TITLE PAGE

THE PREVALENCE OF DEPRESSION AMONG MEDICAL

STUDENTS OF THE UNIVERSITY OF JOS

BY

ORSAR D. O. UJ/2007/MD/0319

AGUBE V. G. UJ/2007/MD/0320

HARUNA F. A. UJ/2007/MD/0321

A PROJECT SUBMITTED TO THE DEPARTMENT OF COMMUNITY

MEDICINE, FACULTY OF MEDICAL SCIENCES UNIVERSITY OF

JOS, IN PARTIAL FULFILMENT FOR THE AWARD OF BACHELOR

OF MEDICINE, BACHELLOR OF SUERGERY DEGREE OF THE

UNIVERSITY OF JOS, PLATEAU STATE NIGERIA.

JUNE, 2015.

DECLARATION

We hereby declare that this is our original work done under appropriate

supervision that it has not been presented in part in whole for another

examination or the award of another degree.

AGUBE V.G UJ/2007/MD/0320 ………………………………..

HARUNA F.A UJ/2007/MD/0321 …………………………………

CERTIFICATION

I certify that I supervised this work and it has fulfilled the minimum

requirement for the award of Bachelor of medicine, Bachelor of surgery

(MBBS) Degree of university of Jos, Nigeria.

…..……………………… ………………………………

Dr D.A Bello Date

(Supervisor)

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………………………………. ……………………………

Dr O.O Chirdan Date

Head of Department,

Community Medicine,

University of Jos.

DEDICATION

We dedicate this work to God Almighty who made it possible for us to carry out

this project. It was His strength and grace that made this possible.

3
 ACKNOWLDGMENT

This work has been carried out to a successful completion because we rode on

the shoulders of those who went ahead of us, whose contribution in no small

measure made this project successful.

We express our profound gratitude to God Almighty for making this work a

reality.

Our appreciation also goes to our supervisor Dr. D.A Bello, whose constant

input and guidance made the work a lot easier for us. We also acknowledge the

contributions of the head of department of community medicine, Dr O.O

Chirdan.

Our thanks go to our lovely parents for their support and provision towards the

success of our project, Mr. and Mrs. M. Orsar, Mr. and Mrs Agube and Mr. and

Mrs. Haruna.

Thanks also go to Dr. Davo, of the department of Psychiatry Jos University

Teaching Hospital (JUTH) who also contributed immensely.

We are grateful to the medical students of University of Jos for their efforts in

our data collection.

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Indeed we are grateful to you all for making this work a great success.

TABLE OF CONTENTS

Title page………………………………………………………………………1

Declaration……………………………………………………………………..2

Certification…………………………………………………………………....3

Dedication…………………………………………………………….………..4

Acknowledgment ……………………………………………….………….…. 5

Table of contents………………………………………………….…….………6

List of tables ……………………………………………………………….…. 9

List of abbreviations …………………………………………………………. 10

Abstract ………………………………………………………………………. 11

Chapter one

1.0 Introduction …………………………………………………………….. 12

1.1Background ……………………………………………………………… 12

1.2Statement of problem ……………………………………………………. 13

1.3 Rationale of study ………………………………………………………. 15

1.4. Objective of the study ………………………………………………….. 17

1.4.1 General objective …………………………………………………….. 16

1.4.2 Specific objective …………………………………………………….. 16

Chapter two

5
1.0 Literature review ………………………………………………………… 17

2.1 Introduction ……………………………………………………………… 17

2.2 Prevalence of depression ………………………………………………….

2.3 Factors that precipitate depression ………………………………………..

2.4 Coping strategy for depression …………………………………………….

Chapter three

2.0 Research methodology ……………………………………………………

3.1 Study area …………………………………………………………………..

3.2 study population …………………………………………………………..

3.3 Study design ………………………………………………………………

3.4 Sample size ………………………………………………………………..

3.5 Sampling technique ……………………………………………………..

3.6 Tools for data collection …………………………………………………..

3.7 Data analysis ………………………………………………………………..

3.7.1 Interpretation of the beck’s depression inventory …………………………

3.8 Ethical consideration ………………………………………………………..

3.9Limitation ………………………………………………………………..

Chapter four

4.0 Results …………………………………………………………………….

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4.1 Socio-demographic characteristics of the respondents ……………………

4.2 Prevalence of depression among medical students ……………………..

4.3 Factors that predispose to depression …………………………………..

4.3.1 Loss of someone ……………………………………………………

4.3.2 Childhood experience …………………………………………………..

4.3.3 Sexual abuse ………………………………………………………………

4.3.4 Smoking ………………………………………………………………….

4.3.5 Alcohol ……………………………………………………………….

4.3.6 Academic challenge ………………………………………………..

4.3.7 Weight …………………………………………………………………..

4.3.8 Health ……………………………………………………………………

4.4 Coping mechanism ……………………………………………………

Chapter five

3.0 Discussion ……………………………………………………………….

5.1 Prevalence of depression ……………………………………………

5.2 Factors that predispose to depression ………………………………

5.3 Coping mechanism for depression ………………………………….

Chapter six

6.0 Conclusion and recommendations ……………………………….

6.1 Conclusion ……………………………………………………….

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6.2 Recommendation ………………………………………………….

References ………………………………………………………………….

Appendix …………………………………………………………………

List of tables

Table 1 Socio-demographic characteristics of respondents

Table 2 Prevalence of depression

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Table 3 Relationship between bereavement and depression

Table 4 Relationship between childhood experience and depression

Table 5 Relationship between sexual abuse and depression

Table 6 Relationship between smoking and depression

Table 7 Relationship between alcohol consumption and depression

Table 8 Relationship between academic challenge and depression

Table 9 Academic stressors of depression

Table 10 Relationship between weight and depression

Table 11 Relationship between health and depression

Table 12 Coping mechanisms among depressed students

LIST OF ABBREVIATIONS

WHO: World Health Organization

JUTH: Jos University Teaching Hospital

BDI: Becks Depression Inventory

DSM: Diagnostic and Statistical Manual of mental disorders

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 ABSTRACT

BACKGROUND

Depression is becoming a major global burden of disability. It is said that nearly

half of the world population will develop one form of depression or the other.

As medical students are a part of the global society, they are not exempted as

they are daily exposed to academic, psychosocial and health related events

which predisposed them to depression. This study was carried out to ascertain

the degree of mental depression, predisposing factors and coping mechanism

among medical students.

METHODS: A cross sectional descriptive study design using a self-

administered questionnaire was used to assess two hundred and seventy five

(275) medical students.

RESULTS: The mean age of respondents was 25+5 years. The prevalence of

depression was 13.8%. The factors that predisposed to depression were:

10
smoking, alcohol consumption, academic challenge and health challenge. Most

of the students cope by smoking or alcohol consumption.

