1.1 Background of the Study
Depression is a disorder, marked by persistent sadness, discouragement, loss of self-worth, and loss of interest in usual activities (National Institute of Mental Health, 2003). The World Mental Health Survey conducted in 17 countries found that on average about 1 in 20 people reported having an episode of depression (World Health Organization, 2012). Depressive disorders often start at a young age; they reduce people’s functioning and often are recurring (Marcus et al, 2012).
Depression is closely associated with stress that stressful life events or stressors have been suggested to be antecedents and even predictors of the majority of depression symptoms (Eremsoy et al, 2005).According to Beck and Young 1978 (as cited in Kinumaraswamy, 2013) around quarter of university students reported isolation from parents, feeling of loneliness, stresses due to overload activities, low grades conflicts or poor social relationship are the cause of their depression. Change in learning style is the other factors that lead students to become depressed because University learning style is new for university students (Aulsaidi et al, 2011).
Even though depression is a common problem all over the world, the prevalence of depression is varies from country to country and culture to culture. This may be due to different factors. For example, according to APA 2000 and Kessler et al. 2003 (as cited in Rosenberg and Kosslyn, 2011), in United States, major depressive disorder is a very common disorder and out of the total population of Americans, 20 % can experience this disorder throughout their life. Similarly the other study done in Stockholm, Sweden shows there is high prevalence of depression that from the overall response rate was 72.9% and 10.2% (5.7% men, 10.7% women) reported depression (Christens son a, Vaez M, etal.2011).
Depression is problem for all age group and occupations; it is extremely prevalent and widespread problem among university students across the country. In an extensive review of literature on the prevalence of depression among university students globally, ( Ibrahim, Kelly, Adams and Glazebrook,2013) revealed that reported prevalence rates among students ranged from 10% to 85%with a weighted mean prevalence of 30.6%.According to Eisenberg,Gollust, and Goldberstein (2007), a research conducted in large public study in Michigan University with sample of 2843 found that 25% of the University students reported that they had the symptoms of depression. Among these student who had symptoms of depression, approximately 14% of the students are Undergraduate students.
In Low and Middle Income Countries, depression is the leading cause of mental illness and this disorder account for approximately 10 % of total years lived with disability (Federal Ministry of Health FMOH, n.d.). In Africa, there are different prevalence rate of depression A large epidemiological study was conducted on 2002 and 2004 in a total sample of 4351 adults of South African adults by using the World Health organization composite International Diagnostic Interview and found that the prevalence of depression was 9.7% for life time and 4.9% for the 12 month response to the interview (Tomlison, Grimsrud, Stein, Williams, ; Myer, 2009). But the other comparative study that was conducted by Amoran, Lawoyin, and Lasebikan (2007) found that the prevalence of depression among adults in Nigeria was lower than the prevalence of depression in South Africa that was conducted by Tomlinson et al.(2009). The other study that was conducted by Ovuge, Boardman, and Wasserman (2005) out of general population of Uganda with a total of 939 by using- 1 item BDI found the prevalence of depression in Uganda showed that 17.4 %.The same to other country the prevalence of depression in African University is also high. For example, Research conducted in Kenyan university students, moderate prevalence rate of 35.7% was found whilst 5.6% reported severe depressive symptoms (Othienoet al., 2014).
Similarly, In Ethiopia the study was conducted by Hailemariam et al. (2012) on a sample of 5131 that the life time prevalence of depression become increased and it accounts around 9 %.Other study conducted by Mossie, Kindu, and Negash (2014) and the prevalence of depression in Jimma town is high. They conduct a study on a sample of 590 by using BDI-II they found that the prevalence of depression was 29.9%. In addition to the prevalence of depression in Jimma town, they identify the severity of depression and they found 17 .3% that had mild, 9.5% moderate, and 2.2% had severe depression. According to Kebede and Alem (1999), the prevalence of mental stress is high and showed that 11.7% of Addis Ababa populations are mentally distressed. On the other study that was conducted in Ethiopia found that the prevalence of depression become high that accounted about 50% of university students had symptom of depression (Lemma, Gelay,Berhane, Worku, ; Williams, 2012).
From aforementioned studies the prevalence of depression among college and university is higher than the general population. In that case, assessing the current status of depression in University students is highly important to fill the gaps. Hence, the objective of this study is to assess stressors and consequences of Depression among University Students and coping mechanisms: College of Health Sciences Students of Arsi University in focus.
