Could Academic Performance Be a Tool for Screening Depression: a Cross-sectional Study among 1 St Year Medical Students?

The medical curriculum leads to increased burden and stress among medical students. The consistent failure may result in depression or vice-versa. Since early diagnosis of depression could help to improve work performance, this study evaluated the association of depression with academic performance among medical students. Total 100 first year medical students (54 males and 46 females) participated in the study. Parameters used were Hamilton depression rating scale 17 (cut-off value 7), average attendance (cut-off value 70%) and average marks (cut-off value 50%) obtained. Chi square test was applied to analyse the association between gender and academic performance with depression. The overall prevalence of depressed medical students was 31%. The association of depression with gender was not statistically significant. The average class attendance and average marks obtained was inversely associated with the HDRS score. Thus, academic performance could be used for screening of possible depressed students by regular teaching faculty followed by their referral to the experts for more in-depth evaluations and appropriate treatment because prior screening would help in early detection of depressive cases and their early treatment as well as such screening will also reduce the burden on experts. This could reduce the rate of lowered academic performance as an adverse effect of depression. KEY-WORDS: Depression, Medical students, Academic performance, HDRS-17 *Corresponding author SHASHI KANT VERMA Department of Physiology, Rohilkhand Medical College and Hospital, Bareilly, UP, India. Int J Pharm Bio Sci 2013 July; 4(3): (B) 749 756 This article can be downloaded from www.ijpbs.net B 750 INTRODUCTION Depression is a major public health problem worldwide, due to its high prevalence rate, difficulty in treatment & its tendency to become chronic depression. Depression exerts a high impact on the life of patients and their families, significantly affecting their social and occupational lives as well as causing other functional impairment. While depression is less common during childhood, it increases during the onset of adolescence. The most common psychological problems of adolescence are depression and anxiety . While joining a university or other tertiary educational institutions are a delightful time for some students, but it can be a stressful for others. First year students are particularly at risk as they face a number of new stressors like social, emotional and physical and family problems during the transitional period of starting a new life in university or college. It had been suggested that some inadequacies in social activities of students might play a role in this type of disturbances. The prevalence of depression is higher in medical students than in general population 5 or age-matched peer 6 as they faced a significantly higher pressure during the early years of medical education. Similar results were reported by other studies 4, . While entering medical school, students' emotional status resembles that of the general population. However, the rise in depression scores and their persistence over time suggests that emotional distress during medical school is chronic and persistent rather than episodic.The prevalence of depression varies between 13 to 66% among medical students. Western countries reported lower prevalence of depression among medical students , while in Asian countries like India, Pakistan and China more varying results (21.5% to 66%) were reported in various studies. Comparisons of depressive symptoms by gender among medical students have yielded mixed findings. Some studies reported no difference in depression score by gender 11 and 13 while others reported higher depression scores among female medical students than their male colleagues’ did 10 and . Depression is known to affect individual’s work performance and attendance. Kessler et al reported that depression is associated with a higher rate of short-term work disability than virtually any other chronic condition and that early intervention and treatment of workers with depression reduces hospitalization and long-term work disability. Birnbaum et al found that additional benefits to the employer from the treatment of depression include reduced work cutback, decreased sporadic absenteeism of treated employees, reductions in some types of medical and prescription drug expenditures following appropriate depression treatment, and productivity improvements by employees.We assume that while considering depression among medical students, work performance can be assessed with their academic performance i.e. their mark grades and attendance (absenteeism). Several students with depression go undiagnosed and untreated at a time, when they are at life’s most important junctures. So, our basic aim of this study was to determine the association of academic performance with depression in medical students. Besides this, we also looked for an overall prevalence of depression and any gender preponderance among depressed students. MATERIALS AND METHODS This study was performed in May 2012, at a private medical college in northern India having an annual intake of 100 MBBS students. This work was approved by Institutional Ethical committee. SAMPLE All the subjects were the student of 1st year MBBS (n=100). After explaining the aims and objectives of the study, the informed consent was obtained from the subjects. The subject’s selection criterion was on the voluntary participation, while subjects with any history of psychiatric illness treatment were excluded from the study. Int J Pharm Bio Sci 2013 July; 4(3): (B) 749 756 This article can be downloaded from www.ijpbs.net B 751 DATA COLLECTION TOOLS 1) Sociodemographic Data This proforma includes questions regarding age, sex, weight, height, marital status, education and working conditions of parents, consumption of tobacco/ alcohol/ sedativehypnotic or antianxiety drug in last one year, any regular exercise, yoga or meditation or history of past psychiatric illness or any major surgery on chest or abdomen. 2) Hamilton Depression Rating Scale 17 (HDRS-17) The degree of depressive symptoms was measured by 17 questions based Hamilton Depression Rating scale. This was recorded by qualified medical staffs that were further supplemented by two trained faculties.For HDRS-17, a score of 0-7 is considered as normal range, a score of 8-10 borderline depression, a score of 11-17 mild depression, a score of 18-24 as moderate depression, and score more than 25 is severe depression. We considered cut-off value 7 for the HDRS score to mark a subject as depressed. 3) Class attendance and Class Test records We took the past 6 month’s average class attendance (in percentage) and average routine class test records of the entire 1st year curriculum subjects. These records were taken from Anatomy, Physiology and Biochemistry Departments. To avoid absentees, we took the best 75 % records in each type of tests viz. System test record, lab assessments, lab test, table viva, part completion test, seminar and tutorial marks. Cut off value for marks were 50%, while the cut-off for attendance was 70%. PROCEDURE Students were informed before the start of study that they did not have to provide their names or any identifying information and the data would be used only for scientific purposes. Questionnaires used in the study were administered in the classroom in the guidance of researchers. These questionnaires were filled using code number. HDRS scale was taken by qualified staff in few successive sessions. After screening two groups were formed. Criteria for inclusion for Group A were a HDRS score ≤ 7 and absence of psychiatric illness history, while Criteria for inclusion for Group B were a HDRS score > 7 and absence of psychiatric illness treatment. Then, we compared the class attendance and test records in both groups. STATISTICAL METHOD Chi square test was used to find out the gender differences in medical student depression, and the difference between the two group’s class average attendance and test scores. A ‘P’ value of <0.05 was considered statistically significant.