CONCLUSIONS: The prevalence of depression among medical students in

University of Jos is low. This because most of the factors that predispose to

depression within students environment such as

It was recommended that students who are depressed should visit the University

clinic for appropriate intervention and the University should put in place

modalities for periodic screening of students.

CHAPTER ONE

1.0 INTRODUCTION
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1.1 BACKGROUND OF STUDY

Depression is a common mental disorder characterised by sadness, loss of

interest or pleasure, feeling of guilt or low self-worth, disturb sleep or appetite,

feeling of tiredness or poor concentration. It can be long standing or recurrent,

substantially impairing a person ability to function at school or work or cope

with daily life.1Depression is frequent in primary care and general hospital

practice but is often undetected. The central features of depression are low

mood, pessimistic thinking, lack of enjoyment, reduced energy, poor

concentration and low self-esteem.2

The symptoms of depression vary in severity therefore the disorder is classified

as mild, moderate and severe. The mild form is characterized by complains of

low mood, lack of energy and enjoyment, and poor sleep. Mood may vary

during the day; usually it is worse in the evening than in the morning in contrast

to the more severe forms.2Moderate depression is characterized by symptoms of

moderate severity; central features are low mood, lack of enjoyment, reduced

energy and pessimistic thinking. Restlessness and slowing down of mental and

motor activities and depressed individuals show no enthusiasm for activities and

hobbies that they will normally enjoy accompanied by reduced energy, poor

concentration and complaint of poor memory. They may have some depressive

thinking like seeing the unhappy side of every event, always expecting the

worst and unreasonable guilt about trivial events of the past. Some biological

symptoms include early morning waking where depressed individuals wake two
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to three hours before their usual time, find it difficult to fall asleep and wake at

night and there may be associated loss of appetite and weight loss.2

In severe depression, the moderate symptoms occur with greater intensity with

other disorders like delusions and hallucinations. The delusions take the form of

worthlessness, guilt, ill health and poverty. The hallucinations may take the

form of auditory hallucination and visual hallucination. As the depression

worsens, the individual begins to have suicidal ideas.2

Depression in people can be precipitated by certain risk factors which include

family history of depression, family history of mood disorders, female gender,

ages between twenty to fifty years, low self-esteem, excessive weight, alcohol

use, tobacco use, physical illnesses like diabetes, cancer and heart disease and

women who are unhappily married, separated or divorced.2

1.2 STATEMENT OF PROBLEM

Depression is the leading cause of disability worldwide, and is a major

contributor to the global burden of disease. About 350 million people of all ages

live with depression globally, according to the World Health Organization

(WHO).3 A study conducted in 2008 by the WHO, World Mental Health Survey

of 17 countries found that around one in 20 people on average reported an

episode of depression in the previous year.3In its most serious form, depression

leads to a forestalling of human potential.3 There are more than 800,000 suicide

per year, according to the WHO’s first global report on suicide prevention. 3The

13
WHO has estimated that depression has higher burden than lung, colorectal,

breast and prostate cancers combined, and more than other psychiatric

conditions such as bipolar disorders and schizophrenia.4Depression in the work

place is a leading cause of loss of work productivity, due to, for example, sick

leave and early retirement, this in addition to huge cost of management of

persons with depression places a burden on the economy.4

In most countries the proportion of people who suffer from depression during

their lives can be as low as 8% and as high as 17% with an average of 12% 5,

and a higher prevalence of 17% in Nigeria.6The prevalence of depression is on

the increase globally. Some of the causes of increased prevalence include

increase in psychopathology, drugs and alcohol abuse, increase intake of high

calorie diet, physical inactivity and inadequate sleep.7

1.3RATIONALE OF STUDY

Depression is a prevalent and widespread problem and like in any other society,

depression is seen in university students which medical students happen to be a

part.8 This group of students are going through a new and challenging phase in

their lives, transiting from adolescence to adulthood, trying to fit, adjusting to

academic work, planning for the future and being away from home and all these

serve as stressors to the students.9As a reaction to this stress, some students skip

classes and isolate themselves without realising they are depressed. Previous

14
studies reported that depression in university students and medical students by

extension is noted around the world and the prevalence seems to be increasing.10

The average age of onset of depression is on the increase making depression a

particularly salient problem for medical student population because over two-

third of young people do not talk about or seek help for mental health problem. 11

Studies to assess the prevalence of depression among medical students in the

University of Jos are few and since studies have shown that 17% of the general

population in Nigeria are depressed, there is a good chance that medical

students in University of Jos will have depression and this over the years

probably have been responsible for the poor performance seen among some

medical students.

Hence, it is imperative and timely to explore the complexity of depression

among medical students in University of Jos to aid in the identification of

missed cases of depression and identify medical students in the early course of

depression and appropriate recommendations made to the faculty of medicine,

University of Jos.

1.4 OBJECTIVES OF THE STUDY

1.4.1 GENERAL OBJECTIVES

To determine the prevalence of depression among medical students in

University of Jos.

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 1.4.2 SPECIFIC OBJECTIVE

1. To determine the prevalence of depression among medical students in

University of Jos

2. To determine the factors that predispose to depression among medical students

in University of Jos.

3. To determine the various coping mechanisms adopted by medical students of

university of Jos with symptoms of depression.

CHAPTER TWO

2.0 LITERATURE REVIEW

2.1 INTRODUCTION

Depression is a common mental disorder characterised by sadness, loss of

interest or pleasure, feeling of guilt or low self-worth, disturb sleep or appetite,

feeling of tiredness or poor concentration. It can be long standing or recurrent,

substantially impairing a person ability to function at school or work or cope

with daily life.1

The cause of depression is yet to be known however, there are risk factors that

are associated with depression. These are; family history of mood disorders,

16
female gender, women who are unhappily married, separated or divorce, ages

between twenty and sixty, low self-esteem, excessive weight gain, alcohol use,

tobacco use, and physical illnesses like diabetes mellitus, cancer and heart

disease. The risk factors that are commonly found among medical students are;

older age, low socioeconomic status, role in choice of medical career, negative

perception of academic performance, difficulty with study course, and

relationship issues.12,13

2.2 PREVALENCE OF DEPRESSION

In a cross - sectional study conducted among 262 medical students from

University of Nigeria Enugu in 2008 to determine the prevalence of depressive

symptoms. It was found out that 23.3% of the students were depressed which

showed study that a quarter of the students had one form of depressive symptom

or the other.14

In another cross - sectional study conducted among 1206 University students in

Western Nigeria in 2006. It was found out that 8.3% of the students were

depressed. It was recommended for an effective model for the prediction of the

development of depression among University students to be developed and

evaluated and interventions aimed at reducing the incidence of depression

among this population need further research.15

17
In a cross-sectional study conducted among 820 undergraduate students in

Obafemi Awolowo University to determine the prevalence of depression and

associated factors and found that 7.0% of the students had severe depression

and 25.2% with moderate depression. It was recommended that factors that are

associated with depression are targeted in terms of intervention.16

In a cross-sectional study conducted among 550 students in three private

Universities in Ogun State and found that self-reported depressive symptoms by

the respondents ranged from 11.45% to 35.81%. It was also found that females

were more depressed (37.30%) than males (34.64%). It was recommended that

factors associated with depression are targeted in terms of intervention.17

In a cross-sectional study conducted among 270 University students in Ghana

to determine the prevalence and determinants of depressive symptoms and was

found to be 39.2%. This study was conducted in a single University and also

relying on self-report of symptoms could have influenced the outcome.

