Hassan Abdul Aziz Al-Ali

215020533

The Prevalence of Depression among Medical
Students and medical interns at King Faisal
University, Al-Ahsa, Saudi Arabia.
 Effect of Depression on medical
students:
 Medical school is thought to be stressful [4]. Medical students are subjected to psychological and academic pressures [5].

 The prevalence of depression in high school students has been found to range from 14% to 33%, with stress reaching 35% [6,7].

 Medical students have higher rates of depressive symptoms than the general population [8].

 Depression prevalence and its symptoms among students vary between studies, ranging from 1.4% to 73.5% [15,16],

 While rates of depression among medical students ranged from 2.9% to 38.2% [17,18].

 In mainland China, 16.8% of students were depressed [19], whereas suicidal ideation was high and exceeded 10% in a
Taiwanese study [20]. Furthermore, it was discovered that over 65% of Chinese physicians had depressive symptoms [21].
 Effect of Depression on medical
students:

 Age, gender, family history of chronic diseases, history of relative loss, and history of psychiatric illness have all been
identified as risk factors for depression [6].

 Student abuse and hazing [10,11], sleep deprivation [12], academic stress and workload [13,14] are all risk factors for
medical students.
 Effect of Depression on medical
students:

 Medical students' depression has been linked to suicide [23,32,33]. According to some studies [34,35], 11.2% to 17.4%
of medical students have suicidal thoughts at least once a year.

 suicidal ideation affects 4.4 % to 23.1 % of medical students, with suicidal attempts ranging from 0.0 % to 6.4 % [17].
Furthermore, it was discovered that females were more likely to have suicidal thoughts, with females accounting for
67.6% of suicidal ideators [43]. Physicians have high suicide rates [44,45], which they relate to untreated psychological
symptoms in medical students [19,46].
Aim:

To assess the prevalence of depression among medical students

 Study Methodology: -
A questionnaire based, observational cross-sectional study conducted in the college of medicine, KFU population.
Study population:
The Inclusion Criteria, medical students and interns of KFU, male and female gender. The Exclusion Criteria: non-medical
students, non-KFU medical students and those who refuse to participate.
Informed consent:
Informed consent was obtained from all participants. All data obtained will be kept private, and the name of the participant
would not be included in the survey. Participants are to be told about the risks and benefits of not providing information and
they have the right of withdrawal from study at any time.
Data Collection:
This study used a questionnaire to achieve the aim of the study that will be distributed randomly among medical students
and interns at KFU. The sample size will be taken at March of 2021. The questionnaire is divided into three parts as
follows: the first part will be about the demographic data (gender, age, marital status, collage year). The second part
contains the Patient Health Questionnaire–9 (PHQ–9) to evaluate the presence of depression among the participants. Third
part includes the risk factors of depression.
 Study Methodology: -

Data analysis:
Categorical variables are presented using numbers and percentages while continuous variables are summarized using mean
and standard deviation. The relationship between the level of depression and the socio demographic characteristics of the
patients had been conducted using Chi-square test. Significant presented in the Chi-square test had been placed in the
multivariate regression model to determine the independent significant predictor associated with depression where the odds
ratio as well as 95% confidence interval were also being reported. A p-value of <0.05 (two sided) was used to indicate
statistical significance. All data analyses were performed using the Statistical Packages for Software Sciences (SPSS)
version 21 Armonk, New York, IBM Corporation.
 Study Methodology: -
Research tool:
Patient Health Questionnaire–9 (PHQ–9), the validity and reliability of this scale as a tool for detecting depressive
symptoms have previously been tested in the Saudi Arabian context [47]. The PHQ–9 is a self-administered instrument with
nine items (numbered 1–9), each of which is based on a four-point Likert-type scale that scores the presence of depression
symptoms from zero to three as follows: “not at all,” “several days,” “more than half the days,” and “nearly every day,”
respectively. If participants' responses to the depressive symptoms criteria were met and had been present for the previous
two weeks, they were diagnosed with depression. As a result, major depressive disorder was diagnosed if the answer to item
1 or 2 was “more than half the days” and four or more of the remaining PHQ–9 items were “more than half the days.” A
PHQ–9 score of 10 was used as a diagnostic cutoff point for depressive symptoms based on these criteria, as previously
recommended in the literature [47,48].
 Study Methodology: -

