UNIVERSITY OF CAPE COAST

COLLEGE OF HEALTH AND ALLIED SCIENCES

SCHOOL OF ALLIED HEALTH SCIENCES

DEPARTMENT OF MEDICAL LABORATORY SCIENCE

TOPIC: PREVALENCE OF DEPRESSION AND ASSESSMENT OF DEPRESSIVE

SYMPTOMS DURING EXAMINATION AND AFTER AMONG UNIVERSITY OF CAPE

COAST REGULAR STUDENTS

DANSO DESMOND

(AH/MLB/18/0037)

i
 DECLARATION

I, Desmond Danso, hereby declare that apart from references to other people’s work which have

been duly acknowledged, “prevalence of depression and assessment of depressive symptoms

during examination and after among University of Cape Coast regular students” is my own

independent work as a student of the University of Cape Coast.

A dissertation submitted to the Department of Medical Laboratory Sciences in partial award of

the degree of Bachelor of Science (Medical Laboratory Sciences). This protocol has never been

submitted in whole or part for the award of any degree in UCC or any other institution.

……………………………………………

DESMOND DANSO

(STUDENT)

…………………………………………...

DR. DAVID LARBI SIMPONG

(SUPERVISOR)

NOVEMBER, 2022

ii
 DEDICATION

This work is dedicated to the almighty God for having brought me this far, to my Mr. Simon

Kwarteng and to all my friends and loved ones for their prayers, guidance and support

throughout my journey on the academic ladder.

ACKNOWLEDGEMENT

Conducting this study would not have been successful without the help of some individuals and

groups. I therefore deem it necessary to express my sincere gratitude to them for their immense

support and contributions in diverse ways.

My first thanks go to the almighty God for protecting and guiding me throughout the process.

Secondly, I wish to thank my supervisor, Dr. David Larbi Simpong who is the brain behind the

successful production of this thesis. It is under her strict and excellent supervision and

contributions that this research has been brought out successfully.

Furthermore, my heartfelt thanks go to the respondents who agreed to participate in the study for

their understanding, time and cooperation throughout the study.

Finally, I am very grateful to my colleague students, friends, authors and publishers whose books

and articles were used and those who contributed in diverse ways to make this study a successful

one, I say God bless you all.

iii
 ABSTRACT

Background: Depression is a prevalent mental disorder and according to the WHO, a major

contributor to the global burden of disease and a leading cause of disability worldwide. There is

currently, however, a paucity of community-based empirical research on the prevalence of

depression, stress and other mental health problems in Ghana. This study is community-based

research to show the prevalence of depression and assessing whether examination is the main

cause of depressive symptoms among University of Cape Coast students.

Aim: The main objective of this study is to assess the prevalence of depression and depressive

symptoms during and after examination among University of Cape Coast regular students and to

ascertain when examination is the main cause.

Materials and methods: A descriptive cross-sectional study design was used to conduct the

research. A structured questionnaire (HDRS or Ham-D) was used to collect data on prevalence

of depressive symptoms. A total sample of 200 were used for this study. Data collected was

analyzed using SPSS version 20.

Results: A mean total HDRS score 14.61 indicating moderate depression and prevalence of

depression of 81% was reported during the examination period compared to a mean total HDRS

score of 13.35 indicating mild depression and prevalence of 70% was reported after the

examination period. There was a strong positive correlation between hypochondriasis

(preoccupation with health and frequent requests for help) and suicidal ideation

Conclusion: In the University of Cape Coast, regular students experience moderate depression

during examination and mild depression after examination. Very high number of students (81%

during examination and 70% after examination) were experiencing depressive symptoms.

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Also, hypochondriac (preoccupation with health and frequent requests for help) reported having

suicidal ideas, therefore the need to give them much attention.

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 LIST OF TABLES

Table 3.1………. Descriptive statistics items on the HDRS

Table 4.1………. Gender distribution of depression severity during examination

Table 4.2………. Gender distribution of depression severity after examination
Table 4.3………. Chi square test for depression severity and gender
Table 4.4………. Age-group distribution of depression severity during examination
Table 4.5………. Age-group distribution of depression severity during examination
Table 4.6………. Relationship depression and work and activities of respondents during
examination
Table 4.7………. Relationship between depression severity and work and activities of

respondents during examination

Table 4.8………. Relationship between depression severity and work and activities of

respondents after examination

Table 4.9………. Correlations between depression symptoms and the total HDRS score

LIST OF FIGURES

Figure 4.1………. Gender distribution of depression severity during examination

Figure 4.2………. Gender distribution of depression severity during examination

LIST OF ABBREVIATIONS

SSA…………. Sub-Saharan African

WHO………… Who Health Organization

DALYs………. Disability-adjusted life years

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 Table of Contents
DECLARATION.............................................................................................................................................2
DEDICATION...........................................................................................................................................3
ACKNOWLEDGEMENT........................................................................................................................3
ABSTRACT...............................................................................................................................................4
LIST OF TABLES.....................................................................................................................................6
LIST OF FIGURES...................................................................................................................................6
LIST OF ABBREVIATIONS...................................................................................................................6
CHAPTER ONE: INTRODUCTION..................................................................................................8
1.1 Background......................................................................................................................................8
1.2 Problem statement.........................................................................................................................10
1.3 Significance of study......................................................................................................................10
1.4 Hypothesis......................................................................................................................................11
1.5 Aim.................................................................................................................................................12
1.6 Specific objectives..........................................................................................................................12
CHAPTER TWO: LITERATURE REVIEW.......................................................................................13
2.1 Introduction...................................................................................................................................13
2.2 Epidemiology of Depression..........................................................................................................13
2.3 Pathophysiology of Depression.....................................................................................................14
2.4 Depression prevalence among university students......................................................................15
2.5 Depression and suicidal thoughts among college students..........................................................16
2.6 Effects of Depression on work and activities of student..............................................................16
2.7 Risk and Protective factors of Depression among university students......................................17
2.7.1 Risk factors..............................................................................................................................17
2.7.2 Protective factors....................................................................................................................17
2.8 Diagnosis of Depression.................................................................................................................17
2.9 Preventive measures to curb Depression among University of Cape Coast regular students..18
2.9.1 Stepped care............................................................................................................................18
2.9.2 Cognitive behavioral therapy.................................................................................................18
2.9.3 Psychotherapy.........................................................................................................................18
CHAPTER THREE: METHODOLOGY..............................................................................................20

