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ORIGINAL ARTICLE
Year : 2021  |  Volume : 24  |  Issue : 9  |  Page : 1385-1390

Screening for Depression Among Recent Nigerian Graduates


1 Department of Family Medicine, Federal Medical Centre, Asaba, Nigeria
2 Department of Family Medicine, Ahmadu Bello Teaching Hospital, Shika, Zaria, Nigeria
3 Department of Internal Medicine, Federal Medical Centre, Asaba, Nigeria

Date of Submission05-Sep-2019
Date of Acceptance29-May-2021
Date of Web Publication16-Sep-2021

Correspondence Address:
Dr. A Nwajei
Department of Family Medicine, Federal Medical Centre, Asaba
Nigeria
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/njcp.njcp_480_19

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   Abstract 


Background: In recent times, Nigerian media have carried multiple reports of violent and traumatic social vices. These are well-known trigger factors for fear, worries, and anxiety for corp members and their families. Core member's presentations at the NYSC primary care clinic are commonly triggered by change in environmental, biological, and psychosocial factors which invariably affect their social and occupational functioning. Aims: The objective of the study was to screen for depression symptoms among young recent Nigerian graduates with the view of further evaluating those positive on screening test with subsequent diagnostic tests. Methods: The survey was conducted on 327 participants of the April 2017 batch of graduates during the Delta State National Youth Service Corps (NYSC) Orientation Camp period in Issele-Uku, Delta State, Nigeria. They were requested to complete a self-administered questionnaire comprising of 2 sections (i) Socio-demographic profile and (ii) Patient-Health Questionnaire -9 (PHQ-9) - a Depression screening tool. Results: The prevalence of depression symptoms in the study was found to be 57.2%. Family size (P < 0.001) and sibling rank (P < 0.001) were the socio-demographic factors found to be related to depression. Independent predictors of depression were family size and sibling ranking. Conclusion: The study found the prevalence of depression symptoms among young adults to be 57.2% which is quite high. Family size and sibling rank were found to be independent risk factors.

Keywords: Depression, fresh Nigerian graduates, socio-demographic factors


How to cite this article:
Nwajei A, Ibuaku J, Esievoadje S, Olaniyan F, Ezunu E. Screening for Depression Among Recent Nigerian Graduates. Niger J Clin Pract 2021;24:1385-90

How to cite this URL:
Nwajei A, Ibuaku J, Esievoadje S, Olaniyan F, Ezunu E. Screening for Depression Among Recent Nigerian Graduates. Niger J Clin Pract [serial online] 2021 [cited 2022 Nov 29];24:1385-90. Available from: https://www.njcponline.com/text.asp?2021/24/9/1385/325914




   Introduction Top


Over the past few years, both the local and international press has been inundated with multiple reports of suicide. Most of the suicides had occurred in young persons who were socio-economically successful in their different pursuits in life[1] Events that occurred after the death of these persons had shown that most of them had been enduring undetected depression which predisposed them to committing suicide[2] Depression is a common mental disorder that presents with depressed mood, loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy and poor concentration[3] It could occur as a result of adverse life events, such as loss of significant person, object, relationship or health, but can also occur due to no apparent cause. These challenges can become chronic or recurrent and lead to substantial impairments in an individual's ability to take care of his or her everyday responsibilities[4] Depression also occurs in children and adolescents below the age of 15 years, but at a lower level than older age groups. The total number of people living with depression in the world is estimated at 322 million.[5] Nearly half of these people live in the South-East Asia Region and Western Pacific Region, reflecting the relatively larger populations of those two Regions (which include India and China, for example). The total estimated number of people living with depression increased by 18.4% between 2005 and 2015.[5]

In 2013, Peltzer et al. found the prevalence of depression among university students in Western Nigeria to be 25%[6] while Dobana and Gobir in 2018 recorded a prevalence rate of 58.2% among university students in North-Central zone of Nigeria.[7] Ademola AD, et al.[8] found prevalence rates of 41.7% (Ghana) and 26.6% (Nigeria) among hypertensive patients in both countries. Naushad S, et al.[9] found prevalence rates ranging from 66.1%-89.5% among pre-varsity college students whose ages ranged from 16–19 years in Mangalore, India. WHO listed risk factors for adolescent depression to be commoner among females, poverty, unemployment, adverse life events such as death or relationship break-up, physical illness, drug, and alcohol abuse[5]. Bulloch et al.[10] noted that “The vulnerability to development of depression is not only related to marital status but that this relationship is modified by age and gender”. It is a major cause of suicide and death among young persons. In Europe, 58 out of every 1000 adults or 33.4 million people suffer from major depression.[11]

This study used the PHQ-9 screening tool because it is easy and quick to complete in addition to having high sensitivity and specificity. There is dearth of data from most African countries and we know that as Primary Care Physicians working in developing countries, we should be able to identify young persons exhibiting signs of depression and offer appropriate assistance.