Ethical considerations:
Data was obtained from the medical students and interns of KFU through online questionnaire with no identification of
anyone. Ethical approval from the ethical committee will be taken. The participants will sign informed consent. All data are
confidential.
Conflict of Interest:
Researcher has no conflict of Interest to disclose and the study have no external funds.
Result:
Gender: Age:

3.2%

22.6
%

46
.8 > 25
% 18 - 21
22 - 25
53.2% Female

Male

74.2
%
 Result:

Marital status: Collage year:

140
90
64.5% 41.9%
120 80

70
100
60
80
50
35.5%
60 40
16.1% 16.1%
30
40 11.3%
20 8.1%
6.5%
20
10

0 0
Married Single 1st year 2nd year 3rd year 4th year 5th year Intern
 Not at all N (%) Several days N (%) More than half the days N (%) Nearly everyday N (%)

Statement Score (3) Mean ± SD

Result:
1. Little interest or pleasure in doing things
0.95 ± 0.91 72 (38.7%) 60 (32.3%) 45 (24.2%) 09 (04.8%)

2. Feeling down, depressed, or hopeless

1.08 ± 1.01 69 (37.1%) 51 (27.4%) 48 (25.8%) 18 (09.7%)

3. Trouble falling or staying asleep, or sleeping too much

1.09 ± 0.96 60 (32.3%) 66 (35.5%) 42 (22.6%) 18 (09.7%)

4. Feeling tired or having little energy

1.34 ± 0.95 42 (22.6%) 60 (32.3%) 63 (33.9%) 21 (11.3%)

5. Poor appetite or overeating

0.95 ± 1.01 81 (43.5%) 51 (27.4%) 36 (19.4%) 18 (09.7%)
6. Feeling bad about yourself or that you are a failure or have let yourself or your
family down

1.13 ± 0.98 66 (35.5%) 42 (22.6%) 66 (35.5%) 12 (06.5%)

7. Trouble concentrating on things, such as reading the newspaper or watching

television

1.06 ± 0.98 66 (35.5%) 60 (32.3%) 42 (22.6%) 18 (09.7%)

8. Moving or speaking so slowly that other people could have noticed. Or the opposite
being so fidgety or restless that you have been moving around a lot more than usual

0.48 ± 0.88 132 (71.0%) 30 (16.1%) 12 (06.5%) 12 (06.5%)

9. Thoughts that you would be better off dead, or of hurting yourself

0.53 ± 0.84 120 (64.5%) 42 (22.6%) 15 (08.1%) 09 (04.8%)

Total PHQ-9 Score

8.63 ± 6.36
Result:
 Risk Factors
Result:
 Depressed N (%) Not depressed N (%)

Factor (n=78) (n=108) P-value §

Result:
Age group

18 – 21 years

>21 years
15 (19.2%)

63 (80.8%)
27 (25.0%)

81 (75.0%)
0.353

Gender

Male 39 (50.0%) 60 (55.6%)

0.454
Female 39 (50.0%) 48 (44.4%)

Marital status

Single 51 (65.4%) 69 (63.9%)

0.833
Married 27 (34.6%) 39 (36.1%)

Academic year level

Junior students 21 (26.9%) 27 (25.0%)

Senior students 24 (30.8%) 36 (33.3%)

0.922
Interns 33 (42.3%) 45 (41.7%)

Perceived causes of depressive symptoms *

Regretted study medicine 27 (34.6%) 15 (13.9%) 0.001 **

Heavy academic load 57 (73.1%) 42 (38.9%) <0.001 **

Sleep deprivation 18 (23.1%) 12 (11.1%) 0.029 **

Loss a family member 21 (26.9%) 06 (05.6%) <0.001 **

Failed in academic year 09 (11.5%) 06 (05.6%) 0.139

Received lower grade than expected 39 (50.0%) 21 (19.4%) <0.001 **

Having difficulties in personal relationships 20 (25.6%) 11 (10.2%) 0.005 **

Having conflict with tutors 09 (11.5%) 05 (04.6%) 0.078

Perceived lack of college facilities 12 (15.4%) 03 (02.8%) 0.002 **

History of chronic disease 09 (11.5%) 0 <0.001 **

Past/current history of psychiatric disease 12 (15.4%) 0 <0.001 **

Family history of psychiatric/chronic disease 15 (19.2%) 06 (05.6%) 0.004 **

Un-satisfaction of personal family income 12 (15.4%) 09 (08.3%) 0.134

Other causes 09 (11.5%) 21 (19.4%) 0.148

 Discussion:

 The purpose of the present study is to determine the prevalence of depression and identify its significant predictors. In this study,
according to the PHQ-9 criteria, the prevalence of depression was found among 41.9% of medical students while 58.1% were negative
to depression.

