Anxiety and Depression Among Nigerian Undergraduates: a Cross- Sectional Study

doi:10.21203/rs.3.rs-3238042/v1

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Anxiety and Depression Among Nigerian Undergraduates: a Cross- Sectional Study

https://doi.org/10.21203/rs.3.rs-3238042/v1

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Background

Globally, there is rising concern regarding the increased prevalence of mental disorders among university students, as studies have demonstrated a significant clinical measure of psychiatric morbidities among undergraduates worldwide. Sadly, there is a paucity of data on the burden of mental illness among undergraduates in Nigeria, and undergraduate students' mental health problems have not received the requisite public attention in Nigeria and many other countries. Therefore, this study aimed to determine the prevalence of anxiety disorders and depression among undergraduate students and the correlation between anxiety and depression among study participants.

Methods

We conducted a cross-sectional study of 877 undergraduates at Bowen University Hospital in Iwo Osun State, Nigeria, between October 2022 and May 2023.

Results

A total of 14.9%, 10.4%, and 1.9% of students had mild, moderate, and severe anxiety disorders, respectively. Similarly, 11.2%, 5.1%, and 0.5% of students had mild, moderate, and severe depression, respectively. The study showed a strong positive correlation between anxiety disorders and depression among undergraduate students.

Conclusion

This study revealed a high prevalence of anxiety and depression. There is a need for concerned authorities to have a blueprint for an efficient mental health support structure and ensure adequate training of personnel at university health centers.

Anxiety

Depression

Undergraduate

HADS

Mental Health

Mental health issues are now occupying the forefront in public health discourse, as they account for one-third of the causes of disability worldwide [1]. Globally, there is a rising concern regarding the increase in the prevalence of mental disorders among university students [2]. According to the World Health Organization (WHO), depression and anxiety disorders are among the leading causes of illness and disease among adolescents, while suicide is the fourth leading cause of death among persons within the age group of 15–29 years, commonly found in the university[3]. Anxiety is a condition notably associated with feelings of tension, uneasiness, worries, or fear, which can occur with or without a precipitating stimulus[4]. Depression comprises a group of symptoms such as persistent low mood, loss of interest in pleasurable activities, reduced energy, loss of concentration, prominent weight changes, altered sleep, feelings of hopelessness and/or worthlessness, and suicidal thoughts or ideas[5].

Undergraduate students are particular people trying to navigate a crucial stage of development in life, which can be difficult. This period of transition from adolescence to adulthood involves social, emotional, and physical maturity to handle and cope with life issues[6]. In the process, an individual tries to discover himself or herself, form intimacy, explore different aspects of life, and provide solutions to thorny situations as they arrive. Combining all of these with the rigor of academic pursuit may pose a significant demand for them.

In a university environment, undergraduates experience an array of challenges, such as adapting to life outside the home, academic stress, inadequate housing, financial and relationship difficulties, peer pressure, and sleep difficulties[7]. Students must grapple with all these to survive the tasking academic condition in which they find themselves, making them vulnerable to psychological distress. The tension and worry that accompany exam preparation and the eventual release of results contribute to an untold effect on mental health[8 ].

The increasing prevalence of mental health problems among undergraduates has become a crucial issue, as global studies have demonstrated a significant clinical measure of psychiatric morbidities among undergraduates worldwide[9]. Li et al. reported that the global prevalence of anxiety and depressive symptoms among university students was 39.0% and 33.6%, respectively. (10) A similar review by Waleria et al. revealed that anxiety and depression accounted for 24.5% and 26.1%, respectively. [11]. Higher figures were reported in studies conducted in the USA, Malaysia, and Egypt, especially among students of Medicine and Nursing[12, 13, 14]. In Nigeria, recent studies have reported 28.1% and 16.4% for anxiety and 21.3% and 12.7% for depression[15, 16].

Unfortunately, the mental health conditions of undergraduate students have not received the needed public health attention, which behooves health centers in the university and policy makers. Worse still, there is dearth of information on psychiatric morbidity among undergraduates and available interventions by university medical centers. Understanding the burden of psychological distress among them will further elucidate the importance of developing mental health policies on campuses for early screening and intervention. This study aimed to investigate the burden of anxiety and depression among undergraduate students at Bowen University, Iwo, Osun State, Nigeria.