Therefore, he recommended that further research should be carried out as there

could be regional differences in depression in other Universities.18

In a cross-sectional study conducted among 923 University students in Nairobi

to determine the prevalence of depression and socio-demographic correlate and

was found to be 35.7% for moderate and 5.6% for major depressive symptoms.

This cross-sectional study relied on self-report of symptoms and could therefore

be inaccurate. Also, the study was conducted in one University and there could

18
be regional differences in other local Universities therefore the need for further

research.19

In a cross sectional study conducted among 396 medical students in a local

university in Malaysia to determine the prevalence of depression and

psychological stress and was found to be 33.6% which showed that more than a

quarter of the students had one form of depressive symptom or the other.20

In another cross-sectional study conducted among 252 students in Ziauddin

Medical University in India to determine the prevalence of anxiety and

depression and was found that 60% of the students were depressed. This finding

is consistent with other western studies. However, there are no local data to

support these outcomes and appropriate intervention.21

2.3 FACTORS THAT PRECIPITATE DEPRESSION

In a cross-sectional study conducted among 451 medical students in University

of Calabar to determine the prevalence of stress and stressors and found that the

major stressors identified were excessive academic work load, inadequate

holiday, and insufficient time for recreation.22

In a cross-sectional study carried out among 87 female medical students in

Pakistan, it was found that those living in University dormitories were more

depressed than those living at home. Those having a history of negative life

event in the recent past were more likely to be depressed.23

19
In another similar study conducted among 264 medical students in Pakistan

medical school. It was found out that helplessness, increased psychological

pressure, mental tension and too much workload are the most common

predisposing factors for depression. It was also found out that females express

more symptoms. 24

A similar study was also conducted among medical students in Karachi,

Pakistan, and it was found out that substance abuse, having family history of

depression and anxiety and loss of a relative in the last one year are the most

common predisposing factors for depression. 25

In another cross-sectional study conducted among 100 medical students from

first and third MBBS of B.P. Koirola institute of Health Sciences Nepal. It was

found out that apart from academic stress and hectic lifestyle were the main

inducing factor for depression. The study included only first and third year

students in the sample. Also, only the well-studied principal stressors were

assessed. Therefore, he recommended that further study should be done to

include all the medical students and all the stressors.26

From previously sited literature it was found out that depressive symptoms was

significantly more among the first year students, those who were married; those

who were economically disadvantaged, those living off campus, those using

tobacco, those that drink alcohol and those with older age.19

2.4 COPING STRATEGY FOR DEPRESSION

20
In a cross-sectional study conducted among 762 medical students in University

of Nigeria Enugu to determine the various coping strategies and found out that

25% talk to friends/classmates, 23.9% discussed it with their parents/guardians

while 17.1% talked to a priest. About 11.5% resorted to alcohol, 4.7% to

smoking/stimulants. Only 2.1% sought medical advice.27

Another cross – sectional study conducted among 282 University students

studying different courses in Navodaya Medical College, Raichur, Karnataka to

determine the differences in perceived stress and its correlates and found that

students used psychosocial support in the form of talking to friends, parents and

relatives and similar findings were reported by other studies. This study was

done in one campus; therefore caution should be taking not to generalize the

result.28

In another cross-sectional study conducted among 319 first year medical

students at King Saud University College of Medicine, Riyadh, and Kingdom of

Saudi Arabia. The coping strategies identified were: respecting ones limit,

setting priorities, avoiding comparisons and participating in leisure activities

(cinema, reading, sports, meeting friends and family). 29

Depression is prevalent among medical and differs among universities in the

same country and among universities in different countries. The common

predisposing factors are smoking and alcohol consumption, while others are

academic challenge, ill health, and loss of love one. Most students cope by

21
talking to someone and others cope by listening to music, watching move,

exercise, smoking and alcohol consumption.

CHAPTER THREE

3.0 RESEARCH METHODOLOGY

3.1 STUDY AREA

The study will be conducted in the department of medicine and surgery of the

faculty of medical Sciences of University of Jos, Plateau State. The University

is a federal University in Jos, Plateau state, North-central Nigeria. The

University offers courses in law, medicine, pharmacy, natural sciences, social

sciences, as well as arts and humanities. The University was first established in

November 1971, as a satellite campus of the University of Ibadan. In October

1975, then military government under General MurtalaMohammed established

the University of Jos as a separate institution.30

The university has three (3) campuses; the main campus which is located along

Bauchi road, it houses the Faculty of Law, Education, Medical Sciences,

Environmental sciences, and School of Post graduate Education. The

permanent site of the University is located along Farin Gadaroad; it houses the

Faculty of Art and Social sciences.30

The third campus which is referred to as the old campus because it is the first

campus of the University, it is located at the Jos Township Market, along

Murtala Mohammed way, it accommodate the centre for continuing education,

22
consultancy services of the University and some departments of the Faulty of

Medical sciences.30

The department of medicine and surgery is one of several departments in the

faculty of medical sciences providing pre-clinical and clinical training of

medical students. The pre-clinical departments and its central administration are

located at the Bauchi road campus of the University. While the clinical

departments and posting for the medical students take place at the Jos

University Teaching Hospital (JUTH), which is located along Shere hills, Jos

North, Plateau State.30

3.2 STUDY POPULATION

The study population will consist of medical students from across all the six (6)

levels.

3.3 STUDY DESIGN

A cross sectional study design will be used to assess the prevalence of

depression among Medical students of university of Jos.

3.4 SAMPLE SIZE

The sample size for the study will be calculated using the formula for cross

sectional descriptive design.

The minimum sample size (n) is given by;

n=Z2pq

d2

23
Where;

n=Minimum sample size

Z =Standard normal deviate at 95% Confidence interval which is 1.96

P=Prevalence of depression among medical students from a previous similar

study conducted in University of Nigeria, Enugu which was 23.3% 14

q= Complimentary probability, q =1- p

=0.767

d= Absolute Precision

=0.05

Thus;

N= (1.96)2 X 0.233X0 .767

(0.05)2

= 0.687

0.0025

=275

Therefore the minimum sample size for the study will be 275. For non-

responses, 10% of this number will be added that is 28. This will give a

minimum sample size of 303.