 This report is consistent from the study conducted in Taif, Saudi Arabia [4]. Based on their findings, the prevalence rate of depression
was 41% among medical students. This had also been reported by Wahed and Hassan [36] as well as Moutinho and colleagues [49],
which reported depression prevalence rate of 30.8% and 34.6%, respectively. In Riyadh, Saudi Arabia [50], study reported a relatively
high depression rate between gender with 66.6% of the males and 87.6% of the females detected to have some sort of depression
starting from mild to severe stage of depression. A higher prevalence rate of depression had also been reported in India [51]. Authors
indicated that the prevalence of depression among medical students in a private medical college in South India was 58%.

 On the contrary, some literatures reported low prevalence rate. For example, in Portugal [5], depression rate was found among 6.1% of
medical students while in Qassim, Saudi Arabia [52], reports indicated that the prevalence of depression was low in both depressive
syndrome and depressive disorder.
 Discussion:

 Moreover, we noted that the prevalence of depression was minimal among 35.5% of medical students, 22.6% were mild
level, 21% were moderate, 17.7% were moderately severe and 3.2% had severe depression.

 The severity of depression among our medical students is comparable to the study of Wahed and Hassan [36], they
documented that depression among university students was mild to moderate among 37.1% whereas 23.1% identified
as having severe to very severe depression. In India [51], 43% of medical students had mild depression, 12% were
moderate and 3% were severe which was also consistent with our results. In Madinah, Saudi Arabia [53], when they
compared the severity of depression between medical students and computer science students, they found out that 33%
of medical suffered moderate form of depression, 4% had severe depression whereas computer science students had
higher form of moderate depression with 53% and 7% had severe depression which was also in line with our results.
 Discussion:

 In our study, the prevalence of depression among those with perceived family of history psychiatric/chronic disease was
statistically significantly higher (p=0.004). This report is consistent from the paper of Rawat et al. [51] where the
prevalence of depression was statistically significantly higher among those with family history of depression and those
with family problems.

 Similarly, we also noted several perceived causes of depressive symptoms demonstrated significant relations with
depression including, regretted study medicine, heavy academic load, sleep deprivation, loss a family member, received
lower grade than expected, having difficulties in personal relationships, perceived lack of college facilities, history of
chronic disease and past/current history of psychiatric disease (all p<0.05) however, after conducting multivariate
estimates only heavy academic load, received lower grade than expected and having difficulties in personal relationships
remained statistically significant which we identified as the significant predictors associated with depression.
 Discussion:

 In a study of Coente and associates [5] they documented that higher depression rates were found among medical students
who had been diagnosed with psychiatric disorder and students with high level of anxiety which was also comparable
with our results.

 On the other hand, we have learned that age group, gender, marital status and academic year level were not predicted to
be the factors of depression. These findings are not consistent from the paper of Mountinho and colleages. [49] They
found out that gender showed significant relationship with depression in which females were more affected with
depression than males. This had also been indicated by Alsalameh et al.[52] where they noted that females expressed
more severity of depression than males. In our study, the depression of males and females were not significantly different
across the group (p>0.05).
 Depression:
Conclusion:

Higher depression rate among medical students were found. Perceived causes of depressive symptoms such as academic
load, decreased of grades and difficulties in dealing with personal relationships predicted to be the most affected by the
depression. Medical universities should devise a management program that promote the wellness of mental health among
medical students during the course of medical training. Early detection of mental health decline among them is equally
important to come up with better and early intervention.

Study limitation:
In this study, researcher got around 2/3 of the wanted sample size (186 participants) and the wanted study population was
269 participants.

Acknowledgment:
Dr. Mohammed Ayub, Assistant Professor of psychology, college of medicine, King Faisal University.
References:

https://drive.google.com/drive/u/0/folders/1UTZxOT_tB4amEGCveUqDSs
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