1. Depression Among Medical
Students
Deeraj Loganathan
Michelle Sachini
Jayasuriya
Syeda Asma
Ashutosh Wanchu

2. What Is Depression?

3. Etiology of Depression
• There is no single known cause of depression!
• Research indicates that depressive illnesses are disorders of
the brain. MRI, have shown that the brains of people suffering
with depression, look different.
• Some types of depression tend to run in families, suggesting a
genetic link.

4. • An external event often seems to initiate an episode of
depression e.g. Death, financial problem, chronic illness or
any unwelcome change in life patterns can trigger a
depressive episode.
• Very often, a combination of genetic, psychological, and
environmental factors is involved in the onset of a depressive
disorder.

5. Diagnosing Depression
• Diagnosis requires the use of the Diagnostic and Statistical
Manual for Psychiatric Illnesses (DSM)
• There are 2 main types of depression to be concerned about:
1. Major Depression: This is a most serious type of depression. Many
people with a major depression can not continue to function
normally.
2. Dysthymia: This is a mild, chronic depression which lasts for two
years or longer. Most people with this disorder continue to
function at work or school but often with the feeling that they are
"just going through the motions." The person may not realize that
they are depressed.

6. Diagnostic criteria
At least 1 of the symptoms is
(1) depressed mood,
(2) loss of interest or pleasure,
as well as at least 5 of the following symptoms have been present
during the same two-week period:
 Depressed mood most of the day
 Markedly diminished interest or pleasure in almost all activities
most of the day
 Significant weight loss or weight gain, or decrease or increase in
appetite
 Insomnia or hypersomnia
 Psychomotor agitation or retardation
 Fatigue or loss of energy
 Feelings of worthlessness or excessive or inappropriate guilt nearly
every day diminished ability to think or concentrate
 Recurrent thoughts of death (not just fear of dying), recurrent
suicidal ideation without a specific plan

7. (B.) It should be excluded that an organic factor initiated and
maintained the disturbance or the disturbance is not a normal
reaction to the death of a loved one.
(C.) At no time during the disturbance have there been delusions or
hallucinations for as long as two weeks in the absence of prominent
mood symptoms (i.e. before the mood symptoms developed or
after they have remitted).
(D.) Not superimposed on Schizophrenia, Schizophreniform Disorder,
Delusional Disorder, or Psychotic Disorder.

8. Diagnostic criteria for Dysthymia:
(A.) Depressed mood (or can be irritable mood in children and
adolescents) for most of the day, more days than not, as indicated
either by subjective account or observation by others, for at least
two years (one year for children and adolescents)
(B.) Presence, while depressed, of at least two of the following:
 1. Poor appetite or overeating
 2. Insomnia or hypersomnia
 3. Low energy or fatigue
 4. Low self-esteem
 5. Poor concentration or difficult making decisions
 6. Feelings of hopelessness

9. (C.) Duringa two-year period (one-year for children and
adolescents) of the disturbance, never without the symptoms
in A for more than two months at a time.
(D.) No evidence of an unequivocal Major Depressive Episode
during the first two years (one year for children and
adolescents) of the disturbance.
(E.) Has
never had a Manic Episode or an unequivocal Hypo manic
Episode.
(F.) Not
superimposed on a chronic psychotic disorder, such as
Schizophrenia or Delusional Disorder.
(G.) It cannot be
established that an organic factor initiated or
maintained the disturbance, e.g., prolonged administration of
an antihypertensive medication.

10. Concequences
of Depression

11. Disability and Depression
• Several studies have shown a close association between
depression and disability.
• Common mental disorders have also been linked to
important indirect costs due to either diminished productivity
or absence from work.
• Studies show that people with depression had a 4.8 times
higher risk than people without symptoms of having had
sickness leave.

12. • More recently, an American study found that for every 100
workers, 6 days of work are lost for sickness leave and 31
days are lost for diminished productivity every month due to
poor mental health.
These statistics will come as no surprise to clinicians used to treating those
with depression or others familiar with the syndrome.

