Prevalence of mental distress and associated factors among Hawassa University medical students, Southern Ethiopia: a cross-sectional study

Individuals with mental distress present with different levels of depression, anxiety or somatic symptoms. These symptoms significantly interfere with their relationships with other people, their work, and enjoyment of life. Having mental distress can be difficult for the person, family and colleagues [1, 2]. Depression in young adults is a serious public health problem, and at the same times a source of immense human suffering [3]. Many studies also reported the high prevalence of mental distress among college students compared to the general population [4]; in particular it is more common among medical students owing to the unique setting of their living condition which exposes them to other dynamics such as added stress with academic challenge, social interaction within the mixed cultural pool and separation from pre-existing social support [5–7]. Lislotte et al. [8] extensively summarized 40 papers published from 1980 to 2005 that were conducted among US and Canadian medical students and concluded that mental distress was highly prevalent among medical students compared to the general population and age-matched peers. In this study mental distress was found more common in female medical students than male medical students. With regard to student populations, it is recognized as a common and debilitating disturbance, whilst related symptoms are evident in all areas of functioning, including motivation, concentration, perception of self-worth and mood [9]. The Eisenberg study, a large cross-sectional study from the United States, indicated that 15.6% of undergraduates and 13.0% of graduate students reported suffering a depressive or anxiety disorder. Depression alone was reported by 13.8% of undergraduates and 11.3% of graduate students, with no major difference between males and females. Anxiety disorders were less common, being prevalent in 4.2% of undergraduates and 3.8% of graduate students [10]. Studies conducted in sub-Saharan Africa show that 20–30% of primary health clinic attendees present with depressive symptoms and other psychological disorders as the first or secondary reason for seeking medical care [11–13]. There are limited studies carried in Ethiopia to estimate the prevalence of mental distress in the general population using Self-Reporting Questionnaire (SRQ-20). These studies showed the prevalence of mental distress ranges from 11.7 to 17.7% [14, 15]. Moreover, there are also few studies conducted among college students to see the prevalence of mental distress [16–19]. The one month prevalence of mental distress reported in these studies was ranged between 21.6 and 49.1%. However, except one study conducted among Addis Ababa University medical students, the remaining three studies included undergraduate university students attending different departments. Furthermore, the previous mentioned study among Addis Ababa University medical students was also conducted in 2001, which may not exactly reflect the current Ethiopian medical students’ situation. In the aforementioned studies prevalence of mental distress was found higher in those students with female sex, a family history of mental illness, frequent conflicts with their peers, never attending religious programs, substance users, being preclinical students, being young age, lack of adequate access to sanitary and recreational service, living in a very crowded environment and being insecure about their safety. Not having adequate income, difficulty in making friends and dating were also found associated with mental distress. In light of the fact that there were few literatures concerning the issue in our country, particularly among medical students, this study was conducted with an aim of providing baseline information for further study and to offer an input for the responsible bodies to plan an intervention for this group of population.

One-third of the study participants were found to be mentally distressed. This study confirmed the high prevalence of mental distress among medical students than the general population which was reported by Kebede et al. [14] and Gelaye et al. [15] as 11.7 and 17.7% respectively. A number of factors including academic pressure, excessive work load, sleep deprivation exposure to patients’ suffering and deaths and lack of adequate holiday break [25, 26] could be reason why mental distress is very common in medical students than the general population. Though the periods and the setups are different from previous studies, the finding of this study is consistent with similar kind of study done on medical students at Addis Ababa University by Alem et al. (32.6%) [16]. On the other hand, mental distress prevalence in our study is lower than the previous studies done in Gondar and Hawassa University [19, 27] and higher than the study done at Adama University [18] (40.9, 49.1 and 21.6%, respectively). These differences could be attributed to the socio-cultural and environmental factors, or the difference in the SRQ-20 cut-off points we used and year of the study.

Unlike the previous studies [8, 27] students’ gender was not found associated with mental distress in our study. Even if no statistical significant association; in this study male were more likely to report mental distress than the previous studies which reported mental distress more in female students. Our study shows the risk of developing mental distress decreases as year of study advances in the medical school. This finding is consistent with previous study done on medical students at Addis Ababa University by Alem et al. [16]. In this study the odds of developing mental distress in pre-medicine students is 3.61 times higher than students in clinical years. Adjustment difficulty to the new environment, new academic challenges, being separated with their close family and old friends might explain why mental distress is common in early years. Moreover, adjustment difficulty to the academic challenge, new social interaction within the mixed cultural pool and separation from pre-existing social support could have their own contribution for making mental distress high among medical students.

Like the previous studies [18, 19] perceiving medical school as stressful, perceiving the living environment as crowded, feeling of insecurity about their safety are associated with students’ mental distress. The odds of developing mental distress with perceiving medical school as very stressful, feeling living environment as crowded, feeling of insecurity about their safety was 3,89, 2.43, and 2.93 respectively. On the other hand history of substance use, students’ monthly income, not visiting religious area, relationship with their fellows, dissatisfaction by university sanitary and recreational facility were not found as a risk factors unlike previous studies [16, 18, 19].

The findings of this study should be taken with caution considering the lack of data on those students who did miss their class–for unknown reasons. If these students were systematically different from those who were in the class at the time of data collection, it might have affected the study findings. Moreover, the study was conducted among medical students of only one institution; the result may not be generalizable to all students attending higher Ethiopian institutions. Nevertheless, the result is indicative of the current status of mental distress among medical students attending institutions of similar setups.

One-third of medical students reported having mental distress; confirming the presence of mental distress in medical students being high. The likelihoods of having mental distress were higher among students who perceive medical school as stressful, living environment as crowded, and feeling insecure about their safety. Designing prevention and treatment programs to address contextually relevant factors is very important.