Depressive Disorders in University Nurse Students in Sousse

Nakhli J, Braham A, Mtiraoui a and Ben Nasr S

Published on: 2019-02-28

Abstract

Aim: Depression represents a public health problem because of its frequency and its impact. It is highest in the age group between 20 and 35 years and especially among students. However, it remains little studied in Tunisia and although these studies exist, they have not been conducted with standardized and reliable tools for screening of major depressive and dysthymic disorders. The aim of our study was to evaluate the frequency of major depressive and dysthymic disorders (according to DSM-IV) and to investigate factors associated with these disorders.

Materials and Methods: We conducted a cross-sectional study of 125 students in private higher nurse institute in Sousse (Tunisia) during a period of two months. We administered to them an anonymous questionnaire exploring the socio-demographic and clinical characteristics and a standardized interview: Mini International Neuropsychiatric Interview.

Results: The mean age of our sample was 22.6 ± 2.1 years, females represented 71.2% and the majority of our subjects were single. The life time frequency of major depressive disorder was 24.8% and 12% at the time of the study. We noted that only married subjects had more history of major depressive disorder (p = 0.004). For the dysthymic disorder, we found that it was 17.6% in life time and 3.2% in current. This disorder was associated with more family and personal history of organic pathology (p = 0.004 and 0.009).

Conclusions: Given the high prevalence of major depressive and dysthymic disorders among students, it seems important to establish a strategy for prevention and adequate care for this young population. These strategies require collaboration between stakeholders and the establishment of counseling centers for students.

Keywords

Major depressive disorder; Dysthymic disorder; Students; Prevalence; Standardized interview

Introduction

According to the World Health Organization (WHO), depression is the 4th most expensive disease. It’s prevalence in general population ranges from between 10 to 21.4%. It is significantly more common in the age group between 20 and 35 years [1,2]. This prevalence becomes higher in students because they are often confronted to stress and anxiety. Several studies have noted high prevalence of depression among students relative to the general population. Stewart in the United States noted a depression in 35 to 50% of first-year medical students [3]. Penden and al. found a prevalence of 35% in university nurse student [4]. These depressive disorders had impact on university functioning and may responsible for several complications such as suicidal thought and substance abuse. In Tunisia, few studies had studied depressive disorders and these studies have not conducted with standardized and reliable tools for screening for these disorders. For this, we conducted this study in a student population at the private nursing institute in Sousse. The aims were to estimate the incidence of major depressive disorder and dysthymic disorder (according to DSM-IV criteria) and their associated factors.

Methods

The sample of our study included 125 students among 145 students enrolled at the private institute of nursing in Sousse, representing a participation rate of 86.2%. The study was carried out over a period of two months (February and March 2016). This sample consists of 89 women (71.2%) and 36 men (28.8%). 39.2% registered in first year, 39.2% in second year and 21.6% in third year. The evaluation was made in an anonymous way. All the participants gave us verbal consent to participate in this study. We explored the socio-demographic and clinical characteristics and we used the Mini International Neuropsychiatric Interview-Plus 5.0 translated towards the Arabic dialect.

The MINI-Plus is used for diagnosis of mental disorders. It explores the majority of axis I disorders according to DSM-IV and ICD-10 criteria. It is divided into 26 modules exploring different mental disorders and exploring suicidality [5]. It has been validated in English against CIDI and SCID-P [6]. It needs short training times than other interviews. Data analysis was performed using SPSS 10.0 statistical software. We used the Khi-2 test to compare qualitative variables using the 5% value as the threshold of significance.

Results

The mean age of our sample was 22.6 ± 2.1 years. Almost all of them were single (92%). 55.2% were living in urban cities. 73.6% and 16.8% had an organic and psychiatric family history.

Depressive disorders prevalence

The time of the survey 12% of our sample had a major depressive disorder and 24.8% had major depressive episodes during lifetime. The mean age onset of major depressive episodes was 21.8 ± 2.5 years. The mean number of major depressive episodes was 1.4 ± 0.7. For dysthymic disorder, it was present in 3.2% at the time of the study and had a lifetime prevalence of 17.6%. The mean age of onset of this disorder in our sample was 21 ± 2.2 years.

Associated factors

We noted that only married subjects had a higher frequency of major depressive disorders (p = 0.004). Other socio-demographic factors were not correlated with this disorder (Table 2).

