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An Exploratory Study of Students with Depression in Undergraduate Research Experiences
- Katelyn M. Cooper
- Logan E. Gin
- M. Elizabeth Barnes
- Sara E. Brownell
*Address correspondence to: Katelyn M. Cooper ( E-mail Address: [email protected] ).
Department of Biology, University of Central Florida, Orlando, FL, 32816
Search for more papers by this author
Biology Education Research Lab, Research for Inclusive STEM Education Center, School of Life Sciences, Arizona State University, Tempe, AZ 85281
Depression is a top mental health concern among undergraduates and has been shown to disproportionately affect individuals who are underserved and underrepresented in science. As we aim to create a more inclusive scientific community, we argue that we need to examine the relationship between depression and scientific research. While studies have identified aspects of research that affect graduate student depression, we know of no studies that have explored the relationship between depression and undergraduate research. In this study, we sought to understand how undergraduates’ symptoms of depression affect their research experiences and how research affects undergraduates’ feelings of depression. We interviewed 35 undergraduate researchers majoring in the life sciences from 12 research-intensive public universities across the United States who identify with having depression. Using inductive and deductive coding, we identified that students’ depression affected their motivation and productivity, creativity and risk-taking, engagement and concentration, and self-perception and socializing in undergraduate research experiences. We found that students’ social connections, experiencing failure in research, getting help, receiving feedback, and the demands of research affected students’ depression. Based on this work, we articulate an initial set of evidence-based recommendations for research mentors to consider in promoting an inclusive research experience for students with depression.
INTRODUCTION
Depression is described as a common and serious mood disorder that results in persistent feelings of sadness and hopelessness, as well as a loss of interest in activities that one once enjoyed ( American Psychiatric Association [APA], 2013 ). Additional symptoms of depression include weight changes, difficulty sleeping, loss of energy, difficulty thinking or concentrating, feelings of worthlessness or excessive guilt, and suicidality ( APA, 2013 ). While depression results from a complex interaction of psychological, social, and biological factors ( World Health Organization, 2018 ), studies have shown that increased stress caused by college can be a significant contributor to student depression ( Dyson and Renk, 2006 ).
Depression is one of the top undergraduate mental health concerns, and the rate of depression among undergraduates continues to rise ( Center for Collegiate Mental Health, 2017 ). While we cannot discern whether these increasing rates of depression are due to increased awareness or increased incidence, it is clear that is a serious problem on college campuses. The percent of U.S. college students who self-reported a diagnosis with depression was recently estimated to be about 25% ( American College Health Association, 2019 ). However, higher rates have been reported, with one study estimating that up to 84% of undergraduates experience some level of depression ( Garlow et al. , 2008 ). Depression rates are typically higher among university students compared with the general population, despite being a more socially privileged group ( Ibrahim et al. , 2013 ). Prior studies have found that depression is negatively correlated with overall undergraduate academic performance ( Hysenbegasi et al. , 2005 ; Deroma et al. , 2009 ; American College Health Association, 2019 ). Specifically, diagnosed depression is associated with half a letter grade decrease in students’ grade point average ( Hysenbegasi et al. , 2005 ), and 21.6% of undergraduates reported that depression negatively affected their academic performance within the last year ( American College Health Association, 2019 ). Provided with a list of academic factors that may be affected by depression, students reported that depression contributed to lower exam grades, lower course grades, and not completing or dropping a course.
Students in the natural sciences may be particularly at risk for depression, given that such majors are noted to be particularly stressful due to their competitive nature and course work that is often perceived to “weed students out”( Everson et al. , 1993 ; Strenta et al. , 1994 ; American College Health Association, 2019 ; Seymour and Hunter, 2019 ). Science course instruction has also been described to be boring, repetitive, difficult, and math-intensive; these factors can create an environment that can trigger depression ( Seymour and Hewitt, 1997 ; Osborne and Collins, 2001 ; Armbruster et al ., 2009 ; Ceci and Williams, 2010 ). What also distinguishes science degree programs from other degree programs is that, increasingly, undergraduate research experiences are being proposed as an essential element of a science degree ( American Association for the Advancement of Science, 2011 ; President’s Council of Advisors on Science and Technology, 2012 ; National Academies of Sciences, Engineering, and Medicine [NASEM], 2017 ). However, there is some evidence that undergraduate research experiences can add to the stress of college for some students ( Cooper et al. , 2019c ). Students can garner multiple benefits from undergraduate research, including enhanced abilities to think critically ( Ishiyama, 2002 ; Bauer and Bennett, 2003 ; Brownell et al. , 2015 ), improved student learning ( Rauckhorst et al. , 2001 ; Brownell et al. , 2015 ), and increased student persistence in undergraduate science degree programs ( Jones et al. , 2010 ; Hernandez et al. , 2018 ). Notably, undergraduate research experiences are increasingly becoming a prerequisite for entry into medical and graduate programs in science, particularly elite programs ( Cooper et al. , 2019d ). Although some research experiences are embedded into formal lab courses as course-based undergraduate research experiences (CUREs; Auchincloss et al. , 2014 ; Brownell and Kloser, 2015 ), the majority likely entail working with faculty in their research labs. These undergraduate research experiences in faculty labs are often added on top of a student’s normal course work, so they essentially become an extracurricular activity that they have to juggle with course work, working, and/or personal obligations ( Cooper et al. , 2019c ). While the majority of the literature surrounding undergraduate research highlights undergraduate research as a positive experience ( NASEM, 2017 ), studies have demonstrated that undergraduate research experiences can be academically and emotionally challenging for students ( Mabrouk and Peters, 2000 ; Seymour et al. , 2004 ; Cooper et al. , 2019c ; Limeri et al. , 2019 ). In fact, 50% of students sampled nationally from public R1 institutions consider leaving their undergraduate research experience prematurely, and about half of those students, or 25% of all students, ultimately leave their undergraduate research experience ( Cooper et al. , 2019c ). Notably, 33.8% of these individuals cited a negative lab environment and 33.3% cited negative relationships with their mentors as factors that influenced their decision about whether to leave ( Cooper et al. , 2019c ). Therefore, students’ depression may be exacerbated in challenging undergraduate research experiences, because studies have shown that depression is positively correlated with student stress ( Hish et al. , 2019 ).
While depression has not been explored in the context of undergraduate research experiences, depression has become a prominent concern surrounding graduate students conducting scientific research. A recent study that examined the “graduate student mental health crisis” ( Flaherty, 2018 ) found that work–life balance and graduate students’ relationships with their research advisors may be contributing to their depression ( Evans et al. , 2018 ). Specifically, this survey of 2279 PhD and master’s students from diverse fields of study, including the biological/physical sciences, showed that 39% of graduate students have experienced moderate to severe depression. Fifty-five percent of the graduate students with depression who were surveyed disagreed with the statement “I have good work life balance,” compared to only 21% of students with depression who agreed. Additionally, the study highlighted that more students with depression disagreed than agreed with the following statements: their advisors provided “real” mentorship, their advisors provided ample support, their advisors positively impacted their emotional or mental well-being, their advisors were assets to their careers, and they felt valued by their mentors. Another recent study identified that depression severity in biomedical doctoral students was significantly associated with graduate program climate, a perceived lack of employment opportunities, and the quality of students’ research training environment ( Nagy et al. , 2019 ). Environmental stress, academic stress, and family and monetary stress have also been shown to be predictive of depression severity in biomedical doctoral students ( Hish et al. , 2019 ). Further, one study found that self-esteem is negatively correlated and stress is positively correlated with graduate student depression; presumably research environments that challenge students’ self-esteem and induce stress are likely contributing to depressive symptoms among graduate students ( Kreger, 1995 ). While these studies have focused on graduate students, and there are certainly notable distinctions between graduate and undergraduate research, the research-related factors that affect graduate student depression, including work–life balance, relationships with mentors, research environment, stress, and self-esteem, may also be relevant to depression among undergraduates conducting research. Importantly, undergraduates in the United States have reported identical levels of depression as graduate students but are often less likely to seek mental health care services ( Wyatt and Oswalt, 2013 ), which is concerning if undergraduate research experiences exacerbate depression.
Based on the literature on the stressors of undergraduate research experiences and the literature identifying some potential causes of graduate student depression, we identified three aspects of undergraduate research that may exacerbate undergraduates’ depression. Mentoring: Mentors can be an integral part of a students’ research experience, bolstering their connections with others in the science community, scholarly productivity, and science identity, as well as providing many other benefits ( Thiry and Laursen, 2011 ; Prunuske et al. , 2013 ; Byars-Winston et al. , 2015 ; Aikens et al. , 2016 , 2017 ; Thompson et al. , 2016 ; Estrada et al. , 2018 ). However, recent literature has highlighted that poor mentoring can negatively affect undergraduate researchers ( Cooper et al. , 2019c ; Limeri et al. , 2019 ). Specifically, one study of 33 undergraduate researchers who had conducted research at 10 institutions identified seven major ways that they experienced negative mentoring, which included absenteeism, abuse of power, interpersonal mismatch, lack of career support, lack of psychosocial support, misaligned expectations, and unequal treatment ( Limeri et al. , 2019 ). We hypothesize negative mentoring experiences may be particularly harmful for students with depression, because support, particularly social support, has been shown to be important for helping individuals with depression cope with difficult circumstances ( Aneshensel and Stone, 1982 ; Grav et al. , 2012 ). Failure: Experiencing failure has been hypothesized to be an important aspect of undergraduate research experiences that may help students develop some the most distinguishing abilities of outstanding scientists, such as coping with failure, navigating challenges, and persevering ( Laursen et al. , 2010 ; Gin et al. , 2018 ; Henry et al. , 2019 ). However, experiencing failure and the stress and fatigue that often accompany it may be particularly tough for students with depression ( Aldwin and Greenberger, 1987 ; Mongrain and Blackburn, 2005 ). Lab environment: Fairness, inclusion/exclusion, and social support within one’s organizational environment have been shown to be key factors that cause people to either want to remain in the work place and be productive or to want to leave ( Barak et al. , 2006 ; Cooper et al. , 2019c ). We hypothesize that dealing with exclusion or a lack of social support may exacerbate depression for some students; patients with clinical depression react to social exclusion with more pronounced negative emotions than do individuals without clinical depression ( Jobst et al. , 2015 ). While there are likely other aspects of undergraduate research that affect student depression, we hypothesize that these factors have the potential to exacerbate negative research experiences for students with depression.
Depression has been shown to disproportionately affect many populations that are underrepresented or underserved within the scientific community, including females ( American College Health Association, 2018 ; Evans et al. , 2018 ), first-generation college students ( Jenkins et al. , 2013 ), individuals from low socioeconomic backgrounds ( Eisenberg et al. , 2007 ), members of the LGBTQ+ community ( Eisenberg et al. , 2007 ; Evans et al. , 2018 ), and people with disabilities ( Turner and Noh, 1988 ). Therefore, as the science community strives to be more diverse and inclusive ( Intemann, 2009 ), it is important that we understand more about the relationship between depression and scientific research, because negative experiences with depression in scientific research may be contributing to the underrepresentation of these groups. Specifically, more information is needed about how the research process and environment of research experiences may affect depression.
Given the high rate of depression among undergraduates, the links between depression and graduate research, the potentially challenging environment of undergraduate research, and how depression could disproportionately impact students from underserved communities, it is imperative to begin to explore the relationship between scientific research and depression among undergraduates to create research experiences that could maximize student success. In this exploratory interview study, we aimed to 1) describe how undergraduates’ symptoms of depression affect their research experiences, 2) understand how undergraduate research affects students’ feelings of depression, and 3) identify recommendations based on the literature and undergraduates’ reported experiences to promote a positive research experience for students with depression.
This study was done with an approved Arizona State University Institutional Review Board protocol #7247.
In Fall 2018, we surveyed undergraduate researchers majoring in the life sciences across 25 research-intensive (R1) public institutions across the United States (specific details about the recruitment of the students who completed the survey can be found in Cooper et al. (2019c) ). The survey asked students for their opinions about their undergraduate research experiences and their demographic information and whether they would be interested in participating in a follow-up interview related to their research experiences. For the purpose of this study, we exclusively interviewed students about their undergraduate research experiences in faculty member labs; we did not consider students’ experiences in CUREs. Of the 768 undergraduate researchers who completed the survey, 65% ( n = 496) indicated that they would be interested in participating in a follow-up interview. In Spring 2019, we emailed the 496 students, explaining that we were interested in interviewing students with depression about their experiences in undergraduate research. Our specific prompt was: “If you identify as having depression, we would be interested in hearing about your experience in undergraduate research in a 30–60 minute online interview.” We did not define depression in our email recruitment because we conducted think-aloud interviews with four undergraduates who all correctly interpreted what we meant by depression ( APA, 2013 ). We had 35 students agree to participate in the interview study. The interview participants represented 12 of the 25 R1 public institutions that were represented in the initial survey.
Student Interviews
We developed an interview script to explore our research questions. Specifically, we were interested in how students’ symptoms of depression affect their research experiences, how undergraduate research negatively affects student depression, and how undergraduate research positively affects student depression.
We recognized that mental health, and specifically depression, can be a sensitive topic to discuss with undergraduates, and therefore we tried to minimize any discomfort that the interviewees might experience during the interview. Specifically, we conducted think-aloud interviews with three graduate students who self-identified with having depression at the time of the interview. We asked them to note whether any interview questions made them uncomfortable. We also sought their feedback on questions given their experiences as persons with depression who had once engaged in undergraduate research. We revised the interview protocol after each think-aloud interview. Next, we conducted four additional think-aloud interviews with undergraduates conducting basic science or biology education research who identified with having depression to establish cognitive validity of the questions and to elicit additional feedback about any questions that might make someone uncomfortable. The questions were revised after each think-aloud interview until no question was unclear or misinterpreted by the students and we were confident that the questions minimized students’ potential discomfort ( Trenor et al. , 2011 ). A copy of the final interview script can be found in the Supplemental Material.
All interviews were individually conducted by one of two researchers (K.M.C. and L.E.G.) who conducted the think-aloud interviews together to ensure that their interviewing practices were as similar as possible. The interviews were approximately an hour long, and students received a $15 gift card for their participation.
Personal, Research, and Depression Demographics
All student demographics and information about students’ research experiences were collected using the survey distributed to students in Fall 2018. We collected personal demographics, including the participants’ gender, race/ethnicity, college generation status, transfer status, financial stability, year in college, major, and age. We also collected information about the students’ research experiences, including the length of their first research experiences, the average number of hours they spend in research per week, how they were compensated for research, who their primary mentors were, and the focus areas of their research.
In the United States, mental healthcare is disproportionately unavailable to Black and Latinx individuals, as well as those who come from low socioeconomic backgrounds ( Kataoka et al. , 2002 ; Howell and McFeeters, 2008 ; Santiago et al. , 2013 ). Therefore, to minimize a biased sample, we invited anyone who identified with having depression to participate in our study; we did not require students to be diagnosed with depression or to be treated for depression in order to participate. However, we did collect information about whether students had been formally diagnosed with depression and whether they had been treated for depression. After the interview, all participants were sent a link to a short survey that asked them if they had ever been diagnosed with depression and how, if at all, they had ever been treated for depression. A copy of these survey questions can be found in the Supplemental Material. The combined demographic information of the participants is in Table 1 . The demographics for each individual student can be found in the Supplemental Material.
a Students reported the time they had spent in research 6 months before being interviewed and only reported on the length of time of their first research experiences.
b Students were invited to report multiple ways in which they were treated for their depression; other treatments included lifestyle changes and meditation.
c Students were invited to report multiple means of compensation for their research if they had been compensated for their time in different ways.
d Students were asked whether they felt financially stable, particularly during the undergraduate research experience.
e Students reported who they work/worked with most closely during their research experiences.
f Staff members included lab coordinators or lab managers.
g Other focus areas of research included sociology, linguistics, psychology, and public health.
Interview Analysis
The initial interview analysis aimed to explore each idea that a participant expressed ( Charmaz, 2006 ) and to identify reoccurring ideas throughout the interviews. First, three authors (K.M.C., L.E.G., and S.E.B.) individually reviewed a different set of 10 interviews and took detailed analytic notes ( Birks and Mills, 2015 ). Afterward, the authors compared their notes and identified reoccurring themes throughout the interviews using open coding methods ( Saldaña, 2015 ).
