Project Proposal

Topic: Prevalence and Correlates of Depression and Anxiety

among University Students
1.1

Background of the Study

Depression and other mental health conditions are a noteworthy public health problem in
colleges. Several students go through their first psychiatric incidence while at college, and 12%
to 18% of students have a diagnosable mental illness (Mowbray, Megivern & Mandiberg, 2006).
Epidemiological studies suggest that the 15 to 21 age category (typical college years) has the
highest past-year prevalence rate of mental illness at 39%. Eisenberg (2007) reported that the
general prevalence of depression and anxiety is 16% among undergraduate scholars and 13%
among graduate scholars. Based on outcomes from the American College Health Association
(ACHA) National College Health Assessment (NCHA), the rates of students reporting having
been diagnosed with depression has increased from 10% in 2000 to 18% in 2006 (American
College Health Association, 2006). A number of factors add to the first appearance of depression
all through college. The movement itself from a conversant home environment to an unfamiliar
college environment, places further life pressures on young adults as they discover their self,
strive to acquire new abilities, are away from well-known social support structures, and have
increased time demands.
Depression can affect academic performances in college. Studies propose that university students
who experience depression are more likely to smoke. Furthermore, studies have also suggested
that students that experience depression do not necessarily consume alcohol more profoundly
than other university students. But students that experience depression, particularly women, are

1|Page

more likely to drink to get drunk and go through difficulties related to alcohol misuse, such as
engaging in risky sex. It is not unusual for students who experience depression to self-medicate
with street drugs.
Depression is also a major threat factor for suicide. When depression is properly diagnosed and
treated, it can help in the reduction of suicide rates among university students. ACHANCHA
survey (2009) informed that about 6 per cent of college students reported seriously considering
suicide, and about 1 per cent reported attempting suicide in the previous year. The survey also
reported that suicide is the third leading cause of death for teens and young adults between the
ages 15 and 24.
The warning signs of depression vary. Students experiencing depression may feel any of the
following: sadness, anxiety, emptiness, hopelessness, guilt, worthlessness, helplessness,
irritableness, restlessness. They may also experience one or more of the following:

Loss of concern for activities that was once enjoyed

Absence of vitality

Difficulty in focusing, recalling information, or making choices

Difficulties in sleeping and remaining asleep, or oversleeping

Loss of desire for food or overeating

Thoughts of suicide or attempts at suicide

Persistent aches, cramps, or digestive complications.

Depression does not have a distinct cause. A lot of factors can result to depression. Some
individuals carry genes that escalate their possibility of depression. However, not all people that
experience depression have these genes, and not all people that carry these genes experience

2|Page

depression. Environment - students surroundings - and life practices, such as stress, also
influences their risk for depression. Pressures of university may consist of:

Residing away from family for the first time

Missing family or friends

Feeling alone or isolated

Undergoing conflict in interpersonal relationships

Encountering new and sometimes demanding school work

Worrying about finances.

Anxiety disorders are among the most common mental health problems of childhood and
adolescence. Students go through extreme, unworkable worries not linked to recent events. They
are often insecure and anxious and have a very strong need for reassurance. They may feel aches
and pains that seem to have no physical basis. According to the U.S. Department of Health and
Human Services, the most predominant anxiety disorders common among children and young
adults are:

Generalized Anxiety Disorder

Social phobias

Panic Disorder

Obsessive-Compulsive Disorder

Post-Traumatic Stress Disorder

As many as 1 in 10 young people may suffer from an anxiety disorder. About 50 per cent of
children and adolescents with anxiety disorders also have a second anxiety disorder or other
mental or behavioural disorder such as depression. Among young adults, more girls than boys
are affected. While it is not clear whether anxiety disorders are triggered by biology,

3|Page

environment, or both, studies have, however, proposed that young adults are more likely to
experience an anxiety disorder if their parents have anxiety disorders (National Institute of
Mental Health). Students with anxiety can show consistent and recognizable behavioural attributes; they
could be easily frustrated, complains of physical pains, such as stomach aches and headaches;

have trouble breathing; exhibits fear; seems on the lookout for danger; upset easily by mistakes
(perfectionism); cries; startles easily; blushes, trembles; expresses worry frequently. Also, they
could have difficulty completing work, act angry, not abide by school rules, act irritable, have
erratic patterns in antecedents, displays ritualistic or repetitive behaviour, be obstinate, act out
impulsively, appear over-reactive.
Suicide is the third leading cause of death among teenagers and young adults (Centres for
Disease Control and Prevention, 2004). Due to the fact that suicide rates in young people have
continuously been increasing, its prevention remains one of the most important challenges for
mental health research. Until now, several papers on youth suicide have been published.
Literature shows that many psychological, epidemiological, socio-economic and psychiatric
factors or processes may lead to suicide.