Study site

The study was carried out between October 17, 2022, and May 20, 2023, at the Bowen University Hospital located in the urban setting of Iwo (population range of 250,000-499,999 inhabitants), Osun State in southwestern Nigeria. Bowen University, founded by the Nigerian Baptist Convention in 2001, is one of the oldest private coeducational institutions of higher education in Nigeria.

Study design and participants

This cross-sectional study included 877 undergraduate students at Bowen University. Undergraduates from different departments and gender groups participated in this study in different semesters.

Enrollment and data collection

The nature of the study, its objectives, risk, and benefit of participation, and the right to remain or opt out of the study at any stage to the intended participants before obtaining informed consent to participate in the study. If informed consent was obtained, we administered a self-administered questionnaire comprising of sociodemographic information and 14 HADS items. Sociodemographic parameters collected from the students included age, sex, and study course. Depression and anxiety among the participants were measured using the HADS items in the questionnaires, which is a valuable tool with good levels of validity and reliability and is widely utilized in many studies for this purpose. The Hospital Anxiety and Depression Scale was used because it is a validated tool designed by Zigmond and Snaith (1983) that can measure both depression and anxiety symptoms even in healthy subjects such as undergraduates. Each HADS item was categorized as either HADS-A for statements related to symptoms of anxiety or HADS-D for statements related to symptoms of depression. Each item had four possible responses, which were scored from 0 to 3, with 3 denoting the highest anxiety or depression level. Once responses to each item were determined, subscale totals (HADS-A and HADS-D) were calculated by adding the responses to all relevant subscale items. HADS is divided into four ranges: normal (0–7), mild (8–10), moderate (11–15), and severe (16–21).

The questionnaires were pretested (pilot study) in April 2022 at a neighboring university to evaluate the clarity of the demographic and HADS items.

Statistical analysis

The completed questionnaires were serially coded and entered into a computer. Data were analyzed using SPSS version 22 (IBM, New York, USA). Means, standard deviations (SD), frequencies, and percentages of participant characteristics were calculated. The independent variables included sociodemographic parameters, and the HADS score was the outcome variable. Statistical significance was set at P < 0.05.

We administered 877 questionnaires in this study. However, we were able to fully examine the data from 810 individuals, yielding a response rate of 92.4%. 323 (39.9%) male and 487 (60.1%) out of the 810 participants were female. The median age was 18.07 years (SD = 2.07) (Table 1).

Table 1

Participant Characteristics
		N	Percentage
Sex	Male	323	39.9
	Female	487	60.1
Age Group	< 21	716	88.4
	≧ 21	94	11.6
Age	Mean (SD)	18.07 (2.07)

Prevalence of depression and anxiety among participants

A total of 121 (14.9%) students experienced mild anxiety, and another 84 (10.4%) and 15 (1.9%) reported moderate and severe anxiety, respectively. Similar to this, 91 (11.2%) students had mild depression, while 41 (5.1%) and 4 (0.5%) had moderate and severe depression, respectively, as shown in Table 2.

Table 2

Prevalence of depression and anxiety among participants
		Frequency	Percent
Anxiety	Normal (0–7)	590	72.8
	Mild (8–10)	121	14.9
	Moderate (11–15)	84	10.4
	Severe (16–21)	15	1.9
Depression	Normal (0–7)	674	83.2
	Mild (8–10)	91	11.2
	Moderate (11–15)	41	5.1
	Severe (16–21)	4	0.5

Association Between Participants’ Sociodemographic Characteristics and Anxiety

The Association between participants' sociodemographic parameters and anxiety was assessed, as shown in Table 3. 42 (13.0%), 24 (7.4%), and three (0.9%) male participants experienced mild, moderate, and severe anxiety, respectively. 79 (16.2%), 60 (12.3%), and 12 (2.5%) female participants experienced mild, moderate, and severe anxiety, respectively. There was a statistically significant association between sex and anxiety (p < 0.05).

Individuals older than 21 years (3, 3.2%) had slightly more severe anxiety than those younger than 21 years (12, 1.7%). Participants under 21 years (10.5%) had a higher prevalence of moderate anxiety. However, the association between age and anxiety levels was not statistically significant (p > 0.05), as shownin Table 3.

