Depression, Anxiety and Stress among Undergraduate Students: A Cross Sectional Study
Author(s)
Choon Khim Teh*,
Choon Wei Ngo,
Rashidatul Aniyah binti Zulkifli,
Rammiya Vellasamy,
Kelvin Suresh
ABSTRACT
Background: The prevalence of moderate to extremely severe level of depression, anxiety and stress among undergraduate students in Malaysia was ranging from 13.9% to 29.3%, 51.5% to 55.0% and 12.9% to 21.6% respectively. Medical students have been shown to be more inclined to emotional disorders, especially stress and depression, as compared to their non-medical peers. Therefore, the objective of this cross-sectional study was to determine the prevalence of depression, anxiety and stress among undergraduate students in Melaka Manipal Medical College. Methods: Self-administered questionnaires consisted of 3 sections: demographic data, socioeconomic data and DASS 21 questions. Data processing was performed using Microsoft Excel 2010. The psychological status was categorized according to the presence or absence of depression, anxiety and stress. The data were analyzed using Epi InfoTM 7.1.4 and SPSS. Student’s t-test, Fisher Exact and Chi-square test were used to analyze the associations. P-value of <0.05 was considered as statistically significant. Multiple logistic regression was used to calculate the adjusted Odd Ratio. Results: A total of 397 undergraduates participated in this study. The prevalence of the depression, anxiety and stress, ranging from moderate to extremely severe, was 30.7%, 55.5%, and 16.6% respectively. Multiple logistic regression shows significant associations between relationship status, social life and total family income per month with depression. Only ethnicity has been shown to be significantly associated with anxiety. There are significant associations between ethnicity and total family income per month with stress. No other factors have been found to be significantly associated. Conclusion: Depression, anxiety and stress have a high detrimental effect to individual and society, which can lead to negative outcomes including medical dropouts, increased suicidal tendency, relationship and marital problems, impaired ability to work effectively, burnout and also existing problems of health care provision. With that, there is a need for greater attention to the psychological wellbeing of undergraduate students to improve their quality of life.
Background: The prevalence of moderate to extremely severe level of depression, anxiety and stress among undergraduate students in Malaysia was ranging from 13.9% to 29.3%, 51.5% to 55.0% and 12.9% to 21.6% respectively. Medical students have been shown to be more inclined to emotional disorders, especially stress and depression, as compared to their non-medical peers. Therefore, the objective of this cross-sectional study was to determine the prevalence of depression, anxiety and stress among undergraduate students in Melaka Manipal Medical College. Methods: Self-administered questionnaires consisted of 3 sections: demographic data, socioeconomic data and DASS 21 questions. Data processing was performed using Microsoft Excel 2010. The psychological status was categorized according to the presence or absence of depression, anxiety and stress. The data were analyzed using Epi InfoTM 7.1.4 and SPSS. Student’s t-test, Fisher Exact and Chi-square test were used to analyze the associations. P-value of <0.05 was considered as statistically significant. Multiple logistic regression was used to calculate the adjusted Odd Ratio. Results: A total of 397 undergraduates participated in this study. The prevalence of the depression, anxiety and stress, ranging from moderate to extremely severe, was 30.7%, 55.5%, and 16.6% respectively. Multiple logistic regression shows significant associations between relationship status, social life and total family income per month with depression. Only ethnicity has been shown to be significantly associated with anxiety. There are significant associations between ethnicity and total family income per month with stress. No other factors have been found to be significantly associated. Conclusion: Depression, anxiety and stress have a high detrimental effect to individual and society, which can lead to negative outcomes including medical dropouts, increased suicidal tendency, relationship and marital problems, impaired ability to work effectively, burnout and also existing problems of health care provision. With that, there is a need for greater attention to the psychological wellbeing of undergraduate students to improve their quality of life.
Cite this paper
Teh, C. , Ngo, C. , Zulkifli, R. , Vellasamy, R. and Suresh, K. (2015) Depression, Anxiety and Stress among Undergraduate Students: A Cross Sectional Study. Open Journal of Epidemiology, 5, 260-268. doi: 10.4236/ojepi.2015.54030.
Teh, C. , Ngo, C. , Zulkifli, R. , Vellasamy, R. and Suresh, K. (2015) Depression, Anxiety and Stress among Undergraduate Students: A Cross Sectional Study. Open Journal of Epidemiology, 5, 260-268. doi: 10.4236/ojepi.2015.54030.