For dysthymic disorder, we found that it was associated with more family and personal history of organic illness (p = 0.004 and 0.009).

Discussion

Prevalence and associated factors of depressive disorders

We found a prevalence of major depressive disorder in 36.8% of cases: 24.8% in current and 12% in lifetime. In USA, Peden found third of nurse students depressed [4]. Rosal showed that 18% and 39% of first and second year medical students were depressed [7]. In Lebanon, depressive symptoms in the Saint Joseph’s medical university were 27.6% [8]. Studies screening for major depressive disorders using a structured or semi-structured interview in students remain rare. Zoccolillo using a structured interview (DIS) noted prevalence in 15% among medical student [9]. The Nigerian study conducted by Adewuya, using MINI showed a relatively low prevalence of depression in students (8.3%) [10]. in a prospective study using Beck’s inventory, the authors found increasing in depressive episodes in 2011, from 5.7% to 7.4% [11]. For associated factors, we found no significant gender differences. This result was also noted in Hamdan-Mansour and Adewuya studies [10,12]. While, other studies found a higher prevalence of depression among female students [13-15]. For marital status, we noted a significant association with depression, but this result wasn’t found in other international studies [16,17]. Hysenbegasi, Zoccolillo found more depressive family history among their students [18,19]. Similarly, several authors found a higher frequency of organic illness in depressed subjects. This rate varies from 23 to 70% [20-22].

Prevalence and associated factors of dysthymic disorders

In our study, 17.6% of students met the criteria for dysthymic lifetime disorder and 3.2% in the current period. In literature, dysthymic disorder in first-line consulting patients ranges from 3.1% to 12.6% [23,24]. In Sweden, Olsson and al., in their prospective study found current dysthymic disorder in 2% of cases [25]. Prescott using the Center for Epidemiologic Studies Depression Scale (CES-D) noted a lifetime dysthymic disorder in 4.7% of students [26]. Vaslamatzis noted more dysthymic disorder among nurse students in Greece than others. These results were due to a higher level of stress [24]. In our study, there was no correlation between dysthymic disorder and socio-demographic factors. Olsson, Prescott retained a significant difference in female students. This result wasn’t found in Garisson’s study [25,26]. In literature, dysthymic disorder was more prevalent in separated and widowed subjects [27]. Carta noted a relation between dysthymic disorder and living in rural area [7]. Baune found more organic illness in patients with dythymic disorder than depressive disorder [4]. Similarly, Howland and al., noted the same result comparing patients with dysthymia and the general population [28].

Conclusion

In our study, the lifetime prevalence of major depressive disorder and dysthymic disorder were 24.8% and 17.6%. They were 12% and 3.2% at the current time of the investigation. The associated factors with major depressive disorder was the marital status and those associated with dysthymic disorder were family and personal history of organic illness. Through this study, we wanted to emphasize the high incidence of these disorders among students and the need for appropriate prevention and management plans. Similarly, the development of a national mental health program to promote prevention and health education among young people is necessary.

References

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Tables

Table 1: Socio-demographic characteristics of our sample.

Socio-demographic characteristics

Number

%

Gender

Men

36

28.8

Women

89

71.2

Status

Single

115

92

Married

10

8

Living

Rural

15

12

Urban

110

88

University year’s studding

First year

49

39.2

Second year

49

39.2

Third year

27

21.6

Organic family history

Yes

92

73.6

No

33

26.4

Psychiatric family history

Yes

21

16.8

No

104

83.2

Organic illness

Yes

6

4.8

No

119

95.2

Table 2: Associated factors with depressive and dysthymic disorders.

Socio-demographic characteristics

Major depressive disorder

p

Dysthymic disorder

p

Gender

Men

33.4%

NS

11.1%

NS

Women

39.4%

29.2%

Status

Single

35.6%

0.004

20.8%

NS

Married

50%

20%

Living

Rural

53.3%

NS

26.5%

NS

Urban

71.8%

38.3%

Organic family history

Yes

33.6%

NS

14.1%

0.004

No

45.4%

39.4%

Psychiatric family history

Yes

52.3%

NS

34.1%

NS

No

33.9%

17.5%

Organic illness

Yes

33.3%

NS

33.3%

0.009

No

37%

19.8%