Once an initial set of themes was established, two researchers (K.M.C. and L.E.G.) individually reviewed the same set of 15 randomly selected interviews to validate the themes identified in the initial analysis and to screen for any additional themes that the initial analysis may have missed. Each researcher took detailed analytic notes throughout the review of an interview, which they discussed after reviewing each interview. The researchers compared what quotes from each interview they categorized into each theme. Using constant comparison methods, they assigned quotes to each theme and constantly compared the quotes to ensure that each quote fit within the description of the theme ( Glesne and Peshkin, 1992 ). In cases in which quotes were too different from other quotes, a new theme was created. This approach allowed for multiple revisions of the themes and allowed the authors to define a final set of codes; the researchers created a final codebook with refined definitions of emergent themes (the final coding rubric can be found in the Supplemental Material). Once the final codebook was established, the researchers (K.M.C. and L.E.G.) individually coded seven additional interviews (20% of all interviews) using the coding rubric. The researchers compared their codes, and their Cohen’s κ interrater score for these seven interviews was at an acceptable level (κ = 0.88; Landis and Koch, 1977 ). One researcher (L.E.G.) coded the remaining 28 out of 35 interviews. The researchers determined that data saturation had been reached with the current sample and no further recruitment was needed ( Guest et al. , 2006 ). We report on themes that were mentioned by at least 20% of students in the interview study. In the Supplemental Material, we provide the final coding rubric with the number of participants whose interview reflected each theme ( Hannah and Lautsch, 2011 ). Reporting the number of individuals who reported themes within qualitative data can lead to inaccurate conclusions about the generalizability of the results to a broader population. These qualitative data are meant to characterize a landscape of experiences that students with depression have in undergraduate research rather than to make claims about the prevalence of these experiences ( Glesne and Peshkin, 1992 ). Because inferences about the importance of these themes cannot be drawn from these counts, they are not included in the results of the paper ( Maxwell, 2010 ). Further, the limited number of interviewees made it not possible to examine whether there were trends based on students’ demographics or characteristics of their research experiences (e.g., their specific area of study). Quotes were lightly edited for clarity by inserting clarification brackets and using ellipses to indicate excluded text. Pseudonyms were given to all students to protect their privacy.
The Effect of Depressive Symptoms on Undergraduate Research
We asked students to describe the symptoms associated with their depression. Students described experiencing anxiety that is associated with their depression; this could be anxiety that precedes their depression or anxiety that results from a depressive episode or a period of time when an individual has depression symptoms. Further, students described difficulty getting out of bed or leaving the house, feeling tired, a lack of motivation, being overly self-critical, feeling apathetic, and having difficulty concentrating. We were particularly interested in how students’ symptoms of depression affected their experiences in undergraduate research. During the think-aloud interviews that were conducted before the interview study, graduate and undergraduate students consistently described that their depression affected their motivation in research, their creativity in research, and their productivity in research. Therefore, we explicitly asked undergraduate researchers how, if at all, their depression affected these three factors. We also asked students to describe any additional ways in which their depression affected their research experiences. Undergraduate researchers commonly described five additional ways in which their depression affected their research; for a detailed description of each way students’ research was affected and for example quotes, see Table 2 . Students described that their depression negatively affected their productivity in the lab. Commonly, students described that their productivity was directly affected by a lack of motivation or because they felt less creative, which hindered the research process. Additionally, students highlighted that they were sometimes less productive because their depression sometimes caused them to struggle to engage intellectually with their research or caused them to have difficulty remembering or concentrating; students described that they could do mundane or routine tasks when they felt depressed, but that they had difficulty with more complex and intellectually demanding tasks. However, students sometimes described that even mundane tasks could be difficult when they were required to remember specific steps; for example, some students struggled recalling a protocol from memory when their depression was particularly severe. Additionally, students noted that their depression made them more self-conscious, which sometimes held them back from sharing research ideas with their mentors or from taking risks such as applying to competitive programs. In addition to being self-conscious, students highlighted that their depression caused them to be overly self-critical, and some described experiencing imposter phenomenon ( Clance and Imes, 1978 ) or feeling like they were not talented enough to be in research and were accepted into a lab by a fluke or through luck. Finally, students described that depression often made them feel less social, and they struggled to socially engage with other members of the lab when they were feeling down.
The Effect of Undergraduate Research Experiences on Student Depression
We also wanted to explore how research impacted students’ feelings of depression. Undergraduates described how research both positively and negatively affected their depression. In the following sections, we present aspects of undergraduate research and examine how each positively and/or negatively affected students’ depression using embedded student quotes to highlight the relationships between related ideas.
Lab Environment: Relationships with Others in the Lab.
Some aspects of the lab environment, which we define as students’ physical, social, or psychological research space, could be particularly beneficial for students with depression.
Specifically, undergraduate researchers perceived that comfortable and positive social interactions with others in the lab helped their depression. Students acknowledged how beneficial their relationships with graduate students and postdocs could be.
Marta: “I think always checking in on undergrads is important. It’s really easy [for us] to go a whole day without talking to anybody in the lab. But our grad students are like ‘Hey, what’s up? How’s school? What’s going on?’ (…) What helps me the most is having that strong support system. Sometimes just talking makes you feel better, but also having people that believe in you can really help you get out of that negative spiral. I think that can really help with depression.”
Kelley: “I know that anytime I need to talk to [my postdoc mentors] about something they’re always there for me. Over time we’ve developed a relationship where I know that outside of work and outside of the lab if I did want to talk to them about something I could talk to them. Even just talking to someone about hobbies and having that relationship alone is really helpful [for depression].”
In addition to highlighting the importance of developing relationships with graduate students or postdocs in the lab, students described that forming relationships with other undergraduates in the lab also helped their depression. Particularly, students described that other undergraduate researchers often validated their feelings about research, which in turn helped them realize that what they are thinking or feeling is normal, which tended to alleviate their negative thoughts. Interestingly, other undergraduates experiencing the same issues could sometimes help buffer them from perceiving that a mentor did not like them or that they were uniquely bad at research. In this article, we use the term “mentor” to refer to anyone who students referred to in the interviews as being their mentors or managing their research experiences; this includes graduate students, postdoctoral scholars, lab managers, and primary investigators (PIs).
Abby: “One of my best friends is in the lab with me. A lot of that friendship just comes from complaining about our stress with the lab and our annoyance with people in the lab. Like when we both agree like, ‘Yeah, the grad students were really off today, it wasn’t us,’ that helps. ‘It wasn’t me, it wasn’t my fault that we were having a rough day in lab; it was the grad students.’ Just being able to realize, ‘Hey, this isn’t all caused by us,’ you know? (…) We understand the stresses in the lab. We understand the details of what each other are doing in the lab, so when something doesn’t work out, we understand that it took them like eight hours to do that and it didn’t work. We provide empathy on a different level.”
Meleana: “It’s great to have solidarity in being confused about something, and it’s just that is a form of validation for me too. When we leave a lab meeting and I look at [another undergrad] I’m like, ‘Did you understand anything that they were just saying?’ And they’re like, ‘Oh, no.’ (…) It’s just really validating to hear from the other undergrads that we all seem to be struggling with the same things.”
Developing positive relationships with faculty mentors or PIs also helped alleviate some students’ depressive feelings, particularly when PIs shared their own struggles with students. This also seemed to normalize students’ concerns about their own experiences.
Alexandra: “[Talking with my PI] is helpful because he would talk about his struggles, and what he faced. A lot of it was very similar to my struggles. For example, he would say, ‘Oh, yeah, I failed this exam that I studied so hard for. I failed the GRE and I paid so much money to prepare for it.’ It just makes [my depression] better, like okay, this is normal for students to go through this. It’s not an out of this world thing where if you fail, you’re a failure and you can’t move on from it.”
Students’ relationships with others in the lab did not always positively impact their depression. Students described instances when the negative moods of the graduate students and PIs would often set the tone of the lab, which in turn worsened the mood of the undergraduate researchers.
Abby: “Sometimes [the grad students] are not in a good mood. The entire vibe of the lab is just off, and if you make a joke and it hits somebody wrong, they get all mad. It really depends on the grad students and the leadership and the mood that they’re in.”
Interviewer: “How does it affect your depression when the grad students are in a bad mood?”
Abby: “It definitely makes me feel worse. It feels like, again, that I really shouldn’t go ask them for help because they’re just not in the mood to help out. It makes me have more pressure on myself, and I have deadlines I need to meet, but I have a question for them, but they’re in a bad mood so I can’t ask. That’s another day wasted for me and it just puts more stress, which just adds to the depression.”
Additionally, some students described even more concerning behavior from research mentors, which negatively affected their depression.
Julie: “I had a primary investigator who is notorious in the department for screaming at people, being emotionally abusive, unreasonable, et cetera. (…) [He was] kind of harassing people, demeaning them, lying to them, et cetera, et cetera. (…) Being yelled at and constantly demeaned and harassed at all hours of the day and night, that was probably pretty bad for me.”
While the relationships between undergraduates and graduate, postdoc, and faculty mentors seemed to either alleviate or worsen students’ depressive symptoms, depending on the quality of the relationship, students in this study exclusively described their relationships with other undergraduates as positive for their depression. However, students did note that undergraduate research puts some of the best and brightest undergraduates in the same environment, which can result in students comparing themselves with their peers. Students described that this comparison would often lead them to feel badly about themselves, even though they would describe their personal relationship with a person to be good.
Meleana: “In just the research field in general, just feeling like I don’t really measure up to the people around me [can affect my depression]. A lot of the times it’s the beginning of a little spiral, mental spiral. There are some past undergrads that are talked about as they’re on this pedestal of being the ideal undergrads and that they were just so smart and contributed so much to the lab. I can never stop myself from wondering like, ‘Oh, I wonder if I’m having a contribution to the lab that’s similar or if I’m just another one of the undergrads that does the bare minimum and passes through and is just there.’”
Natasha: “But, on the other hand, [having another undergrad in the lab] also reminded me constantly that some people are invested in this and meant to do this and it’s not me. And that some people know a lot more than I do and will go further in this than I will.”
While students primarily expressed that their relationships with others in the lab affected their depression, some students explained that they struggled most with depression when the lab was empty; they described that they did not like being alone in the lab, because a lack of stimulation allowed their minds to be filled with negative thoughts.
Mia: “Those late nights definitely didn’t help [my depression]. I am alone, in the entire building. I’m left alone to think about my thoughts more, so not distracted by talking to people or interacting with people. I think more about how I’m feeling and the lack of progress I’m making, and the hopelessness I’m feeling. That kind of dragged things on, and I guess deepened my depression.”
Freddy: “Often times when I go to my office in the evening, that is when I would [ sic ] be prone to be more depressed. It’s being alone. I think about myself or mistakes or trying to correct mistakes or whatever’s going on in my life at the time. I become very introspective. I think I’m way too self-evaluating, way too self-deprecating and it’s when I’m alone when those things are really, really triggered. When I’m talking with somebody else, I forget about those things.”
In sum, students with depression highlighted that a lab environment full of positive and encouraging individuals was helpful for their depression, whereas isolating or competitive environments and negative interactions with others often resulted in more depressive feelings.
Doing Science: Experiencing Failure in Research, Getting Help, Receiving Feedback, Time Demands, and Important Contributions.
In addition to the lab environment, students also described that the process of doing science could affect their depression. Specifically, students explained that a large contributor to their depression was experiencing failure in research.
Interviewer: “Considering your experience in undergraduate research, what tends to trigger your feelings of depression?”
Heather: “Probably just not getting things right. Having to do an experiment over and over again. You don’t get the results you want. (…) The work is pretty meticulous and it’s frustrating when I do all this work, I do a whole experiment, and then I don’t get any results that I can use. That can be really frustrating. It adds to the stress. (…) It’s hard because you did all this other stuff before so you can plan for the research, and then something happens and all the stuff you did was worthless basically.”
Julie: “I felt very negatively about myself [when a project failed] and pretty panicked whenever something didn’t work because I felt like it was a direct reflection on my effort and/or intelligence, and then it was a big glaring personal failure.”
Students explained that their depression related to failing in research was exacerbated if they felt as though they could not seek help from their research mentors. Perceived insufficient mentor guidance has been shown to be a factor influencing student intention to leave undergraduate research ( Cooper et al. , 2019c ). Sometimes students talked about their research mentors being unavailable or unapproachable.
Michelle: “It just feels like [the graduate students] are not approachable. I feel like I can’t approach them to ask for their understanding in a certain situation. It makes [my depression] worse because I feel like I’m stuck, and that I’m being limited, and like there’s nothing I can do. So then I kind of feel like it’s my fault that I can’t do anything.”
Other times, students described that they did not seek help in fear that they would be negatively evaluated in research, which is a fear of being judged by others ( Watson and Friend, 1969 ; Weeks et al. , 2005 ; Cooper et al. , 2018 ). That is, students fear that their mentor would think negatively about them or judge them if they were to ask questions that their mentor thought they should know the answer to.
Meleana: “I would say [my depression] tends to come out more in being more reserved in asking questions because I think that comes more like a fear-based thing where I’m like, ‘Oh, I don’t feel like I’m good enough and so I don’t want to ask these questions because then my mentors will, I don’t know, think that I’m dumb or something.’”
Conversely, students described that mentors who were willing to help them alleviated their depressive feelings.
Crystal: “Yeah [my grad student] is always like, ‘Hey, I can check in on things in the lab because you’re allowed to ask me for that, you’re not totally alone in this,’ because he knows that I tend to take on all this responsibility and I don’t always know how to ask for help. He’s like, ‘You know, this is my lab too and I am here to help you as well,’ and just reminds me that I’m not shouldering this burden by myself.”
Ashlyn: “The graduate student who I work with is very kind and has a lot of patience and he really understands a lot of things and provides simple explanations. He does remind me about things and he will keep on me about certain tasks that I need to do in an understanding way, and it’s just because he’s patient and he listens.”
In addition to experiencing failure in science, students described that making mistakes when doing science also negatively affected their depression.
Abby: “I guess not making mistakes on experiments [is important in avoiding my depression]. Not necessarily that your experiment didn’t turn out to produce the data that you wanted, but just adding the wrong enzyme or messing something up like that. It’s like, ‘Oh, man,’ you know? You can get really down on yourself about that because it can be embarrassing.”
Commonly, students described that the potential for making mistakes increased their stress and anxiety regarding research; however, they explained that how other people responded to a potential mistake was what ultimately affected their depression.
Briana: “Sometimes if I made a mistake in correctly identifying an eye color [of a fly], [my PI] would just ridicule me in front of the other students. He corrected me but his method of correcting was very discouraging because it was a ridicule. It made the others laugh and I didn’t like that.”
Julie: “[My PI] explicitly [asked] if I had the dedication for science. A lot of times he said I had terrible judgment. A lot of times he said I couldn’t be trusted. Once I went to a conference with him, and, unfortunately, in front of another professor, he called me a klutz several times and there was another comment about how I never learn from my mistakes.”
When students did do things correctly, they described how important it could be for them to receive praise from their mentors. They explained that hearing praise and validation can be particularly helpful for students with depression, because their thoughts are often very negative and/or because they have low self-esteem.
Crystal: “[Something that helps my depression is] I have text messages from [my graduate student mentor] thanking me [and another undergraduate researcher] for all of the work that we’ve put in, that he would not be able to be as on track to finish as he is if he didn’t have our help.”
Interviewer: “Why is hearing praise from your mentor helpful?”
Crystal: “Because a lot of my depression focuses on everybody secretly hates you, nobody likes you, you’re going to die alone. So having that validation [from my graduate mentor] is important, because it flies in the face of what my depression tells me.”
Brian: “It reminds you that you exist outside of this negative world that you’ve created for yourself, and people don’t see you how you see yourself sometimes.”
Students also highlighted how research could be overwhelming, which negatively affected their depression. Particularly, students described that research demanded a lot of their time and that their mentors did not always seem to be aware that they were juggling school and other commitments in addition to their research. This stress exacerbated their depression.
Rose: “I feel like sometimes [my grad mentors] are not very understanding because grad students don’t take as many classes as [undergrads] do. I think sometimes they don’t understand when I say I can’t come in at all this week because I have finals and they’re like, ‘Why though?’”
Abby: “I just think being more understanding of student life would be great. We have classes as well as the lab, and classes are the priority. They forget what it’s like to be a student. You feel like they don’t understand and they could never understand when you say like, ‘I have three exams this week,’ and they’re like, ‘I don’t care. You need to finish this.’”
Conversely, some students reported that their research labs were very understanding of students’ schedules. Interestingly, these students talked most about how helpful it was to be able to take a mental health day and not do research on days when they felt down or depressed.
