Etiology of Depression• There is no single known cause of depression!• Research indicates that depressive illnesses are disorders of the brain. MRI, have shown that the brains of people suffering with depression, look different.• Some types of depression tend to run in families, suggesting a genetic link.
• An external event often seems to initiate an episode of depression e.g. Death, financial problem, chronic illness or any unwelcome change in life patterns can trigger a depressive episode.• Very often, a combination of genetic, psychological, and environmental factors is involved in the onset of a depressive disorder.
Diagnosing Depression• Diagnosis requires the use of the Diagnostic and Statistical Manual for Psychiatric Illnesses (DSM)• There are 2 main types of depression to be concerned about:1. Major Depression: This is a most serious type of depression. Many people with a major depression can not continue to function normally.2. Dysthymia: This is a mild, chronic depression which lasts for two years or longer. Most people with this disorder continue to function at work or school but often with the feeling that they are "just going through the motions." The person may not realize that they are depressed.
Diagnostic criteriaAt least 1 of the symptoms is(1) depressed mood,(2) loss of interest or pleasure,as well as at least 5 of the following symptoms have been present during the same two-week period: Depressed mood most of the day Markedly diminished interest or pleasure in almost all activities most of the day Significant weight loss or weight gain, or decrease or increase in appetite Insomnia or hypersomnia Psychomotor agitation or retardation Fatigue or loss of energy Feelings of worthlessness or excessive or inappropriate guilt nearly every day diminished ability to think or concentrate Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan
(B.) It should be excluded that an organic factor initiated and maintained the disturbance or the disturbance is not a normal reaction to the death of a loved one.(C.) At no time during the disturbance have there been delusions or hallucinations for as long as two weeks in the absence of prominent mood symptoms (i.e. before the mood symptoms developed or after they have remitted).(D.) Not superimposed on Schizophrenia, Schizophreniform Disorder, Delusional Disorder, or Psychotic Disorder.
Diagnostic criteria for Dysthymia:(A.) Depressed mood (or can be irritable mood in children and adolescents) for most of the day, more days than not, as indicated either by subjective account or observation by others, for at least two years (one year for children and adolescents)(B.) Presence, while depressed, of at least two of the following: 1. Poor appetite or overeating 2. Insomnia or hypersomnia 3. Low energy or fatigue 4. Low self-esteem 5. Poor concentration or difficult making decisions 6. Feelings of hopelessness
(C.) Duringa two-year period (one-year for children and adolescents) of the disturbance, never without the symptoms in A for more than two months at a time.(D.) No evidence of an unequivocal Major Depressive Episode during the first two years (one year for children and adolescents) of the disturbance.(E.) Has never had a Manic Episode or an unequivocal Hypo manic Episode.(F.) Not superimposed on a chronic psychotic disorder, such as Schizophrenia or Delusional Disorder.(G.) It cannot be established that an organic factor initiated or maintained the disturbance, e.g., prolonged administration of an antihypertensive medication.
Disability and Depression• Several studies have shown a close association between depression and disability.• Common mental disorders have also been linked to important indirect costs due to either diminished productivity or absence from work.• Studies show that people with depression had a 4.8 times higher risk than people without symptoms of having had sickness leave.
• More recently, an American study found that for every 100 workers, 6 days of work are lost for sickness leave and 31 days are lost for diminished productivity every month due to poor mental health. These statistics will come as no surprise to clinicians used to treating those with depression or others familiar with the syndrome.
Depression and Suicide• The morbidity of the depression is difficult to quantify, although lethality of depression, is measurable, which is the ninth leading reported cause of death in the United States.• Almost all people who kill themselves intentionally have a diagnosable mental disorder. Approximately two thirds of individuals who complete suicide have seen a physician within a month of their death.• The risk of suicide is increased by concurrent alcohol and drug abuse, access to lethal means, hopelessness, pessimism, and impulsivity, and is reduced by help-seeking behavior, access to psychiatric treatment, and availability of family and other social supports.