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 3.1 Study design/setting.......................................................................................................................20
3.2 Sample size.....................................................................................................................................20
3.3 Ethical consideration.....................................................................................................................20
3.4 Questionnaire.................................................................................................................................21
3.5 Sampling method...........................................................................................................................22
3.6 Data Analysis.................................................................................................................................22
CHAPTER FOUR: RESULTS...............................................................................................................24
CHAPTER FIVE: DISCUSSION, LIMITATIONS, CONCLUSION, AND RECOMMENDATION
.................................................................................................................................................................. 36
5.1 DISCUSSION.................................................................................................................................36
5.2 LIMITATION................................................................................................................................39
5.3 CONCLUSION..............................................................................................................................39
5.4 RECOMMENDATION.................................................................................................................40
REFERENCES........................................................................................................................................42

viii
 CHAPTER ONE: INTRODUCTION

1.1 Background

Depression is a prevalent mental disorder. According to the WHO, a major contributor to the

global burden of disease and a leading cause of disability worldwide is depression. (Kim et al.,

2013). Normal mood swings and fleeting emotional reactions to problems in daily life are

distinct from depression (Hamdan-Mansour et al., 2009). During a depressive episode, the person

experiences a depressed mood (feeling sad, irritable, empty), insomnia, and a loss of interest in

activities, for most of the day, nearly every day, for at least two weeks. Other symptoms include

impaired attention, feelings of excessive guilt or low self-worth, despair about the future, suicidal

thoughts, disturbed sleep, weight loss, and feeling particularly exhausted or low in energy.

According to recent WHO data from 2014, it is presently the main contributor to the burden of

disease worldwide, with prevalence rates ranging from 3% to 17% globally and rising to between

9.3% and 23% when chronic physical conditions like diabetes, asthma, and arthritis are included

as comorbidities(Gururajan et al., 2016). According to the results of an epidemiological study

carried out in Africa, depression and stress-related illnesses affect 20% of young people

annually(Asare & Danquah, 2015).The frequency of depression among older persons in sub-

Saharan Africa varies, according to a review of available data(Amegbor et al., 2020). Those at

high risk of mental and psychological health issues, such as teenagers and young adults in higher

education, are being given more attention (Hamdan-Mansour et al., 2009). Adolescents

frequently experience intense, dramatic, and unpleasant emotions, and their moods frequently

swing between the two(F. Nyarko, Peltonen, Kangaslampi, & Punam, 2020). According to

(Hamdan-Mansour et al., 2009), the degree and severity of mental and psychological issues that

college students seek assistance for are far greater than what counselors may anticipate.

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Personal neglect is a regular occurrence for people with depression, when the person least

prioritizes their hygiene, exposing them to communicable and non-communicable illnesses.

Nearly half of individuals diagnosed with depression also have an anxiety condition.(Amu et al.,

2021).

According to (Oppong Asante & Andoh-Arthur, 2015a), a study conducted among university

students in Ghana found that female gender, higher study/age levels, lower socioeconomic status,

stressful and traumatic events like posttraumatic stress disorder, and addictive behaviors like

higher alcohol and tobacco use, poor academic performance, and religiosity are risk factors that

increase depression in students. In their study, they found that among a sample of university

students, 31.1% had mild to moderate depression and 8.1% had severe depressive symptoms.

Moreover, (Atindanbila & Abasimi, 2011) assessed depression among university students in

Ghana and found a mean score of 16.14, which is an indication of mild depression according to

the norms of Beck’s Depression Inventory.

There is currently, however, a paucity of community-based empirical research on the prevalence

of depression, stress and other mental health problems in Ghana. Also previous

studies(Atindanbila & Abasimi, 2011; K. Nyarko & Amissah, 2014; Oppong Asante & Andoh-

Arthur, 2015a) focused on the prevalence of depression independently, with no emphasis on their

co-existence in terms of examination being the major cause. This study is community-based

research to show the prevalence of depression and assessing whether examination is the main

cause of depressive symptoms among University of Cape Coast students. This study, therefore,

bridges the gap by estimating the prevalence of depression and its symptomatology and also

ascertain whether examination is main cause of depression. It would, therefore, contribute

immensely to the literature on mental health in Ghana and the rest of SSA.

2
1.2 Problem statement

However, few studies in Ghana have specifically assessed depressive symptoms among

university students. (K. Nyarko & Amissah, 2014) employed the BDI but omitted to mention the

prevalence of depression. Their research looked specifically at any connections between

cognitive distortions and depression among selected university students in Ghana. Also, when

exploring the association between depression and coping mechanisms among students at the

University of Ghana, (Atindanbila & Abasimi, 2011) did not disclose the levels of depression in

their sample despite employing the Beck Depression Inventory. The authors did note, however,

that 16.1% of the students had mild depressive symptoms. Moreover (Oppong Asante & Andoh-

Arthur, 2015a), a study conducted on university students in Ghana found that among a sample of

university students, 31.1% had mild to moderate depression and 8.1% had severe depressive

symptoms.

At the University of Cape Coast, no studies have been conducted to assess the prevalence of depression

and the assessment of depressive symptoms during and after examinations among regular University of

Cape Coast students. This study is community-based research to show the concurrent prevalence

of depression and assess whether examination is the main cause of depressive symptoms

compared to other causes among University of Cape Coast students. It would, therefore,

contribute immensely to the literature on mental health in Ghana and the rest of SSA.

1.3 Significance of study

Despite the high rate of assessment of depression in developed countries, estimation of the

prevalence of depression and depressive symptoms is very low in developing countries,

including sub-Saharan countries. Very little attention has been given to mental health disorders

including depression, stress, anxiety, and among others. This is necessary because various studies

3
have shown that if depression is not adequately controlled, it can lead to health problems, poor academic

performance in students, and a negative impact on the overall economy.

