COMORBIDITY OF DEPRESSION AND ANXIETY AMONG STUDENTS AT THE KENYA MEDICAL TRAINING COLLEGES IN KENYA

Main Article Content

DR. JARED B. MENECHA
DR. SUSAN K. MURIUNGI

Abstract

Objectives: To determine comorbidity of depression and anxiety among students at the Kenya Medical Training College, Kenya


Methodology: This was a cross-sectional descriptive study design. Study participants were basic diploma students in a middle level college in Kenya. Data was collected using a researcher designed self-administered questionnaire for socio-demographic characteristics, the Beck Depression Inventory (BDI) for severity of depression and the Beck Anxiety Inventory (BAI) for the severity of anxiety in all the students in the seven largest KMTC campuses. All the participants gave informed consent.


Results: 18.4% and 20.2% of group A and B respectively had moderate depression while 48.5% and 45.8% respectively had severe depression. The equivalents for anxiety in groups A and B were 24.4% and 23.6% for moderate anxiety and 32.1% and 31.5% for severe anxiety. There was a higher rate of depression and anxiety in the
second year; with a statistically significant association between depression and anxiety and the year of study in the two groups (p<0.0001 each respectively). All the other social demographic characteristics had no statistically significant association with depression or anxiety in the two groups. There was a higher prevalence of depression and anxiety co-morbidity in both groups which was statistically significant (p<0.0001).


Conclusion: Depression and anxiety were highly prevalent and significantly co-existent among the KMTC students. These mental conditions seemed to vary with the level of study training among college students. Therefore, the psychological well-being of college students need to be carefully addressed. There is need to closely monitor anxiety and depression to eliminate the risk factors and consequently prevent the development of adverse outcomes.

Article Details

How to Cite
Menecha, J., & Muriungi, S. (2020). COMORBIDITY OF DEPRESSION AND ANXIETY AMONG STUDENTS AT THE KENYA MEDICAL TRAINING COLLEGES IN KENYA. Advances in Social Sciences Research Journal, 7(8), 360-370. https://doi.org/10.14738/assrj.78.7044
Section
Articles
Author Biography