Table 3

Association Between Participants’ Sociodemographic Characteristics and Anxiety
		Normal	Mild	Moderate	Severe	X²	df	p-value
Gender	Male	254 (78.6)	42 (13.0)	24 (7.4)	3 (0.9)	10.776	3	0.001
	Female	336 (69.0)	79 (16.2)	60 (12.3)	12 (2.5)
Age	< 21	526 (73.5)	103 (14.4)	75 (10.5)	12 (1.7)	2.688	3	0.361
	≥ 21	64 (68.1)	18 (19.1)	9 (9.6)	3 (3.2)

Association Between Participants’ Sociodemographic Characteristics and Depression

In terms of depression, 268 (83.0%) male participants fell within the normal range, whereas 54 (11.1%), 24 (4.9%), and 1 (0.3%) had mild, moderate, and severe depression, respectively. On the depression scale, 406 (83.4%) female participants fell within the normal range, whereas 54 (11.1%), 24 (4.9%), and 3 (0.6%) had mild, moderate, and severe depression, respectively. However, there was no significant association between sex and depression (p < 0.05).

Participants under the age of 21 had somewhat greater rates of moderate and severe depression than those over that age (4.9% and 0.4%, respectively) (Table 4); however, there was no statistically significant relationship between age and anxiety level (p > 0.05).

Table 4

Association Between Participants’ Characteristics and Depression
		Normal	Mild	Moderate	Severe	X²	df	p-value
Gender	Male	268 (83.0)	37 (11.5)	17 (5.3)	1 (0.3%)	0.439	3	0.976
	Female	406 (83.4)	54 (11.1)	24 (4.9)	3 (0.6)
Age	< 21	599 (83.7)	79 (11.0)	35 (4.9)	3 (0.4)	1.438	3	0.274
	≥ 21	75 (79.8)	12 (12.8)	6 (6.4)	1 (1.1)

Correlation between depression and anxiety

The association between depression and anxiety was evaluated using Pearson’s correlation, which showed a strong positive correlation (r = 0.532, p < 0.05). The result is shown in Fig. 1

This study provides evidence of the high prevalence of depression and anxiety disorders among Nigerian undergraduates. We found that 14.9%, 10.4%, and 1.9% of our study participants had mild, moderate, and severe anxiety disorders, respectively, whereas 11.2%, 5.1%, and 0.5% of the participants experienced mild, moderate, and severe depression, respectively. We also observed a strong positive correlation between depression and anxiety disorders among the undergraduate students. In addition, we noticed a significant association between gender and anxiety (p < 0.05) but no significant association between gender and depression among the study participants. Failure to attend to mental health conditions in this category of individuals can linger into adulthood, causing significant impairment in both mental and physical health, thereby reducing their quality of life and limiting their academic performance and occupational prospects. Therefore, it is important to prioritize mental health issues among undergraduate students through early identification and intervention.

Remarkably, we observed the prevalence of anxiety disorders to be 27.2% ( 14.9%, 10.4%, and 1.9% for mild, moderate, and severe anxiety) among Nigerian undergraduates. This is similar to the findings of a similar study in Nigeria, which reported a prevalence of 28.1% for anxiety disorders[15]. Another study in Nigeria reported a prevalence of 16.4% for anxiety disorders[16]. The observed prevalence of 16.8% ( 11.2%, 5.1%, and 0.5% for mild, moderate, and severe) depression among undergraduates in our study is also similar to the reported prevalence of 21.3% and 12.7% for depression in similar studies among undergraduates in Nigeria. [15, 16]. As a result, this study demonstrates that there is considerable mental health distress among Nigerian undergraduates. Several other studies have shown that college students in many parts of the world suffer significant mental health problems. According to American College Health, depression and anxiety are the most frequently reported mental health problems among college students[17]. A study conducted by the WHO Health Organization among university students in 21 countries showed that 20% had mental disorders[18].

Furthermore, our study showed a statistically significant association between sex and anxiety. Similar sociodemographic risk factors have also been linked to anxiety and depression among undergraduate students. Some studies have identified low socioeconomic status, financial difficulties, and stressful life events as predictors of mental health conditions[19, 20, 21]. Studies have reported that students who hailed from deprived places had higher scores on both anxiety and depression scales when compared to those from privileged areas, and those living in shared apartments or low-quality accommodation were more predisposed to psychological ill health[22, 23].