The findings of this study will be useful in policy making and will supplement knowledge in

depression prevalence, assessment of depressive symptoms among regular students at the

University of Cape Coast, and interventional strategies that could be of assistance to students in

tertiary institutions in order to facilitate improved and effective teaching-learning interaction in

schools and curb this mental health issue. Based on the study's findings in the at-risk population,

interventions such as mental health educational campaigns would be implemented. This study

will also help in reducing the high incidence of depression and suicidal ideation among regular

students at the University of Cape Coast and other tertiary institutions, as well as in the country

as a whole.

1.4 Hypothesis

The following hypotheses are to be tested and validated:

1. At the University of Cape Coast, students will perceive examination as the primary cause

of depression, rather than the other causes.

2. There will be a significant difference in the reported symptoms of depression during and

after examination among University of Cape Coast students. These variables are gender,

age, the total score a student get on the HDRS and the depression severity.

3. There is a significant relationship between the symptoms of depression reported by the

students.

4. There is a significant relationship between depression severity and suicidal ideation

among students.

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1.5 Aim

To assess the prevalence of depression and depressive symptoms during and after examination

among University of Cape Coast regular students.

1.6 Specific objectives

1. To estimate the gender distribution of depression severity during examination and after

examination.

2. To estimate the age-group distribution of depression severity during examination and

after examination.

3. To estimate depression severity and its impact on work and activities during and after

examination.

4. To assess suicidal ideation among various depression severity during examination and

after examination.

5. To estimate the total number of normal and depressed students during and after

examination.

6. To predict relationship between the depressive symptoms and the total score during the

examination and after the examination.

5
 CHAPTER TWO: LITERATURE REVIEW

2.1 Introduction

Depression is among the most common mental disorders that affect the quality of an individual’s

life. Persons of all genders, ages, and backgrounds can experience depression (Bhowmik et al.,

2012). Sadness, lack of interest or pleasure, guilt or feelings of low self-worth, interrupted sleep

or food, fatigue, and poor concentration are all signs of depression (Amu et al., 2021). According

to (WHO European Region, 2016), depression may have a detrimental effect on how Non-

communicable diseases develop, increasing the need for medical treatment and its associated

expenses.

Stress, anxiety, and depression are the three main mental health conditions of public health

concern in Sub-Saharan Africa (SSA), with depression and anxiety having prevalence rates of

9% and 10% among the general population, respectively (Amu et al., 2021).

2.2 Epidemiology of Depression

The fourth largest contributor in the year 2000 in terms of the number of disability-adjusted life-

years (DALYs) caused by disease, and the ranking of disability-adjusted life years (DALYs)

calculated for all ages and both sexes, is predicted to position depression in second place by the

year 2020 (Santomauro et al., 2021). In the age range of 15 to 44 years for both sexes, depression

is now the second leading cause of disability-adjusted life-years DALYs (Santomauro et al.,

2021). According to (Amu et al., 2021), stress, anxiety, and depression are the three main mental

health conditions of public health concern in Sub-Saharan Africa (SSA), with depression and

anxiety having prevalence rates of 9% and 10% among the general population, respectively

6
(Amu et al., 2021). Only 1% of patients with mental problems receive any form of psychiatric

care in Ghana according to the WHO (Gold et al., 2012).

In Ghana, a major policy intervention aimed at improving the mental health of indigenes

was the promulgation of the Mental Health Act in the year 2012 (Amu et al., 2021). Various

studies in Ghana have assessed mental health issues. (Osei-Boadi, 2015) , for instance, examined

the influence of social support on the levels of depression, anxiety, and stress among students

and found a high prevalence of mild to severe depression and anxiety (57% and 84%,

respectively), and 49% had stress. (Oppong Asante & Andoh-Arthur, 2015a) examined the

prevalence and determinants of depression among university students and observed that 39.2%

had depressive symptoms, which were associated with limited social support, religion, heavy

alcohol consumption, and traumatizing experiences. also assessed the mediation effects of

depression. All the aforementioned authors reported that depression and anxiety negatively

impacted the participants’ quality of life.

2.3 Depression pathophysiology

The pathophysiology of depression is caused by several factors. Neurochemical,

neuroendocrinological, neuroinflammatory, neuroplastic, and neurotrophic factors are some of

the pathophysiological pathways that are most often involved.

Serotonin, noradrenaline, dopamine, and other neurochemicals have all been extensively

researched and reported on for their role in depression. The monoamine hypothesis explains one

of the most well-known pathophysiological processes behind depression. In the anterior

cingulate cortex, ventral tegmentum, and the 25-region Brodman area, it is hypothesized that

monoamines such as noradrenaline, serotonin, and dopamine are reduced during depression

(Gbadamosi et al., 2022).

7
2.4 Depression prevalence among university students

University students may be especially prone to diagnoses of depression because they face high

levels of academic, interpersonal, and financial stress, and may lack sufficient resources (e.g.,

social support and access to appropriate coping methods) to handle those issues.

Research conducted by (Sarokhani et al., 2013) on depression among university students found

that depression is a prevalent problem and continues to rise among the university student

population. A Nigerian research study (Adewuya et al., 2006) estimated prevalence of depression

among university students, and found that only 2.7% of Nigerian students were depressed. In

addition, (Melaku et al., 2021) study to detect depression, anxiety, and stress symptoms among

Ethiopian undergraduate medical students found 52.3%, 60.8%, and 40.4%, respectively,

whereas the percentages of respondents who had extremely severe symptoms of depression,

anxiety, and stress were 6.2%, 16.2%, and 2.3%, respectively. These studies are indicative of a

pattern of increased vulnerability among undergraduates.

According to (Oppong Asante & Andoh-Arthur, 2015a), in a study conducted on university

students in Ghana, female gender, higher study and age levels, poorer socio-economic status,

stressful and traumatic experiences like posttraumatic stress disorder, and addictive behaviors

like increased alcohol and cigarette use, poor academic performance, and religion are risk factors

that cause depression in students. In their study, they found that among a sample of university

students, 31.1% had mild to moderate depression and 8.1% had severe depressive symptoms.

Moreover, (Atindanbila & Abasimi, 2011) assessed depression among university of Ghana and

found a mean score of 16.14 which is an indication of mild depression according to the norms of

Beck’s Depression Inventory.

