Kebede et al.

Int J Ment Health Syst (2019) 13:30

https://doi.org/10.1186/s13033-019-0287-6 International Journal of
Mental Health Systems

RESEARCH Open Access

Prevalence and predictors of depression

and anxiety among medical students in Addis
Ababa, Ethiopia
Mebratu Abraha Kebede1*, Birke Anbessie1 and Getinet Ayano2

Abstract
Background: Depression and anxiety are among the common mental health problems among medical students
and are associated with poor academic performance, disability and poor quality of life. A better understanding of
the magnitude and correlates of depression and anxiety is essential for planning appropriate intervention for those
population groups. However, research into depression and anxiety and the potential contributing factors is limited in
low and middle-income countries including Ethiopia. Therefore, this study aimed to determine the prevalence and
associated factors of depression and anxiety among medical students.
Methods: A cross-sectional study was conducted among 273 medical students selected by systematic sampling
technique. Hospital anxiety and depression scale (HADS) was used to assess anxiety and depression. Binary and mul-
tivariable logistic regression models were fitted, adjusting for the potential confounding factors. Odds ratios (OR) with
the corresponding 95% confidence interval (95% CI) was computed to assess the strength of association.
Result: The prevalence of co-morbid depression and anxiety was found to be 21.20% (16.35% to 26.05%) and preva-
lence of depression and anxiety was 51.30% (45.37% to 57.23%) and (30.1% 24.66% to 35.54%), respectively. Multivari-
ate analysis showed that being female [AOR 2.56, 95% CI (1.32, 4.95)], first-year educational level [AOR 12.06, 95% CI
(2.18, 66.72)], second-year educational level [AOR 8.99, 95% CI (1.67, 48.45)] and those who had poor/low social sup-
port [AOR 5.36, 95% CI (2.08, 13.76)] were significantly association with anxiety. Students who were in the age interval
of 18–21 years [AOR 2.42, 95% CI (1.64, 9.22)], first-year educational level [AOR 1.63, 95% CI (1.43, 6.26)], second-year
educational level [AOR 1.39, 95% CI (1.17, 5.18)] and who had stressful life events [AOR 1.61, 95% CI (1.14, 2.76)] were
significantly associated with depression among medical students.
Conclusion: The current study demonstrated that a remarkable proportion of medical students are suffering from
depression (51.30%), anxiety (30.10%) as well as comorbid depression and anxiety (21.20%). There was strong evi-
dence of association between anxiety and female sex, first-year educational level, second-year educational level and
having poor/low social support. Whereas a significant association was observed between depression and younger
age (18–21 years old), first-year educational level, second-year educational level and having one or more stressful life
events in the last 6 months. Screening of depression and anxiety among medical students was recommended. Future
studies focusing on better ways of preventing and treating depression and anxiety among medical students are
warranted.
Keywords: Depression, Anxiety, Medical students, Predictors, Ethiopia

*Correspondence: mebratuabraha21@gmail.com
1
Department of Research, Saint Paul Hospital Millennium Medical
College, POBox 171, Addis Ababa, Ethiopia
Full list of author information is available at the end of the article

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Kebede et al. Int J Ment Health Syst (2019) 13:30 Page 2 of 8