On the contrary, we did not observe any statistically significant association between sex and depression in our study. This is similar to the findings of Chen et al in their study on the prevalence and socio-demographic correlates of depression among Chinese University students. There were no statistically significant association between gender and depression in their study[9]. This can be a result of both genders having equal access to rights and academic opportunities. Nevertheless, many studies contradict our findings and discovered significant differences in depression symptoms between genders[24, 25].

We also discovered that there was a strong association between anxiety disorders and depression among Nigerian undergraduates. Anxiety disorders and depression are extremely comorbid and are viewed as falling under the more inclusive umbrella term of internalizing disorders[26]. According to a global estimate, 45.7% of people diagnosed of a major depression also had a lifetime history of anxiety disorders[27]. Many academics have wondered whether depression and anxiety are symptoms of the same mental health condition because of how frequently these two variables have been linked to one another. Anxious people would be subjected to more social exclusion; as a result, they are more inclined to withdraw, which can cause loneliness, a negative self-image, and eventually depression[28]. This highlights the positive correlation observed in this study.

The study's self-report nature, in which students may choose not to completely disclose any psychiatric symptoms or additional psychopathologies they may have, is a problem. Additionally, some students might be hesitant to divulge personal information.

Nigerian undergraduates suffer from a high prevalence of anxiety disorders and depression, hence, government and other constituted authorities should establish an effective support system, including counseling centres, campaigns to encourage people to seek help, policies to reduce stigma on the campuses and adequate training of health personnel at the University health centres.

HADS. Hospital Anxiety and Depression Scale

HADS-A. Hospital Anxiety and Depression Scale for Anxiety disorders

HADS-D. Hospital Anxiety and Depression Scale for Depression

WHO. World Health Organization

Ethics approval and consent to participate

The Institutional Research Ethical Review Committee of Bowen University reviewed and approved the study protocols. Informed consent was obtained from all study participants.

Consent for publication

Not applicable.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

None

Authors' contributions.

O.T.A. conceived and designed the study, collected data, interpreted results, and wrote the draft of the manuscript. O.O. drafted the manuscript critically and performed

supervision. M.M.O. collected data and revised the manuscript. S. Y. A. entered data into the computer system. N. P. collected data and revised the manuscript. O. V. A contributed to the study design and revised the manuscript critically. A. S. A. performed analyses and results interpretation. T.O.A revised the manuscript. All authors read and approved the final manuscript

Acknowledgements

Authors express their profound gratitude to all undergraduates at the Bowen University especially thos who participated in this study.