1.2

Problem Statement

Depression among adolescents is a neglected area of research, when likened with that among
adults; comparatively few studies provide prevalence data solely for adolescents. It is important
to study depression among young adults, because adolescence is an essential stage of life in
which numerous major life choices are made. More importantly, however, is the fact that
experiencing a depressive episode in the early stages of life significantly increases the possibility
of further depressive episodes and co-occurring non-depressive DSM-III-R disorders (Diagnostic
4|Page

and Statistical Manual of Mental Disorders-3rd Edition Revised; a classification system of

psychological illnesses developed by the American Psychiatric Association).
The consequences of depression are substantial. Academic deficiency is known to be associated
with depression. Depression and anxiety are constantly recorded among the top 10 factors
weakening academic performance in the past 12 months on the NCHA (National College Health
Assessment) (ACHA, 2008). Diagnosed depression was related with a 0.49 decline in student
GPA, and treatment was associated with a 0.44 protective effect (Hass, Hysenbegasi & Rowland,
2005). Among other risky behaviours, depression is also known to lead to amplified possibility
of self-injury, attempting or committing suicide and dropping out or failing university (Gollust,
Eisenberg, & Golberstein, 2008).
Depression has no social or cultural precincts; it may affect students regardless of their age,
gender, economic status, background, etc., upsetting both their academic performance and social
functioning within the university environment. Previous studies indicate that demographic
variables are related to depression in the university student population, with certain demographic
factors identified as being more strongly related to the experience of depression. Being female,
for instance, is continually found to be more highly associated with depression than being male
(Adewuya, Ola, Aloba, Mapayi, & Oginni 2006; Connell, Barkham, & Mellor-Clark, 2007).
Other studies have also identified being a first year student (Wong, Chan, Cheung, Ma, &
Tang, 2006) and being enrolled in the faculty of law (Dammeyer & Nunez, 1999) as factors
correlated to greater depression levels. However, there are many inconsistencies and not all
demographic variables have been investigated in a comprehensive manner.
These aforementioned problems have necessitated this study, so as to ascertain how depression,
anxiety and suicidality are affecting the student populace and their productivity in Nigeria.

5|Page

1.3

Objectives of the Study

Generally, the study aims to evaluate the prevalence and correlates of depression and anxiety
among university students in Nigeria.
Consequently, the study aims to assess the influence of the following demographic factors on
depression and anxiety levels among university students in Nigeria.

Age

Gender

Faculty enrolled in

Level of study

Financial status

Relationship status

Alcohol intake

1.4

Research Questions

The major research question of this study is; how prevalent is depression and anxiety among
university students in Nigeria, and what are the correlates? While answering the main research
question stated above, the study also answers the following sub-questions:

What is the relationship that exists between certain demographic factors (age, gender,
faculty enrolled in, level of study, financial status, relationship status, alcohol intake) and
depression and anxiety levels among university students in Nigeria?

6|Page

1.4.1 Research Hypotheses

The hypotheses for the research are set up as follows:
Hypothesis One
H0: Age has no significant influence on depression and anxiety levels among university students
H1: Age has a significant influence on depression and anxiety levels among university students
Hypothesis Two
H0: Gender has no significant influence on depression and anxiety levels among university
students
H1: Gender has a significant influence on depression and anxiety levels among university
students
Hypothesis Three
H0: Faculty enrolled in has no significant influence on depression and anxiety levels among
university students
H1: Faculty enrolled in has a significant influence on depression and anxiety levels among
university students
Hypothesis Four
H0: Level of study has no significant influence on depression and anxiety levels among
university students
H1: Level of study has a significant influence on depression and anxiety levels among university
students

7|Page

Hypothesis Five
H0: Financial status has no significant influence on depression and anxiety levels among
university students
H1: Financial status has a significant influence on depression and anxiety levels among
university students
Hypothesis Six
H0: Relationship status has no significant influence on depression and anxiety levels among
university students
H1: Relationship status has a significant influence on depression and anxiety levels among
university students
Hypothesis Seven
H0: Alcohol intake has no significant influence on depression and anxiety levels among
university students
H1: Alcohol intake has a significant influence on depression and anxiety levels among university
students