Background Attending university is a particularly stressful time due

Depression is a significant public health problem and to unique emergent stressors such as changes in environ-
is characterized by sadness, loss of interest in activi- ment, loss or diminishment of social support networks,
ties and by decreased energy. It is differentiated from academic pressures, developing peer relationships, and
normal mood changes by the extent of its severity, the financial management [14]. The current educational
symptoms and the duration of the disorder [1]. Depres- process may have a negative effect on students’ mental
sion is the fourth most important contributor to the health, with a high frequency of anxiety among medical
global burden of disease and 4.4% of the total disability students [15].
adjusted life years (DAILY) is explained by depression Even though depression and anxiety are found to be
[2, 3]. Epidemiologic evidence also showed that about remarkably high among medical students coupled with
1.2% of the total burden in Africa to 8.9% in high- their impacts in causing poor academic performance,
income countries is explained by depression [4]. disability and poor quality of life, to our knowledge a few
Depression is common in university students espe- studies are available in East Africa including the study
cially it is high among medical students with no pre- area (Ethiopia). Therefore, this study aimed to assess the
ponderance between males and females and in single prevalence and factors associated with depression and
students is higher than married ones [5, 6]. It may be anxiety among medical students in the study area.
a significant hidden problem in medical students and
mechanisms to identify and help students with mental Methods and materials
health problems should be seriously considered [7]. The Study setting, study design and period
high prevalence suggests that immediate preventive Institutional based cross-sectional study was conducted
measures should be implemented, such as the setting from April to May 2017, at St. Paul Hospital millennium
up of psycho-pedagogic support services for students, medical college, Addis Ababa, Ethiopia.
and teacher development programs [8].
Anxiety is a vague feeling of apprehension, worry, Study population
uneasiness, or dread, the source of which is often The study population consisted of All St. Paul Hospital
non-specific or unknown to the individual [9]. Anxi- millennium medical college medical students (from year
ety and depression have a huge effect on society one to internship) who were included in the sample.
and individual, which can lead to the suicidal ten-
dency, relationship problems, medical dropouts, and Sampling procedure
impaired work ability. Therefore, proper counseling The sample size was determined based on a single popu-
services required to the psychological well-being of lation proportion formula using Epi-info version 7 with a
medical students to improve their quality of life [10]. 95% CI, 5% margin of error and taking the prevalence of
Symptoms of depression and anxiety disorders have depression and anxiety 27.7% [26] and 40.9% [25] respec-
the most significant impact on health-related quality tively. By considering a 10% non-response rate and apply-
of life (HRQOL) [11]. ing sample correction formula a total sample size of 273
Psychological illnesses in the form of depression, anx- undergraduate medical students were involved in the
iety, and stress have been reported in a substantial pro- study.
portion of first-year medical students. Multiple social, We used a systematic random sampling technique to
demographic, behavioral, and academic factors have select two hundred seventy-three (273) medical stu-
been found to be significantly associated with most of dents who were included in the study. We determined the
the studied psychological morbidities; among them, sampling interval by dividing the total study population
gender, residence, feeling loneliness, the inability to (medical students) by the total sample size which was
share families in social activities, presence of insomnia two. The first study participant was selected using lottery
and chronic physical illnesses, studying in English lan- method and the next study participants were choose at a
guage, problems with exams’ criteria, and the organiza- regular interval (every second interval) and interviewed
tion of lectures’ timetable were the most common [12]. by data collectors.
Emotional disturbances in the form of depression and
anxiety exist in high rate among undergraduate science Data collection procedures and instrument
students that require early intervention. Factors includ- Data were collected using pretested an interviewer-
ing the feeling of incompetence, lack of motivation to administered questionnaire, which contains data on
learn and difficulty of class work can be considered as a the outcome of interest (depression and anxiety), socio-
source of stressors that may precipitate for depression demographic characteristics (age, sex, source of income
and anxiety [13]. and marital status), academic-related factors (academic

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Kebede et al. Int J Ment Health Syst (2019) 13:30 Page 3 of 8