3.5 SAMPLING TECHNIQUE

A multi-staged sampling technique will be used for this study;

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STAGE 1;

Total number of students in each level will be obtained and the proportion of

participants will be calculated as follows;

Total number of students in each class × minimum sample size

Total number of medical students

This will give the proportion of students to be used for each level. For example

for the 500level class with a population of 142, the proportion to be used will

be;

142/1000 × 275 =39

STAGE 2;

The proportion of students to be selected from each level that will participate in

the study will be selected by simple random sampling technique by balloting.

For example to select thirty – nine, 39 participants from 500 level, 39 yes and

103 no will be place in a box, students who pick the yes will be use for the

study.

3.6 TOOLS FOR DATA COLLECTION

A self-administered questionnaire will be used to obtain information for the

study.

The first section (section A) will consist of questions concerning the socio-

demographic data. It will include questions on age, gender, level, ethnic group,

25
Religion, family size, are both parent alive, are both parent living together,

parents’ occupation.

The second section (section B) will consist of the Beck’s depression inventory

second edition (BDI-11). A 21-item self-report instrument designed to assess

the existence and severity of symptoms of depression as listed in the American

Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders

Fourth Edition (DSM-IV; 1994). The beck’s depression inventory has been used

severally and tested and has content validity and face validity.31

The third section (section C) will consist of questions that will be use to assess

the factors that predispose depression among medical students in University of

Jos.

The fourth section (section D) will consist of questions that will assess the

various coping mechanism medical students in University of Jos do to cope with

the symptoms of depression.

3.7 DATA ANALYSIS

Data obtained from this study will be collated and analysed using Epi info

statistical version 3.5.4. Quantitative data such as age will be presented in mean

and standard deviation. Qualitative data such as sex will be presented using

frequency tables. Chi square test will be used to establish statistical relationship.

95% confidence interval will be used for the study and P value of <0.05 will be

considered statistically significant.

26
3.7.1 INTERPRETING THE BECK DEPRESSION INVENTORY

The highest possible total score for the whole test is 63 while the lowest

possible score for the test is 0

1-10____________________These ups and downs are considered normal

11-16___________________ Mild mood disturbance

17-20___________________Borderline clinical depression

21-30___________________Moderate depression

31-40___________________Severe depression

Over 40__________________Extreme depression

See the Beck’s Depression Inventory second edition (BDI-11) on appendix 1.

3. 8 ETHICAL CONSIDERATIONS

Approval for the conduct of the study will be obtain from the head of

department and also permission will be obtained from relevant authorities

within the university and letter of introduction will be given by the department.

The nature, aims and objective of the study will be explained to each student

and participation will be voluntary with no risk to the students. A verbal

informed consent will be obtained from each student. Students who are likely to

be depressed will be counselled and referred to see a psychiatrist in Jos

University Teaching Hospital or to the health centre of the University of Jos.

27
3.9 LIMITATION

In providing some of the information, the participants may have to rely on their

memory to identify what in the past might have cause their illness, as the human

memory can be imprecise sometimes, there can be recall bias.

CHAPTER FOUR

4.0 RESULTS

28
The study was carried out among medical students in university of Jos, between

April and May 2015. A total of 275 questionnaires were distributed and 275

were retrieved representing a response rate of 100%.

4.1SOCIODEMOGRAPHIC CHARACTERISTICS OF THE

RESPONDENT

The age group of 20-24 years constituted the highest respondents. The mean age

the respondent was 25 years. Most of the respondents 172(62.5%) were male.

Most of the respondents 264(96.6%) are single, while the rest 11(4.0%) are

married in a monogamous setting. Most of the respondents 193(70.7%) live in a

nuclear family. Most of the respondents 243(88.4%) source of income is from

their parents. Most of the respondents 129(46.6%) earn more than N10, 000.

(Table 1)

Table 1. Sociodemographic characteristics of respondents

AGE FREQUENCY PERCENT (%)

15-19 5 1.8

20-24 130 47.3

25-29 123 44.7

29
30-34 17 6.2

TOTAL 275 100

SEX

female 103 37.5

male 172 62.5

TOTAL 275 100

TRIBE

Hausa 3 1.1

Igbo 50 18.2

others 103 37.5

tribes in plateau 99 36.0

Yoruba 20 7.3

TOTAL 275 100

RELIGION

Christianity 260 94.5

Islam 15 5.5

TOTAL 275 100

LEVEL

200 54 19.7

300 61 22.3
30
400 48 17.5

500 46 16.8

600 66 24.0

TOTAL 275 100

MARITAL STATUS

married 11 4.0

single 264 96.0

TOTAL 275 100

FAMILY TYPE FREQUENCY PERCENT (%)

Nuclear 193 70.7

Extended 80 29.3

TOTAL 273 100

SOURCE OF INCOME

friends 4 1.5

husband 1 0.4

parents 243 88.4

relatives 10 3.6

self-employ 6 2.2

31
Others 11 4.0

TOTAL 275 100

ALLOWANCE PER MONTH

<10,000 120 43.6

>70,000 10 3.6

11,000-30,000 129 46.9

31,000-50,000 13 4.7

51,000-70,000 3 1.1

TOTAL 275 100

4.2 PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENT

Most of the respondents are normal, 237(86.1%). The rest have varying degrees

of depressions such as mild mood disturbance, borderline clinical depression,

moderate depression, severe depression and extreme depression. (Table 2)

Table 2: Prevalence of Depression

BECKS INVENTORY FREQUENCY PERCENT (%)

1-10 237 86.1

11-16 30 10.9

17-20 1 0.4
32
21-30 4 1.5

31-40 2 0.7

>40 1 0.4

TOTAL 275 100

4.3 FACTORS THAT PREDISPOSE TO DEPRESSION

4.3.1. Bereavement

Most of the respondents, 9.7% who have loss someone close to them have mild

mood disturbance. Only 0.7% respondent who have extreme depression have

loss someone close to them. (Table 3)

There is no statistical significant relationship between depression and loss of

someone (P>0.05)

Table 3; Relationship between loss of someone and depression

lost someone 1-10(%) 11-16(%) 17-20(%) 21-30(%) 31-40(%) >40(%) TOTAL%

no 112(86.2) 16(12.3) 0(0.0) 1(0.8) 1(0.8) 0(0.0) 130(100)

33
yes 125(86.2) 14(9.7) 1(0.7) 3(2.1) 1(0.7) 1(0.7) 145(100)

