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Depression among students: Critical review

Working Paper · December 2016

DOI: 10.13140/RG.2.2.21978.75205

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Running head: DEPRESSION AMONG STUDENTS 1

Depression among students: Critical review

Dastan T. Faeq

School of Psychology / University of Leicester

 DEPRESSION AMONG STUDENTS 2

Depression is one of the most widespread diseases across the world and a major factor in

problems of mental health (Sarokhani et al., 2013). The issue of students’ mental health is a

global problem that covers all developed and non-developed societies, both modern and

traditional (Bayram & Bilgel, 2008). During their academic life young people face many

contradictions and obligations to succeed, especially at university (Arslan, Ayranci, Unsal &

Arslants, 2009). Also, university students should make the efforts to embrace new

experiences and changes in social aspects, and in behavioural, emotional, academic and

economic situations (Ginwright & James, 2002). Therefore, it is important to understand

concerns regarding students’ mental health. The mental health problems of students are

widely studied at different educational levels, such as college and university (Bayram &

Bilgel, 2008). A number of studies have indicated a high prevalence of mental health

problems among students, including depression, compared to the rest of the population

(Yusoff et al., 2013). More importantly, recent studies in this area indicate that the

psychological and mental problems of students continue to increase (Field, Diego, Pelaez,

Deeds & Delgado, 2012). For example, in the United States a national survey in 2005

mentioned that 86% of university counselling centres noted an increase in serious mental

health and psychological problems among university students (Gallagher, Weaver-Graham &

Tylor, 2005).

One of the most prevalent problems of mental health is depression, which is a serious

health problem among the student population (Ibrahim, Kelly, Adams & Glazebrook, 2013).

Moreover, depression has a significant impact on academic performance, academic

satisfaction and academic achievement (Arslan et al., 2009). A study by Wechsler, Lee, Kuo

and Lee (2000) reported that students with symptoms of depression achieve lower grades and

are less active in the classroom relative to students who do not have these symptoms. The

findings show that depression is a serious problem that requires psychological support for the
 DEPRESSION AMONG STUDENTS 3

majority of students. So far, however, few investigations have been conducted on the recent

findings of depression among students. This paper reviews recent findings on the prevalence

of depression among students, and factors associated with students’ depression. A related

aim is to identify whether the prevalence of depression among students is higher than that of

the general population. The paper will also look at common causes, serious consequences

and the methodology of depression among students. Finally, findings will be discussed

together with suggestions for effective prevention and further studies.

Prevalence of depression among students

Depression is one of the most prevalent problems in the mental health of students at

different educational levels, such as high school, college and university (Arslan et al., 2009).

Previous studies have proposed that psychological morbidity, particularly depression, is a

common disorder among students (Adewuya, Ola, Olutayo, Mapayi & Oginni, 2006; Dahlin

et al., 2005). Studies of psychological problems encountered by counselling centres revealed

that depression was one of the five most common problems among college students. They

highlighted that depression accounted for 39% of problems, a higher rate than anxiety,

problems with romantic relationships, and the self-esteem of students across different settings

(Erdur-Baker, Aberson, Borrow & Draper, 2006; Green, Lowry & Kopta, 2003).

Recently, many studies have been carried out on the rate of depression among students

(Chen et al., 2013). They report that depression is a widespread problem and continues to

increase in the student population (Sarokhani et al., 2013). For instance, one study stated that

the rate of depression varied from 10% to 40% among university students in Turkey (Ustun

& Kessler, 2002). In addition, Green, Lowry and Kopta (2003) indicated that adult students
 DEPRESSION AMONG STUDENTS 4

reported higher levels of symptoms of depression compared to the adult non-student

population. Other studies in this area have also found that the symptoms of depression range

from 27% and over, among students and these symptoms represent the most common

problems encountered by university counselling centres (Mobley, 2008).