year of study, duration of the vacation, impact of educa- discussing, the ultimate purpose and method of the
tional vocation and academic interest), clinical factors study, written consent was sought from SPHMMC
(family history of mental illness, chronic illness), psycho- and informed verbal consent was obtained from each
social factors (social support, stressful life events) as well respondent. The respondents were informed that their
as substance-related factors (khat, alcohol, tobacco and inclusion in the study was voluntary and they were
others). free to withdraw from the study if they are not will-
The hospital anxiety and depression scale (HADS) was ing to participate. If any question they do not want
used to measure depression and anxiety among medical to answer they had the right to do so. To ensure the
students [16]. HADS was validated and extensively used confidentiality of respondents, their names were left
in Ethiopia [17, 18]. The tool containing 14 questions out on the questionnaire. All interviews were indi-
with a cut-off score for depression and anxiety of greater vidually to keep confidentiality. All study participants
than or equal to 8 [16]. who become case were linked to an outpatient psychi-
Social support was measured by Oslo 3-item social atric clinic at SPHMMC after getting permission from
support scale and individual who scored 3–8, 9–11, and them.
12–14 were considered as having poor, moderate and
strong social support respectively [19].
Stressful life events were measured using self-report Result
of experiencing one or more major stressful life events Socio‑demographic characteristics of the respondents
(including health-related problems, death significant oth- A total of 273 participants were included in the study
ers, and financial crisis) in the last 6 months. which makes the response rate 98.5%. The mean age
In the current study, substance use such as alcohol, of the respondents was 1.61 (SD = 0.65) years. Among
cigarette, and khat indicates current use. Of those sub- the respondents, the majority 129 (48%) were in the
stances. Those participants who have a history of sub- age range of 18–21 years, 163 (60.6%) were male, 256
stance use in the last month were considered as current (95.2%) were unmarried, 163 (60.6%) were orthodox
users. religion members and 249 (92.6%) had no additional
source of income (Table 1).
Data quality control issues
The training was given to the data collectors and supervi-
sors on the data collection tool and sampling techniques
by the researcher. Supervision was held regularly during Table 1 Descriptions of Socio demographic characteristics
the data collection period both by the researcher, co- among undergraduate medical students at SPHMMC,
investigators and supervisors to check on a daily basis for Addis Ababa, Ethiopia, 2016/2017
completeness and consistency. Variables Frequency Percent (%)

Age (years)
Data processing and analysis
18–21 129 48.0
After cleaning, data was entered, into EPI info version
22–24 115 42.8
3.14 then it was exported to SPSS versions 20 for analysis.
25 and above 25 9.3
Descriptive statistics (frequencies and percentages) was
Sex
used to explain the study participant in relation to study
Male 163 60.6
variables. Bivariate and multivariate analysis was used to
Female 106 39.4
determine the presences of statistically significant associ-
Marital status
ations between the independent variables and depression
Married 13 4.8
and anxiety. Those variables having a p-value less than
Unmarried 256 95.2
0.2 were entered into the multivariate logistic regression
Religion
model to identify the effect of each independent variable
Orthodox 163 60.6
with the outcome variables. The strength of the asso-
Muslim 42 15.6
ciation was presented by odds ratio and 95% confidence
Protestant 54 20.1
interval. A p-value of < 0.05 on multivariate analyses was
Catholic 7 2.6
considered as statistically significant.
Others 3 1.1
Source of income
Ethical considerations
Yes 20 7.4
Ethical clearance was obtained from the IRB ethi-
No 249 92.6
cal review board of SPHMMC. After thoroughly

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Kebede et al. Int J Ment Health Syst (2019) 13:30 Page 4 of 8