X2 =3.04;df=5;p=0.6942

4.3.2 Childhood experience

Only 30.8% of the respondents who have mild mood disturbance did not enjoy

their childhood. (Table 4)

There is no significant relationship between depression and childhood. (p>0.05)

Table 4; Relationship of childhood experience and depression

1-10(%) 11-16(%) 17-20(%) 21-30(%) 31-40(%) >40(%) TOTA

9(69.2) 4(30.8) 0(0.0) 0.(0.0) 0(0.0) 0(0.0) 13(100

4(1.5) 2(0.8) 1(0.4) 262(10

X2=5.79;df=5;p=0.3277

34
4.3.3 Sexual abuse

Only 20.0% of the respondents who have mild mood disorder were sexually

abuse as children. (Table 5)

There is no significant statistical relationship between depression and sexual

abuse. (p>0.05))

Table 5; Relationship between sexual abuse and depression

Childhood sexual 1-10(%) 11-16(%) 17-20(%) 21-30(%) 31-40(%) >40(%) TOTAL%

abuse
4(1.6) 2(0.8) 1(0.4) 258(100)
No 223(86.4) 27(10.5) 1(1.4)

Yes 12(80.0) 3(20..0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 15(100)

X2=1.71;df=5;p=0.8881

35
4.3.4 Smoking

Most of the respondents 46.2% who smoke have mild mood disturbance. Only

7.7% respondent who has moderate depression smokes while 1.2% respondents

with moderate depression smoke.(Table 6)

There is a relationship between smoking and depression. (p<0.05)

Table 6; Relationship between smoking and depression

Smoke 1-10(%) 11-16(%) 17-20(%) 21-30(%) 31-49(%) >40(%) TOTAL%

No 228(88.0) 24(9.3) 1(0.4) 3(1.2) 2(0.8) 1(0.4) 259(100)

Yes 6(46.2) 6(46.2) 0(0.0) 1(7.7) 0(0.0) 0(0.0) 13(100)

X2=21.59;df=5;p=0.0006

4.3.5 Alcohol

36
Majority of respondents, 19.1% who are depressed take alcohol and have mild

mood disturbance. Only 4.3% of the respondents who take alcohol have severe

depression. (Table 7)

There is significant statistical relationship between depression and alcohol

intake. (p<0.05)

Table 7; Relationship between alcohol consumption and depression

Alcohol 1-10(%) 11-16(%) 17-20(%) 21-30(%) 31-40(%) >40(%) TOTAL%

consumption
No 202(89.0) 21(9.3) 1(0.4) 2(0.9) 0(0.0) 1(0.4) 227(100)

Yes 34(72.3) 9(19.1) 0(0.0) 2(4.3) 2(4.3) 0(0.0) 47(100)

X2=17.85;df=5;p=0.0031

4.3.6 Academic stress

Most of the respondents, 17.2% who are depressed have academic challenges

and have mild mood disturbance. Only 1.1% respondent with severe depression

has academic challenge. (Table 8)

37
Having too much work load was identified as the predominant academic

stressor of most the respondents, 31.1%. (Table 9)

There is a significant statistical relationship between academic challenge and

depression. (p<0.05)

Table 8; Relationship between academic Challenge and depression

1-10(%) 11-16(%) 17-20(%) 21-30(%) 31-40(%) >40(%) TOTA

No 172(91.5) 15(8.0) 0(0.0 0(0.0) 1(0.5) 0(0.0) 188(1

65(74.2) 15(17.2) 1(1.1) 4(4.6) 1(1.1) 1(1.1) 87(10

X2=19.90;df=5;p=0.0013

Table 9; Academic stressors of depression

38
Academic stressors Frequency Percent%

Difficulty to read for a long time 9 10.0

Difficulty to retain what is read 8 8.9

Difficulty to understand 11 12.2

Financial challenges 25 27.8

Having too much work load 28 31.1

Loss of interest to study 5 5.6

Other 4 4.4

Total 90 100.0

4.3.7 Weight

Most of the respondents 14.6% who are depressed feel uncomfortable with their

weight and have mild mood disorder. Only 2.4% of the respondent who feel

uncomfortable with their weight have extreme depression. (Table 9)

There is no significant statistical relationship between depression and weight.

(P>0.05)

Table 10; Relationship between weight and depression

Weight 21-30(%) 31-40(%) >40(%) TOTAL%

No 202(87.4) 3(1.3) 2(0.9) 0(0.0) 231(100)

39
Yes 34(82.9) 6(14.6) 0(0.0) 0(0.0) 0(0.0) 1(2.4) 41(100)

X2=7.50;df=5;p=0.1863

4.3.8 ill Health

Most of the respondents, 26.9% with mild mood disturbance have some form of

ill health. Only 3.8% respondents with severe depression have ill health. (Table

10)

There is a statistically significant relationship between having a health challenge

and depression. (p<0.05)

Table 11; Relationship between health and depression

1-10(%) 11-16(%) 17-20(%) 21-30(%) 31-40(%) >40(%) TOTAL%

no 221(88.8) 23(9.2) 0(0.0) 3(1.2) 1(0.4) 1(0.4) 249(100)

yes 16(61.5) 7(26.9) 1(3.8) 1(3.8) 1(3.8) 0(0.0) 26(100)

X2=23.43;df=5;p=0.0003

40
4.4 Coping Mechanism

Most of the respondents that have depression cope by smoking or drinking

alcohol. (Table 11)

Table 12; Coping mechanisms among depressed students

coping mechanism 11-16(%) 17-20(%) 21-30(%) 31-40(%) >40(%) TOTAL

cry 0(0.0) 1(100.0) 0(0.0) 0(0.0) 1(100)

listen to music 4(100.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 4(100)

pray 6(75.0) 0(0.0) 1(12.5) 0(0.0) 1(12.5) 8(100)

Smoking or drink alcohol 8(66.7) 0(0.0) 2(16.7) 2(16.7) 0(0.0) 10(100)

take sleeping pills 1(100.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 1(100)

talk to someone 6(85.7) 0(0.0) 1(14.3) 0(0.0) 0(0.0) 7(100)

watch a movie 5(100.0) 0(0.0) 0(0.0) 0(0.0) 0(0.0) 5(100)

41
 CHAPTER FIVE

5.0 DISCUSSION

A total of two hundred and seventy-five questionnaires were distributed and two

hundred and seventy-five were retrieved representing a response rate of 100%.

Those respondents of age 20-24 years (47.3%) constituted the highest age while

those of age 15-19(1.8%) constituted the lowest group of respondents. The age

range of the students was 15-34 years, which is similar with the age range of a

previously conducted similar study among medical students in university of

Nigeria, Enugu which is 16-30 years. 23 This is also the age range of the medical

students in other previous similarly conducted studies among medical students.