Although the prevalence of depression in the student population compared to the general

population has not been well researched. A number of studies have looked at the rate of

depression among particular groups of students. A systematic review of published studies,

from January 1980 to May 2005 about the rate of depression in Canadian and US medical

students, reported higher levels of depression in the student population compared to the

general population (Dyrbye, Thomas & Shanafelt, 2006). However, based on this study we

cannot conclude that the prevalence of depression in students is higher than the general

population. This is because the study used only Canadian and US medical students, and the

sample of this systematic review only included 40 studies during the period January 1980 to

May 2005.

Another recent systematic review reported that depression in university students is much

higher compared to the general population (Ibrahim et al., 2013). Similarly, according to this

study, it cannot be concluded that the prevalence of depression is higher than the general

population because this study only focused on university students. Additionally, Dahlin,

Joneborg and Runeson (2005) found that the rates of depression in the general population

were lower relative to that of medical students at the Karolinska Institute in Sweden.

Likewise, a more recent study by Haldorsen, Bak, Dissing and Petersson (2014) found that

the prevalence of depression among Danish medical students was remarkably higher than the

Danish population as a whole.

 DEPRESSION AMONG STUDENTS 5

A Nigerian study by Adewuya et al. (2006), about the prevalence of depression among

university students, found the rate of depression among Nigerian students was only 2.7%.

This is much lower compared to the rate of depression among Nigerian outpatients visiting

general clinics (25%), or compared to an older population sample (over 60 years) (18.3%) in

western Nigeria (Uwakwe, 2000). Another study (Rosal et al., 1997) stated that the level of

depression in the general population was approximately the same as medical students at the

University of Massachusetts. Additionally, a recent study on depression in Chinese

university students by Chen and his colleagues (2013) concluded that the prevalence of

depression was similar to that of the non-student population in the Chinese city of Harbin.

Over recent decades, a large number of studies have been conducted on the rate of

depression in medical students (Dyrbye, Thomas & Ahanafelt, 2005). Recent studies (Sidana

et al., 2012; Dahlin et al., 2005; Dyrbye et al., 2006) have reported that the rate of depression

in medical students is higher than that of the general population. In the literature it can be

clearly seen that medical students, as subjects, cover most of the studies about the prevalence

of student depression. Studies highlight that the rate of depression in medical students shows

a higher score relative to students of other degrees (Yusoff et al., 2013). Studies about the

prevalence of psychological distress among medical students indicated that the rate of

depression students at different medical institutions in different countries ranges between 7%

and 26% (Sidana et al., 2012), whereas at 39% among Indian medical students it is a serious

problem for students in India (Vaidya & Mulgaonkar, 2012, cited in Sidana et al., 2012).

A study in the United Kingdom reported that approximately one-third of medical

students (first-year) have mental health problems of depression and anxiety (Guthrie et al.,

1995 cited in Dyrbye, Thomas & Shanafelt, 2005). Other studies have mentioned that 12%

of medical students in the United Students have serious symptoms of depression measured by
 DEPRESSION AMONG STUDENTS 6

DSM III standard (Zoccolillo, Murphy & Wetzel, 1986). Compared to law students,

Canadian medical students recorded higher rates of depression (Dahlin et al., 2005).

Student gender and depression

It can be expected that, in general, the prevalence of depression in females is higher than

that of males in the general population (Piccinell & Wilkinson, 2000). Nelon-Hoeksema,

Larson and Grayson (1999), in their study on gender differences of depression, reported that

the reasons for these differences remain unclear, whereas gender differences in depressive

disorders are well documented in many studies. More specifically, a twin study in this area

has shown that there is no relationship between gender difference in depression and genetic

risk, and that factors are more likely to relate to environmental aspects, namely family

history, social support, economic situation and life events (Tenant, 2002). In reviewing the

findings of gender differences of the prevalence of depression in students, the empirical

studies have reported different results. The majority of these studies have found that gender

is a major factor with regard to depression among students.

Several recent studies about have shown that there was no difference in the rates of

depression in male and female students. That means that gender does not play a role in the

rate of depression. For example, a recent study (Byaram & Bilgel, 2008) on the prevalence

of depression in Turkey has shown that there was no difference in the score rate with regard

to depression in male and female university students. Other recent studies by Arslan et al.