Educational, clinical, psychosocial and substance use Table 2 Description of clinical, psychosocial
characteristics of the respondents and substance use characteristics among undergraduate
The majority of the participants had the interest to study medical students at SPHMMC, Addis Ababa, Ethiopia,
medical health 222 (82.5%). About 189 (70.3%) of them 2016/2017
reported that a short vocational status (part-time work). Variables Frequency Percent (%)
However, most of the participants who had part-time
Level of education
work 163 (60.6%) reported that the length of the voca-
1st year 58 21.6
tional period does not have an impact on their education.
2nd year 52 19.3
Regarding clinical related characteristics, most of the
3rd year 46 17.1
participant had no history of chronic illness (94.4%) as
well as a family history of mental illness (90.3%). Nearly 4th year 41 15.2
half of the participant 129 (48%) had intermediate 5th year 37 13.8
social support and 29% of the participant had low social 6th year 35 13.0
support. Interest of education
More than half of students had no history of stressful Yes 222 82.5
life events in last 6 month 144 (53.5%) and 206 (76.6%) No 47 17.5
of them had no any history of substance (khat, cigarette, Vocational status
and alcohol) use in the last 3 months (Table 2). Short 189 70.3
Medium 76 28.3
Long 4 1.5
The magnitude of depression and anxiety among medical Impact of educational vocation
students Yes 163 60.6
The prevalence of co-morbid depression and anxiety was No 106 39.4
found to be 21.20% (16.35% to 26.05%) and prevalence of Diagnosed chronic illness
depression and anxiety was 51.3% (45.37% to 57.23%) and Yes 15 5.6
(30.1% 24.66% to 35.54%), respectively. No 254 94.4
Family history of mental illness
Yes 26 9.7
Factors associated with depression and anxiety
No 243 90.3
among medical students
Social support
The multivariable logistic regression revealed that the
Low social support 78 29.0
odds of anxiety was higher among medical students who
Medium social support 129 48.0
are female adjusted odds ratios [AORs, 2.56, 95% CI
Good social support 62 23.0
(1.32, 4.95)], first-year educational level [AOR 12.06, 95%
Stressful life events
CI (2.18, 66.72)], second-year educational level [AOR
No 144 53.5
8.99, 95% CI (1.67, 48.45)] and those who had poor/low
Yes 125 46.5
social support [AOR 5.36, 95% CI (2.08, 13.76) (Table 3).
Current substance (khat, cigarette and alcohol) use
Whereas, being in age ranges between 18 and 21 years
Yes 63 23.4
[AOR 2.42, 95% CI (1.64, 9.22)], first-year educational
No 206 76.6
level [AOR 1.63, 95% CI (1.43, 6.26)], second-year educa-
tional level [AOR 1.39, 95% CI (1.17, 5.18)] and who had
stressful life events [AOR 1.61, 95% CI (1.14, 2.76)] were
significant associated with depression among medical students found to have depression and one in three and
students (Table 4). one in five of the students reported anxiety and comorbid
depression and anxiety, respectively.

Discussion The prevalence and associated factors of anxiety

Main findings The magnitude of anxiety among medical students in the
In this study, the prevalence of depression and anxiety current study (30.1%) was in line with other study con-
among medical students and their possible association ducted in Brazil 33.7% [8]. Contrarily the prevalence of
with various variables were assessed. The results from anxiety in the current study was higher than the studies
the current survey revealed that a remarkable propor- conducted in India (9.8%) [10], and Nepal (5%) [20]. Fur-
tion of medical students had depression, anxiety as well thermore, the magnitude of anxiety in the current study
as comorbid depression and anxiety. One in two medical was lower than the studies conducted in Egypt (73%)

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Kebede et al. Int J Ment Health Syst (2019) 13:30 Page 5 of 8

Table 3 Factors associated with anxiety Table 3 (continued)

