The prevalence of depression among the students was 17.4%. This proportion has huge implications on the life of medical students and thus the burden could be regarded as high. Similar proportions were reported in a study among two medical schools in southeast Nigeria [19] and in a study in Vietnam.[20] A higher proportion of students than was obtained in this study were found to be depressed in other studies involving medical students in Africa [21, 22, 23] as well as other studies outside Africa.[24–29] Also, higher proportion of medical students were reported depressed from systematic reviews.[6, 7] Based on these observations, a study concluded on the importance of initiating stress management strategies among medical students as a way of preventing depression among the students.[4] Also, the need to support the students during the period of training has been suggested through the provision of counselling services so as to detect and manage cases of depression as early as possible.[12]
The highest proportion of the respondents who were depressed were in the third year of their study, followed by first year students, while the least proportion were in the final year. The third year remain the most critical in the life of the medical student in Nigeria as it is the year of the first professional examination for the students. Based on this, the result is to an extent expected. Perhaps, this explains why a similar result was obtained from another medical school in southeast Nigeria.[21] This observation is however different from what was observed in other countries where the second year students had the highest proportion of those who were depressed.[24, 26] In another study, the first year students had the highest proportion of those who were depressed.[30] It is important to note that the numbering of the study years for Medicine in Nigeria may be different from what is obtained in these countries.
From the results of this study, the proportion of respondents who were depressed in the first year of study when compared with the other years is rather surprising. This is because the course content in the first year regarded as the preliminary year in Nigerian medical schools is light when compared with the other years. Moreover, it could be expected that the students in the first year are in joyful mood bearing in mind the intense competition to gain admission to study Medicine in Nigeria. However, this finding may be explained by the fact that first year is also still regarded as a screening year and may have caused anxiety and mood changes for the students, hence the high depression rate. This observation necessitates that newly admitted medical students are properly oriented on the medical curriculum by officers of the faculty and the university. This will give the students first-hand information of what is expected from them in terms of life as a medical student rather than obtaining such from other students or any other person in which case information may be distorted.
The results of this study reveal that majority of the students, 73.4% were normal. 4.2% had moderate depression while the least proportion, 0.4% had extreme depression. In a study in India, majority 69.9% were adjudged normal, 6.4% had moderate depression while the least proportion, 0.7% had very severe depression. [27] The result from a study in Malaysia is however different in which 45% were normal while 13.5% had moderate depression. [29] In another study in Egypt, 19.5% were normal while 24.4% had moderate depression. [ 5] This is an indication that different countries have varied burdens of depression among their medical students. Suffice it to say that depression among medical students remain a general issue. This necessitates that individual medical schools may have a good role to play in ensuring the well-being of the students including instituting counselling services for the students.
The coping strategies for low mood among the students included sleeping 50.4%, interacting with colleagues, 46.9% and wishing it away, 32.2%. In another study in a medical school in southeast Nigeria the strategies included coping passively, 25% and discussing with friends and classmates, 23.9%. [21] In another study in Kenya, the coping strategies among the students included seeking help from peers, 90%, and alcohol use 80%. [31] These observations bring to the fore the importance of support of classmates to the well-being of medical students during the period of training.
A significantly higher proportion of respondents who were less than 25 years of age were depressed when compared with those who were 25 years and above. Hence the younger the age group the higher the proportion of those who were depressed. This is similar to what was obtained in a study in Pakistan. [24] This finding is however at variance with what was obtained in a medical school in Egypt where higher depression scores were associated with increasing age. [32] It could be assumed that age may have a moderating effect on the experiences of the students during the training period in medical school.
The proportion of the respondents who were depressed was significantly higher in the preclinical years compared to the clinical years. In Nigeria, uncertainties about student progression in a medical school is more at the preclinical period of training. Thus this may be an explanation for this finding. Consistent with our findings, from the result of studies in India and Bangladesh, significantly higher proportions of students who were in the first and second year of study were depressed when compared with those in higher levels.[26, 28] Similarly, a study in Turkey reported that depression among the students decreased with increasing year of study.[33] Our finding is however at variance to what was obtained in Cameroon where the odds of being depressed were four times more with the clinical students when compared with those in the preclinical.[22] Also, results of a study in India reported that the proportion of first and second year medical students who were depressed were significantly lower than those in higher levels of study.[27] The fact that different countries may have different medical curricula and these curricula perceived differently by the students may explain these variations.
A higher proportion of the students who were afraid that some students may not graduate from medical school were depressed when compared with those who were not afraid. A study in Malaysia, revealed that a higher proportion of medical students who were under undue pressure during examinations were depressed when compared with those who were not.[23] Also, dissatisfaction with examination criteria was found to be associated with depression among medical students.[24] Similarly medical students who have undue concerns about the future were found to have a higher prevalence of depression when compared with those who had no such concern.[25] It has been postulated that a supportive academic staff is of immense relevance to medical students during the training period,[34] as this will enhance the satisfaction of the students with their medical training. Medical students, when satisfied with their training have decreased odds of being stressed during the period of training. [34] This is in tandem with the suggestion to make the academic curriculum in medical schools more student friendly. [35] This is expected to reduce the stress during the medical training period which is one of the factors responsible for depression among the students.