(2009) and Rosal, Ockene, Barrett and Hebert (1997), on the prevalence of depression in

university students, have found that there was no significant difference between the sexes.

Additionally, a more recent study (Yusoff et al., 2013), on the prevalence and factors related
 DEPRESSION AMONG STUDENTS 7

to depression in 743 Malaysian university students, indicated that male and female students

show nearly same degree of symptoms of depression, and difference in gender was not a

significant factor in rates of depression. Similarly, findings from samples of Turkish

university students using “Beck Depression Inventory” and “Public Health questionnaire”

recorded the rates of depression between male and female students (Bostanci et al., 2005).

Also, a more recent study by Haldorsen et al. (2014) of Danish medical students reported that

female students recorded slightly higher rates compared to male students, but these

differences between the sexes was not significant.

However, a large number of studies about students’ symptoms of depression conclude

that male and female students do have different rates of depression. Most of these studies

indicate that the rate of depression is higher in female students compared to male students,

but the reason for this was not clearly identified. In a recent study by Adewuya et al. (2006),

on the prevalence of depression among Nigerian students using the interview instrument Mini

International Neuropsychiatric, there was a significant difference between the sexes in rates

of depression among university students, with rates in female students two times greater than

male students. Moreover, in the most recent systematic review by Ibrahim et al. (2013),

using the results of 24 recent articles from 1990 to 2010 about depression in university

students, a majority of these articles (16) reported gender differences in the prevalence of

depression among students. Fifteen of these articles showed that the rate of depression in

female students was higher in comparison to male students; only one article reported a higher

rate for men. In addition, Dahlin et al. (2005) and Ceyhan, Ceyhan and Kurtyilmaz (2009)

pointed out that female students had a greater risk of depression compared to male students.

Eisenberg, Gollust, Golberstein and Hefner (2007) observed the same result as they

mentioned that symptoms of depression were higher in female undergraduate students

compared to male undergraduate students.

 DEPRESSION AMONG STUDENTS 8

Students’ age and depression

In terms of students’ age, some studies in particular looked at the relationship between

age and depression in students. A study on depression among Malaysian university students

pointed out that the prevalence of depression was higher in older students compared to

younger students (Shamsuddin et al., 2013). This result also was emphasized in other

studies; senior university students have greater rates of depression relative to beginners or

first year students (Bostanci et al., 2005; Khawaja & Duncanson, 2008).

In contrast, studies in this area (Bayram and Bilgel, 2008; Tomoda et al., 2000) have

shown that students in their final year of university have lower levels of depression compared

to new students. It is hypothesised that this difference in the above findings might be due to

using different samples of students, and different methods of measuring depression. It is

somewhat surprising that no relationship was found in this condition. One study indicated

that the level of depression in older students is nearly the same as younger students (Lester,

1990). This would indicate there is no significant relationship between a student’s age and

the prevalence of depression.

Students’ relationship status and depression

A recent meta-analysis study and systematic review (Sarokhani, 2013), of 35 studies

between 1995 and 2012 from Iran, reported a prevalence rate of 39% for single university

students and 20% for married university students. This study concluded that depression is

more widespread in single students than in married students at university. Moreover, the

same relationship was mentioned in a study of Japanese and American students; depression is

more common among single students than in married university students (Inaba et al., 2005).
 DEPRESSION AMONG STUDENTS 9

It has been suggested that marriage has several advantages in protecting students from

depression. A common interpretation is that married students have higher levels of

confidence and emotional assistance (Sarokhani, 2013). In contrast, another study found that

the prevalence of depression in married students was higher compared to students who were

not married (Bayaram & Bilgel, 2008). The reason for this was not discussed, but it might be

said that single students have fewer responsibilities for family duties or everyday life.

Depression and academic performance

A number of studies have shown that symptoms of depression affect students’

performance and achievement at university, college and school (Stark & Brookman, 1994,

cited in Shamsuddin et al., 2013). Findings in this area indicate that academic tasks cause a

high risk of mental health problems, especially depression in students (Ibrahim et al., 2013;

Sharif et al., 2011). A Turkish study found that depressed students have a poorer academic

performance compared to students who do not report symptoms of depression (Bostanci et

al., 2005). Owens, Stevenson, Hadwin and Norgate (2012), on anxiety and depression on

academic performance among students in the UK, found that depression has a negative

relationship with academic performance. They investigated that a higher level of depression

was associated with poorer academic performance.