• More women than men seek treatment for depression, but this is not necessarily reflective of the true incidence of the disease.• Although depression is more often diagnosed in women, more men than women die from suicide by a factor of 4.5:1.• 56% of suicide deaths in males involve firearms. Poisoning is the predominant method among females.• It is important to understand that the majority of suicide attempts are expressions of extreme distress, not merely bids for attention.
Depression in Medical students!• Studies show that depression is widespread among medical students.• They suggest rate of depression among students entering medical school is similar to that among other people of similar ages, but the prevalence increases disproportionately over the course of medical school• The signs of the illness seemed to intensify as the trainee doctors prepared to enter hospitals for the first time
• Researchers believe that a fear of failure and worries over performing intimate physical examinations on patients, as well as long hours and stress, were to blame.• Frequently "students fear they know nothing and are insecure about the physical examination of other people"• Most common symptoms observed include sadness, dissatisfaction, spontaneous crying, irritability and withdrawal. But students also suffered increased tiredness, weight loss and a lack of interest in sex.
• The British Medical Association says that more than 50% of medical students admit that they have sought help for depression or other mental health problems.• Researchers found that female medical students were more likely to show symptoms of depression than their male classmates.• Those who had a parent who was a doctor were less likely to suffer signs of the condition, it is believed that they were more aware of the pressures of the profession before they started medical school
Treatment• Depression can be treated effectively with antidepressant medications and psychological therapies.• Research suggests that antidepressant medications and psychotherapy are equally effective for treating mild to moderate cases of depression.• For more severe cases, medications are clearly superior.• Electroconvulsive therapy (ECT) is the most effective treatment for depression with psychotic symptoms or when depression is life threatening.
Benefits of Psychotherapy with Depression• It can help reduce stress in life.• It can give a new perspective on problems with family, friends, or co-workers.• It can make it easier to stick to treatment.• It can be used to learn how to cope with side effects from depression medication.• Person learn ways to talk to other people about their condition.• It helps catch early signs that patient’s depression is getting worse.
Magnitude of the problem!• Depression is common, affecting about 121 million people worldwide.• Depression is among the leading causes of disability worldwide.• At its worst, depression can lead to suicide, a tragic fatality associated with the loss of about 850 000 thousand lives every year.• The economic cost of depressive illness is estimated at $30-44 billion a year in the United States alone. The human cost cannot be overestimated.
Why Depression?• Personal experiences of being a medical student led us to believe that there might be a slightly higher frequency of depression amongst our field of workers and we also realised that this was not being handled properly and brought out to the forefront.• At the end of the 6yrs there wont be a point of becoming a doctor if your mentally instable yourself so to help our future generations to come and bring this into the limelight we picked this topic so that through our small step we might be able to over come the obstacle and maybe end up slightly happier than the others.
Objectives• Calculate the % of Depression among the students in GMU on basis of MBBS or non MBBS related fields and its year wise distribution• To establish the relationship between the presence of depression and common variables among the students• To recognize the relationship of environment with the frequency of depression among the students• To estimate the concerns and methods to overcome this depression among the students• To estimate how much knowledge is already present among the students and to educate them more on the topic
Methodology• Study design: Observational Descriptive Cross sectional study• Subjects: All Students studying in the Gulf Medical University• Sample size: There is no sample as the whole population will be tested through the survey including all students.• Data collection method: Self administered questionnaire• Study period: May – December 2009• Inclusion criteria: This survey will include all students only studying in all branches of the university• Exclusion criteria: exclusion of anyone else other than students present in the college as doctors, professors, deans, administrative staff and workers. These people will not be tested as they do not complete our criteria of the survey.
• Independent Variables: all factors were divided under academic and environmental that could potentially affect the mentality of a GMU student. Academic: Environmental: College Habitual Smoking / Alcohol Choice of Entering Drug Expectations Residence Family member is practitioner Support Batch Nationality• Ethical Considerations: All efforts to maintain confidentiality of name and personal identifications will be maintained.