1.2 Statement of the Problem
University year is the most stressful period for students that is described with high a prevalence rate of depression (Busari, 2012). According to Buchanan 2012 (as cited in Sarokhani, et al., 2013), this year is a special period and characterized by a transitional from adolescence to adulthood.
Depression among university students has been associated with various risk factors. It occurs more often in students with the following factors: higher prevalence of depression has nearly always been found among female. Addition to this negative association with indicators of socioeconomic status has also been obtained such as higher alcohol consumption and tobacco use is also other risk factors for depression(Ibrahim et al., 2013; Othieno et al., 2014; Peltzer et al., 2013). Economic problem is the other factor for University students of being depressed (Albusadi et al., 2011).Poor parental relationship students come from is also the other associated factor for depression (Chen et al., 2013, Eisenberg et al., 2007, Sun et al., 2011).
Depression is a major problem for college and university students because college year itself is stressful period (Kumaraswamy, 2013). Because of these different stresses during college and university year, depression affects an individual academic achievement (Chen and Li 2000 as cited in Yousefi et al., 2010).For example, Hysenbegasi, et al. in (2005) conduct a study in western Michigan University of 330 students (121 were students who are diagnosed at the campus health center and 209 are controls) and they found that depression has strong impact on academic productivity among university students. According to their study from those 121 depressed students who were diagnosed in the campus health center, 14.64% were missed a greater number classes, 5.45% were missed a greater number of assignments and 1.36% and 0.74% of depressed students were missed a greater numbers of exams and dropped a greater number of course respectively. There are also evidence to show that individual with depressive symptoms can be predispose to diseases such as HIV infection, diabetes, and even death from suicide (Pitpitan et al., 2012; Nduna et al., 2010).
As far as our knowledge concerned there are few studies that deal about depression in University students of Ethiopia, from those studies done one was by Yetayale (2011),He tried to see the prevalence and associated factors in Addis Abeba University among first year students. The other study conducted by Yalem Work (2015) investigated depression by composing with other variables like gender, family marital status and other study conducted in Adama University on the prevalence of mental distress including depression (Dessie, Ebrahim ; Awoke, 2014). The researchers identified there is a research gap on this area, especially on investigating depression prevalence with its factors, consequences as well as students coping mechanism is the area not investigated. In addition to this according to Kesseler et el, (2005) the increasing or high incidence is problematic of depression disorder in adulthood has its first onset during or shortly before college age. These data highlighted for researcher understanding depression among University students is very sensitive and crucial area. Based on the truth that Arsi University is a newly established University with lack of recreation center and researcher observations binding with experience that many adolescent in the University have been seen involved on risky behavior such as smoking cigarette, chewing chat as means of coping strategy from depression is also the other reasons to prefer this topic.
Considering all this cases indicated above and based on the mental disorders disruptive conditions in adolescents, this research paper tends to focus on causes and consequences of depression among Arsi University students and their coping mechanisms, college of health sciences.
Generally, this research attempts to answer the following basic research questions.
? To what extent depression is prevalent among Arsi University students, college of health sciences?
? What are determinant factors for depression for Arsi University students, college of health Sciences?
? What are the coping strategies Students used?
? What are the consequences of depression among students?
1.3 Objective of the Study
1.3.1 General Objective
The main purpose of this study:-
? To explore the causes and consequences of depression among Arsi University students and their coping mechanisms, college of health sciences.
1.3.2 Specific Objectives
The specific aim of this study is:-
? To assess the prevalence of depression among students.
? To examine the determinant factors for depression.
? To identify the coping strategies used by student to minimize/prevent depression.
? To assess the consequence of depression
1.4 Significance of the Study
Depression is among the most common and presenting psychological disorder. Various studies were conducted in the world regarding depression. However, this type of study is limited in our country in terms of number and coverage. Thus, this study enabled to investigate the causes and consequences of depression among Arsi University and their coping mechanisms, college of health sciences students.
Assessing the current status of depression in university students at this moment is therefore highly important to fill the gap, to recognize and tackle the problem as earliest time as possible and to provide sufficient information for students as well. Moreover, the result of this study will help policy makers, health managers and planners, to formulate national and local mental health policy, strategy, guidelines and action plan. This research also helps for mental health professional, Social worker, Psychologist as well other professionals who work directly or indirectly with adolescents of certain community to design appropriate treatment intervention strategies. In addition to this it will help them to use preventive strategies such as giving training and awareness creation for students.