1.5

Literature Review

Evidence that suggests that university students are vulnerable to mental health problems has
generated increased public concern in many societies (Stanley and Manthorpe, 2001). While
entrance to a university or other tertiary education institutions is a joyous time, it can be a
stressful life event for some students (Wong et al., 2006). First-year students are particularly at8|Page

risk as they face a number of new stressors during the transitional period of starting a new life in
university or college (Voelker, 2003). Just as all young adults, undergraduate students need to
cope not only with psychological and psychosocial changes that are connected to the
development of an autonomous personal life but also with the academic and social demands that
they encounter in university studies in their preparation for specialised careers. Consequently, the
period of undergraduate learning is a very delicate period in a persons life time, and this period
is considered by several as vital for developing structures and intervention procedures that may
avert or decrease psychological problems (Gjerde, 1993).
Suicide is the third leading cause of death among adolescents and young adults between the ages
of 15 and 24 years (National Centre for Health Statistics, 1990). Psychiatric disorders generally
found to predispose toward suicidal behaviour in adults are depression, alcohol and substance
abuse, and psychotic disorders (Hall et al., 1999). Suicide is a significant public health problem
globally. It is difficult to estimate prevalence in different countries due to the fact that in many
countries, suicide is hidden and consequently prevalence estimates taken from national archives
will most likely underestimate real suicide rates. All the same, going by existing data in the
United States, the third leading cause of death is suicide, after accidents and homicides, and this
is predominant within the youth age range of 1524 years.
In his research, Lama M. Al-Qaisy (2011) established dissimilarities between gender, depression
and anxiety. The females experience anxiety more when compared with the males, while males
experience depression more than females. Furthermore, this study established that the students
who were studying educational sciences, arts and administrative and financial, experienced
greater depression and anxiety scores than those whose major areas of study were sciences and
engineering, and these results were not due to mediator factors such as age, study year and
9|Page

residency, as explained in the results. Wong et al. (2006) obtained the same results of the study.
They, also, found a significant difference between the mean of depression scores of male and
female students. Male students means of depression scores were significantly higher compared
to female students. Some previous studies, that investigated mental distress among university or
college students using other survey methods and rating scales, found higher levels of depression
among female students.
Due to the fact that suicide rates in young people have continuously been increasing, its
prevention remains one of the most important challenges for mental health research. Until now,
several papers on youth suicide have been published. Literature shows that many psychological,
epidemiological, socio-economic and psychiatric factors or processes may lead to suicide
(Beautrais, A. L. (2010); Cash, S. J. & Bridge, J. A. (2009); Szumilas, M. & Kutcher, S. P.
(2008); Polewka, A., et al (2004)).
The present research aims to further investigate and clarify the effect of demographic factors of
age, gender, year-level, faculty enrolled in, relationship status, satisfaction with their financial
position and alcohol intake on depression and anxiety in students.

1.6

Methodology

1.6.1 Research Design

The study uses data from questionnaires distributed among students of University of Lagos,
Akoka. Demographic characteristics, such as gender and race/ethnicity, of this sample (students
of University of Lagos) are similar to the national population of students at 4-year colleges or
universities. The questionnaire will be distributed among 250 male and female students in a
random selection process across all faculties in the University. The selection of this sample will
10 | P a g e

aim to cover all categories of students in the University. While a study covering the entire
population will give a more adequate and precise result, it was necessary to select a sample due
to limited finances, time and personnel. The questionnaire provides information on data on ages
of the recipients, their gender, faculty enrolled in, present level of study, financial status in the
last 4 weeks of the survey, relationship status in the present academic session, and also alcohol
intake in the last 4 weeks of the survey. Questions in the questionnaire providing data on
depression, anxiety, and alcohol intake were extracted from the Patient Health Questionnaire
(PHQ) which is designed to facilitate the recognition and diagnosis of the most common mental
disorders in primary care patients. The questionnaire satisfies all ethical considerations.
1.6.2 Study Population, Sampling Technique and Method of Data Analysis
A cross sectional study will be done on the students of University of Lagos, who have spent
more than six months in the school and have no physical or mental illness other than anxiety and
depression. A self-administered questionnaire will be given out to randomly selected students in
equal proportions from all faculties. Descriptive analyses will be performed to investigate the
distribution of our data. The method for analyzing this research work will be based on both
descriptive and inferential statistics. The descriptive statistics will make use of tables, chart,
simple statistics such as mean, median, mode, percentages, and frequencies. Inferential statistics
on the other hand will make use chi-square, correlation matrix, and simple regressions.