Marta: “My lab tech is very open, so she’ll tell us, ‘I can’t come in today. I have to take a mental health day.’ So she’s a really big advocate for that. And I think I won’t personally tell her that I’m taking a mental health day, but I’ll say, ‘I can’t come in today, but I’ll come in Friday and do those extra hours.’ And she’s like, ‘OK great, I’ll see you then.’ And it makes me feel good, because it helps me take care of myself first and then I can take care of everything else I need to do, which is amazing.”
Meleana: “Knowing that [my mentors] would be flexible if I told them that I’m crazy busy and can’t come into work nearly as much this week [helps my depression]. There is flexibility in allowing me to then care for myself.”
Interviewer: “Why is the flexibility helpful given the depression?”
Meleana: “Because sometimes for me things just take a little bit longer when I’m feeling down. I’m just less efficient to be honest, and so it’s helpful if I feel like I can only go into work for 10 hours in a week. It declutters my brain a little bit to not have to worry about all the things I have to do in work in addition the things that I need to do for school or clubs, or family or whatever.”
Despite the demanding nature of research, a subset of students highlighted that their research and research lab provided a sense of stability or familiarity that distracted them from their depression.
Freddy: “I’ll [do research] to run away from those [depressive] feelings or whatever. (…) I find sadly, I hate to admit it, but I do kind of run to [my lab]. I throw myself into work to distract myself from the feelings of depression and sadness.”
Rose: “When you’re sad or when you’re stressed you want to go to things you’re familiar with. So because lab has always been in my life, it’s this thing where it’s going to be there for me I guess. It’s like a good book that you always go back to and it’s familiar and it makes you feel good. So that’s how lab is. It’s not like the greatest thing in the world but it’s something that I’m used to, which is what I feel like a lot of people need when they’re sad and life is not going well.”
Many students also explained that research positively affects their depression because they perceive their research contribution to be important.
Ashlyn: “I feel like I’m dedicating myself to something that’s worthy and something that I believe in. It’s really important because it contextualizes those times when I am feeling depressed. It’s like, no, I do have these better things that I’m working on. Even when I don’t like myself and I don’t like who I am, which is again, depression brain, I can at least say, ‘Well, I have all these other people relying on me in research and in this area and that’s super important.’”
Jessica: “I mean, it just felt like the work that I was doing had meaning and when I feel like what I’m doing is actually going to contribute to the world, that usually really helps with [depression] because it’s like not every day you can feel like you’re doing something impactful.”
In sum, students highlighted that experiencing failure in research and making mistakes negatively contributed to depression, especially when help was unavailable or research mentors had a negative reaction. Additionally, students acknowledged that the research could be time-consuming, but that research mentors who were flexible helped assuage depressive feelings that were associated with feeling overwhelmed. Finally, research helped some students’ depression, because it felt familiar, provided a distraction from depression, and reminded students that they were contributing to a greater cause.
We believe that creating more inclusive research environments for students with depression is an important step toward broadening participation in science, not only to ensure that we are not discouraging students with depression from persisting in science, but also because depression has been shown to disproportionately affect underserved and underrepresented groups in science ( Turner and Noh, 1988 ; Eisenberg et al. , 2007 ; Jenkins et al. , 2013 ; American College Health Association, 2018 ). We initially hypothesized that three features of undergraduate research—research mentors, the lab environment, and failure—may have the potential to exacerbate student depression. We found this to be true; students highlighted that their relationships with their mentors as well as the overall lab environment could negatively affect their depression, but could also positively affect their research experiences. Students also noted that they struggled with failure, which is likely true of most students, but is known to be particularly difficult for students with depression ( Elliott et al. , 1997 ). We expand upon our findings by integrating literature on depression with the information that students provided in the interviews about how research mentors can best support students. We provide a set of evidence-based recommendations focused on mentoring, the lab environment, and failure for research mentors wanting to create more inclusive research environments for students with depression. Notably, only the first recommendation is specific to students with depression; the others reflect recommendations that have previously been described as “best practices” for research mentors ( NASEM, 2017 , 2019 ; Sorkness et al. , 2017 ) and likely would benefit most students. However, we examine how these recommendations may be particularly important for students with depression. As we hypothesized, these recommendations directly address three aspects of research: mentors, lab environment, and failure. A caveat of these recommendations is that more research needs to be done to explore the experiences of students with depression and how these practices actually impact students with depression, but our national sample of undergraduate researchers with depression can provide an initial starting point for a discussion about how to improve research experiences for these students.
Recommendations to Make Undergraduate Research Experiences More Inclusive for Students with Depression
Recognize student depression as a valid illness..
Allow students with depression to take time off of research by simply saying that they are sick and provide appropriate time for students to recover from depressive episodes. Also, make an effort to destigmatize mental health issues.
Undergraduate researchers described both psychological and physical symptoms that manifested as a result of their depression and highlighted how such symptoms prevented them from performing to their full potential in undergraduate research. For example, students described how their depression would cause them to feel unmotivated, which would often negatively affect their research productivity. In cases in which students were motivated enough to come in and do their research, they described having difficulty concentrating or engaging in the work. Further, when doing research, students felt less creative and less willing to take risks, which may alter the quality of their work. Students also sometimes struggled to socialize in the lab. They described feeling less social and feeling overly self-critical. In sum, students described that, when they experienced a depressive episode, they were not able to perform to the best of their ability, and it sometimes took a toll on them to try to act like nothing was wrong, when they were internally struggling with depression. We recommend that research mentors treat depression like any other physical illness; allowing students the chance to recover when they are experiencing a depressive episode can be extremely important to students and can allow them to maximize their productivity upon returning to research ( Judd et al. , 2000 ). Students explained that if they are not able to take the time to focus on recovering during a depressive episode, then they typically continue to struggle with depression, which negatively affects their research. This sentiment is echoed by researchers in psychiatry who have found that patients who do not fully recover from a depressive episode are more likely to relapse and to experience chronic depression ( Judd et al. , 2000 ). Students described not doing tasks or not showing up to research because of their depression but struggling with how to share that information with their research mentors. Often, students would not say anything, which caused them anxiety because they were worried about what others in the lab would say to them when they returned. Admittedly, many students understood why this behavior would cause their research mentors to be angry or frustrated, but they weighed the consequences of their research mentors’ displeasure against the consequences of revealing their depression and decided it was not worth admitting to being depressed. This aligns with literature that suggests that when individuals have concealable stigmatized identities, or identities that can be hidden and that carry negative stereotypes, such as depression, they will often keep them concealed to avoid negative judgment or criticism ( Link and Phelan, 2001 ; Quinn and Earnshaw, 2011 ; Jones and King, 2014 ; Cooper and Brownell, 2016 ; Cooper et al. , 2019b ; Cooper et al ., unpublished data ). Therefore, it is important for research mentors to be explicit with students that 1) they recognize mental illness as a valid sickness and 2) that students with mental illness can simply explain that they are sick if they need to take time off. This may be useful to overtly state on a research website or in a research syllabus, contract, or agreement if mentors use such documents when mentoring undergraduates in their lab. Further, research mentors can purposefully work to destigmatize mental health issues by explicitly stating that struggling with mental health issues, such as depression and anxiety, is common. While we do not recommend that mentors ask students directly about depression, because this can force students to share when they are not comfortable sharing, we do recommend providing opportunities for students to reveal their depression ( Chaudoir and Fisher, 2010 ). Mentors can regularly check in with students about how they’re doing, and talk openly about the importance of mental health, which may increase the chance that students may feel comfortable revealing their depression ( Chaudoir and Quinn, 2010 ; Cooper et al ., unpublished data ).
Foster a Positive Lab Environment.
Encourage positivity in the research lab, promote working in shared spaces to enhance social support among lab members, and alleviate competition among undergraduates.
Students in this study highlighted that the “leadership” of the lab, meaning graduate students, postdocs, lab managers, and PIs, were often responsible for establishing the tone of the lab; that is, if they were in a bad mood it would trickle down and negatively affect the moods of the undergraduates. Explicitly reminding lab leadership that their moods can both positively and negatively affect undergraduates may be important in establishing a positive lab environment. Further, students highlighted how they were most likely to experience negative thoughts when they were alone in the lab. Therefore, it may be helpful to encourage all lab members to work in a shared space to enhance social interactions among students and to maximize the likelihood that undergraduates have access to help when needed. A review of 51 studies in psychiatry supported our undergraduate researchers’ perceptions that social relationships positively impacted their depression; the study found that perceived emotional support (e.g., someone available to listen or give advice), perceived instrumental support (e.g., someone available to help with tasks), and large diverse social networks (e.g., being socially connected to a large number of people) were significantly protective against depression ( Santini et al. , 2015 ). Additionally, despite forming positive relationships with other undergraduates in the lab, many undergraduate researchers admitted to constantly comparing themselves with other undergraduates, which led them to feel inferior, negatively affecting their depression. Some students talked about mentors favoring current undergraduates or talking positively about past undergraduates, which further exacerbated their feelings of inferiority. A recent study of students in undergraduate research experiences highlighted that inequitable distribution of praise to undergraduates can create negative perceptions of lab environments for students (Cooper et al. , 2019). Further, the psychology literature has demonstrated that when people feel insecure in their social environments, it can cause them to focus on a hierarchical view of themselves and others, which can foster feelings of inferiority and increase their vulnerability to depression ( Gilbert et al. , 2009 ). Thus, we recommend that mentors be conscious of their behaviors so that they do not unintentionally promote competition among undergraduates or express favoritism toward current or past undergraduates. Praise is likely best used without comparison with others and not done in a public way, although more research on the impact of praise on undergraduate researchers needs to be done. While significant research has been done on mentoring and mentoring relationships in the context of undergraduate research ( Byars-Winston et al. , 2015 ; Aikens et al. , 2017 ; Estrada et al. , 2018 ; Limeri et al. , 2019 ; NASEM, 2019 ), much less has been done on the influence of the lab environment broadly and how people in nonmentoring roles can influence one another. Yet, this study indicates the potential influence of many different members of the lab, not only their mentors, on students with depression.
Develop More Personal Relationships with Undergraduate Researchers and Provide Sufficient Guidance.
Make an effort to establish more personal relationships with undergraduates and ensure that they perceive that they have access to sufficient help and guidance with regard to their research.
When we asked students explicitly how research mentors could help create more inclusive environments for undergraduate researchers with depression, students overwhelmingly said that building mentor–student relationships would be extremely helpful. Students suggested that mentors could get to know students on a more personal level by asking about their career interests or interests outside of academia. Students also remarked that establishing a more personal relationship could help build the trust needed in order for undergraduates to confide in their research mentors about their depression, which they perceived would strengthen their relationships further because they could be honest about when they were not feeling well or their mentors might even “check in” with them in times where they were acting differently than normal. This aligns with studies showing that undergraduates are most likely to reveal a stigmatized identity, such as depression, when they form a close relationship with someone ( Chaudoir and Quinn, 2010 ). Many were intimidated to ask for research-related help from their mentors and expressed that they wished they had established a better relationship so that they would feel more comfortable. Therefore, we recommend that research mentors try to establish relationships with their undergraduates and explicitly invite them to ask questions or seek help when needed. These recommendations are supported by national recommendations for mentoring ( NASEM, 2019 ) and by literature that demonstrates that both social support (listening and talking with students) and instrumental support (providing students with help) have been shown to be protective against depression ( Santini et al. , 2015 ).
Treat Undergraduates with Respect and Remember to Praise Them.
Avoid providing harsh criticism and remember to praise undergraduates. Students with depression often have low self-esteem and are especially self-critical. Therefore, praise can help calibrate their overly negative self-perceptions.
Students in this study described that receiving criticism from others, especially harsh criticism, was particularly difficult for them given their depression. Multiple studies have demonstrated that people with depression can have an abnormal or maladaptive response to negative feedback; scientists hypothesize that perceived failure on a particular task can trigger failure-related thoughts that interfere with subsequent performance ( Eshel and Roiser, 2010 ). Thus, it is important for research mentors to remember to make sure to avoid unnecessarily harsh criticisms that make students feel like they have failed (more about failure is described in the next recommendation). Further, students with depression often have low self-esteem or low “personal judgment of the worthiness that is expressed in the attitudes the individual holds towards oneself” ( Heatherton et al. , 2003 , p. 220; Sowislo and Orth, 2013 ). Specifically, a meta-analysis of longitudinal studies found that low self-esteem is predictive of depression ( Sowislo and Orth, 2013 ), and depression has also been shown to be highly related to self-criticism ( Luyten et al. , 2007 ). Indeed, nearly all of the students in our study described thinking that they are “not good enough,” “worthless,” or “inadequate,” which is consistent with literature showing that people with depression are self-critical ( Blatt et al. , 1982 ; Gilbert et al. , 2006 ) and can be less optimistic of their performance on future tasks and rate their overall performance on tasks less favorably than their peers without depression ( Cane and Gotlib, 1985 ). When we asked students what aspects of undergraduate research helped their depression, students described that praise from their mentors was especially impactful, because they thought so poorly of themselves and they needed to hear something positive from someone else in order to believe it could be true. Praise has been highlighted as an important aspect of mentoring in research for many years ( Ashford, 1996 ; Gelso and Lent, 2000 ; Brown et al. , 2009 ) and may be particularly important for students with depression. In fact, praise has been shown to enhance individuals’ motivation and subsequent productivity ( Hancock, 2002 ; Henderlong and Lepper, 2002 ), factors highlighted by students as negatively affecting their depression. However, something to keep in mind is that a student with depression and a student without depression may process praise differently. For a student with depression, a small comment that praises the student’s work may not be sufficient for the student to process that comment as praise. People with depression are hyposensitive to reward or have reward-processing deficits ( Eshel and Roiser, 2010 ); therefore, praise may affect students without depression more positively than it would affect students with depression. Research mentors should be mindful that students with depression often have a negative view of themselves, and while students report that praise is extremely important, they may have trouble processing such positive feedback.
Normalize Failure and Be Explicit about the Importance of Research Contributions.
Explicitly remind students that experiencing failure is expected in research. Also explain to students how their individual work relates to the overall project so that they can understand how their contributions are important. It can also be helpful to explain to students why the research project as a whole is important in the context of the greater scientific community.
Experiencing failure has been thought to be a potentially important aspect of undergraduate research, because it may provide students with the potential to develop integral scientific skills such as the ability to navigate challenges and persevere ( Laursen et al. , 2010 ; Gin et al. , 2018 ; Henry et al. , 2019 ). However, in the interviews, students described that when their science experiments failed, it was particularly tough for their depression. Students’ negative reaction to experiencing failure in research is unsurprising, given recent literature that has predicted that students may be inadequately prepared to approach failure in science ( Henry et al. , 2019 ). However, the literature suggests that students with depression may find experiencing failure in research to be especially difficult ( Elliott et al. , 1997 ; Mongrain and Blackburn, 2005 ; Jones et al. , 2009 ). One potential hypothesis is that students with depression may be more likely to have fixed mindsets or more likely to believe that their intelligence and capacity for specific abilities are unchangeable traits ( Schleider and Weisz, 2018 ); students with a fixed mindset have been hypothesized to have particularly negative responses to experiencing failure in research, because they are prone to quitting easily in the face of challenges and becoming defensive when criticized ( Forsythe and Johnson, 2017 ; Dweck, 2008 ). A study of life sciences undergraduates enrolled in CUREs identified three strategies of students who adopted adaptive coping mechanisms, or mechanisms that help an individual maintain well-being and/or move beyond the stressor when faced with failure in undergraduate research: 1) problem solving or engaging in strategic planning and decision making, 2) support seeking or finding comfort and help with research, and 3) cognitive restructuring or reframing a problem from negative to positive and engaging in self encouragement ( Gin et al. , 2018 ). We recommend that, when undergraduates experience failure in science, their mentors be proactive in helping them problem solve, providing help and support, and encouraging them. Students also explained that mentors sharing their own struggles as undergraduate and graduate students was helpful, because it normalized failure. Sharing personal failures in research has been recommended as an important way to provide students with psychosocial support during research ( NASEM, 2019 ). We also suggest that research mentors take time to explain to students why their tasks in the lab, no matter how small, contribute to the greater research project ( Cooper et al. , 2019a ). Additionally, it is important to make sure that students can explain how the research project as a whole is contributing to the scientific community ( Gin et al. , 2018 ). Students highlighted that contributing to something important was really helpful for their depression, which is unsurprising, given that studies have shown that meaning in life or people’s comprehension of their life experiences along with a sense of overarching purpose one is working toward has been shown to be inversely related to depression ( Steger, 2013 ).
