The method was done based on the guild line of research protocol prepared by University of Gonder and following all the procedure accordingly and which helps us to meet the international research procedure and show the result of this study by publish on scientific journal.
Study design and period
Institution- based cross-sectional study was conducted from February- March 2020.
Study Area
The study was conducted in Gondar town, Northwest Ethiopia Amhara region, which is located about 730 km from Addis Ababa to the capital of Ethiopia. According to 2019 /20 academic year central Gondar education office report in the town there were around eleven high and preparatory public schools. The office has around 719 (561 male 158 female teachers). Among the teachers 112 males and 2 females have a second degree. The schools have been provided education services for 6076 male and 7220 female high school and 2998 male 3093 female preparatory students.
Source Population
All high and preparatory public schools teachers working in Gondar town
Study Population
All high and preparatory public- school teachers in Gondar town available during data collection time.
Inclusion and exclusion criteria
Inclusion Criteria
All high and preparatory schools teachers in Gondar town
Exclusion criteria
Those who are severely ill during the data collection time were excluded.=
Sampling procedure and sampling techniques
Sample size estimation
A single population proportion formula was used to estimate the sample size. Sample size with z-value of 1.96 and marginal error of 5% sample was calculated as
n = z a/22p(1-p)/D2
Where n =initial sample size a= confidence interval (95%) p=proportion of =0.5
D=marginal error of 5% ( za/2)2 =1.96
n= 1.962 x (0.232 (1- 0.232) =384
(0.05)2
Since there is no related study to know the prevalence of depression in related to study population in Ethiopia, we used 50%proportion to calculate sample size. And to find the final sample size we were added 10% non -response rate then the final sample was 423.
Sampling procedure
Among eleven High and preparatory public school teachers found in Gondar town simple random sampling techniques through lottery method was used to select each study participant after proportional distributions of sample for public school teachers. The total numbers of teachers in the town is 739 and 423 samples were proportional distributed to each school. To select the sample from each school we have used lottery method by using their record list at school. After we found their identification number from the school teacher’s list document, we were mixed numbers in a piece of paper then select random numbers from mixed numbers via lottery corresponding to proportionally defined sample for each school.
Variables
Dependent variable
Depression yes /no
Independent variables
- Socio- demographic factors
- Sex
- Age
- Marital status
- Religion
- Ø Social and personal factors
- Academic status
- family size
- Job satisfaction
- stressor
- Income
- social support
- hour of spent time in work
- Ø Behavioral and clinical factors
- Substance use
- Mental illness
- family mental illness
- chronic illness
- taking any medication
Operational definitions
Depression: A score of 5 and above in (Patient Health Questioner -9 ) declared as having depression(24).
Social support: assessed by an Oslo-3 social support scale which has total scores of 14 and classified into three , scored 3–8, 9–11 and 12-14 were considered as having poor, moderate and strong social support respectively (10) .
Substance use: Current use: Using at least one of a specific substance for a nonmedical purpose within the last 3 months.
Ever use of substance: Using at least one of any specific substance for the nonmedical purpose at least once in a lifetime.
Perceived stress: The PSS is a 10-item questionnaire to measure the self-reported level of stress from 0 (never) to 5 (very often) with a range of 0 to 40 for the total score of the scale (25) . Scores ranging from 0-13 considered low stress, 14-26 considered moderate stress and 27-40 considered high perceived stress.
The presence of a known chronic medical illness: When subjects have at least one or more chronic diseases such as Diabetes mellitus, Hypertension, Heart disease, HIV, Epilepsy, Asthma and Cancer. (YES / NO)
Job satisfaction: one’s positive perceived emotion on the appraisal of his/her job which is measured by taking the mean (average) score of different 20 items by using a five-point Likert scale (from 1 = very dissatisfied to 5 = very satisfied). The overall job satisfaction score was calculated by taking the average (mean) score of all the subscales. As a result, teachers for whom score below mean considered as dissatisfied and those with mean and above regarded as satisfied. (26).
Salary: Average monthly income 6485 and below Ethiopian birr was considered as poor salary and above 6485 Ethiopian birr were good salary.
Data collection method and tools
Data were collected by using structured self-administered questionnaires which asses socio demographic characteristics, depression levels, presence of stressor, degree of social support, presence of medical illness and family mental illness, levels of income,
Depression was measured by (Patient Health Questionnaire-9), a nine item questionnaire score of 5 and above is considered as having depression with depression severity: (0-4 none, 5-9 mild, 10-14 moderate, 15-19 moderately severe, 20-27 severe. This is questionnaire validity in Ethiopian with Cronbach’s alpha 0.84 reliability index 0.98 (27).
Social support was assessed by the OSSS-3 consists of three items questionnaire assessing the level of social support with a sum score of ranges from 3 to 14, According to this, respondents who scored 3–8, 9–11 and 12-14 were considered as having poor, moderate and strong social support respectively . This tool was adapted in an African context. For example, in a validation study of OSS-3 in Nigeria, the internal consistency Cronbach’s alpha value was found to be 0.8 which is also valid in Ethiopia (24).
Substance use was assessed by ever use of alcohol, Khat, cigarette and other particular substance for non-medical purpose in life. Current the use of substance will be assessed for the last three months. The tool is adapted in the Ethiopian context with WHO student drug-use questionnaire (28).
Job satisfaction was assessed by JSS for one’s positive perceived emotion on the appraisal of his/her job which is measured by taking the mean (average) score of different 20 items by using a five-point Likert scale (from 1 = very dissatisfied to 5 = very satisfied). The overall job satisfaction score will be calculated by taking the average (mean) score of all the subscales and classified as satisfied above average and dissatisfied average or below(25).
Presence of stressors was assessed be perceived stress scale with 10 item questionnaire and valid in Ethiopia with McDonald’s Omega value of 0.78 and 0.68 for the PSS-10: factor-1 and PSS-10: factor-2, respectively (25).
Presence of a known chronic medical illness was assessed by yes/ no question for chronic illness such as diabetes mellitus, hypertension, cancer, asthma, kidney disease and others. Family mental illness was assessed by asking whether teachers have family with mental illness and response of yes/ no.
More over teachers was asked whether they have been taken any medication and with a response of yes/no.
Data collection procedure
The questionnaire was prepared in English then translated to Amharic, and retranslated English by psychiatric professionals and language experts to keep its consistency. A valid questioner was used for collect data. One day training was given for four data collectors and one supervisor by the principal investigator on the data collection method, informed consent and confidentiality issues. A pre -test study was conducted one week prior to the actual data collection on 21 (5%) in the sample size at Makisegnit preparatory and high school and the questionnaire was checked for its reliability, clarity, simplicity, and understandability. Regular supervision by the supervisor and principal investigator was carried out. Each day during data collection, filled questionnaires were checked for completeness, accuracy and consistency. Amharic version had been validated in Ethiopia and used in several institutions based as well community-based studies in Ethiopia.
Data processing and analysis
Data were edited, cleaned, coded and entered in to the Epi-data 3.1 version and analyzed by using SPSS 22 versions. Bivariate and multivariate logistic regression analysis was done to identify the associated factors between dependent and independent variables. Variables with p- value less than 0.25 in a bivariate analysis were candidates for multivariate logistic regression analysis. Variables with a p-value of less than 0.05 in multivariate logistic regressions considered as statistically significant. The strength of the association declared by odds ratio with 95% CI and Hosmer-Lemeshow goodness of fit used to check model . Results presented in the form of table, figures & Charts using frequency & summary statistics such as mean, & percentage to describe the study population in relation to different variables.