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2.5 Depression and suicidal thoughts among university students

Even mildly depressed people are believed to have suicide thoughts in the range of 10%-15%

(Taybos & Terezhalmy, 1982). There are instances that become worse, are more difficult to cure,

or last a long time (Taybos & Terezhalmy, 1982). The lifetime prevalence of MDD among

students was 10-85%, according to a World Mental Health Survey that collected data from 17

nations (including Nigeria, Colombia, Germany, and Italy), compared to 3-21% for the general

population of people old age (Canavan et al., 2013).

Depression affects one's quality of life if untreated. According to (Canavan et al., 2013; Ibrahim

et al., 2013), the disorder has cognitive effects (for example, deficiencies in higher-order

executive functioning) that may impede academic performance and raise the risk of failing

courses or leaving university entirely. It also interferes with everyday tasks and has further

detrimental effects on interpersonal interactions and psychological development (Canavan et al.,

2013).Therefore, going through depression as a college student can affect your chances of having

good relationships later in life as well as your ability to progress in your work.

2.6 The impact of Depression on student work and activities

Studies have indicated that one of the commonest reasons why students visit the university

counseling center is as a consequence of depression, and the situation creates a lot of

complications for the students. It affects their academic performance and motivation, resulting in

worse grades. It also generates worldwide problems for the students including decreased quality

of life and greater risks of committing suicide. They found that up to 40% of the students who

attend these facilities have problems with depression, and many students seeking university

counseling for other concerns are also dealing with depression. (Atindanbila & Abasimi, 2011).

9
2.7 Risk and Protective factors of Depression among university students

2.7.1 Risk factors

Risk factors that play a role in the pathogenesis of mental disorders can be biological,

psychological, and social. Poverty, discrimination, social exclusion, illicit drug use, family

history of mental illness, child maltreatment (abuse and neglect), adverse life events (e.g, poor

academic performance), not having enough rest, and chronic illness are all rick factors that

increase the risk of one being depressed on campus (WHO European Region, 2016). However,

when several risk factors act together, then the risk of developing depression increases sharply.

2.7.2 Protective factors

Factors known to protect an individual from being depressed include social support, personal

competencies (intelligence, social skills, self-understanding, ‘agency’), and resilience (fortitude,

strength, mental fitness). Resilience is expressed through resourceful ways of coping with

adversity. In this sense, resilience will help to buffer the adverse impact of stressors (WHO

European Region, 2016).

2.8 Diagnosis of Depression

Different tools may be used by medical experts to get a precise and thorough diagnosis of

depression. It has been noted that diagnostic methods do not adequately account for a variety of

biological, psychological, and societal factors that might have a major impact on depression

(Munro & Milne, 2020). Therefore, it is important to take the person's personal history and

family history of depression into account while conducting a diagnostic examination (Munro &

Milne, 2020). A person must have five depressive symptoms virtually every day for at least two

weeks in order to be diagnosed with depression, and a low mood or a lack of interest in or

enjoyment from almost all activities must be one of the symptoms (Gbadamosi et al., 2022).

10
The majority of depression diagnoses are made using clinical interview-based tools, although

there are a few instances when depression screening lab tests are available. Because there are

fewer mental health professionals in SSA than in Europe, many medical professionals lack the

necessary training to use diagnostic tools successfully (Gbadamosi et al., 2022). Some of these

clinical interview-based tools include the Hamilton depression rating scale (HDRS), Beck’s

Depression Inventory II (BDI II), and others.

2.9 Preventive measures to curb depression among University of Cape Coast regular

students

2.9.1 Stepped care

Stepped care for elderly patients with sub-threshold depressive symptoms in primary care and

residential facilities has been shown to be very helpful in lowering the prevalence of depression

(WHO European Region, 2016). Watchful waiting, supervised self-help, therapist-led problem

resolution, and referral to a general practitioner for medication are the steps in the preventative

stepped-care methods (WHO European Region, 2016).

2.9.2 Cognitive-Behavioral Therapy

Cognitive behavioral therapy teaches you how to fight off negative thoughts. You will learn how

to become more aware of your symptoms and how to spot things that make your depression

worse. You'll also be taught problem solving skills (WHO European Region, 2016).

2.9.3 Psychotherapy

Psychotherapy can help you understand the issues that may be behind your thoughts and feelings

(WHO European Region, 2016).

11
Also, joining a support group of people who are sharing problems like yours can also help. Ask

your therapist or doctor for a recommendation (WHO European Region, 2016).

12
 CHAPTER THREE: MATERIALS AND METHODS

3.1 Study design/setting

A descriptive, cross-sectional, community-based survey was adopted for this study. A structured

questionnaire was used to interview eligible University of Cape Coast regular students who

consented to participate in the study. Information collected included their ages, genders, and the

17-items questionnaire assessing depressive symptomatology. The study was conducted among

University of Cape Coast regular students who were living either in the university Hall of

residence or in diaspora. University of Cape Coast regular students who were not willing to be

part, University of Cape Coast (postgraduate, distance and sandwich students) were excluded

from the study.

3.2 Sample size

The study was conducted in two phases, that is, during the examination period and after the

examination (start of the semester). For each of the two phases, 100 participants were recruited

to take part in the study.

3.3 Ethical consideration

Ethical approval for this protocol was obtained from the Korle-Bu Teaching Hospital-

Institutional Review Board. Each study participant provided informed consent, and

information confidentiality and subject anonymity were ensured. Respondents had the

freedom to participate or quit the study without any harm or discrimination. Furthermore,

respondents' comfort and privacy were maintained during the interview. The ability to read

and write was not considered a requirement for the study participants. During the study, strict

confidentiality was observed. The participants were identified by codes and numbers instead

13
of their actual names, and the data was kept in a safe place to ensure confidentiality.

Nevertheless, the study conducted benefits the University of Cape Coast, policy

implementers, and any stakeholders who would use the research work to make decisions.