Limitations and Future Directions
This work was a qualitative interview study intended to document a previously unstudied phenomenon: depression in the context of undergraduate research experiences. We chose to conduct semistructured interviews rather than a survey because of the need for initial exploration of this area, given the paucity of prior research. A strength of this study is the sampling approach. We recruited a national sample of 35 undergraduates engaged in undergraduate research at 12 different public R1 institutions. Despite our representative sample from R1 institutions, these findings may not be generalizable to students at other types of institutions; lab environments, mentoring structures, and interactions between faculty and undergraduate researchers may be different at other institution types (e.g., private R1 institutions, R2 institutions, master’s-granting institutions, primarily undergraduate institutions, and community colleges), so we caution against making generalizations about this work to all undergraduate research experiences. Future work could assess whether students with depression at other types of institutions have similar experiences to students at research-intensive institutions. Additionally, we intentionally did not explore the experiences of students with specific identities owing to our sample size and the small number of students in any particular group (e.g., students of a particular race, students with a graduate mentor as the primary mentor). We intend to conduct future quantitative studies to further explore how students’ identities and aspects of their research affect their experiences with depression in undergraduate research.
The students who participated in the study volunteered to be interviewed about their depression; therefore, it is possible that depression is a more salient part of these students’ identities and/or that they are more comfortable talking about their depression than the average population of students with depression. It is also important to acknowledge the personal nature of the topic and that some students may not have fully shared their experiences ( Krumpal, 2013 ), particularly those experiences that may be emotional or traumatizing ( Kahn and Garrison, 2009 ). Additionally, our sample was skewed toward females (77%). While females do make up approximately 60% of students in biology programs on average ( Eddy et al. , 2014 ), they are also more likely to report experiencing depression ( American College Health Association, 2018 ; Evans et al. , 2018 ). However, this could be because women have higher rates of depression or because males are less likely to report having depression; clinical bias, or practitioners’ subconscious tendencies to overlook male distress, may underestimate depression rates in men ( Smith et al. , 2018 ). Further, females are also more likely to volunteer to participate in studies ( Porter and Whitcomb, 2005 ); therefore, many interview studies have disproportionately more females in the data set (e.g., Cooper et al. , 2017 ). If we had been able to interview more male students, we might have identified different findings. Additionally, we limited our sample to life sciences students engaged in undergraduate research at public R1 institutions. It is possible that students in other majors may have different challenges and opportunities for students with depression, as well as different disciplinary stigmas associated with mental health.
In this exploratory interview study, we identified a variety of ways in which depression in undergraduates negatively affected their undergraduate research experiences. Specifically, we found that depression interfered with students’ motivation and productivity, creativity and risk-taking, engagement and concentration, and self-perception and socializing. We also identified that research can negatively affect depression in undergraduates. Experiencing failure in research can exacerbate student depression, especially when students do not have access to adequate guidance. Additionally, being alone or having negative interactions with others in the lab worsened students’ depression. However, we also found that undergraduate research can positively affect students’ depression. Research can provide a familiar space where students can feel as though they are contributing to something meaningful. Additionally, students reported that having access to adequate guidance and a social support network within the research lab also positively affected their depression. We hope that this work can spark conversations about how to make undergraduate research experiences more inclusive of students with depression and that it can stimulate additional research that more broadly explores the experiences of undergraduate researchers with depression.
Important note
If you or a student experience symptoms of depression and want help, there are resources available to you. Many campuses provide counseling centers equipped to provide students, staff, and faculty with treatment for depression, as well as university-dedicated crisis hotlines. Additionally, there are free 24/7 services such as Crisis Text Line, which allows you to text a trained live crisis counselor (Text “CONNECT” to 741741; Text Depression Hotline , 2019 ), and phone hotlines such as the National Suicide Prevention Lifeline at 1-800-273-8255 (TALK). You can also learn more about depression and where to find help near you through the Anxiety and Depression Association of American website: https://adaa.org ( Anxiety and Depression Association of America, 2019 ) and the Depression and Biopolar Support Alliance: http://dbsalliance.org ( Depression and Biopolar Support Alliance, 2019 ).
ACKNOWLEDGMENTS
We are extremely grateful to the undergraduate researchers who shared their thoughts and experiences about depression with us. We acknowledge the ASU LEAP Scholars for helping us create the original survey and Rachel Scott for her helpful feedback on earlier drafts of this article. L.E.G. was supported by a National Science Foundation (NSF) Graduate Fellowship (DGE-1311230) and K.M.C. was partially supported by a Howard Hughes Medical Institute (HHMI) Inclusive Excellence grant (no. 11046) and an NSF grant (no. 1644236). Any opinions, findings, conclusions, or recommendations expressed in this material are those of the authors and do not necessarily reflect the views of the NSF or HHMI.
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Submitted: 4 November 2019 Revised: 24 February 2020 Accepted: 6 March 2020
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Depression and anxiety among high school student at Qassim Region
Reem alharbi.
1 Collage of Medicine, Qassim University, Qassim, Kingdom of Saudi Arabia
Khalid Alsuhaibani
Abdullah almarshad, abdulhameed alyahya.
2 Department of Psychiatry, Qassim University, Qassim, Kingdom of Saudi Arabia
Background:
Adolescence is a stage of changes in body and behaviour that may affect mental health. We found that no study measures the depression and anxiety in adolescence in our region, so we want to measure it and then try to improve our community.
We aim to estimate the prevalence of depression and anxiety among high school students at Qassim region.
A cross-sectional study done in al-Qassim region. A targeted population was secondary school students. The sample size was 1245 students. We used the questionnaire tool the Patient Health Questionnaire (PHQ-9) to assess depression in the students and the GAD7 for anxiety. The data had been gathered through MS Excel then exported to the Statistical Packages for Social Sciences (SPSS) for analyses. A P value cut-off point of 0.05 at 95% confidence interval (CI) was used to determine statistical significance. The analyses measure the association between socio-demographic and other related variables in the survey by using a Chi-square test.
Our study shows that depression by using (PHQ-9) among the 1245 students, 325 (26.0%) were not depressed, 423 (34%) were mildly depressed, 306 (24.6%) were moderately depressed, whereas 129 (10.4%) were moderately severe depressed and 62 (5.0%) were severely depressed. Anxiety by using the GAD-7 questionnaire, it was revealed that out of 1245 students, 455 (36.5%) of them were without anxiety, 425 (34.1%) of them were having mild anxiety, 243 (19.5%) of them were having moderate anxiety and 122 (9.8%) were having severe anxiety. Depression and anxiety, according to gender ( P value <0.001), show a significant relationship.
Conclusion:
We have to raise the awareness of the mental health in our community as the prevalence of mental disorder has significantly increased over time. Health services should make health education for students on how they deal with stress and depression through exercise and good sleep.
Introduction
One of the most important stages of life is adolescence, and since it is so important we should focus our efforts to solve the challenging conditions like depression, anxiety and stress. It is not that simple on an account of the multifactorial changes that are taking place in that period such as biological, physiological and psychological. Psychiatric disorders in this period are a major public health concern because of their impact on the life in almost every aspect from poor academic performance, substance abuse to the suicide attempts.[ 1 , 2 ]
According to the World Health Organization (WHO) reports, community-based studies revealed an overall prevalence rate for mental disorders around 20% in several national and cultural contexts.[ 3 ] An earlier study on Saudi secondary school boys indicated that 38.2% had depression, while 48.9% experienced anxiety and 35.5% suffered from stress.[ 2 ] Another study was done on girls in Abha showed that depression was accounted as 41.5%, anxiety was 66.2% and 52.5% experienced stress.[ 4 ]
About 50% of adult sufferers of anxiety disorders identify that their symptoms began in childhood. Furthermore, the stress is escalating at an alarming rate among adolescents according to many researchers.[ 2 ] Depression (major depressive disorder), is a major cause of disability and suicide, has a prevalence of 5% in the general population and approximately 10–20% in chronically ill medical outpatients. The feelings of sadness and/or a loss of interest in activities once enjoyed can cause depression. Also, it is linked to a variety of emotional and physical problems and can decrease a person's ability to function at work and home.[ 5 , 6 ]
Anxiety is a large heading where disorders such as general anxiety; social anxiety are part of it. It is manifested as nervousness, apprehension, fear and worrying. Besides, it may cause physical symptoms and disturbance. A mild form of anxiety is hazy and disturbed, while severe anxiety can impair the normal function of life.[ 7 ]
Study design
A cross-sectional study was undertaken in the duration from February 2018 until May 2018 among high school students in Qassim Region, KSA.
Population and sample
The study population included most of the high schools in Qassim Region. The exclusion criteria were students with intellectual disabilities. The total number of participants was 1245 students.
Data collection instruments
To assess the depression of the students we used questionnaire tool the Patient Health Questionnaire (PHQ-9).[ 8 ] The PHQ-9 is the depression module, which scores each of the nine Diagnostic and Statistical Manual of Mental Disorders, 4 th Edition (DSM–IV) criteria as ‘0’ (not at all) to ‘3’ (nearly every day). It has been validated for use in primary care.[ 9 ]
The results had been recorded into five categories such as 0–4 as ‘none,’ 5–9 as ‘mild,’ 10–14 as ‘moderate,’ 15–19 as ‘moderately severe’ and 20–27 as 'severe.’[ 8 ]
Whereas to evaluate the anxiety of students we applied the General Anxiety Disorder (GAD-7) survey tool, this is calculated by assigning scores of 0, 1, 2 and 3 to the response categories of ‘not at all,’ 'several days,’ ‘more than half the days’ and ‘nearly every day,’ respectively. GAD-7 total score for the seven items ranges from 0 to 21. Scores of 5, 10 and 15 represent cut-off points for mild, moderate and severe anxiety, respectively.[ 10 ]
Data analysis
The data had been gathered through MS Excel and after data cleaning and data re-coding, it was then exported to the Statistical Packages for Social Sciences (SPSS) for further tabulation and subsequently for statistical data analyses. Both descriptive and inferential statistics had been conducted. A P value cut-off point of 0.05 at 95% confidence interval (CI) was used to determine statistical significance. The analyses measure the association between socio-demographic and other related variables in the survey by using a Chi-square test.
Ethical Considerations
The researchers explained to the participants the important information about this study. Then, the participants were asked to carefully read the consent form, before they agreed to participate in this study. Confidentiality of the participants was ensured. This research was approved by the Regional Ethical Committee in thePrince Noura University.
There were 1245 participants who were recruited in this study, age range was from 13 to 19 years old of whom majority were 17 -18 years old group (55.7%). Females were higher compared to males (55.6% vs 44.4%). Further details of the socio demographic characteristics were elaborated at Table 1 . Figure 1 presented the distribution of students’ depression using the PHQ-9 questionnaire.
Descriptive analysis for socio-demographics variables
Distribution of students’ depression using the PHQ-9
Figure 2 shows the distribution of students’ anxiety using the GAD-7 questionnaire.
The distribution of students’ anxiety using GAD-7 questionnaire
We used the Chi-square test in Table 2 to assess the relationship between the level of depression and the socio-demographic characteristics of students with P values which indicates whether the relationship is statistically significant. A P value of ≤0.05 has been used as a significant level for all statistical tests. About 17–18-year old were higher in all level of depression compared to other age categories, however, its association was not statistically significant ( P value 0.176). Females were predominantly higher than males in all levels of depression with the exception of those without depression where males (57.8%) were slightly higher than females (42.2%) and it shows positive association ( P value <0.001). In the place of residence, student living in Buraidah were dominantly higher in all depression categories in comparison to other places of residence and the test revealed a significant difference ( P value <0.001). Pertaining to the type of education system, the syllabus system was superior in all level of depression opposite to other categories of the education system but we failed to prove its association ( P value 0.305). In regards to educational level, third-year were dominantly depressed among the other year level. However, the analysis revealed that educational level was not statistically associated with depression. Single status was far off depressed compared to married and divorced/widowed and its association was negative ( P value 0.255). Students with mild anxiety were higher in all level of depression except for those without anxiety where it registered far higher than mild, moderate and severe. The analysis revealed that the level of anxiety has a strong relationship with the level of depression.
Relationship between depression and socio-demographic characteristics ( n =1245)
§ P -value has been calculated using a Chi-square test. **Significant at P ≤0.05
Table 3 presented the relationship between the level of anxiety and socio-demographic characteristics of students. In this table, we also applied a Chi-square test with P values which indicates whether the relationship is statistically significant. We used P ≤ 0.05 as a cut-off point for a significant level. About 17–18-year old were superior in all level of anxiety compared to other age categories, however, its relationship was not statistically significant ( P value 0.341). Females were higher than males in all levels of anxiety except for those without anxiety where males (53.2%) were slightly upper than females (46.8%), and it shows strong association ( P value <0.001). In the place of residence, student living in Buraidah were dominantly higher in all level of anxiety compared to other places of residence, and the test revealed statistically significant ( P value <0.001). Concerning the type of education system, the syllabus system was more in all level of anxiety in comparison to other categories of the education system and it shows positive association ( P value 0.022). In regards to educational level, a third-year level was the most anxious among the other year level. However, the analysis revealed that educational level was not statistically associated with anxiety. In marital status, single status was far anxious compared to married and divorced/widowed and its association was strongly positive ( P -value 0.001).
Relationship between anxiety and socio-demographic characteristics ( n =1245)
Discussions
Depression, anxiety and stress are increasing among adolescents (Institute for Health Metrics and Evaluation, 2013).[ 11 ] This study will further exemplify the prevalence of depression, anxiety and stress among students here in Saudi Arabia. Our study assessed the students’ depression and anxiety by using the PHQ-9 questionnaires as well as the GAD-7 questionnaires.[ 12 , 13 ] We trust that this is the first paper in Saudi Arabia to assess the prevalence of depression and anxiety using this version of questionnaires as most of the papers published have utilized the Depression, Anxiety and Stress Scale (DASS) questionnaires.[ 14 , 15 , 16 , 17 , 18 , 19 , 20 , 21 , 22 ] Overall depression shows 26% were not depressed, 34% were mildly depressed, 24% were moderately depressed with 10.4% of moderately depressed and 5% who had severe depression whereas students’ anxiety shows 36% were without anxiety, 34% were with mild anxiety with 19% were having moderate anxiety and a relatively low percentage of severe anxiety with only 9%. This study also shows a significant relationship between gender, place of residence versus the level of depression. When measuring the relationship between socio-demographic variables and level of anxiety, gender, place of residence, type of education system and marital status indicated a significant relationship. Furthermore, when assessing the association between levels of depression versus levels of anxiety, we discover that there was a respectable variation between the two outcomes.
In a study conducted at Jizan, Saudi Arabia, where they have assessed the depression, anxiety and stress among Saudi secondary school students.[ 23 ] They randomly selected four secondary schools (two for boys and two for girls). They found out that of 772 students, 50% of them had symptoms of depression, 59% had symptoms of anxiety, while 39% had symptoms of stress. They also observed that gender had a significant relationship with depression, anxiety and stress. However, their study realized that age in years does not seem to have a significant effect among the outcome variables. This study result is incongruent to our outcome, with only a slight difference in the manner of measuring the mental disorder of the student as the latter they used the DASS questionnaires. Another researcher from Asir Region, Saudi Arabia where he published an article entitled ‘Depression, anxiety, and stress among Saudi Adolescent school boys.’[ 24 ] The study was to determine the prevalence rates and severity of depression, anxiety and stress among Saudi adolescent boys. Using the DASS questionnaires as a tool, the results of his project showed, among 1723 male students, 59.4% had at least one of the three disorders, 40.7% had at least two and 22.6% had all the three disorders. Moreover, more than one-third of the participants (38.2%) had depression, while 48.9% had anxiety and 35.5% had stress. Depression, anxiety and stress were strongly, positively and significantly correlated. We believe that the prevalence of depression and anxiety in our study were slightly higher than his results as the depression in our study were almost three-fourth of the total number of students which we categorized from mild to severe depression with only 26% who were not having any symptoms of depression, whereas we also deemed higher in anxiety result as all students were suffering from anxiety categorized from mild to severe. In the correlation matrix, both of our projects viewed on the same page where we showed that depression and anxiety were both statistically associated. Another author from Jeddah, Saudi Arabia, investigated the perceived depression, anxiety and stress among Saudi postgraduate orthodontic students where she also used the DASS as a survey tool.[ 25 ] This cross-sectional survey was conducted in three dental schools in different regions of Saudi Arabia; Riyadh (Central Region), Jeddah (Western Region) and Dammam (Eastern Region). The findings of her study shows (40.5%) of the participants had depression at mild levels, while more than a half (51.9%) of the participants experienced stress at moderate levels. Very few participants exhibited depression, anxiety and stress at extremely severe level (2.5%, 6.3% and 2.5%, respectively). Further results revealed that both males and females, and students in each year of study similarly experienced the three emotional states from moderate to severe levels. However, no significant difference was found between these groups for the depression and stress scores. This study result is conforming to our findings aside from the relation of two groups of students’ depression and anxiety where we found both of them were statistically associated, whereas the latter found no significant difference between depression and stress score.