The aim of this study was to screen for depression symptoms among young recent graduates undergoing the National Youth Service Corps (NYSC) orientation in Delta State, Nigeria with the view of identifying those positive advising them to undergo subsequent diagnostic test for depression. Hopefully, this will reduce the level of morbidity, mortality and other psychological complications such as suicide among young adults.


   Methods Top


Materials

Many instruments have been developed for the screening of depression. These include among others (i) Hamilton Depression Rating Scale (HDRS), (ii) Clinically Useful Depression Outcome Scale (CUDOS), (iii) Beck Depression Inventory (BDI), (iv) Patient Health Questionnaire (PHQ-2 and 9). PHQ-2 is an ultra-short screening instrument that asks two simple questions about mood and anhedonia.[12] It has been found to be as effective as longer screening instruments such as BDI.[13] PHQ-9 is one of the most common instruments used for depression screening. It has been validated in Nigeria by Adewuya et al.[14] in a study among students which documented an internal consistency of 0.85 and optimal cut-off score of 5. In this study, a cut-off of 5 was employed and interpreted as below 5 – minimal/no depression, while 5 and above indicate depression. It takes 2–5 minutes to complete and has demonstrated 81% sensitivity and 94% specificity for mood disorders among adults.[15] This cut-off of 5 has been used in South West, Nigeria by Oderinde et al.[16] and Fatiregun et al.[17] to assess the prevalence and predictors of depressive symptoms among adolescents in Ido-Ekiti and Oyo State respectively. It is important to note that positive results on a screening test should trigger full diagnostic interview that use standard diagnostic criteria from the Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-IV).[18]

Design

The study was a cross-sectional survey conducted in April 2017.

Setting

The study was conducted in the NYSC Orientation camp, Issele-Uku, Delta State There are 3 batches of participants each year with an average of 1,200–1,500 participants per batch. During these orientation periods lectures on entrepreneurship, healthy living, self-development and para-military training are offered these participants. The April 2017 batch had 1,486 participants of young men and women of less than 30 years of age comprising of a pool of graduates from all states and tribes of Nigeria.

Selection criteria

The study included all consenting corps members who going by NYSC regulations are less than 30 years old. All staff of NYSC and ad hoc staff who were not registered corps members were excluded.

Sampling

A simple random sampling method was used to recruit subjects into the study. The sample size was determined using the statistical formula for estimating the minimum sample size for health studies where the population is less than 10,000, using the population of 1,486 in this batch of corps members. The proportion of those that will be depressed was 58.2% based on a previous local study.[7] This assumption was at 95% confidence level with a 5% margin of error. This gave a calculated sample size of 327.

Study protocol

Recruitment of subjects for the study was carried out as a one-off exercise during the healthy living lecture session. A structured self-administered questionnaire was used to assess two domains: Socio-demographic profile, depression screening tool using the Patient Health Questionnaire-9 (PHQ-9).[19]

Data analysis

The data were analyzed using the software Statistical Package for Social Sciences (SPSS) version 18. A total of 311 out of 327 questionnaires were completed and returned giving a response rate of 95.1%. These were analyzed and the level of statistical significance was set at 95% confidence interval (P < 0.05).

Ethical considerations

Ethical approval was obtained from the Ethics and Research Committee of Federal Medical Centre, Asaba. Permission to carry out the study was obtained from the Delta State Coordinator of NYSC. Also verbal consent was obtained from the respondents before recruitment into the study.


   Results Top


Socio-demographic characteristics

Age was categorized as <25 years and ≥25 years as the NYSC program is designed for graduates less than 30 years of age. Majority of respondents were more than 25 years of age 180 (57.9%) while 161 (51.8%) were males. Majority of the respondents were single (94.9%), while 256 (82.3%) were of the Christian faith. As regards educational sponsorship (7.4%) were self-sponsored, while the bulk 270 (86.8%) were sponsored by parents or guardians. With regard to family size – number of siblings within the family, 4-6 sibling category was the highest constituting 149 (47.9%), closely followed by families with less than 3 siblings 131 (42.1%). Considering ranking in the family, majority 223 (71.7%) were either first, second or third born among their siblings [Table 1].
Table 1: Socio-Demographic Characteristics

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Baseline depression categories

[Table 2] showed that moderate and severe depression were elicited from 57.2% of the respondents using the PHQ-9 questionnaire as the screening tool.
Table 2: Baseline Depression Categories