13. Depression and Suicide
• The morbidity of the depression is difficult to quantify, although
lethality of depression, is measurable, which is the ninth leading
reported cause of death in the United States.
• Almost all people who kill themselves intentionally have a
diagnosable mental disorder. Approximately two thirds of
individuals who complete suicide have seen a physician within a
month of their death.
• The risk of suicide is increased by concurrent alcohol and drug
abuse, access to lethal means, hopelessness, pessimism, and
impulsivity, and is reduced by help-seeking behavior, access to
psychiatric treatment, and availability of family and other social
supports.

14. • More women than men seek treatment for depression, but this is
not necessarily reflective of the true incidence of the disease.
• Although depression is more often diagnosed in women, more men
than women die from suicide by a factor of 4.5:1.
• 56% of suicide deaths in males involve firearms. Poisoning is the
predominant method among females.
• It is important to understand that the majority of suicide attempts
are expressions of extreme distress, not merely bids for attention.

15. Depression in Medical students!
• Studies show that depression is widespread among medical
students.
• They suggest rate of depression among students entering
medical school is similar to that among other people of similar
ages, but the prevalence increases disproportionately over
the course of medical school
• The signs of the illness seemed to intensify as the trainee
doctors prepared to enter hospitals for the first time

16. • Researchers believe that a fear of failure and worries over
performing intimate physical examinations on patients, as
well as long hours and stress, were to blame.
• Frequently "students fear they 'know nothing' and are
insecure about the physical examination of other people"
• Most common symptoms observed include sadness,
dissatisfaction, spontaneous crying, irritability and
withdrawal. But students also suffered increased tiredness,
weight loss and a lack of interest in sex.

17. • The British Medical Association says that more than 50% of
medical students admit that they have sought help for
depression or other mental health problems.
• Researchers found that female medical students were more
likely to show symptoms of depression than their male
classmates.
• Those who had a parent who was a doctor were less likely to
suffer signs of the condition, it is believed that they were
more aware of the pressures of the profession before they
started medical school

18. Treatment
• Depression can be treated effectively with antidepressant
medications and psychological therapies.
• Research suggests that antidepressant medications and
psychotherapy are equally effective for treating mild to
moderate cases of depression.
• For more severe cases, medications are clearly superior.
• Electroconvulsive therapy (ECT) is the most effective
treatment for depression with psychotic symptoms or
when depression is life threatening.

19. Benefits of Psychotherapy with Depression
• It can help reduce stress in life.
• It can give a new perspective on problems with family, friends, or
co-workers.
• It can make it easier to stick to treatment.
• It can be used to learn how to cope with side effects from
depression medication.
• Person learn ways to talk to other people about their condition.
• It helps catch early signs that patient’s depression is getting worse.

20. Magnitude of the problem!
• Depression is common, affecting about 121 million people
worldwide.
• Depression is among the leading causes of disability
worldwide.
• At its worst, depression can lead to suicide, a tragic fatality
associated with the loss of about 850 000 thousand lives
every year.
• The economic cost of depressive illness is estimated at $30-44
billion a year in the United States alone. The human cost
cannot be overestimated.

21. Why Depression?
• Personal experiences of being a medical student led us
to believe that there might be a slightly higher
frequency of depression amongst our field of workers
and we also realised that this was not being handled
properly and brought out to the forefront.
• At the end of the 6yrs there wont be a point of
becoming a doctor if your mentally instable yourself so
to help our future generations to come and bring this
into the limelight we picked this topic so that through
our small step we might be able to over come the
obstacle and maybe end up slightly happier than the
others.

22. Objectives
• Calculate the % of Depression among the students in GMU on
basis of MBBS or non MBBS related fields and its year wise
distribution
• To establish the relationship between the presence of
depression and common variables among the students
• To recognize the relationship of environment with the
frequency of depression among the students
• To estimate the concerns and methods to overcome this
depression among the students
• To estimate how much knowledge is already present among
the students and to educate them more on the topic

23. Methodology
• Study design: Observational  Descriptive  Cross sectional study
• Subjects: All Students studying in the Gulf Medical University
• Sample size: There is no sample as the whole population will be tested
through the survey including all students.
• Data collection method: Self administered questionnaire
• Study period: May – December 2009
• Inclusion criteria: This survey will include all students only studying in all
branches of the university
• Exclusion criteria: exclusion of anyone else other than students present in
the college as doctors, professors, deans, administrative staff and
workers. These people will not be tested as they do not complete our
criteria of the survey.