Another study about the impact of depression on academic performance among

undergraduate students mentioned that depression has a strong and a negative relationship

with academic performance. This robust and risky relationship includes a number of negative

consequences for students (Hysenbagasi et al., 2005). Similarly, a recent study by Ceyhan et

al. (2009), on depression in university students, found that students who have a poor
 DEPRESSION AMONG STUDENTS 10

academic achievement demonstrated considerably greater depressive symptoms compared to

students who indicated a high level of academic achievement. It also should be considered

that students’ depression is a serious risk to academic impairment, which continues and is

increased by depression during academic life (Heiligenstien & Guenther, 1996).

Another notable consequence of depression is that students who display a depressed

mood are likely to lose academic motivation and academic activity. Depressed students also

have many difficulties in academic tasks at university (Khawaja & Bryden, 2008). In

qualitative research by Anderson (2003), students mentioned that depression is one of the

main causes of their academic problems, including academic performance. Overall, studies

in this area reported a negative relationship between academic achievement or performance

and depression.

It is obvious that during their academic life, students have many goals, obligations and

expectations for the future. If some students fail to achieve their goals, meet expectations or

responsibilities, they are at a higher risk of suffering from depression and other psychological

and mental problems (Patchett, 2005, cited in Ceyhan et al., 2009). For this reason it is

assumed that poor academic success or performance is one of the main causes of depression

among students (Baker & Siryk, 1984). However, it is not easy to decide if depression is a

consequence of a low level of academic achievement or vice versa. Depression can have a

negative impact on cognitive functioning and this can impact negatively on academic

performance or achievement (Turner, Thompson, Huber & Arif, 2012).

 DEPRESSION AMONG STUDENTS 11

Common causes of depression among students

The distinct causes of depression among students have not been investigated,

particularly in the previous studies. It is important to remember that the above studies have

shown high rates in the prevalence of depression (from 5% to 30%) in students across the

world (Ibrahim & Kelly, 2011). The large variation in this percentage has not been

mentioned, but it might be said that this is because the studies were performed in different

populations, societies and cultural backgrounds (Bayram & Bilgel, 2008; Dahlin at al., 2005).

Another factor in this large variation may be due to the studies using different methodologies

or tools to diagnose this problem among students (Ovuga, Boardman & Wasserman, 2006).

In the literature, studies have determined different factors of depression among students, but

there are some common causes of depression among students. This part of the review will

look at common factors in many of the studies about the prevalence of depression in students

during their academic career.

The first serious cause associated with the depression among students is socio-economic

status. A limited number of studies have investigated the effect of socio-economic factors on

depression in the student population (Ibrahim et al., 2013). Students’ socio-economic level

has been shown to play a significant role in the symptoms of depression in students (Sareen,

Afifi, McMillan & Asmundson, 2001).

A large cross-national (from 23 countries) study (Steptoe, Tsuda, Tanaka & Wardle,

2007) on the relationship between symptoms of depression and socio-economic background

of university students showed that family and personal income level, parental education and

family wealth, contributed to depression in students. Similarly, data from an analysis of

Egyptian studies on the relationship between socio-economic status and depression among

undergraduate students found that socio-economic background associated negatively with

 DEPRESSION AMONG STUDENTS 12

symptoms of depression in students. This study concluded that students from families with a

low level of income and parental occupation have a tendency towards depression (Ibrahim et

al., 2013). More notably, the financial problems of students and their families have a

negative impact on depression in students (Andrews and & Wilding, 2004). The study

showed that students originally from the countryside recorded higher levels of depression

than students who live in cities (Bayram & Bilgel, 2008). Shamsuddin and his colleagues

(2013) reported that this might be due to an economic situation where families in rural areas

often have a lower economic status. Moreover, it might be explained that some students from

rural areas move away and leave their families while at university, and this might cause some

difficulties for some students.

