A Cross-sectional Study Assessing the Prevalence of Depression among Medical Undergraduates and Interns of Bangalore Medical College and Research Institute, Bengaluru

Introduction

Depression is a common sickness affecting individuals worldwide, with an estimated 3.8% of the population affected globally. It is characterized by sadness, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, feeling of tiredness, and poor concentration. It can be long-lasting or recurrent, can substantially harm an individual’s ability to perform at work or school or can even cause difficulty in coping with daily life. In most severe cases, depression can lead to suicide.¹

It is not typical for childhood and adolescence and therefore can be very difficult to diagnose. Red flags that can alert the physician to depression in a child include recent changes in behavior or a drop in school performance.²

Students in college show higher prevalence of mental health issues as compared to general population. ³ Main reasons contributing to depression among medical college students can be assembled as academic, socio personal, and financial.⁴ Medical schools typically use a curriculum involving educational lectures, modelling, supervised practice, mentoring, and hands-on experience to augment individual study. Unfortunately, some aspects of the training process can have unintended negative consequences on student’s personal health. Recent studies suggest that medical students experience a high degree of personal distress.⁵

This study was undertaken to assess the prevalence of depression among medical undergraduate students and to evaluate the contributing factors.

Materials and Methods

The present study was a questionnaire based cross sectional study conducted at Bangalore Medical College, Bengaluru. A previous study done by Raghav Gupta et al.,⁶ reported an average Patient Health Questionnaire (PHQ-9) score of 5.8±4.3. 46.8% students (n=104) suffered from no depression, while 79 (35.6%), 26 (11.7%), 12 (5.4%) and 1 (0.5%) had mild, moderate, moderately severe, and severe depression, respectively. Based on this data, the sample size of the present study was estimated using the below mentioned formula.

n = Zα² pq/ d²

• Where Zα = Standard table value for 95% confidence interval

• p= proportion of depression among MBBS students i.e., 53.2%

• q= 100-p = 46.8%

• d = absolute precision= 7%

Zα² pq/ d²

= 3.84×53.2×46.8 

    (7)²

= 9560.6

  49

= 195

Final sample size calculated was 195, which was rounded off to 200.

After obtaining approval from the institutional ethics committee, and permission from Director cum Dean, the subjects fulfilling the inclusion criteria were be enrolled. Informed consent was obtained from all the participants included. Samples were collected by universal sampling method.

A validated, semi structured questionnaire was administered among the participants. This questionnaire consisted of two parts: the socio-personal characteristics and patient health questionnaire.

From each year, 50 students were randomly selected using simple random sampling method and the numbers were selected through random number generator.

Inclusion criteria

All students aged 18 years and above, and willing to participate in the study.

Exclusion criteria

Students already diagnosed with some mental illness, such as depression.

Depression was assessed using patient health questionnaire-9.⁷ Score for each question in PHQ-9 ranged from 0 to 3 (from ‘not at all’ to ‘almost every day’) based on the frequency of symptoms experienced. The total score ranged from 0 to 27, with greater score reflecting more frequent depressive symptoms. PHQ-9 score of greater than or equal to 10, with sensitivity of 88% and specificity of 88% was used to determine if the student met criteria for depression.

The data collected was entered in Microsoft Excel and was analyzed using SPSS version 21.0. Sociodemographic data was presented using descriptive statistics, namely mean, median, standard deviation, interquartile range (IQR), percentage, wherever applicable. The factors associated with the quantitative variable were analyzed using independent t test /Mann Whitney u test and Chi-square test. Appropriate parametric and non-parametric tests were applied wherever applicable. Data were presented in the form of tables, figures, and graphs, wherever necessary

Results

Demographic details

A total 207 students from all the years participated in the study. 

Out of 207 participants, 54 (26%) showed minimal depression, 84 (40.5%) participants presented mild depression, 39 (18.8%) moderate depression, 19 (9%) moderately severe depression, and 11 (5%) participants showed severe depression (Figure 1).

It was found that 69 (33.3%) participants had a score equal to or more than 10, while 138 (66.6%) participants had a score from 0-9. Thus, the prevalence of depression was calculated to be 33.3% (Figure 2).

Discussion

The physical and mental health of people related to health care, especially interns, is often neglected by themselves. It is a topic of keen interest to know how depressed are the budding doctors in Bangalore Medical College and Research Institute (BMCRI), since it is one of the largest medical teaching institutions in Karnataka. Expert mental health and human resource professionals opine that work-place stress can lead to depression, which is a common mental health disorder and is amenable to treatment if identified earlier. Hence the present study was undertaken to estimate the magnitude of depression among medical undergraduates of BMCRI and to identify the factors associated with it.

In a cross-sectional online survey conducted by Grover et al., (2018) in Chandigarh, 30.1% of the participants were found to have depression when a cut-off of 10 was used for PHQ-9 total score.⁸ Zaman et al., reported the prevalence of depression among medical residents of a teaching hospital in Dhaka, Bangladesh in 2013 to be 39.6%. The study instrument used in their study was Hamilton Depression rating scale (HAM-D) and the sample size was only 100.⁹

Conclusion

An in-depth understanding of the mental health issues of medical postgraduate students could help in formulating and implementing policies regarding their duty hours and academic training. The present study was conducted to estimate the prevalence of depression among undergraduates and interns of Bangalore Medical College and Research Institute. A total of 207 students participated in the study and the prevalence of depression was estimated to be 33.3%.

This calls for a necessity to change the working conditions or working hours of resident doctors favorably, not only to enhance productivity, but also to promote their overall mental health. However, factors like age of the participants or family history of depression are not amenable to change. But it can make the mentors of postgraduates to be watchful and screen them from time to time for development of any adverse mental health outcomes. 

Recommendations

Depression among medical undergraduates is a research subject that has received limited attention. Lifestyle changes are the best measures to prevent depression and, we can create a friendly environment for all the students to express their problems to teachers or to their friends.

Limitations of the study

• The present study was a cross-sectional study and did not evaluate the longitudinal perspective of the problem. A single-time evaluation was done and the participants were not followed up to observe the trends of depression.
• The study was conducted in a single center. Multi-centric studies including private medical institutions would yield better results and provide an opportunity for comparison.

Conflict of interest

None

Acknowledgement

We would like to first acknowledge Director cum Dean of Bangalore Medical College & Research Institute, Bengaluru for permitting us to take up the depression study in Under graduates. We would also like to thank the State for their support and guidance towards the survey.