24. • Independent Variables: all factors were divided under academic
and environmental that could potentially affect the mentality of a
GMU student.
Academic: Environmental:
College Habitual Smoking / Alcohol
Choice of Entering Drug
Expectations Residence
Family member is practitioner Support
Batch Nationality
• Ethical Considerations: All efforts to maintain confidentiality of
name and personal identifications will be maintained.

25. Materials
• Tools for Data collection: self administered questionnaire following
the WHO prescribed General Health Questionnaire (Goldberg 28
Questions) that was used to evaluate the degree to which people
were experiencing depressive symptoms. It’s used to help screen a
large number of people in a short time.
• The GHQ-28 is a validated screening instrument designed to detect
current psychiatric conditions. It contains questions covering four
areas, namely social dysfunction, somatic symptoms,
anxiety/insomnia and depression.
• There are seven questions in each of the four domains, giving a
total of 28 questions. In the guidelines for interpretation, five or
more positive answers (out of the 28) indicate a probable case of
mental dysfunction.

26. • A special questionnaire designed by the researchers (student
group and the supervisor) which includes in addition to the
questions listed in the “General Health Questionnaire”, other
questions that are relevant to our study (Questionnaire form-
Appendix 1)
• For analysis depression was identified according to the
following cut-off levels (put the cut-off level for the scores
used in this study.

27. • Analytical Approach: SPSS program – Statistical package for
Social Sciences. The information was entered into SPSS after
making them on Excel Spreadsheets. Graphs made for
analysis were done using Microsoft Excel.

28. Limitations
• Many of the students were slightly apprehensive in providing
demographic data such as their Age, Sex, and Nationality etc.
• It was tough to include all students as many of them were
either absent from the gathering or would not comply to our
requests.
• Most of the students in the higher MBBS were posted in
different hospitals and were unavailable for questioning (5th yr
MBBS).
• Many of the students filled the questionnaires for fun hence
not providing accurate data (those papers were not
considered to prevent weakening of the study).

29. • Students are from a wide variety of cultural and social
backgrounds; therefore a standardized questionnaire such as
the GHQ may underscore or overvalue depressive scores. This
is because the social norms are different for various ethnic
groups.
• The GHQ is meant for large communities and isn’t a screener
for depression but rather for a range of depressive moods
and can reflect a temporary moment of stress, therefore
giving us false positive results for depression scores.

30. Data Analysis
Interpretation

31. % Distribution according to Age (n=300)

32. %Distribution on Nationality (n=300)
%Distribution on College (n=300)

33. %Distribution on Residence

34. %Distribution on Support Groups

36. Gender Not Depressed Borderline Severe Depression
Depression
Male 73 7 10
81.1% 7.8% 11.1%
Female 150 30 27
72.5% 14.5% 13%
College MBBS BPT DMD Pharma D
Not Depressed 158 25 31 11
75% 76% 78% 69%
Depressed 53 8 9 5
24% 22%
25% 31%

37. Nationality Not Depressed Depressed
Indian 64 23
73.6% 26.4%
Americas 13 4
76.5% 23.5%
Europe 8 4
66.7% 33.3%
Africa 19 3
86.4% 13.6
Middle East 62 19
76.5% 23.5%
Pakistan 48 18
72.7% 27.3%

38. Residence Not Depressed Borderline Depression Severe Depression
Family 121 29 23
69.9% 16.8% 13.3%
Friend 34 3 5
81% 7.1% 11.9%
Alone 40 3 5
83.3% 6.3% 10.4%
Hostel 29 2 4
82.9% 5.7% 11.4%
Suicidal Tendency No Depression Depression
Yes 18 20
47.4% 52.6%
No 206 57
78.6% 21.3%