In India, the prevalence of the DASS was significantly higher in females. Around four-fifths of the respondents had at least one of the studied disorders and 34.7% of the respondents had all the three negative states. For depression and anxiety, the peak age was 18 years.[ 22 , 26 ] Whereas in Iran, 24.9% of students suffered from stress, 21.6% from depression and 20.2% had anxiety. Meantime, there was a reliable relation between ‘family relationship status of students’ and depression ( P = 0.0001) and anxiety ( P = 0.05).[ 27 ] In Turkey, they also reported that the prevalence of depression was higher in females than males, with one-third of the total sample was depressed which was collected using the Beck Depression Inventory (BDI) which consisted of 27 items.[ 28 ] We viewed that these international studies were symmetrical to the outcome of our paper where we also demonstrate in the table that females were more depressed compared to males and that their mental states get affected as their ages increased.
In Belgrade, Serbia, an article published regarding the factors associated with the depression, anxiety and stress among a high medical school of professional studies students.[ 29 ] Their finding shows that among 535 students they surveyed, 13.6% of the examined student population had symptoms of depression, 25.6% had symptoms of anxiety and 26% had symptoms of stress, which were varying from mild to extreme. They also found out that both depression and anxiety were significantly correlated with the gender but no significant difference in age. Also in Brazil, a group of researchers measured the depression, stress and anxiety in medical students.[ 30 ] They reported 34.6% reported depressive symptomatology, 37.2% showed anxiety symptoms and 47.1% stress symptoms. When assessing the relationship between each predictor, they found a significant difference between each variable. Gender also indicates a significant association between depression and stress. Moreover, in China, one of the studies published tackling prevalence and related risk factors of anxiety and depression among Chinese college freshmen.[ 31 ] They accounted that 65.55% of freshmen had depression and 46.85% had anxiety. Minority status, low family income and religious belief were significantly associated with current mental health problems. These findings indicate that mental disorders are highly prevalent among the freshman student population. These study findings are comparable to our results where we showed the same pattern of prevalence of mental disorder and its correlation against the socio-demographic variables. Although some countries were showing increase in anxiety to some extent, we generalized that the prevalence of mental disorder is growing as the student goes further in school.
Parents should be more aware of the mental status of their children especially during adolescence as the prevalence of mental disorder has significantly increased over time. In school, teachers should ascertain students’ attitude and behaviour at all times while under their watch (during exams, marks, friendship, general health and interest). Maintaining a good teacher–student relationship will be beneficial in the long run. Parents and teachers’ collaboration on nurturing students’ good behaviour will decrease the prevalence of depression, anxiety and stress among students in the society.[ 27 ]
Recommendation
We have to improve the mental health of our community by giving courses to parents and teachers. The Ministry of Health and Ministry of Education should put hands together to enhance the students quality of life. We must orient the students on how to deal with stresses. Further studies can help which type of prevention and intervention can be used to decrease the burden of students depression and anxiety.
Financial support and sponsorship
Conflicts of interest.
There are no conflicts of interest.
Acknowledgements
We are thankful to the students for kindly answering our questionnaire. We really appreciate all data collectors: Mayar Mohammed, Maha Alenizi, Amjad Alhumaid, Lama Nasser, Bayan Alsaqaby, Khaled Alfozan, Fahad Alharbi, Abdullah Altorbag, Abdulrahman Alkhulayfi and Musa Almuhanna. We are thankful to Dr. Homidan Alhomidan for his time in correcting our report and Dr Abdulrahman Aldekel for his nice recommendation, we appreciate the advice from Dr. Mohamed al Alsuhaibani.
Depression, Anxiety, Loneliness Are Peaking in College Students
Photo by Cydney Scott
Nationwide study, co-led by BU researcher Sarah Ketchen Lipson, reveals a majority of students say mental health has impacted their academic performance
Kat j. mcalpine.
A survey by a Boston University researcher of nearly 33,000 college students across the country reveals the prevalence of depression and anxiety in young people continues to increase, now reaching its highest levels, a sign of the mounting stress factors due to the coronavirus pandemic, political unrest, and systemic racism and inequality.
“Half of students in fall 2020 screened positive for depression and/or anxiety,” says Sarah Ketchen Lipson , a Boston University mental health researcher and a co–principal investigator of the nationwide survey , which was administered online during the fall 2020 semester through the Healthy Minds Network. The survey further reveals that 83 percent of students said their mental health had negatively impacted their academic performance within the past month, and that two-thirds of college students are struggling with loneliness and feeling isolated—an all-time high prevalence that reflects the toll of the pandemic and the social distancing necessary to control it.
Lipson, a BU School of Public Health assistant professor of health law, policy, and management, says the survey’s findings underscore the need for university teaching staff and faculty to put mechanisms in place that can accommodate students’ mental health needs.
“Faculty need to be flexible with deadlines and remind students that their talent is not solely demonstrated by their ability to get a top grade during one challenging semester,” Lipson says.
She adds that instructors can protect students’ mental health by having class assignments due at 5 pm, rather than midnight or 9 am, times that Lipson says can encourage students to go to bed later and lose valuable sleep to meet those deadlines.
Especially in smaller classroom settings, where a student’s absence may be more noticeable than in larger lectures, instructors who notice someone missing classes should reach out to that student directly to ask how they are doing.
“Even in larger classes, where 1:1 outreach is more difficult, instructors can send classwide emails reinforcing the idea that they care about their students not just as learners but as people, and circulating information about campus resources for mental health and wellness,” Lipson says.
And, crucially, she says, instructors must bear in mind that the burden of mental health is not the same across all student demographics. “Students of color and low-income students are more likely to be grieving the loss of a loved one due to COVID,” Lipson says. They are also “more likely to be facing financial stress.” All of these factors can negatively impact mental health and academic performance in “profound ways,” she says.
At a higher level within colleges and universities, Lipson says, administrators should focus on providing students with mental health services that emphasize prevention, coping, and resilience. The fall 2020 survey data revealed a significant “treatment gap,” meaning that many students who screen positive for depression or anxiety are not receiving mental health services.
“Often students will only seek help when they find themselves in a mental health crisis, requiring more urgent resources,” Lipson says. “But how can we create systems to foster wellness before they reach that point?” She has a suggestion: “All students should receive mental health education, ideally as part of the required curriculum.”
It’s also important to note, she says, that rising mental health challenges are not unique to the college setting—instead, the survey findings are consistent with a broader trend of declining mental health in adolescents and young adults. “I think mental health is getting worse [across the US population], and on top of that we are now gathering more data on these trends than ever before,” Lipson says. “We know mental health stigma is going down, and that’s one of the biggest reasons we are able to collect better data. People are being more open, having more dialogue about it, and we’re able to better identify that people are struggling.”
The worsening mental health of Americans, more broadly, Lipson says, could be due to a confluence of factors: the pandemic, the impact of social media, and shifting societal values that are becoming more extrinsically motivated (a successful career, making more money, getting more followers and likes), rather than intrinsically motivated (being a good member of the community).
The crushing weight of historic financial pressures is an added burden. “Student debt is so stressful,” Lipson says. “You’re more predisposed to experiencing anxiety the more debt you have. And research indicates that suicidality is directly connected to financial well-being.”
With more than 22 million young people enrolled in US colleges and universities, “and with the traditional college years of life coinciding with the age of onset for lifetime mental illnesses,” Lipson stresses that higher education is a crucial setting where prevention and treatment can make a difference.
One potential bright spot from the survey was that the stigma around mental health continues to fade. The results reveal that 94 percent of students say that they wouldn’t judge someone for seeking out help for mental health, which Lipson says is an indicator that also correlates with those students being likely to seek out help themselves during a personal crisis (although, paradoxically, almost half of students say they perceive that others may think more poorly of them if they did seek help).
“We’re harsher on ourselves and more critical of ourselves than we are with other people—we call that perceived versus personal stigma,” Lipson says. “Students need to realize, your peers are not judging you.”
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There are 25 comments on Depression, Anxiety, Loneliness Are Peaking in College Students
first of all, excellent writing! This report is extremely triggering for a few reasons. Obviously students are NOT okay at the moment, now confirmed by the student. But what does the university do about it? They micro-manage EVERY aspect of students’ life to mitigate Covid risk. Here, tell me why the university took away household table seating in the dining hall? That was one of the ONLY places on campus where students can eat with each other and actually see their friends’ faces. What type of modeling was used to make this decision and its impact on covid spread on campus. Same thing for the green badge, was there a statistical difference in case before and after students have to walk around showing that? The university’s policies are simply incentivizing off-campus, more dangerous gatherings because the university won’t facilitate anything like that on campus. Oh, and the university response? ‘you’re doing great sweetie’ type of deal – absolutely ridiculous. I know BU can’t keep this up much longer, they are losing far too much money because of Covid and less students on campus – there will be a reckoning. Students, stand up.
BU will acknowledge this but then still won’t do anything to actually help.
Great, but this school is doing absolutely nothing to help it
I appreciate this article because I feel that the issue of mental health isn’t talked about enough amongst students and just college culture in general. I don’t see any concerns coming from college faculty, at least clearly. It’s so important to talk about mental health, especially during a pandemic.
This article is definitely going in the right direction. That being said, as the other comments have also mentioned, BU needs to do MUCH more than just publishing an article telling students, “well, at least you aren’t alone.” If 83% of your student body reports their mental health affects their school work, then if not for them, at least change something for the benefit of the school’s name. To put it bluntly, this does not look good. Also referencing BU’s response to sexual harassment, BU now has a track record of acknowledging issues that significantly impact its students in an article or maybe a speech to only do NOTHING about it. Please, I implore the school to act. Act or we will.
We know mental health stigma is going down
Actually, we know support for those taught and teaching that prejudice is diminishing, though that does not mean by any stretch of the imagination it is not still being taught. It continues to be taught (often resolutely) at Boston University. The above sentence is one manner in which it continues to be taught, Passive Reference. It is also actively taught. “Perceived stigma” is another interesting Passive Reference, directed prejudices are intended by their directors to be perceived. “perceived” stigma is an obfuscation of the process whereby it is perceived. It surprises me, that so many women, eschewing “the stigma” of rape, continue to declare “the stigma” of mental illnesses. Sometimes history does not inform us. A few years ago 5 students died by suicide at a Canadian college, blamed was “the stigma” of mental illnesses, not those conveying it. When a young man at U Penn died by suicide it prompted his sister to set up a now national organization protesting “the stigma” of mental illnesses, not those conveying it. National organizations abound conveying “the stigma” of mental illnesses to eagerly awaiting audiences. Publications abound, but to my knowledge not one single publication directly addresses how it is taught or who teaches it. Nor, to my knowledge is there a campus in the US, or any English speaking country, where someone is given guidance on how to address those directing it. Whom to approach. How to resolve it. [email protected] offers no such guidance. I invite each of you to return to 1972, when a small group of personally empowered women said, “Stop directing the term stigma at rape, you have done enough harm” and take that lesson to heart: We stopped.
And I invite [email protected] to take a role in bringing about that change.
Harold A Maio, retired mental health editor
Wow – so what is BU doing about this when we have pleaded with admin and offered so many ideas and solutions to helping here since September 2020?
The silence is deafening BU.
The Well Being Project is stagnate.
The Dean is silent.
The provost says students are happy based on some survey they did just before holidays when students knew they were going home.
The Director of Mental Health says appts for mental health are down – that’s the sign everything is fine?
We are hearing the opposite and many students have just lost their faith in support from BU as well as just returning home for LFA where they have a support system.
Where are the social in person safe activities outside and inside?
Where are the RAs and their weekly activities and support of their residents or are they just there to write students up?
Where are the self-care tips and resources offered daily to students?
Where in the daily MANDATORY self-check survey of their health – are any questions about their emotional well being including their mood, stress levels, sleep and appetite?
Where is the support for faculty who are seeing these issues and trying to reach out?
Where are the therapy dogs from pre-pandemic we asked for weekly or biweekly to come outside and offer unconditional emotional support during this tough time?
Where are some campus wide concerts or comedy relief concert paid for by BU – virtually or outside so students have anything to look forward to? If it’s down to money / the $70,000 Tuition or should cover some of it or funds from housing since many were not reimbursed when they returned home for support.
Where is any work with this amazing wise resource Dr. Lipson to take any of her guidance since last summer instead of just posting it here?
Is anyone listening to the isolation and pain of so many terriers? I have heard troubling stories for months since we began our BU Parent group that is NOT monitored by the Deans office unlike others. I have helped refer and counsel families worried if they speak up there might be some retaliation. There is no retaliation just a deaf ear to making any changes to improve morale and well being of our terriers during a pandemic. And then posting this article is the ultimate hutzpah when no one has listened to Dr.Lipson / your own shining star about these issues.
Why not shine as you have with COVID testing? What if this were your family member feeling isolated and disillusioned with their dreams at BU with no outreach from BU except an occasional ZOOM message.
BU can do so much better and be the example for the rest of the nation. Why test so stringently if you will not allow any safe activities except for favorites like sports teams and band members?
Terriers are ZOOMED OUT. Don’t wait for a suicide or more depression to appear in students. It’s almost too late to be proactive / but you can try and we ask that you try hard. Be an example for other colleges.
We are not giving up on being heard. We are parents who care and love BU and know it can do better.
A lot of good points made – I wanted to touch upon when you mentioned that appointments for mental health are apparently down. As a student actively seeking mental health resources, my experience is that it has been extremely difficult to even schedule any sort of mental health appointments or counseling; we are unable to make an appointment online or in-person anymore, and the only information we are given is a phone number to call (the Behavioral Medicine number). I find this frustrating as many of us need more than just a phone conversation to help – even a zoom meeting would be helpful, but why aren’t there zoom appointments for SHS like there are for almost every other service on campus (e.g., pre-professional advising, financial aid, etc.)? I’ve noticed that the loneliness and isolation is affecting not only me but my roommates as well, who have stronger support systems and more friends on campus than I do – we’ve all been lacking motivation to do any of our work and they’ve mentioned that they feel like they need a break (spring break canceled due to pandemic concerns). Even some of my professors seem burnt out – forgetting class, getting behind on their syllabus, etc. In my opinion, BU should be more proactive in giving students resources instead of making it difficult to find said resources. Lastly, I wanted to add that I understand a lot of services are probably very different now due to the pandemic, but a single “wellness week” and emails about it do not do much to actually help students – I find it comparable to “self care” where the self care is just drinking wine and putting on a skincare mask and pushing all your real problems aside.
I agree with those who are asking for BU to do more to support students. I’m a faculty member who is trying to do my best to support my students. I’m more than willing to give extensions, modify assignments, and lower my expectations this semester. I’m checking in on students who miss class to make sure they’re okay. I’m trying to cut as much material as I can while still meeting my course learning objectives. At the same time, I don’t think it’s fair to expect faculty to do everything when it comes to students’ wellbeing. I’ve been in meetings where faculty were asked (both implicitly and explicitly) to help students make friends and socialize during class. I know faculty who are doing this in their courses (and I applaud them for their efforts), but shouldn’t Res Life and other staff at BU be providing opportunities for students to safely socialize? Sure, it’s cold, but certainly BU can be creative and think of ways to encourage students to get out of their dorms and make friends. Faculty are struggling too, and BU’s administration can help us by helping our students.
This is an excellent article, and though not surprising, it is shocking that the BU administration has not done anything to remedy this mental health crises. This is a mental health pandemic happening and it should be as high of a priority for BU as the trying to control the virus. If BU doesn’t step up and come up with a plan to address this then our students will suffer for years to come. This should have happened months ago. You can’t have a healthy individual/society if you are only concerned with physical health. It has to be a holistic approach.
Nice article I hope all instructors read this article I am one of the students sometimes fell a depression and live in the anxiety that is effectives on my life and do not have the energy to do anything particularly during what we live now
First, I would like to focus on the positive and thank BU mental health staff for being there for my son when he was in urgent need of mental health support back in the Fall semester. My call was answered right away and my son was able to speak with a professional with in 15 minutes. I was very impressed and relieved. They were there when we needed them.