References
[1] World Health Organization (2013) WHO Definition of Health. WHO, Geneva.
http://www.who.int/about/definition/en/print.html [2] Russ, T.C., Stamatakis, E., Hamer, M., Starr, J.M., Kivimaki, M. and Batty, G.D. (2013) Association between Psychological Distress and Mortality: Individual Participant Pooled Analysis of 10 Prospective Cohort Studies. British Medical Journal, 345, e4933.
http://dx.doi.org/10.1136/bmj.e4933 [3] Al-Naggar, R.A. and Al-Naggar, D.H. (1987) Prevalence and Associated Factors of Emotional Disorders among Malaysian University Students. International Journal of Collaborative Research on Internal Medicine & Public Health, 4. [4] Saravanan, C. and Wilks, R. (2014) Medical Students’ Experience of and Reaction to Stress: The Role of Depression and Anxiety. The Scientific World Journal, 2014, Article ID 737382.
http://dx.doi.org/10.1155/2014/737382 [5] Wong, J.G.W.S., Cheung, E.P.T., Chan, K.K.C., Kamela, K.M. and Tang, S.W. (2006) Web-Based Survey of Depression, Anxiety and Stress in First-Year Tertiary Education Students in Hong Kong. Australian and New Zealand Journal of Psychiatry, 40, 777-782.
http://dx.doi.org/10.1080/j.1440-1614.2006.01883.x [6] Saddichha, S. and Christoday, K.R.J. (2010) Prevalence of Depression, Anxiety, and Stress among Young Male Adults in India: A Dimensional and Categorical Diagnoses-Based Study. Journal of Nervous & Mental Disease, 198, 901-904.
http://dx.doi.org/10.1097/NMD.0b013e3181fe75dc [7] Gan, W.Y., Mohd Nasir, M.T., Shariff, Z.M. and Hazizi, A.S. (2011) Disordered Eating Behaviours, Depression, Anxiety and Stress among Malaysian University Students. College Student Journal, 45, 296. [8] Al-Ani, Radeef, A.S. and Ghazi, F.G. (2015) Depression, Anxiety and Stress among Undergraduate Science Students in Malaysia. 17th Johor Mental Health Conference, Malaysia, 17-18 April 2015, Unpublished.
http://irep.iium.edu.my/42809/ [9] Radeef, A.S., Faisal, G.G., Ali, S.M. and Ismail, M.K.H.M. (2014) Source of Stressors and Emotional Disturbances among Undergraduate Science Students in Malaysia. International Journal of Medical Research & Health Sciences, 3, 401-410.
http://dx.doi.org/10.5958/j.2319-5886.3.2.082 [10] Safree, M.A., Yasin, M. and Dzulkifli, M.A. (2011) Differences in Depression, Anxiety and Stress between Low- and High-Achieving Students. Journal of Sustainability Science and Management, 6, 169-178.
http://jssm.umt.edu.my/files/2012/01/19.June11.pdf [11] Zaid, Z.A., Chan, S.C. and Ho, J.J. (2007) Emotional Disorders among Medical Students in a Malaysian Private Medical School. Singapore Medical Journal, 48, 895-899. [12] Ronk, F.R., Korman, J.R., Hooke, G.R. and Page, A.C. (2013) Assessing Clinical Significance of Treatment Outcomes Using the DASS-21. Psychological Assessment, 25, 1103-1110. [13] Gomez, F. A Guide to the Depression, Anxiety and Stress Scale.
http://www.iwsml.org.au/images/mental_health/Frequently_Used/Outcome_Tools/Dass21.pdf [14] Anonymous (2014) Overview of the DASS and Its Uses.
http://www2.psy.unsw.edu.au/Groups/Dass/over.htm [15] Anonymous (2013) Depression Anxiety Stress Scale-21 (DASS-21).
http://www.scireproject.com/outcome-measures-new/depression-anxiety-stress-scale-21-dass-21 [16] Henry, J.D. and Crawford, J.R. (2010) The Short-Form Version of the Depression Anxiety Stress Scales (DASS-21): Construct Validity and Normative Data in a Large Non-Clinical Sample. British Journal of Clinical Psychology, 44, 227-239. [17] Nieuwenhuijsen, K., de Boer, A.G.E.M., Verbeek, J.H.A.M., Blonk, R.W.B. and vanDijk, F.J.H. (2002) The Depression Anxiety Stress Scales (DASS): Detecting Anxiety Disorder and Depression in Employees Absent from Work Because of Mental Health Problems. Occupational & Environmental Medicine, 60, i77-i82.
http://oem.bmj.com/content/60/suppl_1/i77.short
http://dx.doi.org/10.1136/oem.60.suppl_1.i77 [18] Shamsuddin, K., Fadzil, F., Wan Ismail, W.S., Azhar Shah, S., Omar, K., Muhammad, N.A., et al. (2013) Correlates of Depression, Anxiety and Stress among Malaysian University Students. Asian Journal of Psychiatry, 6, 318-323. [19] Cohen, S. and Wills, T.A. (1985) Stress, Social Support, and the Buffering Hypothesis. Psychological Bulletin, 98, 310-357.
