|Year : 2021 | Volume
| Issue : 3 | Page : 116-121
Prevalence of depression, anxiety, stress, and substance use among medical undergraduates
Pooja Chauhan1, Sushma Katkuri2
1 Department of Community Medicine, RVM Institute of Medical Sciences and Research Center, Siddipet, Telangana, India
2 Department of Community Medicine, ESIC Medical College and Hospital, Hyderabad, Telangana, India
|Date of Submission||02-Mar-2021|
|Date of Decision||04-Apr-2021|
|Date of Acceptance||01-May-2021|
|Date of Web Publication||25-Sep-2021|
Dr. Pooja Chauhan
Department of Community Medicine, RVM Institute of Medical Sciences and Research Center, Laxmakkapally Village, Mulugu, Siddipet, Telangana - 502 279
Source of Support: None, Conflict of Interest: None
Background: Prevalence of anxiety and depression indicates the mental health status of the community. Prevalence of stress among the medical students varies from 12% to 73%. They affect their curriculum. Substance use affects their health and academics. It has been estimated by the World Health Organization that there are about 2 billion people who use alcohol, 1.3 billion people who smoke, and 185 million people who use the drugs.
Objective: The objective is to study the prevalence of depression, anxiety, stress, and substance use among medical undergraduates.
Materials and Methods: This cross-sectional survey was conducted among 243 medical and students of a medical college, during the period of November to December 2015. The students were contacted keeping the privacy, and the data were collected in the prescribed study questionnaire. The name, batch, or registration number was not enquired to maintain the confidentiality.
Results: The prevalence of depression was 39.1%; mild = 15.2%; extremely severe = 0.8%; moderate = 18.5%. The prevalence of anxiety was 48.5%; mild = 11.5%; extremely severe = 8.6%; moderate = 14.8%. The prevalence of stress was 34.6%; mild = 18.9%; extremely severe = 0.8%. 97 students expressed their inability to concentrate during classes. 15.2% were involved in violence while 14% had thoughts of self-harm/suicide. 54.2% preferred parents as their primary support approach for mental support. 23.5% told the reason for not approaching mentors as they were not accessible. The prevalence of smoking was 5.7%; that of alcohol was 5.7%; and that of tobacco chewing was 3.3%. 12.2% had father as their role model for substance use and 3.6% initiated it out of curiosity.
Conclusion: The prevalence of depression, anxiety, and stress as well as substance use was high in these medical and students. Consequences of mental health issues are lethal. Father was the most common role model for substance use among these students.
Keywords: Anxiety, depression, medical, prevalence, stress, substance use
|How to cite this article:|
Chauhan P, Katkuri S. Prevalence of depression, anxiety, stress, and substance use among medical undergraduates. MRIMS J Health Sci 2021;9:116-21
| Introduction|| |
Prevalence of anxiety and depression indicates the mental health status of the community. Studies have shown that the prevalence of stress among the medical students varies from 12% to 73%.,
World Health Organization (WHO) recognized the importance of mental health as an important component of overall health of an individual. Mental health issues are an important public health problem because of its increasing prevalence and the morbidity it causes. If left unattended, mental health problems can lead to extreme morbidity and mortality. Lack of proper sleep, feeling of weakness, irritability, and tension of the muscles are some of the symptoms which are common to depression and anxiety. Not feeling interested in the daily activities is one of the prominent symptoms of the depression along with improper pattern of the sleep, feeling weakness, not able to concentrate, and guilt feeling.
By the time an individual reaches adulthood, majority of the mental health problems start manifesting. Among these populations, these mental health issues are associated with the disturbances of the emotions. These mental health issues among the college students affect their curriculum. The stress among the college students is caused by pressure of studies, overworking, competition stress, high parent expectations, strain in the new personal relationships, being female, etc.