World Mental Health Day [cited 2023 Jul 7]. Available from: https://www.unfpa.org/events/world-mental-health-day
Ibrahim MB, Abdelreheem MH. Prevalence of anxiety and depression among medical and pharmaceutical students in Alexandria University. Alexandria J Med 2015;51(2):167–73.
Mental health of adolescents[cited 2023 Jul 8]. Available from: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health
Seligman Walkman, M.E.P, Walker, E.F., & Rossebham, D.L.(2001).Abnormal psychology(4th ed.)New York: W.W Norton & Company.
NIMH. National Institute of Mental Health (NIMH) | National Institutes of Health (NIH) [Internet]. National Institutes of Health (NIH). 2020. Available from: https://www.nih.gov/about-nih/what-we-do/nih-almanac/national-institute-mental-health-nimh
Buchanan JL. Prevention of Depression in the College Student Population: A Review of the Literature. Vol. 26, Archives of Psychiatric Nursing. 2012. p. 21–42.
H Spiessl et. al[Depression, a widespread disease, epidemiology, care situation, diagnosis, therapy and prevention.Available from:https://pubmed.ncbi.nim.nih.gov.
Wani MA. Stress Anxiety and Depression Among Science and Arts Students. Int J Educ Psychol.
Chen L, Wang L, Qiu XH, Yang XX, Qiao ZX, Yang YJ, et al. Depression among Chinese University Students: Prevalence and Socio-Demographic Correlates. PLoS One. 2013;8(3):1–6.
Zhang H, Wang D. Commentary: The global prevalence of depression and anxiety symptoms among college students and its influencing factors – a commentary on Li et al. (2022). J Child Psychol Psychiatry Allied Discip. 2022;63(11):1231–3.
Paula W de, Breguez GS, Machado EL, Meireles AL. Prevalence of anxiety, depression, and suicidal ideation symptoms among university students: a systematic review. Brazilian J Heal Rev. 2020;3(4):8739–56.
Beiter R, Nash R, McCrady M, Rhoades D, Linscomb M, Clarahan M, et al. The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Vol. 173, Journal of Affective Disorders. 2015. p. 90–6.
Shamsuddin K, Fadzil F, Ismail WSW, Shah SA, Omar K, Muhammad NA, et al. Correlates of depression, anxiety, and stress among Malaysian university students. Vol. 6, Asian Journal of Psychiatry. 2013. p. 318–23.
Abdel Wahed WY, Hassan SK. Prevalence and associated factors of stress, anxiety, and depression among medical Fayoum University students. Alexandria J Med.2017;53(1):77–84.
Seun-Fadipe CT, Mosaku KS. Sleep quality and psychological distress among undergraduate students of a Nigerian university. Vol. 3, Sleep Health. 2017. p. 190–4.
James BO, Thomas IF, Omoaregba JO, Okogbenin EO, Okonoda KM, Ibrahim AW, et al. Psychosocial correlates of perceived stress among undergraduate medical students in Nigeria. Int J Med Educ. 2017;8:382–8.
American College Health Association (2018). American College Health Association, National College Health Assessment II Reference Group Executive Summary Spring 2018. Silver Spring, MD American College Health Association.
Auerbach RP, Alonso J, Axinn WG, Cuijpers P, Ebert DD, Green JG, et al. Mental disorders among college students in the World Health Organization World Mental Health Surveys. Psychol Med. 2016;46(14):2955–70.
Andrews B, Wilding JM. The relation of depression and anxiety to life-stress and achievement in students. Vol. 95, British Journal of Psychology. 2004. p. 509–21.
Mirza I, Jenkins R. Disorders in Pakistan : a systematic review. Br Med J. 2004;328(April):1–5.
Turner RJ, Lloyd DA. Stress Burden and the Lifetime Incidence of Psychiatric Disorder in Young Adults: Racial and Ethnic Contrasts. Arch Gen Psychiatry. 2004;61(5):481–8.
Bayram N, Bilgel N. The prevalence and socio-demographic correlations of depression, anxiety, and stress among a group of university students. Vol. 43, Social Psychiatry and Psychiatric Epidemiology. 2008. p. 667–72.
Accommodating Students_ Journal of Youth Studies_ Vol 5, No 2.
Franko DL, Striegel-Moore RH, Bean J, Barton BA, Biro F, et al. Self-reported symptoms of depression in late adolescence to early adulthood: a comparison of African-American and Caucasian females. J Adolesc Health 2005;37(6):526–9.
Wade TJ, Cairney J, Pevalin DJ. The emergence of gender differences in depression during adolescence: national panel results from three countries. J Am Acad Child Adolesc Psychiatry 2002;41(2):190–8.
Axelson DA, Birmaher B. Relation between anxiety and depressive disorders in childhood and adolescence. Depression and anxiety. 2001;14(2):67-78.
Kessler RC, Sampson NA, Berglund P, et al.: Anxious and non-anxious major depressive disorder in the World Health Organization World Mental Health Surveys. Epidemiol Psychiatr Sci 2015; 24:210–226 Crossref, Medline, Google.
Chaplin TM, Gillham JE, Seligman ME. Gender, anxiety, and depressive symptoms: A longitudinal study of early adolescents. The Journal of early adolescence. 2009 Apr;29(2):307-27

No competing interests reported.

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Version 1

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Anxiety and Depression Among Nigerian Undergraduates: a Cross- Sectional Study

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Version 1

Abstract

Background

Methods

Results

Conclusion

Figures

INTRODUCTION

METHODS

Study site

Study design and participants

Enrollment and data collection

Statistical analysis

RESULTS

Prevalence of depression and anxiety among participants

Association Between Participants’ Sociodemographic Characteristics and Anxiety

Association Between Participants’ Sociodemographic Characteristics and Depression

Correlation between depression and anxiety

DISCUSSION

STUDY LIMITATIONS

CONCLUSION

Abbreviations

Declarations

References

Additional Declarations

Status:

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