39. Batch No Depression Borderline Severe
Depression Depression
1st YR 46 7 7
20.5% 18.9% 18.4%
2nd Yr 58 10 8
25.9% 27% 21.1%
3rd Yr 35 3 7
15.6% 8.1% 18.4%
4th Yr 42 11 8
18.8% 29.7% 21.1%
5th Yr 43 6 8
19.2% 16.2% 21.1%

40. Guidance Counselling No Depression Depression
Yes 19 15
55.9% 44.1%
No 205 61
77.1% 22.9%
Support No Depression Borderline Depression Severe Depression
Family 75 5 7
86.2% 5.7% 8%
Friend 122 31 24
68.9% 17.5% 13.6%
Faculty 23 7
76.7% 23.3%

41. Appetite No Depression Borderline Depression Severe Depression
Decreased Appetite 62 15 18
65.3% 15.8% 18.9%
No change 129 18 11
81.6% 11.4% 7%
Increased Appetite 33 5 9
70.2% 10.6% 19.1%
Headaches No Depression Borderline Depression Severe Depression
Yes 57 14 20
62.6% 15.4% 22%
No 167 24 18
79.9% 11.5% 8.6%

42. Lack of Sleep No Depression Borderline Depression Severe Depression
Yes 53 14 13
66.3% 17.5% 16.3%
No 171 24 25
77.7% 10.9% 11.4%
Feeling of No Depression Borderline Depression Severe Depression
Worthlessness
Yes 46 9 14
66.7% 13% 20.3%
No 178 29 24
77.1% 12.6% 10.4%

43. self reflection category No Depression Borderline Depression Severe Depression
Happy 112 10 7
86.8% 7.8% 5.4%
Satisfied 87 18 23
68% 14.1% 18%
Sad 25 10 8
58.1% 23.3% 18.6%

44. Conclusion
• Depression in GMU was found to be 21% on an average in the whole
University. On a breakdown a maximum of 25% was seen in MBBS
whereas a similar pattern was seen in the Non MBBS fields showing no
relation in concordance with depression.
• We were also able to manage a Yr wise frequency of the problem with the
highest frequency being in the 4th yr – 50.8%, followed by the 2nd yr –
48.1%.
• A number of common instances were seen with depression among the
students ranging from residing with family, Sex, Batch, Suicidal
tendencies, Support grps, Appetite changes etc.
• Environmental factors such as smoking, alcohol, drug use, self satisfaction,
personal choices of entry although seemed to be clinically affecting
people showed no statistical significance through our study.

45. • We also found out that there were no measures being
undertaken either by the student body or the faculty on
recognisable scales to end the misery of the student.
• In the end we would, with the humble support of Dr.
Sharbatti, like to make everyone aware of the condition and
together overcome it and make a medical students life a little
less demanding.

46. Recommendations
• Help the students build up their stressful routine step by step
rather than throwing everything all at once.
• Access to mental health care deserves further consideration.
• Implement new ways to teach students to recognize the
importance of their own health and to seek help when they
need it:
 Anonymous forums
 Workshops
 Support groups
 Stress rounds

47. • Open mindedness should be shown towards such conditions
by family, friends & faculty.
• Adequate gaps between Exams should be maintained so that
students get sometime for themselves too. (Laurie Raymond,
a psychiatrist and the director of the Office of Advising
Resources at Harvard Medical School in Boston)
• Define the specific role of each student at the beginning itself
to avoid further confusion.

48. Acknowledgement
• We would like to thank Dr. Shatha Sharbatti for her painstaking
effort with us and apologise for depressing her in the process.
• We would also like to thank the rest of the community dept. as we
found out many a good advice through their groups.
• We would like to thank all the students who had participated in our
questionnaire.
• Dr. Jaya Devin from the Dept of ………………. for his sincere
assistance and motivation.
• We would specially thank GMC Computers for losing our soft copy
thrice as it gave us more time for a better product.