DR. SUSAN K. MURIUNGI, DAYSTAR UNIVERSITY

SCHOOL OF HUMAN &SOCIAL SCIENCES, DEPARTMENT OF PSYCHOLOGY

References

References
1. Kessler, R. C., Gruber, M., Hettema, J. M., Hwang, I., Sampson, N., & Yonkers, K. A. (2008). Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up. Psychological medicine, 38(3), 365-374.
2. Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of internal medicine, 146(5), 317-325.
3. Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.
4. Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological medicine, 43(5), 897-910.
5. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-184.
6. Gulliver, A., Griffiths, K. M., Christensen, H., & Brewer, J. L. (2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC psychiatry, 12(1), 81.
7. Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621.
8. Kanner, A. M., Barry, J. J., Gilliam, F., Hermann, B., & Meador, K. J. (2010). Anxiety disorders, subsyndromic depressive episodes, and major depressive episodes: do they differ on their impact on the quality of life of patients with epilepsy?. Epilepsia, 51(7), 1152-1158.
9. Gupta, S., Choudhury, S., Das, M., Mondol, A., & Pradhan, R. (2015). Factors causing stress among students of a Medical College in Kolkata, India. Education for Health, 28(1), 92.
10. Pulido‐Martos, M., Augusto‐Landa, J. M., & Lopez‐Zafra, E. (2012). Sources of stress in nursing students: a systematic review of quantitative studies. International Nursing Review, 59(1), 15-25.
11. Cokley, K., McClain, S., Enciso, A., & Martinez, M. (2013). An examination of the impact of minority status stress and impostor feelings on the mental health of diverse ethnic minority college students. Journal of Multicultural Counseling and Development, 41(2), 82-95.
12. Shah, M., Hasan, S., Malik, S., & Sreeramareddy, C. T. (2010). Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC medical education, 10(1), 2.
13. Ab Latif, R., & Mat Nor, M. Z. (2016). Stressors and coping strategies during clinical practices among diploma nursing students. Education in Medicine Journal, 8(3), 21-33.
14. Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic medicine, 81(4), 354-373.
15. Puthran, R., Zhang, M. W., Tam, W. W., & Ho, R. C. (2016). Prevalence of depression amongst medical students: a meta‐analysis. Medical education, 50(4), 456-468.
16. Hope, V., & Henderson, M. (2014). Medical student depression, anxiety and distress outside North America: a systematic review. Medical education, 48(10), 963-979.
17. Hegney, D. G., Craigie, M., Hemsworth, D., Osseiran‐Moisson, R., Aoun, S., Francis, K., & Drury, V. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results. Journal of nursing management, 22(4), 506-518.
18. Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, S. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and impact of health care provider-diagnosed anxiety and depression among US children. Journal of developmental and behavioral pediatrics: JDBP, 39(5), 395-403.
19. Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., & Mata, D. A. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. Jama, 316(21), 2214-2236.
20. Givens, J. L., & Tjia, J. (2002). Depressed medical students' use of mental health services and barriers to use. Academic medicine, 77(9), 918-921.
21. Inam, S. B. (2007). Anxiety and depression among students of a medical college in Saudi Arabia. International journal of health sciences, 1(2), 295.
22. Dahlin, M., Joneborg, N., & Runeson, B. (2005). Stress and depression among medical students: A cross‐sectional study. Medical education, 39(6), 594-604.
23. Aktekin M, Karaman T, Senol Y, et al: Anxiety, depression and stressful life events among medical students: A prospective study in Antalya, Turkey. Med Educ 2001;35:12–7.
24. Sidik MS, Rampal L, Kaneson N. Prevalence of emotional disorders among medical students in a Malaysian university. Asia Pac Fam Med 2003; 2:213–7.
25. Ndetei DM: The association and implications of anxiety and depression in university medical and paramedical students in Kenya. East African medical journal 1987; 64(3): 214-226
26. Osman, A., Hoffman, J., Barrios, F. X., Kopper, B. A., Breitenstein, J. L., & Hahn, S. K. (2002). Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients. Journal of Clinical Psychology, 58(4), 443-456.
27. Sharp, L. K., & Lipsky, M. S. (2002). Screening for depression across the lifespan. Am Fam Physician, 66, 1001-1008.
28. Ndetei DM, Khasakhala L., Nyabola, L., Ongecha, F., and Kokonya, D.A. Psychosocial and health aspects of drug use by students in public secondary schools in Nairobi Kenya. Substance abuse 2009; 30:61-68
29. Munamad SK, Sajid M, Areef B, et al: Prevalence of depression, anxiety and their associated factors among Medical students in Karachi, Pakistan. J Pak Med Assoc 2006; 12: 583-6
30. Bazmi SN: To assess prevalence of anxiety and depression among medical students in a medical college of Saudi Arabia. International journal of health sciences 2007; 1(2): 295-300
31. Leadbeater, B., Thompson, K., & Gruppuso, V. (2012). Co-occurring trajectories of symptoms of anxiety, depression, and oppositional defiance from adolescence to young adulthood. Journal of Clinical Child & Adolescent Psychology, 41(6), 719-730.
32. Givens J, Tjia J: Depressed medical students’ use of mental health services and barriers to use. Acad med 2002; 77: 918 – 921.
33. Munamad SK, Sajid M, Areef B, et al: Prevalence of depression, anxiety and their associated factors among Medical students in Karachi, Pakistan. J Pak Med Assoc 2006; 12: 583-6
34. Thornicroft G, Maingay S: The global response to mental illness, an enormous health burden is increasingly being recognized. BMJ 2002; 325(9): 608-609.
35. Vaidya PM, Mulgaonkar KP: Prevalence of depression, anxiety and stress in undergraduate Medical students and as correlation with their academic performance: Indian JOCC Ther 2007; 39(1): 7-10
36. Dahlin, M. E., & Runeson, B. (2007). Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study. BMC Medical education, 7(1), 6.
37. Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of affective disorders, 173, 90-96.
38. Bazmi SN: To assess prevalence of anxiety and depression among medical students in a medical college of Saudi Arabia. International journal of health sciences 2007; 1(2): 295-300
39. Scot J, Dickey B: Global burden of depression: The intersection of culture and medicine. Br. J. Psychiatry 2003; 183: 92- 4
40. Tartakousky MS: Depression & anxiety among College Students. Depression and Anxiety 2008; 0: 1-10.