Substance use among college students affect their health and academics. It is a global problem. It has been estimated by the WHO that there are about 2 billion people who use alcohol, 1.3 billion people who smoke, and 185 million people who use drugs. Students commonly abuse substances such as tobacco, alcohol, modern medicines, and cannabis even though they are aware of its harmful effects on their health for a variety of reasons. The prevalence of substance use among the students as well as among the medical students has been found to vary from 20% to 40% in India.,
With this background, the present study was undertaken to determine the prevalence of depression, anxiety, and stress, as well as the prevalence of substance use, among medical undergraduates studying in a premier medical institution of Hyderabad.
| Materials and Methods|| |
This cross-sectional survey was conducted among 243 medical and students of Malla Reddy Institute of Medical Sciences and Malla Reddy Institute of Sciences, respectively, during the period of November to December 2015. The students were contacted keeping the privacy, and the data were collected in the prescribed study questionnaire. The name, batch, or registration number was not enquired to maintain the confidentiality. Institution ethics committee permission was obtained.
Written informed consent from the dean of the respective college was obtained. Students enrolled at least 6 months prior were included in the study. Oral informed consent was obtained from each of the participants and those who agreed were included in the study.
A predesigned, pretested, semi-structured, anonymous, self-administered questionnaire was used. Information was collected on basic sociodemographic (such as age, gender, semester, and course) and personal characters (living arrangements, any history of death or divorce in family, alcohol intake, and tobacco chewing). A previously validated and standardized survey instrument (Depression Anxiety and Stress Scale [DASS] 42) was used to assess the information on depression, anxiety, and stress which consists of 42 symptoms divided into 3 subscales and 14 items. Questionnaire regarding educational stress among students was also used. A Likert 5-point scale is used as a response format ranging from “0” – never faced to “5” – high impact. Queries regarding perceived pressure, peer pressure, lack of concentration levels, dissatisfaction with academic grades, over stress, and parental pressure in academics were included. Any past history of suicidal attempts and thoughts of self-harm were also assessed through this questionnaire. Deaths in family or divorce between parents which can bring about changes in the mental health status were also assessed. Student's way of coping up with stress and whom they approach for their mental health support was included. A step further, students were also asked whether he/she is addicted to any of health hindrance substances such as tobacco chewing and alcohol intake, and if they were addicted, the reasons behind initiation of substance use and any role model using those substances were also assessed.
The data were analyzed using proportions.
| Results|| |
The present study was conducted to assess the prevalence of depression, anxiety, stress, educational stress, and substance abuse among medical students.
[Table 1] shows the student characteristics. A total of 243 students participated in the survey. Of them, 172 (70.8%) were medical students and 71 (29.2%) were students. 13 (5.3%) students among the 243 did not mention their gender. Among the remaining 230, 53 (21.8%) were male and 177 (72.8%) were female. The age of the students who participated ranged 17–21 years. Of the 243, 19 (7.8%) students did not mention their age. There was only one (0.4%) student at the age of 17. Students aged between 18 and 20 years were 220 (90.5%). Those aged 21 years were 3 (1.2%). Of the 243 students, 97 (39.9%) students did not mention whether they were staying with or away from their families. Among the rest, 89 (36.6%) students lived with their family whereas 57 (23.5%) lived away from them.
[Table 2] shows the prevalence of depression, anxiety, and stress. Depression was found among 95 (39.1%) of the total students, ranging from mild (n = 37, 15.2%) to extremely severe (n = 2, 0.8%). More students were found to be moderately depressed (n = 45, 18.5%). Anxiety was found more prevalent among the students (n = 118, 48.5%), ranging from mild (n = 28, 11.5%) to extremely severe (n = 21, 8.6%). Most of them were moderately anxious (n = 36, 14.8%). Of the total participants, 84 (34.6%) students were found to be the victims of stress, scaling from mild (n = 46, 18.9%) to extremely severe (n = 2, 0.8%).
