Abstract
This study assessed the epidemiology of depressive symptoms in Nigerian medical students. A cross-sectional study of 262 medical students from University of Nigeria, Enugu campus, one of the foremost medical schools in Nigeria was studied. Data were collected using structured self-administered questionnaires and the Zung self-rating depression scale developed by Zung as an instrument, which measures the subjective experience of depression. The age range of students was 16–30 years. The prevalence of depression among the students was 23.3%. Students aged 16–20, females, and those who had a professional examination during the period of the study had higher levels of depression, although these findings were not significant. However, students who smoked regularly had significantly higher levels of depression than those who did not smoke. Medical educators in Nigeria need to be aware of the vulnerability of medical students to depression.
Introduction
Depressive symptoms among medical students have been extensively studied and reported in some parts of the world. Clark and Zeldow 1 reported considerable depressive symptomatology among medical students at Ahvas University of Medical Sciences, and Chan 2 studied Chinese medical students and reported that about 50% were in the depressed range. Porcu et al. 3 reported a prevalence of 49.2% among Brazilian medical students.
Medical training in Nigeria is very challenging and more difficult by the incessant disruption of academic programmes caused by industrial conflicts. This study assesses the epidemiology of depressive symptoms in Nigerian medical students. Its findings will assist medical educators in knowing how to reduce depression and stress in students undertaking medical training.
Materials and methods
This was a cross-sectional study carried out among medical students of the Faculty of Medicine University of Nigeria Enugu Campus. A proportional random sampling of 300 medical students from the total population of medical students in the Enugu Campus of the University was taken. Data were collected using a structured, self-administered questionnaire and the Zung self-rating depression scale developed by Zung as a simple quantitative measurement of the subjective experience of depression. 4 This instrument has been shown to be applicable to Nigerian patients. 4 Data entry and analysis were done using SPSS statistical package and statistical calculation was done at 5% significance level.
Results
The age range of the students was 16–30 years with a mean of 23.7 years SD ± 2.7 years. Two hundred and fifty-three (96.6%) of the respondents were single and nine (3.7%) were married. Sixteen (6.1%) students engaged in cigarette smoking. The number of years spent in school by the respondents ranged from 2 to 9 years. Two hundred and thirty-six students (90.1%) described their relationship with lecturers as friendly, while 26 (9.9%) felt otherwise. Stressors identified by the students were chiefly lack of leisure time (31.6%), long lecture periods (29.7%) and short holiday periods (20.5%). One hundred and fifty-two (58.0%) had a professional exam to sit within the year of this study.
Sixty-one students were depressed, giving a prevalence of depression among students studied of 23.3%. Students aged 16–20 years, females, those unmarried, students in their second and third years as well as students who had professional examination during the year of study had higher prevalence of depressive symptoms than other students. Smoking among the students was associated with significantly higher level of depressive score (Table 1).
Sociodemographic characteristics and prevalence of depressive symptoms
NS, not significant; SDS, self-rating depression scale
Discussion
The prevalence of depression was 23.3%. Chan 2 reported a level of depression of 50% among medical students in China and Mauro Porcu et al. 3 49.3% among Brazilian medical students. Unfortunately there was no local study for comparison but the observed disparity in the levels of depression could be explained by sociocultural and environmental differences.
Levels of depression were found to be higher in the younger age group, women and unmarried students. Ahmadi et al. 5 reported a higher prevalence of depression among female medical students and younger medics than their male and older counterparts. Older students are more familiar with the medical school process and this could explain why they scored low. Absence of someone to confide in is a vulnerability to depression and marriage has been reported to have a protective effect on depression. 6
Students who had professional exams to sit during the time of this study had higher depressive scores. Academic work related stress was also reported by Bilesha to increase medical student's depressive symptoms. 7
Cigarette smoking among the students increased their depressive scores. It seemed that students who were depressed resorted to smoking as a coping mechanism. Okeke 8 reported stress in medical school as reason for starting to smoke in her study about smoking habits of physicians in the same locality. Students who perceived their lecturers as hostile and unapproachable had higher depressive scores. This was corroborated by Lemp who reported that students who suffer humiliation from lecturers reported it as a source of stress and misery. 9
Medical educators need to be aware of the vulnerability of medical students to depression and should consider incorporating training on coping skills into the medical curriculum.
Footnotes
Acknowledgement
We hereby acknowledge the assistance of Miss C C Iwuala, Mr C U Nweke, Mr I O M Ohuche and Mr A M Okoli all medical students for their assistance in collecting the data used for this study.