On the other hand, I’m hearing from my son and all of his friends that the academic culture of rigor for the sake of rigor, grade deflation and the purposeful weeding out of students from core classes rather than supporting and helping each student succeed, not only continues but has been increased during COVID. These students have a sense that professors are concerned about online cheating so have ramped the rigor to address this. Not sure if this is real or perceived and I’m sure this is not going on in all classes as I also heard examples of supportive professors, but this is definitely a theme I am hearing from students. This style of academics is known to be outdated and ineffective, yet it continues, even at a higher level, during a pandemic.
I’m hoping this feedback can serve helpful to administration.
THANK YOU!!!! As a college student, who has survived the past year with a 4.0, attending full-time to obtain my degree in IT. I am struggling for the first time. After technology issues that set me behind four days, I really thought my instructors would understand. One of my instructors couldn’t care less. The workload is beyond overwhelming, her curriculum seems almost cruel. I graduate next month and I feel like I am losing my mind. I already suffer from severe anxiety, so the level I’m at now is almost debilitating. I have been obtaining degrees since 1998, and familiar with online learning. I’ve never had issues. This morning I received an email from her reminding me of the due date, in all bold caps, followed by some !!!! … She made it clear she is not available on the weekend, but expects us to be flexible. So my dilemma is this, I am failing my coding class now, but I don’t feel that I should be financially responsible to pay for having to retake it, as well as have it impact my financial aid and scholarships I receive for my academic performance.
Hi. I’m a BU alumna, a college professor, and mom to 4 college-aged sons. WONDERING… Do students feel there is explicit and implicit prejudice against college students as “purveyors of COVID?” I think this adds to the discomfort or enjoyment of being a college student and part of a university community. Thoughts? Thanks!
I notice that the students like to complain on here. One thing that university researchers on mental health have a difficult time assessing is knowing the familial support system (or lack thereof) students come into university life with. Psychologists will affirm that this plays a huge role in the mental health of students, at any age. Just as elementary through high schools today are expected to be the emotional, parental, physical, educational, and social supporter of each student, so too are universities being given this sort of expectation. Don’t get me wrong…I believe in striving for mental health and making resources available on campuses. However, within the communities of students – whether their friends or family – we have to realize that the internal conversation around mental health for many cultures is either non-existent or looked down upon. We can sing mental health from the rooftops all day long and hope that students are listening…..and I hope they do.
ECT/Electroshock use has been on the rise last 5 years or so and not just used for depression nor as a last resort. No FDA testing ever done of devices used or the procedure itself. Increase risk for suicide following as many cannot find help for their repeated brain injuries after consenting to this. Lawsuits taking place in the US and England around these damages covered up. See site ectjustice to learn more. Please speak out on social media so others are made aware of the truth of this practice.
People shouldn’t hesitate to ask for psychological help. I think it’s one of the main problems why people struggle mentally. Maybe, it’s a matter of self-critique, and society says sometimes that we should be strong… But when someone gets in an emotional crisis, only a professional can help. And I also never see when students/educators judge their peers/colleagues if someone contacted mental health support. I looked through the list of different affordable mental health services across English-speaking countries – https://ivypanda.com/blog/mental-health-resources – I was shocked how many problems we can have, and how many professionals exist to help with them. Maybe, it may be helpful to others too. Let’s take care of ourselves.
I tried to find the source for “83 %” of college students say their performance was negatively affected by mental health. Did you just pull that number out of thin air? I tried to go through everything I could and could not find this number anywhere in any actual published writing.
Please see page six of the report, the pie chart listed under Academic Impairment.
I think you just made up certain elements of this article and they actually have 0 foundation whatsoever. It has led me down a rabbit hole of attempting to try to find the published support for some of the claims you make. Including the 83 % figure. If you’re going to write articles that will be heavily referenced (which this is, because other idiots went on to quote this article), you should at least get the facts straight.
Please see page 6 of the report, the pie chart listed under Academic Impairment: https://healthymindsnetwork.org/wp-content/uploads/2021/02/HMS-Fall-2020-National-Data-Report.pdf
That is a misrepresentation of the data, in my opinion. Including students who reported mental health impacting their academic performance 1-2 days out of the week is insufficient to be grouped in with 83% of students. The way it is presented in this article makes it seem much more drastic than that. It should say, “28% of students felt 1-2 days out of the week had been negatively impacted by their mental health in the past month..” and report the other percentages. Not combined into one group and twisted in a sensationalistic way. I was attempting to use this information for a research paper of my own and was sent down a rabbit hole trying to find a source. Other people have cited this article, and that is your responsibility as a researcher.
Reading it because to help a friend with his assignment. He studies in FAST, Islamabad, Pakistan. If anyone of his class fellows are here, good luck to you
It is 3:12 in the morning and I just got off the phone with son. He called because he was riddled with anxiety and suffering with loneliness and a seeming inability to form meaningful connections. This is his first year at BU. He loves the University; However, in addition to the rigorous academic challenges, he is crushed by the seeming inability to form connections with others. This, on so many levels, surprises me. He is intelligent, interesting, friendly, handsome and well rounded. Upon my introduction to the University’s logistical layout, I was immediately aware that it not appear easily conducive to meeting people… As opposed to a smaller private college if you will. Clearly, BU had an obligation to address the many challenges brought about as a result of Covid. Understandable, but perhaps a bit extreme, ie: The students not being allowed to eat or congregate. Regardless, what I also observed is that there are few, if any, common rooms.. areas for students to hang out, play board games, ping pong, darts, tell jokes, b.s. and share common concerns. Or My point being, there should be multiple places (Besides sneaking into local clubs, or drinking Alone in your dorm) where kids can go..day or night. Organized events as well, aside from sports. As aforementioned, my son also found it very challenging and frustrating to contact a counselor through your service. When you do, the schedules are booked…… I have been heartbroken. Nonetheless, the consistent voice if encouragement. I want more from the school. I, like all others noted before me. More social emotional support. More access to social opportunities. More professors understanding and working with the challenges our children are struggling to navigate. In closing, it’s not just a BU crisis. I listen to very similar difficulties from many other University families…. PLEASE be more proactive. PLEASE care PLEASE help It is imperative and essential to a successful college experience and outcome. Thank you. And thank you all aforementioned
very very nice
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Original research article, covid-19: a source of stress and depression among university students and poor academic performance.
- 1 International Business School, Qingdao Huanghai University, Qingdao, China
- 2 Qingdao Municipal Center for Disease Control and Prevention, Qingdao, China
- 3 Faculty of Economics, Administrative and Social Sciences, Department of International Trade and Logistics, Nisantasi University, Istanbul, Turkey
Current research examines how COVID-19 has impacted the daily life of students, specifically personal and academic aspects. The authors investigated the role of academic and family stress caused by COVID-19 on students' depression levels and the subsequent impact on their academic performance based on Lazarus' cognitive appraisal theory of stress. The non-probability convenience sampling technique has been used to collect data from undergraduate and postgraduate students using a modified questionnaire with a five-point Likert scale. This study used structural equation modeling to examine the link between stress, depression, and academic performance during COVID-19. It was confirmed that educational and family stress significantly leads to depression among students, negatively affecting their academic performance and learning outcomes. This research provides valuable information to parents, educators, and other stakeholders concerned about their children's education and performance.
Introduction
The outbreak of coronavirus diseases (COVID-19) has had a significant impact on the lives of people worldwide ( 1 ), particularly since the World Health Organization (WHO) declared a global pandemic ( 2 ) in the second week of March 2020. As a result, many countries implemented various anti-epidemic measures, including limiting foreign nationals' travel ( 1 ), closing public spaces, and shutting down the entire transit system ( 2 ) to contain the spread of highly contagious infections from human to human. The education sector is not immune to the fact that the conventional educational system is no longer effective, and academic institutions worldwide are exploring online education alternatives ( 3 ). This is because all educational institutions worldwide have been closed due to lockdowns, and the students cannot meet their teachers in person. COVID-19 is one of the most stressful pandemics that humanity has ever experienced. It has drastically disrupted people's daily routines and negatively affects their physical and mental ( 1 ). The impact of such incidents on students' psychological health is rarely investigated, and in Pakistan, inadequate information exists on it ( 4 ). Xiong et al. ( 2 ) published pioneering research on the general population in Italy, Turkey, Iran, Spain, Nepal, and the United States. The pandemic, it was declared, affects young and older people differently ( 5 ). As a result, it was determined that sociodemographic predictors of mental distress in students and their level of satisfaction with the continuous blended learning mode were necessary.
On February 26, 2020, the first case of COVID-19 was reported in Pakistan ( 6 ). As of March 20th, 2021, over 623,135 confirmed cases. To curb and contain the virus, the government instructed educational institutions to shut down their operations on March 13th, 2020. Following this, on March 23rd, 2020, a 14 days lockdown was enforced in which all unnecessary activities in daily life were prohibited ( 7 ). As with China and Italy, the nationwide smart lockdown began on March 27, 2020, later phased out ( 8 ). The goal of the activity restrictions was to save lives by preventing viral transmission, reducing its incidence, and alleviating the burden on the medical care system ( 9 ). School closures in response to pandemics such as the flu have remained a successful strategy for lowering virus transmission rates and flattening disease incidence peaks ( 9 , 10 ). This strategy appeared to be quite effective because it minimized student-student contact and protected students from infection ( 11 ). On the other hand, it impacted students and the general public ( 9 , 12 ). Wang et al. reported that restricted routine activities and self-isolation had a significant psychological impact on people ( 13 ). Recently, it was discovered that the COVID-19 pandemic is causing psychological distress in some people ( 14 , 15 ).
One of the essential pillars of any nation's development is its higher education system ( 16 ). HEIs' success is mainly dependent on the success of their students, who are the primary stakeholders ( 17 ). Having the necessary skills and abilities to compete in today's rapidly changing industrial environment is essential for students to succeed ( 18 ). In today's intensely competitive academic climate, various factors play a significant role in how well students perform academically ( 19 , 20 ). According to Aafreen, Priya, and Gayathri ( 17 ), academic life is stressful for students because of the constant pressure from various sources. In numerous countries, university and school closures have impacted young people's mental health, increasing anxiety and loneliness ( 21 ). Based on findings from previous studies conducted during pandemics, the WHO recognized that imposing measures such as social isolation may increase individuals' anxiety, stress, and anger ( 22 , 23 ). Stress is frequently felt due to a threat to psychological, intellectual, or somatic wellbeing ( 24 , 25 ). Any form of change that creates emotional, physical, or psychological distress is called stress. Sometimes, it also promotes deviant behavior ( 23 ). It is an individual body's reaction to anything that demands attention or action. To some extent, everyone experiences stress. Individual morale suffers greatly when they are subjected to much stress ( 23 ). It manifests when a person cannot control their inner and outer emotions. Stress can harm an individual's mental health if it persists for an extended period or reaches a certain level ( 26 ). Suicidal thoughts and unhappiness are common symptoms of depression, affecting people worldwide ( 27 , 28 ).
Similarly, depression harms one's energy, ability to focus, and ability to make career decisions ( 29 ). To build an educated society, students are essential. When students are depressed, their academic performance suffers, significantly impacting their lives. Possible reasons are family problems, new lifestyles in colleges and universities, and poor academic grades. Stress and academic pressure can also be significant factors in developing depression ( 30 ). Home quarantine, a lack of physical activity, uncertainty about the pandemic's trajectory, a lack of information, and fear of contracting COVID-19 were identified as risk factors for poor mental health among university students in Bangladesh ( 31 ). Moreover, fear of infection and a perceived high risk of infection were identified as factors affecting the mental health of university students in China ( 23 , 31 ).
Multiple studies have investigated and confirmed that COVID-19 has increased stress and depression level in society. Some researchers investigated it from an organizational perspective, while some studied it from a family relationship perspective. However, the literature review indicates that rare attention is paid to this phenomenon from students' academic and family stress perspectives. Lazarus's theory, which focuses on a person's relationship to their environment, is used in this study to examine the impact of stress on a student's level of depression in the current pandemic period. It is also discussed how stress and depression impact students' academic performance. There are preliminary studies that examine the impact of stress on students' depression levels and academic performance during the COVID-19 pandemic, particularly in Pakistan, where the study was conducted ( 32 ). Apart from that, this study is unique. It examines the relationship between the variables listed using a multivariate statistical technique followed by structural equation modeling (SEM) and examines the stress by incorporating family and academic aspects.
Theory and Literature
In 1966, a psychologist named Richard Lazarus published Psychological Stress and Coping, which pioneered the concept of cognitive appraisal theory ( 33 ). Appraisal and coping are central concepts in any theory of psychological stress, according to this theory ( 34 ), and there is a strong connection between the two. The theory holds that stress is caused by a discrepancy between the demands placed on individuals and their capacity to cope with those demands ( 35 ). As a result of the recent adaptation, stress is not defined as a specific cause of incitement or as an individual's psychological, behavioral, or subjective reaction. Instead, it is viewed as a relationship between a person and their surrounding circumstances ( 36 ). People see the environment as essential to their wellbeing, and they try to deal with the overwhelming demands and challenges that come with living in modern society ( 37 ).
The cognitive appraisal model is predicated on the notion that one's expectations about the significance and outcome of an event, encounter, or function affect stress and other emotional processes ( 35 ). This explains why different people's reactions to the same environment elicit different levels of intensity, duration, and quality of emotion ( 15 ). Primary and secondary appraisals can be influenced by a wide range of factors (such as goals and values), and specific patterns can lead to different types of stress ( 38 ). Stress can cause a variety of mental and physical reactions in other people. According to Semedo et al. ( 39 ), individuals may experience stress due to the external environment or subjective feelings, resulting in mental health issues like anxiety and depression. Stress can have adverse effects on one's health ( 40 ). Due to the high-stress levels, students' learning outcomes have been adversely affected ( 26 ). Stress can be dealt with in a variety of ways. Identifying the root causes of stress can lead to terms like family stress and academic stress, among others.
Academic Stress and Students' Depression Levels
Adults' mental health is generally thought to improve, and depression disorder decreases between 18 and 25 years. On the other hand, high rates of depression are becoming more common ( 41 ), and many university students are testing above the clinical cut-off points for severe depression in this particular screen ( 42 ). According to Aafreen, Priya, and Gayathri ( 43 ), 30 percent of high school students suffer from depression in various ways. As a result, many recent high school graduates face an increased risk of developing depression upon entering college ( 44 ). Students' stress levels rise as they progress through the educational system. This is due in part to increasingly difficult coursework, tighter deadlines on assignments, and issues with finding housing for students who have relocated from other cities. Students' university experiences may also play a role in developing depressive symptoms. Subjective and objective experiences are closely linked to depressive disorders. The stress that comes with being a student at a university contributes to the wide range of depressive experiences that students have.
In a survey of students from Canadian universities, 42.3% of respondents said they had experienced severe anxiety and stress ( 45 ). Furthermore, 58.1% of students said academic projects are too complex to handle. The majority of Germans, Bulgarians, and Poles view assignments as a burden that cannot be compared to other concerns in life ( 41 ). Multiple studies on university students' stress have found a relationship between their educational needs and demands and depression disorder and apparent anxiety. Lörz et al. ( 46 ) found that even after controlling for 13 different risk factors for depression in a cross-sectional study of 900 Canadian university students, stress experienced as a result of academic workload was associated with high levels of negative symptoms (e.g., demographic features, abusive past, intellectual way, and personality, currently experienced stressful trials in life, societal support). Few studies have shown that students who complain about their academic workload or label it “traumatic” are more likely to suffer from depressive disorders ( 30 ).
In the current pandemic period, students are advised to consider all of the potential sources of stress before enrolling in college. The pandemic has created a sense of fear among students in ety. Thus, it is claimed that academic pressure created during the pandemic situation causes depression among students (see Figure 1 ). For this reason, the following hypothesis is proposed;
Figure 1 . Conceptual model.
H 1 : Academic stress among students in the period of COVID-19 significantly generates depression among students.
Family Stress and Students' Depression Levels
Topuzoglu et al. ( 47 ) found that from 3 to 16.9% of the world's population suffers from depression. University students are more likely than the general population to experience depression. One-third of students (a subjective mean occurrence of 30.6%), as per Mirza et al.'s ( 48 ) study, report experiencing stress and depression, which indicates a 9% higher rate of depression among students than the general population ( 49 ). When depression sets in, a person's ability to lead an everyday, healthy life is severely impacted. Affecting students' social and family ties, academic performance, and physical wellbeing are just some of the possible outcomes of this problem. As a result, their abilities deteriorate, and they lose the desire to learn new things, which leads to subpar work and even university dropouts ( 50 , 51 ). Depression is a significant risk factor for university students to commit suicide, so it is imperative to identify the factors that can cause students to become depressed.