Furthermore the result of this study also helps to other researchers as data source that will pave a way for further study to be conducted in University and at national level.
1.5 Delimitation of the study
In terms of content, the study was delimited on depression. With regard to place, the research is delimited to Assela town, Arsi University, college of Health science compound. College of health science is selected for research site because it was easy to get subjects from different background like from different culture, socioeconomic status etc. The study content also delimited on causes and consequences of Depression among University Students and their coping mechanisms among Arsi University, college of health sciences students. This is because factor like financial, shortage of man power limitation and research topic or area researcher interested on it. In the case of population the research was delimited to regular program under graduate students of Arsi University, College of health sciences.
1.6 Limitation of the study
1. BID depression screening tool only was limit in depressive measurement that requires a strictly clinical diagnosis and related to many factors as family and personal history which could not determine accurately in this cross-sectional study design.
2. Data collection procedure was carried out in class by gathering class students together at the same time. While filling self-administered questionnaire, students respond can be influenced by others or each other.
3. Because of budget constrain, this study can only asses the college of health science students that cannot be the representation of all university students.
4. Because of continues assessment testing schedule some department students were busy on study during my data collection time. Thus forced the researcher to extend the data collection time until they become free.
1.7 Operational Definitions of Terms
? Depression- in this study, it is a disorder, marked by persistent sadness, discouragement, loss of self-worth, and loss of interest in usual activities (National Institute of Mental Health,2003)
? Coping strategy- is a mechanism that student used to minimize or tackle depression.
? Mood- the internal expression of student’s emotion which will be stated as depressed.
2.1 Research Design
Mixed research design specifically a concurrent embedded design was conducted to explore the causes and consequences of depression and their coping mechanisms, among Arsi University students of College of health sciences. It is a design in which one data set provides a support for the other. That was help researcher to come with more evidence, better argument by combining quantitative and qualitative research designs.
This study explored the causes and consequences of depression and their coping mechanisms among University students. Therefore, the target population of this study was all male and female students who were registered as regular undergraduate student in Arsi University, college of health sciences.
2.3 Sample Size and Sampling Techniques
From total of 1232(male=838 and female=394) Arsi University, college of Health sciences regular under graduate students297 respondent was selected with margin error (0.5%) and 95% confidence according to sample table( Krejcie & Morgan, 1970) by using probability sampling that gives equal chance for all study participants to be selected. However by considering possible none response during survey the final sample size was increased by 5% to n final?=?297 +15 which was 312 (see table 1). Since the population of this study is heterogeneous in this study, specifically stratified sampling technique was used. Stratifying the population was implemented by using two variables i.e. study year and sex. First participants study year was stratified then sex stratum was made within student stratification made based on their study year that help researcher to see two variables relation with depression among students. At the end study number of subjects in each stratum determined by possible proportion size (PPS) from each stratum using systematic random sampling by using list of names obtained from college of health science registrar office.
College of health sciences regular students
Sex Year Total
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M 51 26 37 53 23 18 208
F 35 19 21 18 7 4 104
Table: 1 Sample size quantitative survey
2.4 Inclusion and exclusion criteria
2.4.1. Inclusion criteria
-The inclusion criterion for this study was all regular under graduate students who are enrolled in Arsi University, Asella College of health science in 2017.
-Those students only volunteer to participate on this study
2.4.2 Exclusion criteria
The exclusion criteria for this study were severely ill students during the time of data collection.
2.5 Instrument of Data Gathering
In order to collect data for the study the researcher propose or indicate specific tools, according to the nature of data a structured questionnaire was used to collect data on socio-demographic characteristics (age, sex, study year, family marital status and students monthly income they got from any source) while standardized questionnaires were used to explore an evidence about the prevalence and causes of depression among University students and their coping mechanisms.
The researcher used revised Beck Depression Inventory i.e. BDI-II consistent with the DSM-IV (Beck, Steer, & Brown, 1996) was employed specially to see the prevalence of depression among study participants. The scale consisted of 21 items, each scale containing four responses ranging from 0 to 3.The BDI-II has been well studied and has excellent reliability and validity for measuring severity of depression (Beck, Steer, & Garbin, 1988).BDI-II; was found that with the coefficient alpha of 0.91 for 140 samples, and 0.92 for 500 samples (Beck, Steer, Ball, &Ranieri, 1996).