Most of the respondents are male, 62.5%. This higher proportion of male

compared to females can be attributed to the fact that in our environment more

value is placed on the education of the male child against the girl child

education. This finding is in agreement with a similarly conducted study in

Obafemi Awolowo University in Nigeria, where it was found out that 54.3% of

the respondents where male while 45.7% of the respondents are female.

However in other society where equal access to education is made available to

both males and females, the proportion of females in school was equal to or

even higher compared to their male counterparts in school. A case in point is a

42
previous similar study conducted in Karachi, Pakistan among medical students

to determine the prevalence of depression, anxiety and their associated factors.

It was found out that 58.8% of respondents are female while 41.5% of the

respondents are males.25 In another previous similar conducted among

University students in China to determine the prevalence of depression and

socio-demographic correlates in 2013, it was found out that 51% of respondents

are female while 49% of respondents are males.33

Most of the respondents are Christians, 94.5% while 5.5% are Islam. This

higher proportion of Christians can be attributed to the fact that religion still

plays a critical role in the psychosocial environment of Nigeria. The university

is located in a predominantly Christian environment and as such most of the

students are Christians.

Most of the respondents are single, 96.0% while only 4.0% are married. This

finding is similar to a previously conducted study among medical students in

Karachi Pakistan to determine the prevalence of depression, anxiety and their

associated factors. It was found that 93.7% of the respondents are single while

6.3% are married.25 This higher proportion of single respondents is because of

the desire to pursue education as oppose to marriage.

Most, 70.7% are from a nuclear family setting while 29.3% are from extended

family setting. This finding is similar to a previously conducted study in

Karachi, Pakistan to determine the prevalence of depression, anxiety and their

43
associated factors. Is was found that 73.0% of the respondents live in a nuclear

family setting while, 27.0% live in an extended family setting. African families

are often times considered to be extended in nature; however this study shows

that most respondents are from the nuclear family setting. The reason for this

can be attributed to changing African societal pattern towards the western

pattern and also the rising cost of living which makes it difficult to sustain large

families.

5.1 PREVALENCE OF DEPRESSION

The prevalence of depression among medical students in university of Jos was

found to be 13.8%. This result is not in keeping with the prevalence of

depression obtained from a previous similar study conducted among medical

students in other universities.

In a study conducted among medical students in university of Nigeria, Enugu

the prevalence of depression was found to be 23.3%. 15 In another study

conducted among medical students in a local university in Malaysia, the

prevalence of depression was found to be 33.6%.19 In another study conducted

among medical students in Ziauddin medical university in India, the prevalence

of depression was found to be 60%.20

In another cross sectional study to determine the prevalence of depression and

anxiety among medical and pharmaceutical students in Alexandria University,

44
the prevalence of depression among the medical students was found to be

57.9%.30

The result obtained from the study is also not in keeping with the prevalence of

depression conducted among other students.

In a study conducted among university students in western Nigeria the

prevalence of depression was found to be 8.3%.16 In another study conducted

among university students in Ghana the prevalence of depression was found to

be 39.2%.17 Also in another study conducted among university students in

Nairobi, the prevalence of depression was found to be 41.3%.18

The low prevalence of depression in this study (13.8%), may be due to the

difference in teaching and assessment methodology including introduction of

problem based learning and objective structured performance evaluation in the

recent years. Another reason may be the sample size difference (275 vs. 189 and

142).21,25 Different sociopolitical situation and sociodemographic background of

participants can also be a contributor in this regard.

5.2 FACTORS THAT PREDISPOSE TO DEPRESSION

The factors that predispose to depression from the study are smoking, alcohol

consumption, academic challenge and health challenge. Other factors that could

predispose to depression where also assessed, such as loss of someone,

childhood experience, sexual child abuse and weight. These findings are similar

to what was obtained in previous similar studies.

45
In a study conducted among medical students in university of Nigeria, Enugu

the factors that predisposed to depression are smoking and academic

challenge.15 In another study conducted among university students in western

Nigeria, the factors that predisposed to depression are smoking, alcohol

consumption and academic challenge. 16

medical students in B.P. Koirola institute of Health Sciences in Nepal, the

factors that predispose to depression are academic stress and hectic lifestyle. 22

These show that smoking, alcohol consumption and academic challenge are

common predisposing factors for depression among medical students.

Stress has been found to correlate with depression.20 Previous studies have

noted that various stressors, such as financial, workload, academic pressure,

inadequate teacher and students relationships, parent and child relationship,

physical illness, emotional problems and worries about the future, contribute to

some but not all medical students.34, 35, 36

5.3 COPING MECHANISM FOR DEPRESSION

From this study, 13.8% of the respondents were found to be depressed, of this

number, 10.5% cope by listening to music, 18.4% cope by talking to someone,

13.2% cope by watching a movie, 21.1% cope by praying ,2.6% cope by crying,

2.6% cope by taking sleeping pills and 31.6% cope by smoking or by alcohol

consumption.

46
This is not in agreement with the proportion of coping mechanism for

depression in a previous similar study conducted among 762 medical students in

University of Nigeria, Enugu. The study showed that 66% cope by talking to

someone and 16.2 % cope by smoking or alcohol consumption.15

Compared to this study, fewer students from the study conducted cope by

talking to someone while more students cope by smoking or alcohol

consumption.

In another study conducted among 282 university students in Navodaya Medical

College, Raichur, Karnataka, it was found out that most students cope by

talking to someone.24

Different individuals use different strategies for coping with negative affective

state and associated life problems. Strategies are developed to identify means to

reduce stress. The strategy that is eventually used by an individual depends on

the individual’s personality, life experience, faith and the nature of loss.

Because of these and also differences in socio-political and socio-demographic

background, the respondents in this study cope differently from other

respondents in other similar conducted study.

CHAPTER SIX

6.0 CONCLUSION AND RECOMMENDATIONS

6.1 CONCLUSION

47
 It was concluded from this study that 13.8% of medical students in university of

Jos have varying forms of depression. The factors that predispose to depression

among the students were found to include academic challenge, health challenge,

smoking and alcohol consumption. Most of the respondents (31.6%) cope by

smoking or alcohol consumption which is unhealthy and it is identified in this

study as a predisposing factor to depression.

6.2 RECOMMENDATIONS

From the above mentioned, the following recommendations are suggested

1. Students who are found to be depressed should visit the university school clinic

for appropriate intervention and where necessary they should be referred to see

a psychiatrist of the Jos University Teaching Hospital, (JUTH).

2. The University of Jos should put in place modalities for periodic screening of

students so those students who are tending towards depression are identified

early and appropriately treated.

3. The University of Jos authorities should carry out studies on other students in

the university, so that those found to be depressed are appropriately treated.