among undergraduate medical students at SPHMMC, Explanatory Anxiety COR, 95% (CI) AOR, 95% (CI)
Addis Ababa, Ethiopia, 2016/2017 variables
Yes No
Explanatory Anxiety COR, 95% (CI) AOR, 95% (CI)
variables Substance use
Yes No
Yes 18 46 0.88 (0.47, 1.64) 0.85 (0.41, 1.77)
Sex No 63 142 1 1
Male 40 123 1 1 n = 269
Female 41 65 1.94 (1.14, 3.29)* 2.56 (1.32, 4.95)** Diagnosed chronic illness = cardiovascular disease, liver diseases, Epilepsy, HIV/
Age AIDS…
18–21 51 78 1.39 (0.56, 3.46) 0.26 (0.05, 1.22) * Significant association (p-value < 0.2 in bivariate)
22–24 52 93 0.50 (0.19, 1.31) 0.30 (0.08, 1.10) ** Significant association (p-value < 0.05 in multivariate analysis) Hosmer and
Lemeshow test = 0.317
25 and above 8 17 1 1
Marital status
Married 1 11 1 1
Single 80 177 4.97 (0.63, 39.17) 3.23 (0.35, 29.63)
Source of income
[21], Bahrein (51%) [22], and Brazil (37.2%) [22], Ethio-
Yes 2 18 1 1
pia) (40.9%) [23], Egypt (78.4%) [12], Pakistan (70.7%)
No 79 170 0.24 (0.05, 1.06) 1.450 (0.28, 7.85) [24], India (66.9%) [25], and in (84.5%) [13]. The possible
Educational level reasons for the observed difference include the instru-
1st year 29 29 4.83 (1.75, 13.39)* 12.06 (2.18, 66.72)** ment used to measure anxiety, the sample size, the course
2nd year 22 30 3.54 (1.26, 9.99)* 8.99 (1.67, 48.45)** load and the existing socio-cultural differences among
3rd year 10 36 1.34 (0.41, 4.13) 3.42 (0.76, 15.33) the countries.
4th year 8 33 1.17 (0.36, 3.78) 2.07 (0.42, 10.15) Regarding associated factors, the multivariate logis-
5th year 6 31 0.94 (0.27, 3.23) 1.90 (0.41, 8.81) tic regression analysis in the current study showed that
6th year 6 29 1 1 being females were 2.56 times more likely to have anxi-
Interest toward medical education ety than males. The possible reason might be increased
Yes 63 159 1 1 exposure to acute life events, gender-specific roles, and
No 18 29 1.57 (0.81, 3.02) 1.46 (0.76, 3.18) smaller social networks. The current result is smaller
Vocational period than the study conducted in Northeast Brazil [8] but
Short 65 124 1.573 (0.16, 15.42) 4.00 (0.33, 48.11) higher than the study conducted in the University of
Medium 15 61 0.738 (0.07, 7.60) 2.28 (0.17, 29.86) Gondar, Ethiopia [23].
Long 1 4 1 1 Students who were the first year medical students had
Impact of vocational period 12.06 times more likely to have anxiety as compared with
Yes 57 106 1.84 (1.05, 3.21)* 1.47 (0.73, 2.93) those who were 6-year medical students. This might be
No 24 82 1 1 due to exposure to a new environment, new friends,
Diagnosed chronic illness apart from family or new teaching–learning process. This
Yes 6 9 1.59 (0.55, 4.63) 1.02 (0.20, 3.62) is relatively higher than the study conducted previously
No 75 179 1 1 in Abbottabad (Pakistan) [15]; this might be due to the
Family history of mental illness difference in socio-demographic, culture, teaching envi-
Yes 11 15 1.81 (0.79, 4.14) 2.55 (0.89, 7.23) ronment or curriculum.
No 70 173 1 In addition, students who were second-year medical
Social support students had 8.99 times more likely to have anxiety as
Low/poor 35 43 3.77 (1.71, 8.31)* 5.36 (2.08, 13.76)** compared with those who were a six-year medical stu-
Medium/interme- 35 94 1.73 (0.81, 3.69) 2.23 (0.98, 5.32) dent which is high. This might be due to the number of
diate
credit hours of the lesson, exposed to new medical words
High/good 11 51 1 1
Stressful life events
which are difficult to understand and easily hold and tak-
No 35 109 1 1
ing the exam frequently.
Yes 46 79 1.81 (1.07, 3.07)* 1.26 (0.67. 2.34)

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Kebede et al. Int J Ment Health Syst (2019) 13:30 Page 6 of 8