Since stressors have been suggested to be antecedents and predictors of depression symptoms (Eremsoy et al, 2005) that Medical Student Stressor Questionnaires (MSSQ) was employed to identify which stressor were determinant factors for depression. The items MSSQ represent 20 events that have been reported to be possible stressors in medical students. Respondents were asked to rate each event in themselves during the past months by choosing from five responses: ‘causing no stress at all’, ‘causing mild stress’, ‘causing moderate stress’, ‘causing high stress’ and ‘causing severe stress’. The MSSQ is scored by assigning a value of zero to four for each of the respective responses. The mean domain score of stressor lies 0.00 – 1.00 = Mild, 1.01 – 2.00 = Moderate, 2.01 – 3.00 = High & 3.01 – 4.00 = Severe.
The MSSQ consists of 20 items representing the six stressor domains.
1. Academic related stressor
2. Interpersonal and intrapersonal related stressor
3. Social related stressor
4. Teaching and learning related stressor
5. Desire and drive related stressor
6. Group activities related stressor
Reliability analysis shows that the MSSQ has a high internal consistency because the tool has Cronbach’s alpha coefficient value of (?=0.95) (Muhammad. S and Ahmad. F, 2010).
The brief cope is an abbreviated version of the COPE Inventory (Carver, C.S, 1997). For the purpose of this study a modified version of the brief cope, consisting of 21 questions was used(Ryan, 2013). COPE inventory assessing coping strategies with the good reliability and validity, it was found with Cronbach coefficient alpha of (?=0.79) (Carver, Scheier ; Weintraub , 1989).Questions were measured on a five point Likert Scale ranging from ‘never’ to ‘always’. Questions measured the use of Problem Focused coping such as active coping, planning and instrumental support, and Emotion Focused coping such as emotional support, substance use, and positive reframing. The researcher was also used personally prepared structured questionnaires to assess consequence of depression among respondents. These add open ended questioner to make it open for subjects to add consequences they faced during this academic year that was not described above. In addition to this the researcher was prepared and conducted interview by using unstructured questionnaire for student’s counselor in the health Sciences College and Assela hospital Psychiatric clinic psychiatrists on the area of this research specially on reported case regarding to depression.
2.6 Pre- testing of the Study
The researcher had close supervision regarding the material for the data collection and quality of data collection. To ensure quality of data collection tools or reliability, pre-test was implemented on 30 students of Arsi University, college of health sciences who were not included in this study. On this test it was found total reliability and validity of the scale indicated a high Cronbach’s alpha values (?=0.91) specifically it shows for beck depression (?=0.83), MSSQ (?=0.94), Coping strategies (?=0.77) and questionnaires to measure consequence of depression (?=0.59) .After wards necessary correction was made on the questionnaires because the purpose of this test was to ensure that the respondents were able to understand the questions and to check the wording, logic and other ambiguity of the questions in a sensible way to the respondents.
2.7 Data Collection Procedure
The researcher was asked permission from Arsi University, Assela college of Health science. The questionnaires were distributed to sample respondents in their respective college compound. The purpose of the study was explained to the students before delivering questionnaire. After obtaining oral consent, the researcher was administered the questionnaire to all selected study participants. The researcher gave orientation for study participants on how to fill the questionnaires, about ethical principles, confidentiality and data management prior to involvement on data collection. Finally, after the data was collected, the researcher made it ready for scoring by giving code. In addition, the researcher was conducted interview for college student counselor and psychiatric clinic department psychiatrist to get further information about investigated area and respondents. Frist by taking appointment the interview was conducted at their work place.
2.8 Data Analysis Procedures
After the data were checked for accuracy and completeness; the incomplete data were discarded from analysis. The data were analyzed quantitatively and in qualitative form. In the case of quantitative methods of analysis the data were coded, and then Statistical Package for the Social Sciences (SPSS window 20) was used for analysis. Descriptive summary using frequencies, percentage and cross tabs were used. In addition bivariate logistic regression analysis used to assess the association of independent variable with dependent variable ; then independent variables having P- value ; 0.05 were candidates for multivariate logistic regression entry. Multivariate logistic regression was used to identify predictor variables. Odds ratios was calculated ; statistical significance accepted at the p1000 115(63.5%) 70(64.8%)