3.4 Questionnaire

The Hamilton Depression Rating Scale was the questionnaire used in this study (HDRS or

HAM-D). The most frequently used clinician-administered depression evaluation scale is the

HDRS (commonly known as the Ham-D). The original version had 17 items on it that are

related to recent depressive symptoms. Despite the fact that the scale was intended to be

completed after an unstructured clinical interview, semi-structured interviewing techniques

are now accessible. The HDRS was first created for hospital inpatients, which explains its

focus on melancholy and somatic depressive symptoms. Four items from a later 21-item

version were intended to subtype depression but are sometimes incorrectly used to score

severity. The HDRS has the drawback of not assessing unusual symptoms of depression, such

as hypersomnia and hyperphagia. This instrument may identify two-week depression

episodes. Table 3.1 is the interpretation of a respondent’s total HDRs score.

Table 3.1 Total HDRS score and its interpretation

Total HDRS score Indication

0-7 Normal

8-13 Mild depression

14-18 Moderate depression

19-22 Severe depression

≥23 Very severe depression

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3.5 Sampling method

Participants were selected at random at various hostels and lecture rooms. When data collectors

arrived at various hostels and lecture theaters, a random direction was chosen. The eligible

participants (University of Cape Coast regular students) are first taken through the study and

subsequently, they were consented to either withdraw from the study. In a room where eligible

participants are more than four, they are all taken through the study at the same time and

afterwards they are consented individually to partake in the study. A structured questionnaire

was used to obtain information from University of Cape Coast regular students on assessing their

depressive symptoms during and after examination. The questionnaire was interviewer

administered and also any participant who preferred self-administration to was guided through

the completion of the questionnaire.

3.6 Data Analysis

Data was entered in Microsoft Excel 2019 Software, which was used to create a database.

Duplicate listings and checks were used to check for the completeness and consistency of the

data. Data was then exported to SPSS version 20 for analysis. The calculated mean and total

score were performed for both during and after the examination. Descriptive statistics were used

on all 17 items on the questionnaire, for both the phases in which the data were collected.

Crosstabulations were performed between variables (gender, age groups, suicidal thoughts, work

and activities) and severity of depression. For each comparison, correlation and chi square and

the statistical significance was based on a p-value of 0.05 at a CI of 95%. The results were

displayed in tables and graphs. The number of questions on the Hamilton Depression Rating

Scale (HDRS) is 17, and the maximum and minimum score were 53 and 0 respectively. Any

total score above 7 indicates that a respondent had mild to very severe depressive symptoms.

15
 CHAPTER FOUR: RESULTS

This section presents and discusses preliminary data, which comprise of background information

about the respondents. These include gender and age. A total of 200 regular undergraduate

regular students were recruited for participation in this study. 100 students each were recruited

for both the first phase (during the examination) and second phase (after the examination).

Depressed mood (sadness, hopelessness, worthlessness), feelings of guilt, suicide, insomnia,

anxiety, both physical and somatic, loss of interest in activities, retardation, weight loss, and

other symptoms are assessed by the HDRS(Hamilton, 1967). Scores for some components are

based on a four-point scale, others on a three- or two-point scale, with higher scores reflecting

the severity of the occurrence of the depressive symptom. A total HDRS score is also calculated,

with scores >7 used to classify participants as having mild to very severe depression and scores

≤7 used to classify participants as normal or having no depression.

As shown in Table 4.1 means of all 17 items on the HDRS and the total scores for all the

respondents in both phases (during and after examination) of the study were calculated. The

mean for the total score during examination and after examination were 14.61±7.824SD and

13.35±8.157SD respectively. As a result, depression severity can be classified as being moderate

during the examination and mild after examination. With respect to the means of all the 17 items

assessing symptoms of depression, the means for all the items during examination, with the

exception of suicidal thoughts, insomnia (early and middle of the night), and work and activities,

were greater than the means of the items after examination. This is an indication that depression

symptoms during the examination were more common than after the examination.

16
Table 4.1 Descriptive statistics items on the HDRS

Variables During Examination After Examination

Mean SD Mean SD
AGE
22.72 2.257 22.84 1.932
DEPRESSED MOOD
1.44 1.373 1.39 1.399
FEELINGS OF GUILT
1.37 1.012 1.11 1.024
SUICIDE
.31 .884 .39 .886
INSOMNIA: EARLY IN
THE NIGHT .55 .687 .69 .813
INSOMNIA: MIDDLE
OF THE NIGHT .37 .646 .64 .835
INSOMNIA: EARLY
HOURS OF THE .72 .805 .69 .813
MORNING
WORK AND
ACTIVITIES .84 .940 .98 1.101
RETARDATION
.70 .905 .63 .939
AGITATION 1.56 1.653 1.32 1.563
ANXIETY PSYCHIC
1.43 1.320 1.19 1.134
ANXIETY SOMATIC .79 .844 .74 .960
SOMATIC
SYMPTOMS:
GASTROINTESTINAL .53 .731 .40 .603

GENERAL SOMATIC
SYMPTOMS .51 .577 .36 .482
GENITAL SYMPTOMS
.38 .599 .32 .530
HYPOCHONDRIASIS
.77 1.014 .54 1.019
LOSS OF WEIGHT 1.25 1.192 .94 1.179
INSIGHT
1.09 .780 1.02 .853
TOTAL HDRS SCORE 14.61 7.824 13.35 8.157

17
Taking into consideration the gender distribution of depression severity during the examination,

out of the 81% of respondents who were experiencing mild to very severe depression, 32% were

females and 49% were males, as illustrated in Table 4.2. Again, with respect to the gender

distribution of the severity of depression after examination, out of the 70% of respondents who

were experiencing mild to very severe depression, 30% were females and 40% were males, as

illustrated in Table 4.2. The differences in both the respondents during and after examination

were not much to yield statistical significance after performing the chi square test [during

examination (p-value=0.631) and after examination (p-value=0.208)] as shown in table 4.3.

Figure 4.1 and 4.2 are bar charts representing the gender distribution of depression severity

during and after examination, respectively.