Table 4 Factors associated with depression Table 4 (continued)

among undergraduate medical students at SPHMMC, Explanatory Depression COR, 95% (CI) AOR, 95% (CI)
Addis Ababa, Ethiopia, 2016/2017 variables
Yes No
Explanatory Depression COR, 95% (CI) AOR, 95% (CI)
variables Substance use
Yes No
Yes 34 30 1.10 (0.62, 1.93) 1.35 (0.73, 2.53)
Sex No 128 101 1 1
Male 81 80 1 1
n = 269
Female 50 56 1.11 (0.68, 1.81) 0.99 (0.57, 1.75) Diagnosed chronic illness = cardiovascular disease, liver diseases, Epilepsy, HIV/
Age AIDS…
18–21 77 52 2.63 (1.08, 6.41)* 2.42 (1.64, 9.22)** * Significant association (p-value < 0.2 in bivariate)
22–24 52 63 1.47 (0.60, 3.59) 1.90 (0.63, 5.69) ** Significant association (p-value < 0.05 in multivariate analysis) Hosmer and
Lemeshow test = 0.161
25 and above 9 16 1 1
Marital status
Married 1 11 1 1
Single 137 120 0.51 (0.15, 1.74) 0.27 (0.58, 0.98) Regarding social support, students who had poor/low
Source of income social support were 5.36 times more likely to have anxiety
Yes 8 12 1 1 than students who had good social support; this might be
No 130 119 1.64 (0.65, 4.15) 2.21 (0.76, 6.40) due to the feeling of loneliness and lack of social inter-
Educational level action. The current result is higher than the study con-
1st year 38 20 2.85 (1.20, 6.78)* 1.63 (1.43, 6.26)** ducted at the University of Gondar, Ethiopia [23].
2nd year 34 18 2.83 (1.17, 6.87)* 1.39 (1.17, 5.18)**
3rd year 18 28 0.96 (0.39, 2.37) 0.50 (0.16, 1.65)
The prevalence and factors associated with depression
4th year 16 25 0.96 (0.38, 2.41) 0.52 (0.16, 1.68)
The study revealed that the prevalence of depression was
5th year 18 19 1.42 (0.56, 3.62) 1.01 (0.33, 3.04)
(51.3% (CI 46.0, 56.9) high. Regarding the prevalence, the
6th year 14 21 1 1
current study’s finding was similar to other studies car-
Interest toward medical education
ried out in the different area of India 49.1% [7] and 51.3%
Yes 109 18 1 1
[25]. However, the current study result is higher than the
No 29 113 1.67 (0.88, 3.180 1.86 (0.90, 3.82)
studies conducted in Addis Ababa University (Ethiopia)
Vocational period
which were 27.7% [26], in University of Gondar (Ethio-
Short 98 91 1.08 (0.15, 7.81) 1.37 (0.15, 12.85)
pia) which was 40.9% [23], in Madinah (Saudi Arabia)
Medium 38 38 1.00 (0.13, 7.47) 1.48 (0.15, 14.82)
Long 2 2 1 1
which was 28.3% [27], Sangareddy (India) which was 14%
Impact of vocational period
[10] and North East Brazil which was 33.7% [8]; but lower
Yes 82 81 0.90 (0.55, 1.48) 0.81 (0.45, 1.47)
than the study conducted in Egypt which was 63.6% [12],
No 56 50 1 1
in Tabriz (Iran) which was 62.7% [28], in Malaysia which
Diagnosed chronic illness was 64.4% [13], in India which was 58% [5] and in Kara-
Yes 10 5 1.97 (0.65, 5.92) 2.36 (0.69, 8.13) chi (Pakistan) which was 70% [24]. The variation might
No 128 126 1 1 be due to the difference in sample size and data collec-
Family history of mental illness tion tool which was SRQ-20 with 836 participants in the
Yes 15 11 1.33 (0.59, 3.01) 1.25 (0.50, 3.11) University of Gondar, Ethiopia [23], DASS-21 with 421
No 123 120 1 1 participants in Egypt [12], PQ-2 with 60 participants in
Social support Madinah, Saudi Arabia [27], BDI with 175 participants
Low/poor 41 37 1.53 (1.18, 3.01)* 1.32 (0.63, 2.73) in Tabziz, Iran [28], DASS-21 with 194 participants in
Medium/inter- 71 58 1.70 (0.92, 3.13) 1.76 (0.90, 3.43) Malaysia [13], BDI with participant in India [7], SRQ-20
mediate with 172 participants in North east Brazil [8];difference
High/good 26 36 1 1 in data collection tool which was CES-D in Addis Ababa
Stressful life events University, Ethiopia [26], DASS-21 in Odisha, India [25],
No 64 80 1 1 PHQ-9 in India [5], DASS-42 Sangareddy, India [10] and
Yes 74 51 1.81 (1.12, 2.95)* 1.61 (1.14, 2.76)** AKUADS in Karachi (Pakistan) [24].