Materials• Tools for Data collection: self administered questionnaire following the WHO prescribed General Health Questionnaire (Goldberg 28 Questions) that was used to evaluate the degree to which people were experiencing depressive symptoms. It’s used to help screen a large number of people in a short time.• The GHQ-28 is a validated screening instrument designed to detect current psychiatric conditions. It contains questions covering four areas, namely social dysfunction, somatic symptoms, anxiety/insomnia and depression.• There are seven questions in each of the four domains, giving a total of 28 questions. In the guidelines for interpretation, five or more positive answers (out of the 28) indicate a probable case of mental dysfunction.
• A special questionnaire designed by the researchers (student group and the supervisor) which includes in addition to the questions listed in the “General Health Questionnaire”, other questions that are relevant to our study (Questionnaire form- Appendix 1)• For analysis depression was identified according to the following cut-off levels (put the cut-off level for the scores used in this study.
• Analytical Approach: SPSS program – Statistical package for Social Sciences. The information was entered into SPSS after making them on Excel Spreadsheets. Graphs made for analysis were done using Microsoft Excel.
Limitations• Many of the students were slightly apprehensive in providing demographic data such as their Age, Sex, and Nationality etc.• It was tough to include all students as many of them were either absent from the gathering or would not comply to our requests.• Most of the students in the higher MBBS were posted in different hospitals and were unavailable for questioning (5th yr MBBS).• Many of the students filled the questionnaires for fun hence not providing accurate data (those papers were not considered to prevent weakening of the study).
• Students are from a wide variety of cultural and social backgrounds; therefore a standardized questionnaire such as the GHQ may underscore or overvalue depressive scores. This is because the social norms are different for various ethnic groups.• The GHQ is meant for large communities and isn’t a screener for depression but rather for a range of depressive moods and can reflect a temporary moment of stress, therefore giving us false positive results for depression scores.
Conclusion• Depression in GMU was found to be 21% on an average in the whole University. On a breakdown a maximum of 25% was seen in MBBS whereas a similar pattern was seen in the Non MBBS fields showing no relation in concordance with depression.• We were also able to manage a Yr wise frequency of the problem with the highest frequency being in the 4th yr – 50.8%, followed by the 2nd yr – 48.1%.• A number of common instances were seen with depression among the students ranging from residing with family, Sex, Batch, Suicidal tendencies, Support grps, Appetite changes etc.• Environmental factors such as smoking, alcohol, drug use, self satisfaction, personal choices of entry although seemed to be clinically affecting people showed no statistical significance through our study.
• We also found out that there were no measures being undertaken either by the student body or the faculty on recognisable scales to end the misery of the student.• In the end we would, with the humble support of Dr. Sharbatti, like to make everyone aware of the condition and together overcome it and make a medical students life a little less demanding.
Recommendations• Help the students build up their stressful routine step by step rather than throwing everything all at once.• Access to mental health care deserves further consideration.• Implement new ways to teach students to recognize the importance of their own health and to seek help when they need it: Anonymous forums Workshops Support groups Stress rounds
• Open mindedness should be shown towards such conditions by family, friends & faculty.• Adequate gaps between Exams should be maintained so that students get sometime for themselves too. (Laurie Raymond, a psychiatrist and the director of the Office of Advising Resources at Harvard Medical School in Boston)• Define the specific role of each student at the beginning itself to avoid further confusion.
Acknowledgement• We would like to thank Dr. Shatha Sharbatti for her painstaking effort with us and apologise for depressing her in the process.• We would also like to thank the rest of the community dept. as we found out many a good advice through their groups.• We would like to thank all the students who had participated in our questionnaire.• Dr. Jaya Devin from the Dept of ………………. for his sincere assistance and motivation.• We would specially thank GMC Computers for losing our soft copy thrice as it gave us more time for a better product.