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Availableat:http://www.euro.who.int/en/health-topics/noncommunicable-

disease/pages/news/2012/10/depression-in-europe/depression-

definition.Accessed 10.10.2015

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2. Gelder M, Mayou R, Geddes J. Mood Disorders in Psychiatry. Oxford

University Press, New York.2009;2(1):98-100

3. World Health Organization (WHO).World suicide prevention day 2012.

http://www.who.int/mediacentre/events/annual/world_suicide_prevention_day/

en/Accessed 13.01.2015

4. World Health Organization (WHO). The global burden of disease. Available

at:http://www.who.int/healthinfo/global_burden_disease/GBD_report_2004upd

ate_full.pdf. Last update 2004

5. Kessler RC, Berglund P, Demler O. The epidemiology of major depressive disorders.

Result from National Comordity Survey Replication

(NCSR).JAMA.2003;289(203):3095-3105

6. Jude F, Komiti A, Chua P, Mijch A, Hoy J,Grech P, et al. Nature of depression in

HIV/AIDS. Aust N.Z.J. psychiatry 2005;39:826-32

7. Brandon H. Depression as a disease of modernity. Journal of Affect Disorder.

2012;140(3):205-214

8. Iidar EA, koushi MF, Mazloum S, Navidian A. Prevalence of depression among

students of Zabol Medical School. Journal of shahrekord University of Medical

Sciences.2004;6(2):15-29

9. Buchanan JL. Prevention of depression in the college population; a review of the

literature. Achives of psychiatric nursing.2012;26(1):21-42

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10. Eller T, Aluoja A, Vasar V, Veldi M. Symptoms of Anxiety and Depression in

Estonian Medical Students with sleep problems. Depression and

Anxiety.2006;23(4):250-256

11. Castaldelli JM, Martins SS, Bhugra D et al. Does ragging play a role in medical

student’s depression cause or effect? Journal of affective disorders 2012;139(3):291-297

12. Lewinsohn PM, Hoberman HH, Rosenbaum M.A Perspective Study of Risk Factors

for Unipolar Depression. Journal of Abnormal Psychology 1988, 97(3); 251-264.

13. Mukhopodhyay P et al. Evaluation of Major Risk Factors related to Depression among

Medical Student NRS Medical College. International Journal of Medical Research and

Health.2014, 3(4); 911-917

14. Aniebue PN. Prevalence of depression among medical students in Nigerian university;

Sage Journal 2008; 38(3)157-158

15. Obiodun AO et al.Social psychiatry and psychiatric epidemiology; Springer open

journal2006;41 (8) 674-67

16. Peltzer K, Pengpid S, Olowu S. Depression and associated Factors among

University students in Western Nigeria; Journal of Psychology in Africa 2013;

23(3), 459-466

17. Abiodun MG, Oluwafunto JS. Prevalence and Gender Difference in self-

reported Depressive symptomatology among Nigerian University Students:

Implication for Depression Counselling. The Counsellor 2014; 33(2), 129-140

18. Kwaku OA, Johnny AA. Prevalence and determinants of depressive symptoms

university students in Ghana; Journal of Affective Disorder 2015; 171: 161-166

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19. Othieno CJ, Okoth RO, Peltzer K, Pengpid S, Malla LO. Depression among

University students in Kenya: prevalence and sociodemographic correlates.Journal of

Affective Disorder 2004; 165: 120-125.

20. Sherina MS, Rampal L, kaneson N. Psychological stress among undergraduate

medical students; Malaysia medical journal 2004;59(2)143-145

21. Inam SN, Saqib A, Alam E. Department of community health sciences Ziauddin

medical university Karachi. Prevalence of anxiety and depression among

medical students of private University. Journal of the Pakistan medical

association 2002/2003;53(2)44-47

22. Afiong OO, Eme TO, Oboko OO, Bassey MI. Prevalence of Stress, Stressors

and Coping Strategies among Medical Students in a Nigerian Medical School;

African Journal of Medical and Health Sciences 2015;14(1), 29-34

23. Rab F, Mamdou R, Nasir S. Rates of depression and anxiety among female

medical students in Pakistan; Eastern Mediterranean Health

journal2008;14(1)126-133

24. Shaikh BT, et al. Education for Health; PubMed2004;17(3):346-353

25. Khan MS, Mahmood S, Badshah A, Ali SU, Jamal Y.Prevalence of depression,

anxiety and their associated factors among medical students in Karachi

Pakistan; Journal of Pakistan Medical Association2006;56(12)583-586

26. Basinet B, Jaiswal M, Adhikari B, Shyangwa PM. Depression among

undergraduate medical student. Kathmandu University Medical journal

2012;39(3);56-59

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27. Nwobi EA, Ekwueme OC, Ezoeke UE. Mental Depression and Coping

Strategies among Medical Students of University of Nigeria. Journal of College

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28. Mane AB, Krishnakumar MK, Niranjan PC, Hiremath SG. Differences in

perceived stress and it correlate in professional courses. Journal of Clinical and

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29. Mona S. Perception of stress and coping strategies by medical students at King

Saud University Riyadh, Saudi Arabia. Journal of Taibah University Medical

Sciences2014;9(1):30-35

30. University of Jos. About University of Jos. Available at http://

www.unijos.edu.ng/the_university/history.phpAccessed 13.01.2015

31. Beck AT, Ward CH, Mendelsolson M, Mock J. An inventory for measuring

depression.Arch Gen Psychiatry 1961; 4:561-71.

32. Motaz B, Ibrahim MH, Abdulraheem. Prevalence of anxiety and depression

among medical and pharmaceutical students in Alexandria University.

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33. Chen L, et al., Depression among Chinese Medical Students: Prevalence and

sociodemographic Correlates. PLoS ONE 2013;8(3),128-135

34. Yusoff MS, Abdulrahim AF, Baba AA, et al., Prevalence and Associated

Factors of Stress, Anxiety And Depression among prospective Medical

students. Asian Journal of Psychiatry 2013; 6(2), 128-133

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35. Niemi PM, Vainiomaki PT. Medical students distress: quality, continuity and

gender differences during a six-year medical programme. Medical Teacher

2006; 28(2), 136-141

36. Sharifirad G, Marjani A, Abdolrahman C, Mostafa Q, Hossein S. Stress among

Isfahan medical Sciences Students. Journal of research in Medical Sciences

2012; 17(4), 402-409

APPENDIX

QUESTIONNAIRE

THE PREVALENCE OF DEPRESSION AMONG MEDICAL

STUDENTS IN UNIVERSITY OF JOS

We are final year students of University of Jos. We are undertaking a study on

the above subject matter as part of the requirements for the award of MBBS

degree. We solicit your full cooperation in providing the necessary information

53
 and we assure you that the information obtained will be confidential and will

only be used for academic purposes. Thank you.