Studies also show that students who are from a higher socio-economic position such as a

high level of social class, an educated background and economic situation, are more likely to

have a sense of control. This sense of control can provide students better protection against

mental health problems, namely depression, associated with moving to a university

environment (Lanchman & Weaver, 1998). Additionally, the educational level of students’

parents could play role in depression associated with the university environment of students.

For example, Ibrahim et al. (2013) found that students with less educated family are 50% to

60% more likely to suffer from problems of depression compared to highly educated families

(father and mother). It is also reported that the father’s occupation has an effect on

depression in students. For instance, Ibrahim and Kelly (2011) found that students whose

father had a professional job are 60% more likely to obtain depressive disorders compared to

students whose father was an unskilled worker.

The second most common cause, reported as a serious factor for the rate of depression in

students, is living away from home or transition to new environment, such as university and
 DEPRESSION AMONG STUDENTS 13

college. For some students, separation from home or family might cause psychological

distress, especially depression. This is due to problems and difficulties associated with living

in a new and different environment at university or college without social support (Asyan,

Thompson & Hamarat, 2001). It was also found that students who live at home with their

families are less likely to be affected by depression because their families provide more

support and enhanced protection against academic stress (Christie, Munro & Retting, 2002).

It is pointed out that although it is less costly for students to share accommodation, and gives

more social advantages, those share house students may be dissatisfied with their

environment and housemates, and there are more opportunities to be diverted away from their

studies. It is believed that this dissatisfaction leads to increased psychological distress such

as depression and stress.

Another problem with accommodation is that students who live alone may face problems

without social support, especially international students. A study by Haldorsen et al. (2014)

found that students dealing with social problems and psychological distress have a higher rate

of the symptoms of depression compared to students living with their family.

The above evidence shows that students, who live with their family and partners and

have the social support to deal with their problems, have a better chance of living without

depression while at university and college. Although the transition to college and university

is a successful step, and it is a good opportunity for students to have a better future, in poor

countries it might cause some students who move to university some social and psychological

problems, including depression. For example, Adewuya and his colleagues (2006) explained

that symptoms of depression in Nigerian students could be caused by poor academic

conditions, overcrowded classrooms, a poor quality of accommodation, and a lack of learning

materials and equipment.

 DEPRESSION AMONG STUDENTS 14

An important finding mentioned in the recent study of Haldorsen et al. (2014) found that

the stress factors of students have a significant association with symptoms of depression. In

the previous study Haldorsen et al. (2014) concluded that increased stress in students led to

raised symptoms of depression. Similarly, Bayram and Bilgel (2008) emphasized the same

relationship between depression, stress and anxiety.

The third main cause of depression among students is study satisfaction. That means

that students who are not satisfied with their course of study have greater rate of depression

than students who are satisfied (Bayram & Bilgel, 2008). A possible interpretation for this

finding may be the student’s lack of interest and motivation in their major, because on some

occasions the student’s parents choose the subject for study (Chen et al., 2013). Another

recent study concluded that students who are content with their education are less likely to

suffer from depression and anxiety (Dahlin et al., 2005).

Interestingly, another cause of depression in school and college age students is body size

or body weight. Depression related to body size has been investigated by a number of studies

(Granberg, Simons, Gibbons & Melby, 2008). There is evidence of no relationship between

body weight and psychological distress in adult students. For example, a study by Granberg

and his colleagues (2008) on the relationship between depression and body size among 343

African-American middle-school females, found no link between symptoms of depression

and weight. That means that an unhealthy weight did not cause more symptoms of

depression among those female students. The authors explained that this finding may be due

to the belief that African-American girls are more likely to overestimate their weight.