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Kebede et al. Int J Ment Health Syst (2019) 13:30 Page 7 of 8

The multivariate logistic regression analysis in the cur- younger age (18–21 years old), first-year educational
rent study showed that students who were in the age level, second-year educational level and having one or
interval of 18–21 years were 2.42 times more likely to more stressful life events in the last 6 months. Screen-
have depression as compared than those who were 25 ing of depression and anxiety among medical students
and above years old. The current result is similar to the was recommended. Future studies focusing on better
study conducted in the International Islamic University ways of preventing and treating depression and anxiety
of Malaysia [13]. among medical students are warranted.
Regarding educational level, those who are the first
Acknowledgements
year and second-year medical students were 1.63 and The authors acknowledge saint Paul Hospital Millennium Medical College,
1.39 times more likely to have depression respectively as Ethiopia for funding the study and the IRB of the institution for their ethi-
compared to those who were 6-year medical students. cal evaluation and approval. The authors appreciate the respective study
institutions and the study participants for their cooperation in providing the
The current finding is similar to the study conducted in necessary information.
India [5]. This might be due to lack of social interaction;
unfamiliar types exam schedule; lower grade than antici- Authors’ contributions
MAK conceived the study and was involved in the study design, reviewed the
pated; lack of vacation or break [23] or language problem article, analysis, report writing and drafted the manuscript. GA were involved
[7]. in the study design, analysis and drafted the manuscript. BA was involved in
With respect to stressful life events, students who writing and edition of revised manuscript. All authors read and approved the
final manuscript.
had faced one or more of stressful life events in the last
6 months were 1.61 times more likely to have depres- Funding
sion as compared to those who had not faced stressful life This research work is funded by Saint Paul Hospital Millennium Medical Col-
lege, federal ministry of health of Ethiopia.
events in the last 6 months. This might be due to the loss
of close family or friends; financial crises or family prob- Ethics approval and consent to participate
lems. The current result is lower than the study conducted Ethical approval was obtained from Saint Paul Hospital Millennium Medical
College. Confidentiality was maintained at all levels of the survey. Informed,
in India [5] and the University of Gondar, Ethiopia [23]. written consent was obtained from each study participant. The right to with-
draw from the research process at any point in time was respected. Privacy
The strength and limitation of the study and strict confidentiality was maintained during the interview process.

The present study had several strengths: (1) We used Consent for publication
adequate sample size and the participants were involved Not applicable.
from a well-defined catchment area; (2) We measure
Competing interests
our outcome of interest (depression and anxiety) using The authors declare that they have no competing interests.
standard and validated instrument (HADS); (3) we also
estimated the prevalence of coexisting anxiety and Author details
1
Department of Research, Saint Paul Hospital Millennium Medical College,
depression among the study participants. POBox 171, Addis Ababa, Ethiopia. 2 Research and Training Department,
However, the current study also had some limitations: Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
first, due to the cross sectional nature of the study the
Received: 4 January 2019 Accepted: 29 April 2019
association between different factors and anxiety as
well as depression may not imply causation; second, the
possibility of recall bias because of the retrospective
nature of cross-sectional studies: thirdly, not measur- References
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