[Table 3] shows educational stress reasons and feeling among the students. About 56 (23.0%) students felt pressurized by their daily studies. Those who felt it constantly were 26 (10.7%). 54 (22.2%) students felt that there was too much competition among their classmates, which brought them a lot of academic pressure. 28 (11.5%) of them were extremely pressurized because of this. 73 (30%) students took a lot of academic pressure considering their future education and employment. Of them, the severely disturbed students were 34 (14%). 97 (39.9%) students felt it very difficult to concentrate during classes. 45 (18.5%) of them said that they could not concentrate at all. 49 (20.2%) students were not satisfied with their academic grades. 16 (6.6%) among them disturbed constantly by this feeling. Among 243, 89 (36.6%) students felt that there are too many examinations/tests in college. Most of them (n = 54, 22.2%) were stressed out all the time. 45 (18.5%) students felt that their parents cared too much about their grades which brought them a lot of academic pressure, in which 20 (8.2%) were extremely pressurized. 48 (19.8%) students could not sleep because of worry when they could not meet the goals they set for themselves.
Among the total of 243 students, 37 (15.2%) students admitted that they were involved in violence in the past 1 year. 34 (14.0%) students were under high stress which led to the thoughts of self-harm/suicide. 28 (11.5%) students had a history of attempting suicide, reasons for which were not studied [Table 4].
There were multiple responses when they were asked who they preferred to approach for their mental support. Most of the responses included parents as their primary support for their mental health (n = 132, 54.2%). 118 (48.5%) students felt comfortable to communicate with their friends. About 59 (24.3%) students felt that their siblings were approachable. Very few students (n = 8, 3.2%) went to their academic mentors for mental support. About 15 (6.1%) students mentioned others whom they would approach and 24 (9.9%) students did not feel comfortable with anyone in sharing their problems in times of stress [Table 5].
[Table 6] shows the reasons for not approaching their mentors (N = 240). Of the total of 243 students, only 8 (3.2%) were comfortable enough to approach their academic mentors for their mental support. The remaining 240 (98.8%) were asked the reasons for not approaching their mentors. 57 (23.5%) students felt that their mentors were not accessible. 123 (50.6%) students mentioned that because their relationship was not that strong, they did not feel comfortable to approach. 55 (22.6%) students mentioned some other reasons.
[Table 7] shows the prevalence of substance use among students. About 14 (5.7%) students admitted that they were resorting to smoking. Of them, 4 (1.6%) were current users. 14 (5.7%) students resorted to drinking, in which 4 (1.6%) were currently using. About 8 (3.3%) students were resorting to tobacco chewing. Of them, 2 (0.8%) were current users.
[Table 8] shows the reasons and role models for substance use among the students. There were multiple responses given by the students upon being questioned if they had ever seen their role models using the substance. 184 (75.72%) did not mention any role model using substance. Most of the students (n = 30, 12.2%) mentioned their fathers as the role model. Second highest response was that their friends were the role models who were using substance (n = 20, 8.1%). 13 (5.2%) mentioned their mothers as role models, and 9 (3.6%) mentioned their siblings. 15 (6.1%) students mentioned their favorite celebrities to be using substance. Very few (n = 5, 2%) students mentioned their favorite teachers. When asked the reasons for starting substance use, multiple responses were given. Most of the students (n = 9, 3.6%) mentioned curiosity as the main reason. Second common reason for initiation of tobacco use was to relieve the stress (2.8%). 6 (2.4%) admitted that they started using substance for enjoyment and 2 (0.8%) students mentioned that it was because of peer pressure. 2 (0.8%) mentioned various other reasons. Only 0.4% stated that disharmony in their family made them to initiate the tobacco use.
| Discussion|| |
In the present study, the prevalence of depression was 39.1%; mild = 15.2%; extremely severe = 0.8%; moderate = 18.5%. The prevalence of anxiety was 48.5%; mild = 11.5%; extremely severe = 8.6%; moderate = 14.8%. The prevalence of stress was 34.6%; mild = 18.9%; extremely severe = 0.8%. 97 students expressed their inability to concentrate during classes. 15.2% were involved in violence, while 14% had thoughts of self-harm/suicide. 54.2% preferred parents as their primary support approach for mental support. 23.5% told the reason for not approaching mentors as they were not accessible. The prevalence of smoking was 5.7%; that of alcohol was 5.7%; and that of tobacco chewing was 3.3%. 12.2% had father as their role model for substance use and 3.6% initiated it out of curiosity.