On the other hand, an American study found that overweight students in a middle school

in Texas were more depressed compared to students of a normal weight (Schiefelbein,

Mirchandani, George, Castrucci & Hoelscher, 2010). This finding is also supported by
 DEPRESSION AMONG STUDENTS 15

another study from the United States from 1980 to 2002. It indicated a high rate of

depression in overweight and obese teenagers and children, and this high rate continues to

increase (Ogden et al., 2006). Additionally, some studies highlighted that obesity or being

overweight has a positive relationship with depression in adolescents in the United States

(Jorm et al., 2003). Jorm and his colleagues also showed that these studies also looked at

gender differences in overweight adults. They found that female adults in the United States

were more depressed compared to male adults. A possible interpretation of this phenomenon

may refer to findings that boys are less likely to overestimate their weight, and think they do

not weigh enough, whereas most girls overestimate their weight (Strauss, 1999).

From the above evidence, it might be true that adults and younger students who have a

healthy or normal weight are less depressed than adult students who have an unhealthy or

abnormal weight. Indeed, adult female students are more likely to show symptoms of

depression. Furthermore, Ceyhan and Kurtyilmaz (2009) found that students who are

satisfied with their body shape are less depressed than students who are displeased with their

body shape.

Serious consequences

It is clear that depression has a substantial negative consequence for students as

individuals in society. Few studies have been performed about the impact of depression on

students’ personal ability and academic career. It is suggested that depression can lead to

many mental and physical disorders, which are big threats for students who make up an

important part of the population in the community (Bayram & Bilgel, 2008). Hysenbegasi et

al. (2005) stated that depression might cause problems for the future occupations of students
 DEPRESSION AMONG STUDENTS 16

by delaying access or difficulties in choosing a career. Another study by Field et al. (2012)

reported that depression brings various mental problems, which lead to psychological, social

and physical problems for students during and after their academic life. It is believed the

major problems in students’ depression include poor self-assessment, lack of pleasure and

interest in everyday life, problems in eating and sleeping, and suicidal thoughts (Arslan et al.,

2009).

Additionally, this disorder has many negative effects associated with personal, cognitive,

and emotional problems, notably, decision making and problems of time management (Chen

et al., 2013); poor academic achievement and low level of exam performance (Hysenbegasi et

al., 2005); decreased attention and drug abuse; over consumption of alcohol and increased

levels of smoking in adults and university students (Yusoff et al., 2013); and negative effects

on everyday work and achievements (Sobocki, Lekander, Borgstrom, Dtrom & Runeson,

2007). Most importantly, the most serious consequence of depression is the threat of suicide

in students. An earlier study on suicide in students explained that depression is the most

prevalent cause of suicide attempts among students (Eisenberg et al., 2007). Unfortunately,

however, there is no exact data showing the rate of suicide among students worldwide. The

study mentioned that 2.7% of depressed students tried to commit suicide, while 9.5% to 10%

had suicidal thoughts (Dahlin et al., 2005; Kisch, Leino & Silverman, 2005).

Research methods of students’ depression

In reviewing the research methods, it is noted that almost all studies in this area used the

two main methods to investigate depression among students. In recent studies, quantitative

research methods were mostly used to detect depression among students, using different tools
 DEPRESSION AMONG STUDENTS 17

to collect data and statistical analysis. In review the methodology, I will mention the two

most common methods with a few studies as examples that used the different methods.

First, in most of the quantitative studies a self-report questionnaire was used as a

psychometric tool to collect the data from the student population. The “Beck Depression

Inventory (BDI)” was widely used to assess symptoms of depression among students

(Bostanci et al., 2005). This instrument was developed by Beck, Ward, Mendelson, Mock,

and Erbaugh (1961) (Ceyhan et al., 2009). However, this self-report inventory was not

specifically designed to measure depression among students, though it is believed this

instrument is suitable to collect data from students (Bostanci et al., 2005). Another common

self-report inventory is “The University Student Depression (USDI)”. This instrument was

specifically designed for students by Khawaja and Bryden (2006) (Sharif et al., 2011). Other

common instruments used included the “Major Depression Inventory (MDI)”, Depression,

Anxiety and Stress Scale (DASS), and the “Major Depressive Disorder (MDD)” (Dahlin et

al., 2005; Yusoff et al., 2013; Tomoda et al., 2000).