http://psycnet.apa.org/journals/bul/98/2/310/
http://dx.doi.org/10.1037/0033-2909.98.2.310 [20] Cohen, S. and Hoberman, H.M. (1983) Positive Events and Social Supports as Buffers of Life Change Stress. Journal of Applied Social Psychology, 13, 99-125.
http://repository.cmu.edu/cgi/viewcontent.cgi?article=1264&context=psychology
http://dx.doi.org/10.1111/j.1559-1816.1983.tb02325.x [21] Everson, S.A., Maty, S.C., Lynch, J.W. and Kaplan, G.A. (2002) Epidermiological Evidence for the Relation between Socioeconomic Status and Depression, Obesity, and Diabetes. Journal of Psychosomatic Research, 53, 891-895.
http://deepblue.lib.umich.edu/handle/2027.42/51444
http://dx.doi.org/10.1016/S0022-3999(02)00303-3 [22] Monroe, M.L., Edward, P.T. and Neal, H.G. (1980) Childhood Depression, Family Income, and Locus of Control. Journal of Nervous & Mental Disease, 168, 732-735. [23] MohdSidik, S., Rampal, L. and Kaneson, N. (2003) Prevalence of Emotional Disorders among Medical Students in a Malaysian University. Asia Pacific Family Medicine, 2, 213-217. [24] Kean, D. and Pamela, E. (2005) The Influence of Parent Education and Family Income on Child Achievement: The Indirect Role of Parental Expectations and the Home Environment. Journal of Family Psychology, 19, 294-304.
http://psycnet.apa.org/journals/fam/19/2/294/
http://dx.doi.org/10.1037/0893-3200.19.2.294 [25] Radeef, A.S., Faisal, G.G., Ali, S.M. and Ismail, M.K.H.M. (2014) Source of Stressors and Emotional Disturbances among Undergraduate Science Students in Malaysia. International Journal of Medical Research & Health Sciences, 3, 401-410.
[1] World Health Organization (2013) WHO Definition of Health. WHO, Geneva.
http://www.who.int/about/definition/en/print.html [2] Russ, T.C., Stamatakis, E., Hamer, M., Starr, J.M., Kivimaki, M. and Batty, G.D. (2013) Association between Psychological Distress and Mortality: Individual Participant Pooled Analysis of 10 Prospective Cohort Studies. British Medical Journal, 345, e4933.
http://dx.doi.org/10.1136/bmj.e4933 [3] Al-Naggar, R.A. and Al-Naggar, D.H. (1987) Prevalence and Associated Factors of Emotional Disorders among Malaysian University Students. International Journal of Collaborative Research on Internal Medicine & Public Health, 4. [4] Saravanan, C. and Wilks, R. (2014) Medical Students’ Experience of and Reaction to Stress: The Role of Depression and Anxiety. The Scientific World Journal, 2014, Article ID 737382.
http://dx.doi.org/10.1155/2014/737382 [5] Wong, J.G.W.S., Cheung, E.P.T., Chan, K.K.C., Kamela, K.M. and Tang, S.W. (2006) Web-Based Survey of Depression, Anxiety and Stress in First-Year Tertiary Education Students in Hong Kong. Australian and New Zealand Journal of Psychiatry, 40, 777-782.
http://dx.doi.org/10.1080/j.1440-1614.2006.01883.x [6] Saddichha, S. and Christoday, K.R.J. (2010) Prevalence of Depression, Anxiety, and Stress among Young Male Adults in India: A Dimensional and Categorical Diagnoses-Based Study. Journal of Nervous & Mental Disease, 198, 901-904.
http://dx.doi.org/10.1097/NMD.0b013e3181fe75dc [7] Gan, W.Y., Mohd Nasir, M.T., Shariff, Z.M. and Hazizi, A.S. (2011) Disordered Eating Behaviours, Depression, Anxiety and Stress among Malaysian University Students. College Student Journal, 45, 296. [8] Al-Ani, Radeef, A.S. and Ghazi, F.G. (2015) Depression, Anxiety and Stress among Undergraduate Science Students in Malaysia. 17th Johor Mental Health Conference, Malaysia, 17-18 April 2015, Unpublished.
http://irep.iium.edu.my/42809/ [9] Radeef, A.S., Faisal, G.G., Ali, S.M. and Ismail, M.K.H.M. (2014) Source of Stressors and Emotional Disturbances among Undergraduate Science Students in Malaysia. International Journal of Medical Research & Health Sciences, 3, 401-410.