In China, 75% of students who graduate from middle school are allowed to continue their education in a 4-year university. For every 10% increase in the number of students pursuing higher education, the rate of depression rises by 24–38% ( 52 ). University students are typically between the ages of 18 and 23, or in other words, in their late teens and early twenties. University students are referred to as “post-adolescents”. Risk factors for adolescent depression are numerous and complex, involving a wide range of personal and family characteristics and educational and social circumstances ( 16 ). Relationship building with one's family is one of the most important aspects of overcoming depression because it has a significant impact on the growth and development of one's children ( 53 ). According to Halonen et al. ( 54 ), adolescent depression is influenced by factors such as family bonding. Depressed teenagers are more likely to have strained relationships with their parents than their peers who are not depressed.
Both soft and hard risks can affect a family's health ( 55 ). Parents with little or no education are among the most challenging families to work with because of their weak family structure (economically). Depressed students are more likely to have several risk factors, including high-risk students ( 50 ). They have low self-esteem and cannot deal with emotional breakdowns, and students who come from families where they feel safe and secure ( 56 ). University students born into educated families, especially mothers with a college degree or higher, are less likely to suffer from depression than those born into families with little or no education. A second reason is that children born to college-educated mothers are less likely to suffer from depression than children of less-educated mothers ( 57 ).
While studying depression in teenagers, it is also essential to consider one's social circle ( 53 ). The traditional Pakistani culture emphasizes family ties, sensitive feelings, collectivism, and peace. Students who live in hostels or share a room with other students lose this family inspiration when they are adolescents. Depression is a real possibility if this process goes unchecked ( 58 ). It's not uncommon for Pakistani university students to worry about finding a job after graduation. They must maintain a high-grade point average (GPA) throughout their academic career if they hope to land an excellent job in the future. Aside from the pressures of school and work, they have to deal with a myriad of other issues that they must deal with on their own. In the pandemic period, students are also experiencing stress in their family life. It is claimed that this stress in the COVID-19 perspective creates depression among students. Thus, the following hypothesis is proposed;
H2 : Family stress among students in the period of COVID-19 significantly generates depression among students.
Students' Depression Levels and Students' Academic Performance
Many people who attend college represent the transition from adolescence to adulthood, generally regarded as the most stressful period of one's life ( 26 ). Students' mental health may be jeopardized if stress from exams and shifting social circles is added to the mix. One-third of students suffer from moderate to severe depression throughout their college careers ( 56 ). For depressed, attainable-focused environments (e.g., colleges and universities) can lead to lower grades and a lack of self-confidence because they believe the world is unfair and have no control over their destiny. They are unsure of their future path in life. As a result, students with low self-esteem are reluctant to take on challenging assignments and projects, harming their educational careers ( 59 ).
Mental and physical processes and benightedness can be found in symptoms such as poor sleep schedule, lack of concentration, and a state of remorse that can be seen in people with depression ( 60 ). However, despite many students suffering from depression and the flawed educational system, rare studies have examined the impact of depression on academic performance, particularly in COVID-19 in the emerging economies, specifically Pakistan. Students who are emotionally stable and financially secure are more likely to perform poorly on exams. Their academic career suffers significantly due to their low self-esteem and depression ( 59 ). Depressed students are more likely to skip classes, tests, and assignments. They are more likely to drop out of college than their non-depressed peers if they find their classes too complicated ( 26 ). Depressed students are prone to becoming ruthless, harming their academic performance and making them moody.
Anxiety and academic performance have been shown to have an even more ambiguous relationship than previously thought. Comprehensive studies have found that students' performance improves with increased anxiety ( 53 ). On the other hand, a few studies have found that anxiety does not appear to be correlated with lower academic performance ( 61 ). A higher level of anxiety can help students perform better in school. Even though there is a high incidence of depression among the students, their GPA is unaffected. This study is intended to find a more specific and straightforward answer to the shared relationship between students' depression levels and academic performance based on given differences in various research findings, particularly in the COVID-19 scenario. Based on the given arguments, the researcher formulates the following hypothesis:
H3 : Depression among students during the COVID-19 period has a significant negative effect on their academic performance.
Methodology
Target population and sampling procedure.
Male and female students in higher education institutions focus on this study. Students from management sciences, engineering, and computer science departments participated and provided the researchers with their responses. The non-probability sampling technique has been used in this study, and students were given a survey to complete and asked to provide their thoughts on it on their own using a five-point Likert scale. Items for the study were taken from Maajida Aafreen et al.'s ( 43 ) study and were partially modified. The data were collected from February to May 2021. There were 721 questionnaires given out to the students, and 186 of those responses were useful. There were 118 female respondents, 65 male respondents, and one person who preferred not to disclose their gender.
Data Analysis and Results
The structural equation modeling (SEM) method investigated the link between stress, depression, and academic performance. Before SEM, confirmatory factor analysis (CFA) was performed to confirm the relationship between the elements of the manifest factors and their measuring model. CFA ensures that the measurement model is legitimate and unidimensional. The Cronbach's alpha value was examined to ensure data reliability, which presented a 0.889 value confirming the reliability of data (minimum suggested value as is 0.6). Because of this, it can be concluded that this measurement model has a high degree of accuracy. In terms of psychological legitimacy, factor loading can determine the ideal loading for established items.
Similarly, the minimum value of the average variance extracted (AVE) for all results should be >0.5, which were found ideally fitted with the required value. Based on these, empirical tests were carried out to ensure that all constructs were distinct from one another. According to Fornell and Larcker ( 62 ), variance in results should be more significant than other constructs to make this claim. AVE square root values are correlated more strongly than different AVE values. To be safe, a correlation of no more than 0.9 was recommended by Hair et al. ( 63 ). Hair et al. ( 63 ) and Fornell and Larcker ( 62 ) suggested that the constructs have adequate discriminant validity by demonstrating that both conditions were met. The analysis of structural and measurement models indicated significant results. The authors examined different fit indices for structural and measurement models, such as chi-square to degree of freedom, normative fit index, goodness of fit index, comparative fit index, etc. According to Bagozzi and Yi ( 64 ) the value of fit indices should be higher than 0.9. Table 1 represents the list of fit indices with the suggested and obtained values of measurement and structural models.
Table 1 . Evaluating the Structural and measurement models.
Testing of Hypotheses and Discussion
This study examines the relationship between stress and depression and their impact on students' academic performance during the COVID-19 pandemic. Specifically, the authors focused on students in higher education institutions. They analyzed how the family and academic stress during the COVID-19 pandemic has emerged and how these elements impact students' academic performance. The hypotheses are examined using the SEM technique and are supported by structural parameters. According to the findings, students' academic stress promotes depression with a beta value of 0.298 and a p -value of 0.003. The results suggest that students' depression levels are positively impacted by prolonged academic stress, specifically in COVID-19. Thus, the first hypothesis, i.e., academic stress among students in the period of COVID-19 significantly generates depression among students, is accepted.
Family stress also appears to have a significant source of depression among students with 0.321 beta and 0.002 p -values, respectively. Thus, the second hypothesis, i.e., family stress among students in COVID-19, significantly generates depression, is also accepted. Similarly, the student's academic performance is negatively linked with the student's level of stress and depression. The structural analysis indicated that academic performance is negatively related to students' depression with a −0.332 beta value and 0.001 p -values. This means that the more depressed a student is, the more their academic performance will suffer. Thus, the third hypothesis, i.e., Depression among students during the COVID-19 period has a significant negative effect on their academic performance, is also accepted.
The results of this study provide university institutions with new opportunities to support students' psychological wellbeing and the conditions necessary to support it. There is a lack of support services for students' emotional wellbeing in higher education institutions, particularly in the COVID-19 pandemic. The psychological needs of these students are given little consideration, which is accelerating the stress and depression levels among students. Proper counseling, guidance from teachers, and family support can help alleviate stress and depression. Students should have access to stress and depression counseling services in their schools. Counselors have a responsibility to model and enforce good conduct and sound judgment in their students. Creating a positive and safe learning environment is the responsibility of school administrators. Teachers should also take responsibility for helping and guiding students who are depressed, as this will help them learn and perform better. The ability to rely on one's family for support is another critical factor in coping with stressful situations.
Limitations exist in the current research as well. Researchers collected information from university students in Pakistan. More research will be needed in the surrounding areas to understand better how stress and depression affect university students' academic performance. For this reason, researchers should expand their geographic scope to include other regions. The outcomes of large-scale studies may be inconsistent. Further research will be needed to determine the impact of anxiety and depression on students' academic performance in the future. Futhre studies are also recommended to include different control variables, such as age, gender, study discipline, etc., to examine whether these factors make any difference in the main result or not.
The pandemic has created a social disorder in society, and all industries are affected by it. The academic sector is also primarily influenced by it. This is among the pioneer studies that examine the relationship between students' academic and family stress and their effect on their depression level, leading to academic performance, specifically in the period of the COVID-19 pandemic. It is found that education and family stress in the period of the COVID-19 pandemic has a hugely significant adverse effect on students' personalities. It is a substantial source of depression among students from their academic and family perspective and ultimately negatively affect their academic performance. All related stakeholders should take initiatives to counter this issue by counseling students to tackle this future generation's problem.
Data Availability Statement
Publicly available datasets were analyzed in this study. This data can be found here: https://data.worldbank.org/ .
Author Contributions
ZJ and XJ: conceptualization, software, data curation, and writing—original draft preparation. RT: methodology, writing—reviewing, and editing. HD: visualization and investigation. All authors contributed to the article and approved the submitted version.
This study was supported by Research Project of Shandong Provincial Department (Item Number Z2021290) and Education and Teaching Research Project of Shandong Province (Item Number 2021JXY053).
Conflict of Interest
The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.
Publisher's Note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.
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Keywords: academic stress, family stress, student learning, academic performance, COVID-19
Citation: Jiang Z, Jia X, Tao R and Dördüncü H (2022) COVID-19: A Source of Stress and Depression Among University Students and Poor Academic Performance. Front. Public Health 10:898556. doi: 10.3389/fpubh.2022.898556
Received: 17 March 2022; Accepted: 25 March 2022; Published: 25 April 2022.
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Copyright © 2022 Jiang, Jia, Tao and Dördüncü. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
*Correspondence: Ran Tao, taotao0212@163.com
This article is part of the Research Topic
The Effect of Business Cycles on Population Health in the Emerging Economies, Volume III
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- Published: 28 July 2020
Prevalence and associated factors of depression among Jimma University students. A cross-sectional study
- Gutema Ahmed 1 ,
- Alemayehu Negash 1 ,
- Habtamu Kerebih 2 ,
- Daniel Alemu 3 &
- Yonas Tesfaye ORCID: orcid.org/0000-0002-6707-9900 1
International Journal of Mental Health Systems volume 14 , Article number: 52 ( 2020 ) Cite this article
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Depression is a common health problem among university students. It is debilitating and has a detrimental impact on students psychosocial, emotional, interpersonal functioning and academic performance, However, there is a scarcity of information on this regard in higher education institutions in Ethiopia, so the current study was conducted to assess the prevalence of depression and its associated factors among Jimma University students.
An institution-based quantitative cross-sectional study was conducted on a total of 556 sampled students selected by a multistage stratified sampling technique. Beck Depression Inventory (BDI-II) was used to screen depression severity. Data was collected through a pretested, structured, and self-administered questionnaire. The collected data were checked manually for completeness and entered into Epidata manager Version 2.0.8.56 data entry software then exported to SPSS version 20 Statistical software for analysis. The obtained data were described using descriptive statistics as well as logistic regression analysis was done to determine the independent predictors of the outcome variable. First bivariate analysis was done and variables significant at p value ≤ 0.25 were entered into a multivariate logistic regression analysis to control for confounders. The significance of association was determined at a 95% confidence interval and p-value < 0.05.
The prevalence of depression among the students was 28.2%. Having a mentally ill family member (OR = 2.307, 95%CI 1.055–5.049), being from the college of Social science and humanity (OR = 2.582, 95%CI 1.332–5.008), having sex after drinking (OR = 3.722, 95%CI 1.818–7.619), being hit by sexual partner (OR = 3.132, 95%CI 1.561–6.283), having childhood emotional abuse (OR = 2.167, 95%CI 1.169–4.017), having monthly pocket money between 500-999 ETB (OR = 0.450, 95% CI 0.204–0.995), and promoted academic performance (OR = 2.912, 95% CI 1.063–7.975) were significantly associated with depression.
The prevalence of depression among Jimma University students was high and positively associated with being from the college of social science and humanity, history of a hit by a sexual partner, having a mentally ill family member, having more monthly pocket money, promoted academic performance, having sex after drinking and childhood emotional abuse. Therefore, establishing depression screening services on the campus and designing proper mental health intervention programs is recommended to tackle the problem.
Background of the study
Depression is a common and severe mental disorder [ 1 , 2 ] caused by the combinations of genetic [ 2 , 3 ], social, psychological and environmental factors [ 1 , 3 ]. Globally the prevalence of depression is increasing at an alarming rate [ 2 , 3 ]. Depressive disorders are the most pressing public health problems associated with substantial impairment, comorbidity, poor quality of life, and high mortality [ 1 , 3 ]. It affects economic activity [ 3 , 4 ], learning, social [ 5 , 6 ], cultural life [ 3 , 7 ] and people’s ability to participate in their communities [ 2 , 4 ]. Depression also poses a risk of suicide and suicide attempts [ 1 , 2 , 4 , 8 , 9 ] in young adults.
University students are a special segment of the society at a specific developmental milestone that bridges a critical transitory period from adolescence to adulthood [ 10 ]. This transitional period embraces a very important process like endocrine surge, emotional turmoil, and identity development which can lead to crises, which include self-doubt, social withdrawal, loneliness, lowered self-esteem [ 10 , 11 , 12 ]. University students are challenged by geographic changes [ 10 ], separated from family members [ 6 , 10 , 13 ], academic stress [ 10 , 13 , 14 , 15 , 16 ], alongside financial difficulties urging the student to develop new coping mechanisms [ 8 , 11 , 17 ]. Therefore, University students worldwide are at higher risk to develop mental health disorders particularly to depression [ 14 , 18 ], and suffer from its impact [ 19 ].
Various studies across the globe showed the prevalence of depression among university students varied, as low as 4% [ 20 ] and as high as 79.2% [ 21 ]. A systematic review of 35 studies conducted among university students in Iran from 1995 to 2012 showed that the prevalence of depression was 33% [ 22 ]. Different American countries had the prevalence of depression range between 33% and 41% [ 6 , 23 , 24 ]. The report on different European countries stated that the prevalence of depression ranges between 6.1% and 34.2% [ 5 , 8 , 25 ]. The study done in different Asian countries reported that the prevalence of depression ranges between 4% and 79.2% [ 14 , 18 , 20 , 22 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 ]. The study conducted in African Universities showed that the prevalence of depression ranges between 16.2% and 67% [ 13 , 36 , 37 , 38 , 39 , 40 , 41 ]. In Ethiopia, the prevalence of depression among students is between 29.1% and 32.2% [ 9 , 42 ].
Depression among university students is significantly associated positively and negatively with marital status [ 22 ], sex and gender [ 11 , 12 , 13 , 23 , 26 , 32 , 38 , 42 , 43 ], age [ 13 , 20 , 25 , 33 , 38 ], family problems [ 5 , 7 , 13 , 14 , 20 , 25 , 29 , 37 ], parental education [ 5 , 13 , 20 ], social support [ 25 ], family history of mental illness [ 5 , 14 , 40 ], financial struggles [ 11 , 17 , 20 , 25 , 29 , 38 ], academic achievement [ 6 , 13 ], field of study [ 44 ], year of study [ 20 , 25 , 29 , 32 , 36 , 40 , 42 ], type of college [ 13 ], satisfaction of major study [ 5 , 20 , 25 , 32 ], substance use (alcohol, tobacco and khat) [ 13 , 14 , 29 , 37 , 39 , 40 , 42 , 45 ], risky sexual behaviour [ 37 , 39 ], physical abuse [ 39 ], child abuse [ 39 , 40 ], forced sexual experience [ 37 , 39 ], sexual partner abuse [ 37 ] and background residence [ 8 , 46 ]. As a result of depression, students missed greater number of classes, assignments, exams and even forced to dropout from the University [ 4 , 6 , 13 , 15 ].
Persistent ignorance and misperceptions of the disease lead to painful stigmatization and avoidance of the diagnosis by many of those affected [ 33 ]. Having this high prevalence of depression among students; help and treatment-seeking behavior is very low [ 47 , 48 ]. Therefore establishing proper screening and intervention programs [ 18 , 29 , 49 ] and educating the students through stress management programs and counseling them in the University is recommended for the overall reduction of mental illness [ 14 , 32 , 36 , 50 ].