1.7

Limitations of the Study

Certain limitations should be kept in mind when interpreting the results of this study. In the
present study, depression and anxiety were the main focus and thus did not examine the full

11 | P a g e

range of mental health problems prevalent in student populations. Also, the questionnaire
(questions extracted from the Patient Health Questionnaire (PHQ)) used to screen for depression
and anxiety have been validated against clinical diagnoses but are not equivalent to diagnoses.
Another limitation goes thus; this study is based on findings on data from a single university. As
stated earlier, the overall demographic characteristics of our sample are similar to the national
population of students at 4-year colleges or universities, but the university is not necessarily
representative in other respects.

1.8

Definition of terms

Depression: A psychiatric condition showing indications such as persistent feelings of

uselessness, misery, poor focus, lack of liveliness, inability to sleep, and, at times, suicidal
inclinations.
Anxiety: A medical state marked by extreme uneasiness or fear of real or illusory vulnerability.
Adolescent: Someone who has attained puberty but is not yet an adult; a young adult.
Correlates: Either of two variables that are related with the result that a variation in one is
accompanied by a linear variation of the other.

12 | P a g e

References
Adewuya A, Ola B, Olutayo O, Mapayi B, Oginni O. (2006). Depression amongst Nigerian
university students. Prevalence and sociodemographic correlates. Psychiatric
Epidemiology 2006; 41: 674678.
American College Health Association. (2006). American College Health Association National
College Health Assessment (ACHA-NCHA) spring 2005 reference group data report.
Journal of American College Health, 55, 516.
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders
(4th ed.). Washington, DC: Author.
Beautrais, A. L. (2010). Risk factors for suicide and attempted suicide among young people.
Australian and New Zealand Journal of Psy-chiatry, 34, 420-436.
Cash, S. J., & Bridge, J. A. (2009). Epidemiology of youth suicide and suicidal behaviour.
Current Opinion in Paediatrics, 21, 613-619.
Centers for Disease Control and Prevention. (2004). Youth risk behaviour surveillance: National
college health risk behavior survey. Morbidity and Mortality Weekly Report, 46, 154.
Connell, J., Barkham, M., & Mellor-Clark, J. (2007). CORE-OM mental health norms of students
attending university counselling services benchmarked against an age-matched primary
care sample. British Journal of Guidance & Counselling, 35, 41-57.
Dammeyer, M. M., & Nunez, N. (1999). Anxiety and depression among law students: Current
knowledge and future direction. Law and Human Behavior, 23, 55-73.
Eisenberg D, Gollust SE, Golberstein SE, Hefner JL. (2007). Prevalence and correlates of
depression, anxiety and suicidality among university students. American Journal of
Orthopsychiatry 2007;77:534542. [PubMed: 18194033].
13 | P a g e

Eisenberg, D., Golberstein, E., & Gollust, S. G. (2008). Help-seeking and access to mental
health care in a university student population. Medical Care, 45, 594601.
Gjerde PF (1993). Depressive symptoms in young adults: A developmental perspective on gender
differences. In: Funder DC, Parke DR, Tomilinson- Keasey CA, Widaman K (eds).
Studying lives through time. American Psychological Association, Washington DC., pp.
255288.
Hall RC, Platt DE, Hall RC. (1999). Suicide risk assessment: a review of risk factors for suicide
in 100 patients who made severe suicide attempts. Evaluation of suicide risk in a time of
managed care. Psychomatics 40:1827.
Hass SL, Hysenbegasi A, Rowland CR. (2005). The impact of depression on the academic
productivity of university students. Journal of Mental Health Policy and Economics
2005;8:145151. [PubMed: 16278502].
Mowbray, C., Manidberg, J., Stein, C., Kopels, S., Curlin, C., Megivern, D., et al. (2006).
Campus mental health services: Recommendations for change. American Journal of
Orthopsychiatry, 76, 226237.
Polewka, A., Kroch, S., & Chrostek, M. J. (2004). Suicidal behavior and suicide attempts in
adolescents and young adultsEpidemiology, risk factors, prevention and treatment.
Przegl Lek, 6, 261-264.
Stanley N, Manthorpe J (2001). Responding to students mental health needs: impermeable
systems and diverse users. J. Mental Health, 10(1): 4152.
Szumilas, M., & Kutcher, S. P. (2008). Youth and suicide. CMAJ fact sheet. Canadian Medical
Association Journal, 178, 286.

14 | P a g e

Voelker R (2003). Mounting student depression taxing campus mental health services. JAMA,
289: 20552056.
Wong, J. G. W. S., Cheung, E. P. T., Chan, K. K. C., Ma, K. K. M., & Tang, S. W. (2006).
Webbased survey of depression, anxiety and stress in first-year tertiary education
students in Hong Kong. Australian and New Zealand Journal of Psychiatry, 40, 777-782.

15 | P a g e