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Relationship between socio-demographic characteristics and depression

[Table 3] shows the results of the cross-tabulation of depression categories and socio-demographic variables of the participants. Significant association were found for family size and sibling ranking. Among recent graduates, it was found that the larger the family size ≥7, the greater the chances of developing depression (83.9%) as in contrast to the (48.1%) among those with family size of 1-3. This association was found to be significant at P < 0.001. Graduates who ranked 4th or more in the sibling ranking constituted (76.1%) of those depressed in contrast to constituting (50%) if they 1st born. This was statistically significant at P < 0.001. Gender, marital status and educational sponsorship did not attain statistical significance with depression.
Table 3: Relationship Between Socio-Demographic Characteristics and Depression Categories

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A binary logistic regression was performed to ascertain the effects of age, gender, marital status, educational sponsorship, family size and sibling rank on the likelihood that participants have depression. The binary logistic regression model was statistically significant, x2(4) =27.332, P < 0.011. The model explained 11.3% (Nagelkerke R2) of the variance in depression and correctly classified 65.0% of cases.

Age, gender, marital status, religion and educational sponsorship were not good predictors of depression in this study. However, family size (number of children) and siblings rank are good predictors in this study. Decreasing family size was associated with an increased likelihood of depression compared with reference category (≥7th ref): family size 1-3 persons (x2 (1) = 4.95, OR = 3.52, P < 0.02, CI = 1.16–10.68) and family size of 4–6 persons (x2 (1) =3.74, OR = 2.86, P < 0.05, CI = 1.09–8.29). Ranking first in the family was associated with about 2.63 times reduction in the likelihood of depression (x2 (1) =7.24, OR = 0.38, P < 0.007, CI = 0.19-0.77) and being second and third born was associated with a higher likelihood of depression (x2 (1) =8.71, OR = 2.72, P < 0.003, CI = 0.19—0.71) than the reference category (≥4th) [Table 4].
Table 4: Independent Predictors of Depression

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   Discussion Top


This study gave a prevalence of 57.2% which is quite high implying that more than half of the respondents had depression symptoms at the time the study was conducted. Classically, patients with depression present with psychological symptoms of depressed mood, loss of interest in activities, impaired concentration, feelings of worthlessness or guilt, and suicidal ideation.[18] Probably this high prevalence may be attributable to the fact that a significant proportion of graduate corpers were unhappy with their area of posting for their National Youth Service. This study's figure of 57.2% is comparable to Dobana's[7] study in North-Central zone of Nigeria which got a figure of 58.2% and the work done by Afolabi et al.[20] in Ilesha which gave a prevalence rate of 59.4%, but higher than those of Sanni et al.[21] (24.9%), Umoh and Idung[22] (24.5%) and Ogunsemi et al.[23] (29.1%) This disparity could be attributed to study areas, sample populations, depression tools used and period of the various studies.

In this study, the prevalence of depressive symptoms was higher in participants who were more than 25 years of age. This is comparable to the study by Gureje et al.[24] which had a mean age of onset of depression as 29.2 years, but higher than the age range of 20–24 years as obtained by Akhtar-Danesh et al.[25] in their Canadian study. However, the association between age category and depression was not statistically significant in this study (P = 0.48)

Males 91 (27.8%) were more depressed than females 87 (26.6%) in this study. Sanni et al.[21] in their study in North-Central Nigeria equally found that males were more depressed than females. Akhtar-Danesh et al.[25] in Canada had a preponderance of females in their own study. Prevalence of depression based on gender has been found to vary considerably.[26]

The socio-demographic factors found to be statistically significant in this study were family size (P < 0.001) and sibling ranking (P < 0.001). Independent predictor of depression was family size (OR = 0.837, P = 0.005, CI = 0.723-0.969). Age, gender, marital status, religion, and educational sponsorship did not have any statistically significant relationship to prevalence of depressive symptoms in this study. Afolabi et al.[20] in Ilesha had the same finding as this study with regard to age, gender, and religion.

Limitations

Recall bias may influence the result of the study as depressive symptoms will be based on what the respondents tell the researchers. Participants may have minimized their responses to avoid social stigmatization.


   Conclusion Top


In this study, it was found that the prevalence of depressive symptoms among young adults was quite high (57.2%). Family size and sibling ranking were found to be significantly associated with depressive symptoms, and binary logistic regression shows that both the family size and sibling rank were the only independent risk factors.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

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Peltzer K, Pengpid S, Olowu S. Depression and associated factors among university students in Western Nigeria. J Psycho Afr 2013;23:459-66.  Back to cited text no. 6
    
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    Tables

  [Table 1], [Table 2], [Table 3], [Table 4]



 

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