SECTION A: SOCIO - DEMOGRAPHIC DATA

1. Age (years)............................

2. Sex a) male [ ] b) female[ ]

3. Tribe..................................................................................

4. Religion

a) Christianity [ ] b) Islam [ ] c) others (specify)……………

5. Level

a) 100 [ ] b) 200 [ ] c) 300 [ ] d) 400 [ ] e) 500 [ ] f) 600 [ ]

6. Marital status

a) Single [ ] b) married [ ] c) separated [ ] d) divorced [ ] e) widowed [ ]

7. If married, what type of marriage?

a) married with one wife [ ] b) married with more than one wife [ ] c) married

with more than one husband [ ]

8. Family type

a) Father, mother and siblings [ ] b) father, mother, siblings and relatives [ ]

9. What is your source of income

a) Parents b) relatives c) friends d) others (specify)……………..

10. If parents, what is

54
a) Father’s occupation………..b) Mothers occupation…………………………

11. Allowance per month:.......................................................

SECTIONB: BECKS DEPRESSION INVENTORY

Complete this section by making a circle ‘O’ appropriately once for each

option per question.

12. 0. I do not feel sad.

1. I feel sad

2. I am sad all the time and I can't snap out of it.

3. I am so sad and unhappy that I can't stand it.

13. 0. I am not particularly discouraged about the future.

1. I feel discouraged about the future.

2. I feel I have nothing to look forward to.

3. I feel the future is hopeless and that things cannot improve.

14. 0. I do not feel like a failure.

1. I feel I have failed more than the average person.

2. As I look back on my life, all I can see is a lot of failures.

3. I feel I am a complete failure as a person.

15. 0. I get as much satisfaction out of things as I used to.

2. I don't get real satisfaction out of anything anymore.

3. I am dissatisfied or bored with everything.

16. 0. I don't feel particularly guilty

1. I feel guilty a good part of the time.

2. I feel quite guilty most of the time.

3. I feel guilty all of the time.

17. 0. I don't feel I am being punished.

1. I feel I may be punished.

2. I expect to be punished.

3. I feel I am being punished.

18. 0. I don't feel disappointed in myself.

1. I am disappointed in myself.

2. I am disgusted with myself.

3. I hate myself.

19. 0. I don't feel I am any worse than anybody else.

1. I am critical of myself for my weaknesses or mistakes.

2. I blame myself all the time for my faults.

56
 3. I blame myself for everything bad that happens.

20. 0. I don't have any thoughts of killing myself.

1. I have thoughts of killing myself, but I would not carry them out.

2. I would like to kill myself.

3. I would kill myself if I had the chance.

21. 0. I don't cry any more than usual.

1. I cry more now than I used to.

2. I cry all the time now.

3. I used to be able to cry, but now I can't cry even though I want to.

22. 0. I am no more irritated by things than I ever was.

1. I am slightly more irritated now than usual.

2. I am quite annoyed or irritated a good deal of the time.

3. I feel irritated all the time.

23. 0. I have not lost interest in other people.

1. I am less interested in other people than I used to be.

2. I have lost most of my interest in other people.

3. I have lost all of my interest in other people.

57
24. 0. I make decisions about as well as I ever could.

1. I put off making decisions more than I used to.

2. I have greater difficulty in making decisions more than I used to.

3. I can't make decisions at all anymore

25. 0. I don't feel that I look any worse than I used to.

1. I am worried that I am looking old or unattractive.

2. I feel there are permanent changes in my appearance that make me look

unattractive.

3. I believe that I look ugly.

26. 0. I can work about as well as before.

1. It takes an extra effort to get started at doing something.

2. I have to push myself very hard to do anything.

3. I can't do any work at all.

27. 0. I can sleep as well as usual.

1. I don't sleep as well as I used to.

2. I wake up 1-2 hours earlier than usual and find it hard to get back to

sleep.

3. I wake up several hours earlier than I used to and cannot get back to

sleep.

58
28. 0. I don't get more tired than usual.

1. I get tired more easily than I used to.

2. I get tired from doing almost anything.

3. I am too tired to do anything.

29. 0. My appetite is no worse than usual.

1. My appetite is not as good as it used to be.

2. My appetite is much worse now.

3. I have no appetite at all anymore.

30. 0. I haven't lost much weight, if any, lately.

1. I have lost more than five pounds.

2. I have lost more than ten pounds.

3. I have lost more than fifteen pounds.

31. 0. I am no more worried about my health than usual.

1. I am worried about physical problems like aches, pains, upset stomach, or

Constipation.

2. I am very worried about physical problems and it's hard to think of much

else.

59
 3. I am so worried about my physical problems that I cannot think of

anything else.

32. 0. I have not noticed any recent change in my interest in sex.

1. I am less interested in sex than I used to be.

2. I have almost no interest in sex.

3. I have lost interest in sex completely.

SECTION C: TO ASSESS FACTORS THAT PREDISPOSE TO

DEPRESSION.

33. Have you lost someone close to you? Yes ( ) No ( )

34. If yes who was it ………………..

35. With whom did you spend your childhood? Parents ( ) or Guidant ( )

36. Did you enjoy your childhood? Yes ( ) No ( )

37. If No, why? …………………………

38. Have you been sexually abuse as a child? Yes ( ) No ( )

39. Do you smoke? Yes ( ) No ( )

40. If yes, what type a) cigarette b) marijuana c) others (specify)……..

41. If yes, how many sticks per day? Always...................................................

42. If yes, how often? always ( ) Sparingly ( ) When it’s convenient ( )

43. Do you take alcohol? Yes ( ) No ( )

60
44. If yes, how many bottles per day? .........................................................

45. Are you having challenges in your study? Yes ( ) No ( )

46. If yes, what are the challenges? -----------------------------------------------------

47. Do you feel uncomfortable with your weight? Yes ( ) No ( )

48. If yes, why…………………….......................................................................

49. Are you having any problem with your health? Yes ( ) No ( )

50. If Yes, what is it……………………..................................................

SECTION D: TO ASSESS FOR COPING MECHANISM

51. What do you do when you feel discouraged? a) Talk to someone ( ) b) watch

a movie ( ) c) smoke or drink alcohol ( ) d) others(specify)…….

52. What do you do when you feel you are not living up to expectation? a) Talk to

someone ( ) b) watch a movie ( ) c) smoke or drink alcohol ( ) d)

others (specify)….......................................................................….

53. What do you do when you cannot sleep? a) Take sleeping pills ( ) b) do

chores ( ) c) read ( ) d) others (specify)................................................

54. What do you when you feel uncomfortable about your weight? a) Exercise (

) b) diet ( ) c) take slimming pills ( ) d) others (specify)............

Thank you for your cooperation, the information you have given will be kept

confidential.

61
62