References
1. Kessler, R. C., Gruber, M., Hettema, J. M., Hwang, I., Sampson, N., & Yonkers, K. A. (2008). Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up. Psychological medicine, 38(3), 365-374.
2. Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of internal medicine, 146(5), 317-325.
3. Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.
4. Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological medicine, 43(5), 897-910.
5. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-184.
6. Gulliver, A., Griffiths, K. M., Christensen, H., & Brewer, J. L. (2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC psychiatry, 12(1), 81.
7. Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621.
8. Kanner, A. M., Barry, J. J., Gilliam, F., Hermann, B., & Meador, K. J. (2010). Anxiety disorders, subsyndromic depressive episodes, and major depressive episodes: do they differ on their impact on the quality of life of patients with epilepsy?. Epilepsia, 51(7), 1152-1158.
9. Gupta, S., Choudhury, S., Das, M., Mondol, A., & Pradhan, R. (2015). Factors causing stress among students of a Medical College in Kolkata, India. Education for Health, 28(1), 92.
10. Pulido‐Martos, M., Augusto‐Landa, J. M., & Lopez‐Zafra, E. (2012). Sources of stress in nursing students: a systematic review of quantitative studies. International Nursing Review, 59(1), 15-25.
11. Cokley, K., McClain, S., Enciso, A., & Martinez, M. (2013). An examination of the impact of minority status stress and impostor feelings on the mental health of diverse ethnic minority college students. Journal of Multicultural Counseling and Development, 41(2), 82-95.
12. Shah, M., Hasan, S., Malik, S., & Sreeramareddy, C. T. (2010). Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC medical education, 10(1), 2.
13. Ab Latif, R., & Mat Nor, M. Z. (2016). Stressors and coping strategies during clinical practices among diploma nursing students. Education in Medicine Journal, 8(3), 21-33.
14. Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic medicine, 81(4), 354-373.
15. Puthran, R., Zhang, M. W., Tam, W. W., & Ho, R. C. (2016). Prevalence of depression amongst medical students: a meta‐analysis. Medical education, 50(4), 456-468.
16. Hope, V., & Henderson, M. (2014). Medical student depression, anxiety and distress outside North America: a systematic review. Medical education, 48(10), 963-979.
17. Hegney, D. G., Craigie, M., Hemsworth, D., Osseiran‐Moisson, R., Aoun, S., Francis, K., & Drury, V. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results. Journal of nursing management, 22(4), 506-518.
18. Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, S. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and impact of health care provider-diagnosed anxiety and depression among US children. Journal of developmental and behavioral pediatrics: JDBP, 39(5), 395-403.
19. Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., & Mata, D. A. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. Jama, 316(21), 2214-2236.
20. Givens, J. L., & Tjia, J. (2002). Depressed medical students' use of mental health services and barriers to use. Academic medicine, 77(9), 918-921.
21. Inam, S. B. (2007). Anxiety and depression among students of a medical college in Saudi Arabia. International journal of health sciences, 1(2), 295.
22. Dahlin, M., Joneborg, N., & Runeson, B. (2005). Stress and depression among medical students: A cross‐sectional study. Medical education, 39(6), 594-604.
23. Aktekin M, Karaman T, Senol Y, et al: Anxiety, depression and stressful life events among medical students: A prospective study in Antalya, Turkey. Med Educ 2001;35:12–7.
24. Sidik MS, Rampal L, Kaneson N. Prevalence of emotional disorders among medical students in a Malaysian university. Asia Pac Fam Med 2003; 2:213–7.
25. Ndetei DM: The association and implications of anxiety and depression in university medical and paramedical students in Kenya. East African medical journal 1987; 64(3): 214-226
26. Osman, A., Hoffman, J., Barrios, F. X., Kopper, B. A., Breitenstein, J. L., & Hahn, S. K. (2002). Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients. Journal of Clinical Psychology, 58(4), 443-456.
27. Sharp, L. K., & Lipsky, M. S. (2002). Screening for depression across the lifespan. Am Fam Physician, 66, 1001-1008.
28. Ndetei DM, Khasakhala L., Nyabola, L., Ongecha, F., and Kokonya, D.A. Psychosocial and health aspects of drug use by students in public secondary schools in Nairobi Kenya. Substance abuse 2009; 30:61-68
29. Munamad SK, Sajid M, Areef B, et al: Prevalence of depression, anxiety and their associated factors among Medical students in Karachi, Pakistan. J Pak Med Assoc 2006; 12: 583-6
30. Bazmi SN: To assess prevalence of anxiety and depression among medical students in a medical college of Saudi Arabia. International journal of health sciences 2007; 1(2): 295-300
31. Leadbeater, B., Thompson, K., & Gruppuso, V. (2012). Co-occurring trajectories of symptoms of anxiety, depression, and oppositional defiance from adolescence to young adulthood. Journal of Clinical Child & Adolescent Psychology, 41(6), 719-730.
32. Givens J, Tjia J: Depressed medical students’ use of mental health services and barriers to use. Acad med 2002; 77: 918 – 921.
33. Munamad SK, Sajid M, Areef B, et al: Prevalence of depression, anxiety and their associated factors among Medical students in Karachi, Pakistan. J Pak Med Assoc 2006; 12: 583-6
34. Thornicroft G, Maingay S: The global response to mental illness, an enormous health burden is increasingly being recognized. BMJ 2002; 325(9): 608-609.
35. Vaidya PM, Mulgaonkar KP: Prevalence of depression, anxiety and stress in undergraduate Medical students and as correlation with their academic performance: Indian JOCC Ther 2007; 39(1): 7-10
36. Dahlin, M. E., & Runeson, B. (2007). Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study. BMC Medical education, 7(1), 6.
37. Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of affective disorders, 173, 90-96.
38. Bazmi SN: To assess prevalence of anxiety and depression among medical students in a medical college of Saudi Arabia. International journal of health sciences 2007; 1(2): 295-300
39. Scot J, Dickey B: Global burden of depression: The intersection of culture and medicine. Br. J. Psychiatry 2003; 183: 92- 4
40. Tartakousky MS: Depression & anxiety among College Students. Depression and Anxiety 2008; 0: 1-10.