Ramón-Arbués et al. studied 1074 college students and found that the prevalence of depression, anxiety, and stress was 18.4%, 23.6%, and 34.5%, respectively. This prevalence was less compared to the present study for depression and anxiety but similar for stress. They reported that younger than 21 years of age, addiction to the internet, lack of sleep, smoking, and low self-esteem were important risk factors for depression, anxiety, and stress.
Bazmi Inam studied 288 male and 105 female students. The prevalence of overall depression and anxiety was 44.4% in males while it was very high in females, i.e. 66.6%, and this was very high compared to the findings of the present study. Suicidal ideation was not reported in their study, while in the present study, it was 14% had expressed it.
Iqbal et al. carried out a cross-sectional study using DASS 42 and found that 51.3% had depression, 66.9% had anxiety, and 53% had stress. These findings are high compared to the findings of the present study.
Fawzy and Hamed estimated the prevalence of depression, anxiety, and stress among 700 medical students using DASS 21. The prevalence of depression, anxiety, and stress was 65%, 73%, and 59.9%, respectively, and very high compared to the findings of the present study. They observed that being female was significantly associated with stress.
Azim and Baig carried out a mixed-method study among 188 medical students using DASS 21. The prevalence of depression, anxiety, and stress was 71%, 72%, and 35%, respectively, which was more compared to the present study, except stress. Students in their study expressed that money problems, poor lifestyle, etc., were some of the factors which increased pressure on them.
Nezam et al. assessed the prevalence of depressive symptoms among 2798 engineering and medical college students. 47.78% of the students were found to have depressive symptoms. It was more in engineering students compared to the medical students, which was 34.74%, which is comparable to the findings of the present study where we found it to be 39.1%.
Sravani et al. assessed depression, anxiety, and stress among the undergraduate students in Hyderabad, Telangana, among 845 students. The mean Depression and Anxiety Score (DAS) score was significantly more in married students compared to unmarried students. Third-year students were found to have significantly more average DAS score. They concluded that clinical years put more stress on the students.
Chatterji et al. carried out a cross-sectional study to assess the tobacco use among the 515 medical students and 349 nonmedical students. They reported that the prevalence of tobacco use (18.3% vs. 43.6%) and smoking (14.9% vs. 40.7%) was less in medical students when compared to non-medical students. Medical students were found to have better knowledge related to tobacco hazards and other related things.
Ramakrishna et al. studied 1189 medical students. They found that the prevalence of tobacco use was 8.7% while we found it to be only 3.3%. The authors reported that 34% of students initiated tobacco use after entry into the medical college. Higher expenditure per month and family history were risk factors for current tobacco use. The odds of tobacco use were 3.2 times more than other year students. Odds of tobacco use were 4.7 times more among those who thought that tobacco use was not harmful.
Kumari and Nath carried out a cross-sectional study among 250 medical students. 28.8% were found to be tobacco users, which is very high compared to the findings of the present study. Residence and religion were not found to be the risk factors for tobacco use. The prevalence of tobacco use was more in hostellers compared to day-scholars.
Arora et al. found that the prevalence of substance abuse was 20.43%. Later years of medical education showed more prevalence. 91.7% of the medical students were aware of the ill effects of substance use. 72.4% said that they used the substance to get relief from stress and the same proportion said it for occasional celebration. 59.6% said that they tried to quit the use.
| Conclusion|| |
The prevalence of depression, anxiety, and stress as well as substance use was high in these medical and students. Consequences of mental health issues are lethal. Father was the most common role model for substance use among these students.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]