponnamperuma GC, Alfaris EA. Stress and its effects on medical students: A cross-sectional study at a college of medicine in Saudi Arabia. J Health Popul Neutr 2011;29:516-22.
Aris S, Dzulkifli MD. Differences in depression, anxiety and stress between low-and high-achieving students. J Sustain Sci Manage 2011;6:169-7.
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]
Shamsuddin K, Fadzil F, Ismail SW, Shah SA, Omar K, Muhammad NA, et al
. Correlates of depression, anxiety and stress among Malaysian university students. Asian J Psychiatry 2013;6:318-23.
RadeefAS, Faisal GG, Ali SM. Source of Stressors and Emotional Disturbances Among Undergraduate Science Students In Malaysia. Int J Med Res Health Sci 2014;3:401-10.
Yasin MASM, Dzulkifli MA. Differences in depression, anxiety and stress between low and high-achieving students. J Sustain Sci Manage 2011;6:169-78.
Deressa W, Azazh A. Substance use and its predictors among undergraduate medical students of Addis Ababa University in Ethiopia. BMC Public Health 2011;11:660-7.
Holm M, Tyssen R, Stordal KI, Haver B. Self-development groups reduce medical school stress: A controlled intervention study. BMC Med Educ 2010;10:23-30.
Warnecke E, Quinn S, Ogden K, Towle N, Nelson MR. A randomised controlled trial of the effects of mindfulness practice on medical student stress levels. Med Educ 2011;45:381-8.
[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7]
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