References
1. Kessler, R. C., Gruber, M., Hettema, J. M., Hwang, I., Sampson, N., & Yonkers, K. A. (2008). Co-morbid major depression and generalized anxiety disorders in the National Comorbidity Survey follow-up. Psychological medicine, 38(3), 365-374.
2. Kroenke, K., Spitzer, R. L., Williams, J. B., Monahan, P. O., & Löwe, B. (2007). Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Annals of internal medicine, 146(5), 317-325.
3. Chisholm, D., Sweeny, K., Sheehan, P., Rasmussen, B., Smit, F., Cuijpers, P., & Saxena, S. (2016). Scaling-up treatment of depression and anxiety: a global return on investment analysis. The Lancet Psychiatry, 3(5), 415-424.
4. Baxter, A. J., Scott, K. M., Vos, T., & Whiteford, H. A. (2013). Global prevalence of anxiety disorders: a systematic review and meta-regression. Psychological medicine, 43(5), 897-910.
5. Kessler, R. C., Petukhova, M., Sampson, N. A., Zaslavsky, A. M., & Wittchen, H. U. (2012). Twelve‐month and lifetime prevalence and lifetime morbid risk of anxiety and mood disorders in the United States. International journal of methods in psychiatric research, 21(3), 169-184.
6. Gulliver, A., Griffiths, K. M., Christensen, H., & Brewer, J. L. (2012). A systematic review of help-seeking interventions for depression, anxiety and general psychological distress. BMC psychiatry, 12(1), 81.
7. Hofmann, S. G., & Smits, J. A. (2008). Cognitive-behavioral therapy for adult anxiety disorders: a meta-analysis of randomized placebo-controlled trials. The Journal of clinical psychiatry, 69(4), 621.
8. Kanner, A. M., Barry, J. J., Gilliam, F., Hermann, B., & Meador, K. J. (2010). Anxiety disorders, subsyndromic depressive episodes, and major depressive episodes: do they differ on their impact on the quality of life of patients with epilepsy?. Epilepsia, 51(7), 1152-1158.
9. Gupta, S., Choudhury, S., Das, M., Mondol, A., & Pradhan, R. (2015). Factors causing stress among students of a Medical College in Kolkata, India. Education for Health, 28(1), 92.
10. Pulido‐Martos, M., Augusto‐Landa, J. M., & Lopez‐Zafra, E. (2012). Sources of stress in nursing students: a systematic review of quantitative studies. International Nursing Review, 59(1), 15-25.
11. Cokley, K., McClain, S., Enciso, A., & Martinez, M. (2013). An examination of the impact of minority status stress and impostor feelings on the mental health of diverse ethnic minority college students. Journal of Multicultural Counseling and Development, 41(2), 82-95.
12. Shah, M., Hasan, S., Malik, S., & Sreeramareddy, C. T. (2010). Perceived stress, sources and severity of stress among medical undergraduates in a Pakistani medical school. BMC medical education, 10(1), 2.
13. Ab Latif, R., & Mat Nor, M. Z. (2016). Stressors and coping strategies during clinical practices among diploma nursing students. Education in Medicine Journal, 8(3), 21-33.
14. Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic medicine, 81(4), 354-373.
15. Puthran, R., Zhang, M. W., Tam, W. W., & Ho, R. C. (2016). Prevalence of depression amongst medical students: a meta‐analysis. Medical education, 50(4), 456-468.
16. Hope, V., & Henderson, M. (2014). Medical student depression, anxiety and distress outside North America: a systematic review. Medical education, 48(10), 963-979.
17. Hegney, D. G., Craigie, M., Hemsworth, D., Osseiran‐Moisson, R., Aoun, S., Francis, K., & Drury, V. (2014). Compassion satisfaction, compassion fatigue, anxiety, depression and stress in registered nurses in Australia: study 1 results. Journal of nursing management, 22(4), 506-518.
18. Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, S. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and impact of health care provider-diagnosed anxiety and depression among US children. Journal of developmental and behavioral pediatrics: JDBP, 39(5), 395-403.