Second, few systematic reviews and meta-analysis studies have been carried out to

investigate depression in students. Recently, Sarokhani et al. (2013) conducted a meta-

analysis research and systematic review on the prevalence of depression in university

students. They used the data from Iranian 35 studies about depression in university students

between 1995 and 2012. In addition, Dyrbye et al. (2006) performed a systematic review of

40 published studies from 1980 to 2005 on depression and other types of psychological

distress in Canadian and US medical students. Ibrahim et al. (2013) carried out a systematic

review of 24 published studies from different countries between 1990 and 2010 on the

prevalence of depression among students.

 DEPRESSION AMONG STUDENTS 18

Discussion

The prevalence of depression among students is clearly emphasized by the above recent

findings. Various studies have shown different rates of depression in students in different

countries. Some recent studies have reported that the rate of depression among students is

higher than in the general population, and a number of studies have emphasized this level of

prevalence compared to the general population (Dahlin et al., 2013; Dyrbye et al., 2006;

Green et al., 2003; Haldorsen, et al., 2005; Ibrahim et al., 2013). Other studies have reported

contrasting results in depression among students. They found that rates of depression in

students are not greater, and are nearly the same as the general population (Uwakwe, 200;

Chen et al., 2013).

However, the majority of findings report a higher rate of depression in the student

population. It is difficult to decide whether the rate of depression among students is higher or

lower than the general population. These studies were performed among students from

different countries that have different cultures, economic levels and academic environments.

Moreover, the studies used different instruments of measurement and different research

methods to investigate this problem (Sarokhani et al., 2013). One notable finding is that

some studies mentioned the highest rate of depression is found in medical students relative to

non-medical students (Yusoff et al, 2013). Medical training, which is a stressful, with large

amounts of work, is reported as the main reason for this high rate among medical students

(Dyrbye et al., 2005; Yusoff and Rahim, 2011). However, medical training is crucial and

demanding for students in medical departments.

Regarding gender differences, this paper highlighted that a large number of studies

indicate that the rate of depression in females is higher than in male students. A possible

interpretation for this phenomenon is that females are at a higher risk of depression, which
 DEPRESSION AMONG STUDENTS 19

may be due to their biopsychological features including social, emotional and physiological

factors (Dyrbye et al., 2006; Zaid, Chan & Ho, 2007). As indicated above, most of the

studies in this area find that older students are more depressed than younger students. A

significant reason, suggested for this problem in older groups of students, might be due to

uncertainty about the future, looking for employment and job concerns (Bostanci et al.,

2005).

Another subject reviewed in this paper is the link between a student’s relationship status

and depression. As mentioned, studies show different results in this situation, but the

majority report that single students have more problems with depression than married

students. With regards to academic performance this is the main priority of students during

their academic career. As discussed, poor academic performance has a negative contribution

on depression in students. So far, the relationship between academic performance and

depression remains unclear and is not well documented. Some studies have concluded that it

is more likely that depression results in poor academic performance, rather than a low level of

academic performance resulting in depression.

The main causes of depression have not been well researched due to the different causes

of depression in different societies across the world. In general, it is believed that the causes

of depression in students are due to complicated interactions between social, physiological,

developmental and psychological factors (Lack & Green, 2009). In reviewing the relevant

papers some common causes of depression among students are: separation from home, socio-

economic level, poor academic performance, and body shape or weight, especially among

adult students.

To prevent and reduce the rate of depression in students, effective services in mental

health should be offered. These services can offer effective skills to manage academic stress;
 DEPRESSION AMONG STUDENTS 20

furthermore, problem solving strategies and additional social support can be given. A lack of

social support, especially for students who study abroad and live away from home, can cause

depression. Moreover, students’ awareness of depression and other psychological distress

can be improved through seminars and workshops. Counselling centres at different

educational institutions should give high quality services about depression through

counselling programmes.

Considering the common prevalence of depression among students, and its negative

impact on students’ abilities, future research should investigate the psychometric properties

of common instruments that measure depression, as some are not designed to detect

depression in students. Moreover, as discussed above, international students are at high risk

of depression. Therefore, a further longitudinal study with a large number of samples could

examine in more detail depression and associated factors in international students.

 DEPRESSION AMONG STUDENTS 21

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