http://dx.doi.org/10.5958/j.2319-5886.3.2.082 [10] Safree, M.A., Yasin, M. and Dzulkifli, M.A. (2011) Differences in Depression, Anxiety and Stress between Low- and High-Achieving Students. Journal of Sustainability Science and Management, 6, 169-178.
http://jssm.umt.edu.my/files/2012/01/19.June11.pdf [11] Zaid, Z.A., Chan, S.C. and Ho, J.J. (2007) Emotional Disorders among Medical Students in a Malaysian Private Medical School. Singapore Medical Journal, 48, 895-899. [12] Ronk, F.R., Korman, J.R., Hooke, G.R. and Page, A.C. (2013) Assessing Clinical Significance of Treatment Outcomes Using the DASS-21. Psychological Assessment, 25, 1103-1110. [13] Gomez, F. A Guide to the Depression, Anxiety and Stress Scale.
http://www.iwsml.org.au/images/mental_health/Frequently_Used/Outcome_Tools/Dass21.pdf [14] Anonymous (2014) Overview of the DASS and Its Uses.
http://www2.psy.unsw.edu.au/Groups/Dass/over.htm [15] Anonymous (2013) Depression Anxiety Stress Scale-21 (DASS-21).
http://www.scireproject.com/outcome-measures-new/depression-anxiety-stress-scale-21-dass-21 [16] Henry, J.D. and Crawford, J.R. (2010) The Short-Form Version of the Depression Anxiety Stress Scales (DASS-21): Construct Validity and Normative Data in a Large Non-Clinical Sample. British Journal of Clinical Psychology, 44, 227-239. [17] Nieuwenhuijsen, K., de Boer, A.G.E.M., Verbeek, J.H.A.M., Blonk, R.W.B. and vanDijk, F.J.H. (2002) The Depression Anxiety Stress Scales (DASS): Detecting Anxiety Disorder and Depression in Employees Absent from Work Because of Mental Health Problems. Occupational & Environmental Medicine, 60, i77-i82.
http://oem.bmj.com/content/60/suppl_1/i77.short
http://dx.doi.org/10.1136/oem.60.suppl_1.i77 [18] Shamsuddin, K., Fadzil, F., Wan Ismail, W.S., Azhar Shah, S., Omar, K., Muhammad, N.A., et al. (2013) Correlates of Depression, Anxiety and Stress among Malaysian University Students. Asian Journal of Psychiatry, 6, 318-323. [19] Cohen, S. and Wills, T.A. (1985) Stress, Social Support, and the Buffering Hypothesis. Psychological Bulletin, 98, 310-357.
http://psycnet.apa.org/journals/bul/98/2/310/
http://dx.doi.org/10.1037/0033-2909.98.2.310 [20] Cohen, S. and Hoberman, H.M. (1983) Positive Events and Social Supports as Buffers of Life Change Stress. Journal of Applied Social Psychology, 13, 99-125.
http://repository.cmu.edu/cgi/viewcontent.cgi?article=1264&context=psychology
http://dx.doi.org/10.1111/j.1559-1816.1983.tb02325.x [21] Everson, S.A., Maty, S.C., Lynch, J.W. and Kaplan, G.A. (2002) Epidermiological Evidence for the Relation between Socioeconomic Status and Depression, Obesity, and Diabetes. Journal of Psychosomatic Research, 53, 891-895.
http://deepblue.lib.umich.edu/handle/2027.42/51444
http://dx.doi.org/10.1016/S0022-3999(02)00303-3 [22] Monroe, M.L., Edward, P.T. and Neal, H.G. (1980) Childhood Depression, Family Income, and Locus of Control. Journal of Nervous & Mental Disease, 168, 732-735. [23] MohdSidik, S., Rampal, L. and Kaneson, N. (2003) Prevalence of Emotional Disorders among Medical Students in a Malaysian University. Asia Pacific Family Medicine, 2, 213-217. [24] Kean, D. and Pamela, E. (2005) The Influence of Parent Education and Family Income on Child Achievement: The Indirect Role of Parental Expectations and the Home Environment. Journal of Family Psychology, 19, 294-304.
http://psycnet.apa.org/journals/fam/19/2/294/
http://dx.doi.org/10.1037/0893-3200.19.2.294 [25] Radeef, A.S., Faisal, G.G., Ali, S.M. and Ismail, M.K.H.M. (2014) Source of Stressors and Emotional Disturbances among Undergraduate Science Students in Malaysia. International Journal of Medical Research & Health Sciences, 3, 401-410.