Table 4.2 Gender distribution of depression severity during and after examination
Depressio During Examination After Examination
n severity
F M Total F M Total

Normal 7 12 19 8 22 30

7.0% 12.0% 19.0% 8.0% 22.0% 30.0%

Mild 11 21 32 7 11 18

11.0% 21.0% 32.0% 7.0% 11.0% 18.0%

Moderate
9 7 16 16 13 29

9.0% 7.0% 16.0% 16.0% 13.0% 29.0%

Severe 6 9 15 3 6 9

6.0% 9.0% 15.0% 3.0% 6.0% 9.0%

Very
6 12 18 4 10 14
Severe
6.0% 12.0% 18.0% 4.0% 10.0% 14.0%
Total 39 61 100 38 62 100

39.0% 61.0% 100.0% 38.0% 62.0% 100.0%

18
Table 4.3 Chi square test for depression severity and gender

Variable During Examination After Examination

Value Significance Value Significance

Gender 2.575 0.631 5.883 0.208

Figure 4.1

19
 Figure 4.2

As shown in table 4.4, the age group distribution of depression severity during examination, the

majority of respondents were under the age of 28; 9% were between the ages of 18 and 20; 61%

were between the ages of 21 and 23; 28% were between the ages of 24 and 27; and only 2% were

28 or older. None of the respondents, who were all aged 28 and above had a normal total HDRS

score. The Pearson correlation between age-group and depression was a weak positive

correlation that was not statistically significant. A Chi-square test was also performed for age-

group and depression severity; a value of 9.266 was obtained, but it was not statistically

significant.

20
Table 4.4 Age-group distribution of depression severity during examination
Depressio 18-20 21-23 24-27 28 and Pearson Chi Square
n Severity older Correlation test
Value Sig. Value Sig.
0-7 3 13 3 0 0.119 0.238 9.266 0.680
3.0% 13.0% 3.0 0.0%

8-13 2 21 9 0
2.0% 21.0% 9.0%

14-18 1 8 6 1
1.0% 6.0% 1.0%.
8.0%
19-22 2 7 5 1
2.0% 7.0% 5.0% 1.0%

23 and 1 12 5 0
higher 1.0% 12.0% 5.0% 0.0%

Total 9 61 28 2
9.0% 61.0% 28.0% 2.0%

As shown in Table 4.5, the age group distribution of depression severity after examination, the

majority of respondents were under the age of 28; 14% were between the ages of 18 and 20, 49% were

between the ages of 21 and 23, 36% were between the ages of 24 and 27, and only 1% were age 28 or

older. None of the respondents, who were all aged 28 and above had a normal total HDRS score.

The Pearson correlation between age-group and depression was a weak positive correlation that

was not statistically significant. A Chi-square test was also performed for age-group and

depression severity; a value of 9.266 was obtained, but it was not statistically significant.

21
Table 4.5 Age-group distribution of depression severity after examination
Depression 18-20 21-23 24-27 28 and Pearson Chi square test
severity older Correlation
Value Sig. Value Sig.
0-7 5 11 14 0 -0.054 0.591 8.047 0.781
5.0% 11.0% 14.0% 0.0%
8-13 3 9 6 0
3.0% 9.0% 6.0% 0.0%

14-18 2 18 8 1
2.0% 18.0% 8.0 1.0%
19-22 1 5 3 0
1.0% 5.0% 3.0% 0.0%
23 and 3 6 5 0
higher 3.0% 6.0% 5.0% 0.0%

Total 14 49 36 1
14.0% 49.0% 36.0% 1.0%

As illustrated in Table 4.6, more than half of than 54% of respondents reported feelings of

incapacity, indecision, decreased productivity, and loss of interest in their work and activities

during the examination period. Also, during the examination period, 46% of the respondents

reported not having any difficulty in performing their work and activities, 17% recorded having

normal depression, 20% recorded having mild depression, 6% recorded moderate depression,

and 3% recorded severe to very severe depression. Out of the 33% of respondents who reported

having severe to very severe depression, 14% reported feelings of incapacity and indecision,

12% reported loss of interest in hobbies and social activities, 3% reported being decreased

productivity, and 1% reported unable to work.

22
Also as shown Table 4.7, more than half of the 54% of respondents reported feelings of

incapacity, indecision, decreased productivity, and loss of interest in their work and activities

during the examination period. Also, during the examination period, 46% of the respondents

reported of not having any difficulty in performing their work and activities, 24% recorded

having normal depression, 12% recorded having mild depression, and 10% recorded moderate

depression. All the respondents who recorded severe to very severe depression had difficulty in

their work and activities. Out of the 23% of respondents who reported having severe to very

severe depression, 8% reported feelings of incapacity and indecision, 9% reported a loss of

interest in hobbies and social activities, 5% reported decreased productivity, and 1% reported

being unable to work.

A Pearson correlation and a Chi-square test were performed for both phases of the sample taken.

The Pearson correlation between work and activities and depression severity during the

examination was 0.633, indicating a strong positive correlation and was significant. The Chi

square test performed was also significant at a p-value of 0.05. Moreover, the Pearson correlation

between work and activities and depression severity after the examination was 0.577, indicating

a strong positive correlation that was significant. The chi square test performed was also

significant at a p-value of 0.05.

Table 4.6 Relationship depression and work and activities of respondents during
examination
Depression Work and Activities Chi square test Pearson
Severity Correlation

0 1 2 3 4 Value Sig. Value Sig.

Normal 51.64 0.00 0.633 0.00
17 1 1 0 0
17.0% 1.0% 1.0% 0.0% 0.0%

23
Mild
20 10 2 0 0
20.0% 10.0% 2.0% 0.0% 0.0%
Moderate
6 5 4 1 0
6.0% 5.0% 4.0% 1.0% 0.0%
Severe
2 9 3 1 0
2.0% 9.0% 3.0% 1.0% 0.0%
Very
severe 1 5 9 2 1
1.0% 5.0% 9.0% 2.0% 1.0%
Total
46 30 19 4 1
46.0% 30.0% 19.0% 4.0% 1.0%

Table 4.7 Relationship depression and work and activities of respondents after examination
Depressio Work and Activities Chi square Pearson
n Severity test Correlation
0 1 2 3 4 Value Sig. Value Sig.
Normal 24 5 0 1 0 49.148 0.00* 0.577 0.00*
24.0% 5.0% 0.0% 1.0% 0.0%
Mild 12 3 2 1 0
12.0% 3.0% 2.0% 1.0% 0.0%
Moderate 10 7 9 2 1
10.0% 7.0% 9.0% 2.0% 1.0%
Severe 0 4 2 2 1
0.0% 4.0% 2.0% 2.0% 1.0%
Very 0 4 7 3 0
severe
0.0% 4.0% 7.0% 3.0% 0.0%
Total 46 23 20 9 2
46.0% 23.0% 20.0% 9.0% 2.0%

24
As illustrated in Table 4.8 and 4.9, suicidal thoughts were experienced by respondents

experiencing depressive symptoms; during the examination, 13% of the respondents were

experiencing some level of suicidal thoughts. Also, after examination, 20% of the respondents

were experiencing some level of suicidal thoughts. Suicidal ideation after examination among

University of Cape Coast regular students was higher than suicidal ideation after examination.