Social support has been shown to promote mental health and acts as a buffer against stressful life events [ 51 ]. A lack of social support is a determinant of mental health problems including depressive symptoms among university students [ 52 , 53 ]. Research evidence indicates a significant negative relationship between social support and psychological disorders including depression and stress [ 52 , 54 , 55 ].
There is a scarcity of studies on the prevalence of depression and its predictors in the Ethiopian university students, moreover, depression was reported merged with other disorders and, limited variables were addressed in the previous studies. Therefore, studying depression on university students is vital to investigate the problem thoroughly and come up with important recommendations. Furthermore, the findings of this study will be fundamental for the University administrators and other stakeholders to screen and provide mental health services on the campus and further help interested researchers in the topic area to conduct additional studies on different study designs.
Method and materials
Study setting, design, population, and sampling technique.
The study was conducted in Jimma University main campus from April 5 to 20, 2016. An institution-based quantitative cross-sectional study was conducted among 556 regular undergraduate main campus students of Jimma University. A multistage stratified sampling technique was used to select the study participants. All colleges in Jimma University’s main campus were included and stratification was done on the department level and year of the study. A total of four colleges and 30 departments were found on the main campus. Eleven departments were selected randomly by the lottery method. Each respondent was selected by simple random sampling technique using the enrollment registry as a frame. A total of 6155 regular undergraduate students found on the main campus in 2016.
Sample size estimation
The sample size was estimated using a single population proportion formula; \(\text{n = }\,\left( {{z\alpha }\,\text{ / }\,\text{2}} \right)^{\text{2}} \,\text{P}\,\left( {{1 - p}} \right)\,\text{ / }\,\text{d}^{\text{2}}\) considering, n; Sample size, z; critical value 1.96, α/2; confidence level, P; prevalence of depression at Hawassa college students = 23.6% [ 56 ], d; margin of error = 0.05 (5%). Accordingly, it becomes 277. Since the total population was less than ten thousand finite population correction formula was used to get the desired sample size, \(\text{nf}\,\text{ = }\,\text{n}\,\text{ / }\,\left( {\text{1}\,\text{ + }\,\text{n}\,\text{ / }\,\text{N}} \right)\) ; where nf is the final sample size, n; the calculated sample size (277) and N; the total population(6155), hence it becomes 266. Since the sampling was multistage, the calculated sample size was multiplied by two for design effect and a 10% non-response rate was added to get the final sample size of 586.
Data collection procedure and tools
A self-administered structured questionnaire was used to collect the data. The Questionnaire consisted of socio-demographic, economic, social, and environmental variables. The tool was developed after an extensive review of the literature on the topic area. Beck Depression Inventory (BDI-II) was used to screen the presence and the severity of depressive symptoms. The 21-item was scored on a scale of 0–3 in a list of four statements arranged in increasing severity about a particular symptom of depression. The total score ranges from 0 to 63. BDI scores of 14 or higher were categorized as the presence of depression for logistic regression analysis [ 20 ]. According to BDI-II: a score of 0 to 4 is (Normal), 5 to 13 is (Borderline clinical depression), 14 to 19 is (Mild depression), 20 to 28 is (Moderate depression), and 29 to 63 is (Severe depression) [ 7 , 13 , 20 ]. The internal consistency (Cronbach’s α) of the Beck Depression Inventory was ranging from 0.75–0.88 across different studies [ 11 , 20 , 35 , 57 ], in this study the internal consistency was high (Cronbach’s α = 0.897). The level of Social support of the respondents was measured by Oslo 3-items social support scale. The tool was validated and has been used in previous studies in Ethiopia [ 58 , 59 , 60 ]. In this study, the tool had Cronbach’s α score of 0.91. A score of 3–8 indicates poor support, 9–11 is moderate support and 12–14 is strong support. Substance use was measured by the current user (A person who used any of the substances at least once in the past 30 days) and lifetime user (use of any of the substances at least once in an individual’s lifetime) [ 61 ].
The questionnaire was translated to the local languages (Amharic and Afaan Oromo) and back-translated to English to check its consistency, additionally, consensus version was developed in group discussions by involving different research experts of the field, this was compared with the original version and confirmed to be good for use by consultant mental health experts. Moreover, the face validity test was performed by three independent experts in the field. The questionnaire was pre-tested on 28 students to check the impending problems of the actual data collection. Finally, the Amharic and Afan Oromo version of the questionnaire was used to collect the data. The self-administered questionnaire was later collected from the respondents by the data collection facilitator after checking the completeness of the information.
Data processing and analysis
The collected data were cleaned, coded, and entered into Epidata manager Version 2.0.8.56 data entry software and analyzed using SPSS version 20 data analysis software. Descriptive statistics (mean, percentage, frequencies, and standard deviation) were done to summarize the dependent and independent variables. Bivariate logistic regression analysis was done to see the association of each independent variable with the outcome variable. Accordingly, variables with p-value ≤ 0.25 were entered into a multivariate logistic regression to control the confounder. Finally, a p-value of less than 0.05 was considered statistically significant association, and the adjusted odds ratio with 95% CI was calculated to determine the strength of association.
Data quality management
Regular supervision was made by the data collection supervisor to ensure that all necessary data were properly collected. Each day of data collection, the filled questioners were cheeked manually first for completeness and consistency then the collected data were processed timely and enter from a paper onto the computer twice. When incomplete questionnaires found the data collection supervisors kindly asked the respondents to fill the missed information, if the respondents were not willing to fill the missed information, the questionnaire was discarded from the analysis for gross incompleteness.
Ethical approval and consent to participate
The study protocol was approved by the Institutional Review Board of Jimma University, Institute of Health. Written informed consent was obtained from each study participant. The involvement of the study participants was voluntarily and participants were informed of the right to withdraw anytime from the study. The data collection was undertaken confidentially and responses were kept private and anonymous. The study was conducted as per the Helsinki declaration.
Socio-demographic, economic, academic and health status characteristics of the respondents
A total of 556 respondents participated in the study giving a response rate of 94.9%. From the total respondents, the majority were male 64.7% (n = 360). The mean age of the respondents was 21.21(SD = ± 1.99 years) with minimum and maximum age to be 18 and 35 years, respectively. Majority of the participants were Oromo, Orthodox Christians and single, 59% (n = 328), 37.8% (n = 210) and 86.0% (n = 478) respectively. Most of the participants 43.2%(n = 240) were from the College of Health Sciences and 32.7% (n = 182) were first-year students. The majority of 39.4% (n = 219) respondents earned monthly pocket money between 300–499 ETB. About 42.4% (n = 236) of the respondent has moderate social support. Among the respondents, 59.2% (n = 329) and 51.3% (n = 285) of students had academic work overload and overburdened by test schedules respectively. According to the participant’s response, 6.7% (n = 37) and 8.5% (n = 47) of the participant had a chronic physical illness and family members with mental illness respectively. Table 1 .
Substance use, risky sexual behavior, and negative life events characteristics of the respondents
This study revealed that 66% (n = 78) of the respondents currently chew khat and 24.2% (n = 51) were drinking alcohol over the last 30 days. Similarly, 44.4% (n = 12) of the respondents had smoked cigarettes and 15.5% (n = 9) of the respondents smoked shisha in the past 30 days. Furthermore, about 28.6% (n = 12) of the participants reported the use of Ganja in the past month. Table 2 .
Prevalence of depression
Nearly one-third 28.2%, (n = 157) of the participants had depression. A total of 40.6% (n = 226) of the participants were free from depression (Normal), 31.1% (n = 173) had borderline clinical depression, 14.4% (n = 80) had mild depression, 9.9% (n = 55) had moderate depression and 4% (n = 22) had severe depression.
Factors associated with depression
Bivariate logistic regression analysis showed, being single, having a poor parental relationship, chronic physical illness, family history of mental illness, having sex after drinking, being hit by a sexual partner, being forced to have sex, having childhood physical, emotional and sexual abuse, witnessing parental violence, earning 500–999ETB pocket money and academically promoted status were associated with depression. Multicollinearity and Lemeshow-Hosmer test of model fitness tests were done before the final model. Finally, multivariate logistic regression analysis revealed a family history of mental illness, college type, being hit by a sexual partner; childhood emotional abuse, academic performance, pocket money, and sex after drinking had a significant association with depression.
Accordingly, the odds of having depression were nearly two and a half fold higher (OR = 2.307, 95% CI 1.055–5.049) among students who had a family member with mental illness as compared to their counterparts. Similarly, the odds of having depression were nearly two and a half fold higher (OR = 2.582, 95% CI 1.332–5.008) among students who were from the college of Social science and humanity than students from the college of law and governance. Additionally, the odds of having depression were approximately four times more likely (OR = 3.722, 95% CI 1.818–7.619) in the students who had sex after drinking alcohol than their counterparts. Students who have been hit by sexual partners were three times (OR = 3.132, 95%CI 1.561–6.283) more likely to develop depression than students who had no such events. Likewise, students who reported childhood emotional abuse were two times more likely (OR = 2.167, 95%CI 1.169–4.017) to report depression than their counterparts. Furthermore, students who have reported getting monthly pocket money between 500 and 999(ETB) had a 55% low risk of having depression (OR = 0.450, 95%CI 0.204–0.995) than students with pocket money greater than 1000(ETB). Finally, the odds of having depression among students with promoted academic status were three-fold higher than students who have passed with great distinction academic status (OR = 2.912, 95%CI 1.063–7.975). Table 3 .
The finding of this study showed that the prevalence of depression among Jimma university regular undergraduate students was 28.2% ± 3.74 (95% CI 24.46%–31.94%). This figure is largely falling within the prevalence rates reported across different studies in a similar study population. The finding was similar to the studies carried out in Addis Ababa 27.7% [ 62 ], Hawassa 30% [ 63 ], and Ambo 32.2% [ 42 ] university students. But the current study finding was higher than the study done in Adama 21.6% University [ 64 ]. The difference could be explained by the Adama study was used a lower sample size (413) and different assessment tools (SRQ-20). However, this study finding was lower than the study done in Jimma 58.4% [ 65 ] and Addis Ababa 51.3% [ 66 ]. The variation might be due to the difference in the data collection tool in which previous studies were used 10-item Kessler Psychological Distress Scale and Hospital anxiety and depression scale (HADS). The other reason might be the difference in study participant’s sociodemographic and economic characteristics like age, marital status, address, educational status, parent educational level, and family monthly income. In this study, the majority of the study participant’s parents don’t have advanced educational status, this may expose students with low parental educational status to have lower self-esteem and more pressure on their psychology [ 53 , 67 ]. Additionally, lack of free and open discussion about various stressful issues in the University, and sharing university life experiences might lead those students from low parental education status more vulnerable to depression [ 68 ]. Another difference could be the family’s monthly income. In this study the majority of the study respondent’s families had better income, this may lead students with better family monthly income less worried about the academic achievements, more indulged in substances, and risky practices, this may ultimately contribute to the prevalence of depression in the study setting.
In this study 31.1% of the respondents had borderline depression, 14.4% of the participants had mild depression, 9.9% had moderate depression and 4% had severe depression. A consistent finding was reported from the study done among Indian University students, that disclosed 37.7%, 13.1%, and 2.4% of the students were suffering from moderate, severe, and extremely severe depression [ 69 ], however this study finding was different from the study done in China, where 40.1% of the students were classified as minor depression (borderline), 8.4% as moderate and 3.3% as the severe depression [ 20 ]. The reason for the difference could be different cutoff points used for depression symptoms severity categorization between the two studies.
The results of this study showed that having a family history of mental illness is a significant predictor of depression. This is in line with the study done in India medical students, Newzeland, and Germany which showed an individual from family members with mental illness are more prone to develop depression [ 14 , 70 , 71 ]. This might be explained by the fact that mental illness has a genetic base, families are stigmatized and there is a lot of burden on the family members regarding financial expenses and giving care for the patient as well as the offsprings might be stressed and worried about their parent’s health condition, this might increase the risk of having depression [ 1 , 2 ].
This study also revealed that students from the college of social science and humanity had a higher depression rate than students from the college of law and governance. Consistent findings were reported from the study done in Egypt and India [ 13 , 69 ]. Although the reasons are not clear at the moment, it may be related to better job prospects for law graduates in the Ethiopian context. This issue requires the attention of the academic administration of the Humanities and Social Science departments of the university, hence special classes should be organized for the Humanities and Social Science students to make them psychologically more competent to develop skills and adopt effective strategies to manage stress and symptoms of depression. Another reason could be, in the current study students from the College of social science and humanity were reported more alcohol and other substance use, which might lead them to develop depression compared to students from the College of Law. Further qualitative and quantitative studies needed to elucidate this finding.
Risky sexual behavior like having sex after drinking was associated with depression in this study. Similar findings were reported from the studies done in Kenya [ 39 ] and Jimma University [ 72 ]. This might be explained by the fact that students who are abusing substances are more prone to develop depression. Moreover, participating in a risky sexual activity may prone the students to have guilt feeling and worry about acquiring STI including HIV/AIDS, which might lead to psychological distress mainly depression.
In the current study history of hit by a sexual partner and childhood emotional abuse were significant association with depression. Similar results were found from the studies conducted among Kenya university students and the USA [ 39 , 73 ]. This might be explained by people expect care and love from a sexual partner when this is not met they may be disappointed and dissatisfied which might lead them to have divorce and abuse substances [ 74 ]. Besides, child abuse might lead the individual to develop short term and longterm psychological damage and adopt behavioral risk factors such as smoking, alcohol abuse, poor diet, and lack of exercise which in turn lead to depression [ 75 ]. Moreover, emotionally abused children are more likely to be withdrawn and had a poor interaction with the family as well as the community this increases the risk of having depression in these groups [ 76 ].
In this study, academic performance and depression were found to have a strong association. Students who passed with promoted academic status were more prone to develop depression than students who passed with great distinction. A consistent findings were reported from the studies conducted in Saudi Arabia and Pakistan [ 13 , 77 ]. This could be explained by depression and poor academic performance has a bi-directional association. Various studies found that depression deteriorates cognitive functioning like memory, attention, concentration, abstract reasoning, and judgment which trigger the students to achieve poor academic activities. in another pole students with poor academic status will be tensioned, worried, and end up with substances for improving their concentration, which can ultimately lead them to have depression [ 26 , 78 ].
According to this study finding, depression is associated with monthly pocket money. Students who got low pocket money were less likely to develop depression compared to the students who received higher pocket money. It is known that most of the literature reports that having financial problems (struggles) leads students to develop stress and depression however this study finding is inconsistent with the study report from Egypt [ 38 ]. In Ethiopia University tuition fee(educational, dormitory and meal) will be paid after the students graduated and got Job, it is also well known that the majority of the students join from rural and poor families so, universities will be a better comfortable setting for many students, these students can get a free meal, better accommodation than home, this will make those students with low pocket money less stressed to have financial problems. But in opposite students with more monthly pocket money come from urban areas where substance use is more common compared to students from the rural area. Another reason could be students who get more monthly pocket money are less cared for in their academic achievements and enjoying the money, this commonly ends up with warning academic status, this might make the students stressed, abuse substance, hopeless, and could be a risk factor for depression. Further researches needed to elucidate the reasons.
This study has shown a high prevalence of depression among Jimma university students. Additionally, the study has revealed statistically significant association between depression and academic, socio-economic, abuse, substance use, risky sexual behavior and family mental health problem variables. Based on the findings, it is better if the Ethiopian Ministry of Education and Health work in collaboration with higher administrative bodies of the University to design mental health promotion and prevention strategies for the prevention of the new incidences of depression and to provide appropriate mental health treatment services for the affected students. Further longitudinal and qualitative studies are needed to understand the cause-effect relationship between the outome and associated variables.
Availability of data and materials
The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.
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Acknowledgements
Authors would like to thank Jimma University for financial support and the study participants for providing study information.
Jimma University has funded the study. Jimma University has no role in the design of the study and collection, analysis, and interpretation of data and in writing the manuscript.
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GA was the principal investigator of the study and was involved from inception to design acquisition of data, analysis, and interpretation, and drafting and editing of the manuscript. AN, HK, YT and DA were involved in the reviewing of the proposal, tool evaluation, data analysis and interpretation, and critical review of the draft manuscript. All authors read and approved the final manuscript.
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Ahmed, G., Negash, A., Kerebih, H. et al. Prevalence and associated factors of depression among Jimma University students. A cross-sectional study. Int J Ment Health Syst 14 , 52 (2020). https://doi.org/10.1186/s13033-020-00384-5
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