19. Rotenstein, L. S., Ramos, M. A., Torre, M., Segal, J. B., Peluso, M. J., Guille, C., & Mata, D. A. (2016). Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. Jama, 316(21), 2214-2236.
20. Givens, J. L., & Tjia, J. (2002). Depressed medical students' use of mental health services and barriers to use. Academic medicine, 77(9), 918-921.
21. Inam, S. B. (2007). Anxiety and depression among students of a medical college in Saudi Arabia. International journal of health sciences, 1(2), 295.
22. Dahlin, M., Joneborg, N., & Runeson, B. (2005). Stress and depression among medical students: A cross‐sectional study. Medical education, 39(6), 594-604.
23. Aktekin M, Karaman T, Senol Y, et al: Anxiety, depression and stressful life events among medical students: A prospective study in Antalya, Turkey. Med Educ 2001;35:12–7.
24. Sidik MS, Rampal L, Kaneson N. Prevalence of emotional disorders among medical students in a Malaysian university. Asia Pac Fam Med 2003; 2:213–7.
25. Ndetei DM: The association and implications of anxiety and depression in university medical and paramedical students in Kenya. East African medical journal 1987; 64(3): 214-226
26. Osman, A., Hoffman, J., Barrios, F. X., Kopper, B. A., Breitenstein, J. L., & Hahn, S. K. (2002). Factor structure, reliability, and validity of the Beck Anxiety Inventory in adolescent psychiatric inpatients. Journal of Clinical Psychology, 58(4), 443-456.
27. Sharp, L. K., & Lipsky, M. S. (2002). Screening for depression across the lifespan. Am Fam Physician, 66, 1001-1008.
28. Ndetei DM, Khasakhala L., Nyabola, L., Ongecha, F., and Kokonya, D.A. Psychosocial and health aspects of drug use by students in public secondary schools in Nairobi Kenya. Substance abuse 2009; 30:61-68
29. Munamad SK, Sajid M, Areef B, et al: Prevalence of depression, anxiety and their associated factors among Medical students in Karachi, Pakistan. J Pak Med Assoc 2006; 12: 583-6
30. Bazmi SN: To assess prevalence of anxiety and depression among medical students in a medical college of Saudi Arabia. International journal of health sciences 2007; 1(2): 295-300
31. Leadbeater, B., Thompson, K., & Gruppuso, V. (2012). Co-occurring trajectories of symptoms of anxiety, depression, and oppositional defiance from adolescence to young adulthood. Journal of Clinical Child & Adolescent Psychology, 41(6), 719-730.
32. Givens J, Tjia J: Depressed medical students’ use of mental health services and barriers to use. Acad med 2002; 77: 918 – 921.
33. Munamad SK, Sajid M, Areef B, et al: Prevalence of depression, anxiety and their associated factors among Medical students in Karachi, Pakistan. J Pak Med Assoc 2006; 12: 583-6
34. Thornicroft G, Maingay S: The global response to mental illness, an enormous health burden is increasingly being recognized. BMJ 2002; 325(9): 608-609.
35. Vaidya PM, Mulgaonkar KP: Prevalence of depression, anxiety and stress in undergraduate Medical students and as correlation with their academic performance: Indian JOCC Ther 2007; 39(1): 7-10
36. Dahlin, M. E., & Runeson, B. (2007). Burnout and psychiatric morbidity among medical students entering clinical training: a three year prospective questionnaire and interview-based study. BMC Medical education, 7(1), 6.
37. Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of affective disorders, 173, 90-96.
38. Bazmi SN: To assess prevalence of anxiety and depression among medical students in a medical college of Saudi Arabia. International journal of health sciences 2007; 1(2): 295-300
39. Scot J, Dickey B: Global burden of depression: The intersection of culture and medicine. Br. J. Psychiatry 2003; 183: 92- 4
40. Tartakousky MS: Depression & anxiety among College Students. Depression and Anxiety 2008; 0: 1-10.