The suicidal ideation in both phases of this study were all significant at a p-value of 0.05[during

examination (p=0.000) and after examination (p=0.000]. The findings in this study are consistent

with the prevalence found in other studies assessing depression and suicidal ideation among

university students.

A Pearson correlation and a Chi-square test were performed for both phases of the sample taken.

The Pearson correlation for suicidal ideation and depression severity during examination was

0.618, indicating a strong positive correlation and was significant. The chi square test performed

was also significant at a p-value of 0.05. Moreover, the Pearson correlation between work and

activities and depression severity after the examination was 0.673, indicating a strong positive

correlation and was significant. The Chi-square test performed was also significant at a p-value

of 0.05.

Table 4.8 Relationship between suicidal thoughts and depression severity during
examination

Depression Suicidal thoughts Chi square test Pearson

Correlation
severity
0 1 2 3 4 Value Sig. Value Sig.
Normal 19 0 0 0 0 51.643 0.000** 0.618 0.000**
19.0% 0.0% 0.0% 0.0% 0.0%

25
Mild 29 0 1 1 1
29.0% 0.0% 1.0% 1.0% 1.0%
Moderate 15 0 1 0 0
15.0% 0.0% 1.0% 0.0% 0.0%
Severe 13 1 1 0 0
13.0% 1.0% 1.0% 0.0% 0.0%
Very severe 11 2 1 3 1
11.0% 2.0% 1.0% 3.0% 1.0%
Total 87 3 4 4 2
87.0% 3.0% 4.0% 4.0% 2.0%

Table 4.9 Relationship between suicidal thoughts and depression severity after examination

Depressio Suicidal thoughts Chi square test Pearson

Correlation
n severity
0 1 2 3 4 Value Sig. Value Sig.
Normal 30 0 0 0 0 81.126 0.000* 0.673 0.000*
30.0% 0.0% 0.0% 0.0% 0.0%
Mild 18 0 0 0
18.0% 0.0% 0.0% 0.0% 0.0%
Moderate 26 2 1 0 0
26.0% 2.0% 1.0% 0.0% 0.0%
Severe 6 1 2 0 0
6.0% 1.0% 1.0% 0.0% 0.0%
Very severe
0 5 3 5 1
0.0% 5.0% 3.0% 5.0% 1.0%
Total 80 8 6 5 1
80.0% 8.0% 6.0% 5.0% 2.0%

From table 4.10, depressive symptoms were paired to see if there was a correlation. In this study,

we found depressed mood (sadness and worthlessness), retardation (slowness of thought, speech,

and activity), and insomnia (during midnight) to have a strong positive correlation with

respondents’ total HDRS score, and all the Pearson correlations were significant at a p-value of

26
0.05 for both during the examination and after the examination. Also, loss of weight during

examination had a weak positive correlation with the respondents’ total HDRS score and was

significant at a p-value of 0.05, but loss of weight after examination had a weak positive

correlation with the respondents’ total HDRS score but was not statistically significant at a p-

value of 0.05. Again, the Pearson correlation between suicidal thoughts and hypochondriasis

(preoccupation with health, request for help) among respondents during the examination was a

weak positive correlation (0.216) but the Pearson correlation between suicidal thoughts and

hypochondriasis (preoccupation with health, request for help) among respondents after the

examination was a strong positive correlation (0.570). These correlations, both during and after

the examination, were all statistically significant at a p-value of 0.05.

Table 4.10 Correlations between depression symptoms and the total HDRS score

Variables During Examination After Examination

Value Significance Value Significance
Hypochondriasis 0.216 0.031** 0.570 0.000**
and suicidal
thought
Insomnia (middle 0.499 0.000** 0.524 0.000**
of the night) and
total HDRS score
Loss of weight and 0.263 0.008** 0.075 0.46
total HDRS score

Retardation and 0.581 0.000** 0.513 0.000**

total HDRS score

Depressed mood 0.502 0.000** 0.581 0.000**

and total HDRS
score

27
 CHAPTER FIVE: DISCUSSION, LIMITATIONS, CONCLUSION, AND

RECOMMENDATION

5.1 DISCUSSION

This study was conducted to examine the prevalence and assessment of depression symptoms

among University of Cape Coast regular students during examination and after examination.

According to the findings of this study, 81% of regular students at the University of Cape Coast

experienced mild to very severe depression, 48% experienced mild to moderate depressive

symptoms, and 33% experienced severe to very severe depressive symptoms. Again, this study

found that after examination, 70% of a sample of 100 regular students at the University of Cape

Coast experienced mild to very severe depression, 47% experienced mild to moderate depressive

symptoms, and 23% experienced severe to very severe depressive symptoms. This clearly

indicates a higher prevalence of depressive symptoms during examination than after the

28
examination The prevalence of depression as found in this study for both during and after

examination is comparable, consistent, but higher than the prevalence found in other studies

(Adewuya et al., 2006; Atindanbila & Abasimi, 2011; Melaku et al., 2021; Oppong Asante &

Andoh-Arthur, 2015b). The high prevalence rate is also consistent with findings from a major

study in Ghana, where 21% of adults assessed reported moderate to severe psychological distress

(Canavan et al., 2013) and also in(Pobee et al., 2022).

In this study, severe to very severe depression during and after examination were reported

33%(12% females and 21% males) and 23%(7% females and 16% males) respectively, which is

higher than the one reported in study of depression among a large sample of students at

universities across the African continent and in others different regions (Anyayo et al., 2022;

Hossain & Kabir, 2022; Khan et al., 2021; Melaku et al., 2021; Ngasa, 2020). Unlike what have

been reported elsewhere (Adewuya et al., 2006), the gender difference was not statistically

significant. Factors such as the type of sample, the number of participants for each gender, and

other variables could have confounded the results. As found in other studies(Adewuya et al.,

2006), this study did not find any gender differences in depression prevalence(Olum et al., 2020;

Oppong Asante & Andoh-Arthur, 2015b; Rotenstein et al., 2016; Sarokhani et al., 2013). The

findings in this study did not find any age differences in depression prevalence. It's possible

because the majority of the respondents were in the same age group, with the majority of

students reporting being between the ages of 20 and 24.

Taking into consideration suicidal thoughts in students experiencing depressive symptoms,

during the examination, 13% of the respondents were experiencing some level of suicidal

thoughts. Also, after examination, 20% of the respondents were experiencing some level of

suicidal thoughts. Suicidal ideation after examination among UCC regular students was higher

29
than suicidal ideation after examination. The suicidal ideation in both phases of this study were

all significant at a p-value of 0.05[during examination(p=0.000) and after examination(p=0.000].

The findings in this study are consistent with the prevalence found in other studies assessing

depression and suicidal ideation among university students(F. Nyarko, Peltonen, Kangaslampi, &

Punamäki, 2020; Organización Mundial de la Salud, 2014; Rotenstein et al., 2016). The findings

and prevalence of suicidal ideation among the respondents in this study were all higher than the

prevalence found in other studies (F. Nyarko, Peltonen, Kangaslampi, & Punamäki, 2020;

Organización Mundial de la Salud, 2014; Rotenstein et al., 2016; Shao et al., 2020). The high

incidence found in this study might be explained by discrepancies resulting from the

methodology and type of questionnaire administered.

Moreover, the work and activities of the respondents experiencing depressive symptoms were

affected, during the examination, 54% of the respondents reported having difficulties in

performing their work and activities. Also, after examination, 54% of the respondents reported

having difficulties in performing their work and activities. The prevalence of difficulty in

performing work and activities among UCC regular students experiencing depressive symptoms

during examination was equal to the prevalence of difficulty in performing work and activities

after examination. The effects on work and activities in both phases of this study were all

significant at a p-value of 0.05 [during examination(p=0.000) and after examination(p=0.000].

The findings in this study are consistent with the prevalence found in other studies(Dapaah &

Amoako, 2019; Wang et al., 2020). Students revealed that they usually feel incapable, sometimes

feel indecisive and weak in performing their activities.

Furthermore, depressive symptoms were paired to check the correlation between them. In this

study, we found depressed mood (sadness and worthless), retardation (slowness of thought,

30
speech, and activity) and insomnia (during midnight) to have a strong positive correlation with

respondents’ total HDRS score, and all the Pearson correlations were significant at a p-value of

0.05 for both during the examination and after the examination. Also, loss of weight during

examination had a weak positive correlation with the respondents’ total HDRS score and was

significant at a p-value of 0.05 but loss of weight after examination had a weak positive

correlation with the respondents’ total HDRS score but was not statistically significant at a p-

value of 0.05. Again, the Pearson correlation between suicidal thoughts and hypochondriasis

(preoccupation with health, request of help) among respondents during examination was weak

positive correlation (0.216) but the Pearson correlation between suicidal thoughts and

hypochondriasis (preoccupation with health, request for help) among respondents after

examination was a strong positive correlation (0.570). These correlations, both during and after

the examination were all statistically significant at a p-value of 0.05. The findings in this study

are comparable and consistent with other studies in Ghana and foreign countries(Atindanbila &

Abasimi, 2011; Edwards, 2003; Shao et al., 2020; Trivedi, 2004).

5.2 LIMITATION

First, the study was conducted at the University of Cape Coast among regular students; thus, care

should be taken when applying the findings to other demographics. Therefore, the study should

be extended to sandwich students, postgraduates, and teaching and non-teaching staffs of the

University of Cape Coast and subsequently in other tertiary institutions in Ghana to order to give

a true representation of the country. The results of this research need to be read carefully since

various factors, most notably the cross-sectional design that was used, might have introduced

bias. As a result of the research's cross-sectional design, it is difficult to establish a cause-and-

effect link; yet, a cross-sectional study has the benefit of allowing for the evaluation of

31
prevalence by studying a large population at one moment in time. Correlations and association

predictions may both be made in a cross-sectional investigation. Additionally, since the research

relied on a self-report assessment tool, it may have been biased toward respondents’ desirability.

The study's tool was only able to screen for the existence of depressive symptoms, not provide a

diagnosis of depression. For individuals who were found to have depressive symptoms, a formal

clinical interview would be necessary as a follow-up in order to properly diagnose depression.

5.3 CONCLUSION

Among University of Cape Coast regular students, the prevalence of depression and its

symptoms was moderate during examination and mild after examination. Symptoms such as

depressed mood (feeling of sadness and hopelessness), anxiety psychic (fears and worrying

about minor matters), retardation (slowness of thought and speech), and feelings guilts all had

greater means during examination as compared to their means after examination. Suicidal

thoughts, insomnia in the middle of the night, and loss of interest in work and activities, on the

other hand, had higher means after examination than during examination.

The rate of severe and very severe depression was very high, both during (13%) and after (20%)

the examination. Students who reported suicidal thoughts (feeling that life is not worth living,

suicidal ideas, or gestures) also reported having severe to very severe depression.

There was also a strong association between hypochondriasis (preoccupation with health and

frequent requests for help) and suicidal thoughts. Students who usually worry about their disease

conditions and frequently request help must be given much attention to reduce the incidence of

suicide at the University of Cape Coast. Psychotherapy and education on mental health issues

must be given to students to create awareness about mental health disorders and the need to seek

assistance.

32
5.4 RECOMMENDATION

Students must be informed about depression and all other mental health disorders and how to

overcome them as early as possible. These campaigns must emphasize the importance and

effectiveness of seeking mental health advice from mental healthcare professionals in the form of

regular visits to the counseling unit. Thus, information is important, but must be combined with

prescriptive information about how to take preventive action, and accessibility to mental health

facilities must be improved.

Again, the government and managements of universities must establish enough mental health

facilities and employ enough mental healthcare professionals where students and the general

population can access mental healthcare, and counseling must be covered by the National Health

Insurance Scheme (NHIS).

33
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