The prevalence and risk factors of depression in engineering college students: A cross-sectional study

ABSTRACT

Background:

Engineering students like any other students face several stressors in their lives, which make them vulnerable to depression. Depression may affect students’ academic performance.

Aim:

The present study aims to estimate the prevalence and associated risk factors of depression among engineering students.

Material and Methods:

A cross-sectional study was conducted in December 2016 among 110 randomly selected students from an engineering college in a rural area of Pune district, India. PHQ-9 questionnaire was used. Univariate and multivariable ordinal logistic regression was used to quantify association.

Results:

Of a total of 110 students, 71.8% were males, while 28.2% were females. The mean age was 20.7 years. 29.1% had no depression, 48.2% had mild depression, and 22.7% had moderate depression. Univariate analysis found four variables significantly associated with a greater risk of depression: parental stress, sibling stress, economic stress, and interpersonal conflict. In the adjusted (multivariable) ordinal logistic regression analysis controlling for all independent variables, only lack of economic support and interpersonal conflicts retained their statistical significance.

Conclusion:

The prevalence of depression in engineering students is high and strongly associated with the presence of economic and personal stress. Screening for depression and giving them care and support is of paramount importance.

College students are in the transition phase from adolescence to adulthood. Along with the emotional instability due to the transition from dependence on parents to relative independence, they are also burdened with the pressure of academic outputs, family-related stressors, duration of courses being more, meeting the expectations of parents and teachers, vast curriculum, concerns of future study, worry about future job prospects, and achieving a stable financial future. The field of engineering is considered a respectable profession. With an increased number of engineering colleges, India currently has 32,25,190 engineering students.[1-4]

How an individual evaluates the nature of academic demands, the resources available, personal skills, and presumed outcomes determine whether stress is experienced. Adolescents lack appropriate coping strategies to deal with stress, which ultimately can lead to mental health disorders like depression. College students with symptoms of anxiety and depression are at an increased risk for substance abuse, such as alcohol which is influenced by peer pressure.[5-8]

Depression is a highly prevalent, disabling condition, with half of the onsets occurring in adolescence. Usually, these feelings exist only for a short period, from which the students recover soon. If these feelings are persistent for more than two weeks, the individual is considered to have depression. Depression can recur in a lifetime. It has been reported that depression at this age can increase the risk of depression in adulthood by two to fourfold. Therefore, it has the potential for personal and public health consequences. Depression can range from the mere perception of sadness to a suicidal state. It is a noted cause of disability and the 11^th leading cause of global disease burden.[9-14]

The prevalence of depression among engineering undergraduate students in India was reported as 29.6%.[15] Depression in this age group affects students’ academic performance.[16] These complications can be prevented by early diagnosis and appropriate management of depression. Equally important is to target the potential risk factors that can increase a student’s likelihood of developing depression.

Therefore, the objective of this study was to estimate the prevalence and determine the associated risk factors of depression among engineering students in the western part of India.

METHODS

A cross-sectional observational study was undertaken during December 2016 in an engineering college located in a rural area of the Pune district of Maharashtra, India. Engineering students of all academic years and gender were eligible to participate in the study. It was determined that a sample size of 100 will be needed with a 95% confidence level with a total margin of error of 8% (the margin of error is the amount of error that we can tolerate) with the expected prevalence of depression as 29.6 and finite correction of 500%.[15] There were 500 eligible students in the college at the time of this study. All 500 students were given a unique serial number, and a random sample of 110 students was taken.[15,17] This study was carried out as a part of training Interns in doing research projects during their Community Medicine posting. The research project was carried out with all ethical guidelines and declaration of helenski.

A pretested, self-administered questionnaire was used as the study instrument which was divided into three sections. The sociodemographic variables were covered in the first section. The second section comprised the Patient Health Questionnaire (PHQ-9), which measured the main outcome of interest, that is, depression. PHQ-9 is an instrument for making criteria-based diagnoses of depressive and other mental disorders commonly encountered in primary care. PHQ-9 is a nine-item depression module from the full PHQ. The PHQ-9 is a self-administered version of the PRIME-MD (Primary Care Evaluation of Mental Disorders). PHQ-9 uses modified Diagnostic and Statistical Manual fourth edition (DSM-IV) criteria to assesses the presence of major depressive disorder.[18] PHQ-9 is also a reliable and valid measure of depression severity. Its simplicity and brevity make the PHQ-9 a useful clinical and research tool.[12,19] A PHQ-9 score greater than 4 was classified as depression. The severity of depression was classified as follows: mild (5–9), moderate (10–14), moderately severe (15–19), and severe (20–27).[19] The third section consisted of questions designed to identify potential risk factors for depression.

Data were collected in a confidential manner. The study questionnaire was self-administered after ensuring privacy for each study participant. The study questionnaire did not include the name and roll number of the students which could have revealed their identity. The study participants were assured that their personal identity will be kept confidential. These measures were taken so that the social desirability bias could be minimized.

Confidentiality of personal data was ensured strictly throughout the study. The informed consent was taken from each participant before collecting data after explaining the purpose of the study and assuring them that their responses would be kept confidential. All procedures followed the National Ethical Guidelines and as per the 1964 Helsinki declaration and its latest amendment.

Continuous variables were expressed as mean ± standard deviation and median (minimum-maximum). Nominal data were expressed as numbers and percentages. The primary outcome of interest was the prevalence of depression as measured using PHQ-9. Depression was treated as an ordinal variable with the following categories: none, mild, moderate, moderately severe, and severe. The key independent variables of interest were age, gender, failed but allowed to keep term (ATKT)—yes/no, years lost in academics—yes/no, lack of parental support—yes/no, lack of sibling support—yes/no, lack of economic support—yes/no, and interpersonal conflicts—yes/no.

Univariate and multivariable ordinal logistic regression was used to quantify the relationship between the independent variables and the ordinal dependent variable (depression). The effect of independent variables on the outcome variable was expressed as odds ratios (ORs) with 95% confidence intervals (CIs). All data were analyzed using IBM SPSS version 28.0 (IBM, Armonk, NY, USA). A difference was considered statistically significant if the P value was less than or equal to 0.05.

RESULTS

Participant characteristics

A total of 110 students were evaluated. Table 1 shows the characteristics of our study population. Of a total of 110 students, 71.8% were males, while 28.2% were females. The mean age was 20.7 years. Concerning the main study outcome, 29.1% of participants had no depression, 48.2% had mild depression, and 22.7% had moderate depression.

Table 1.

Participant characteristics (n=110)

Characteristic	Categories	Number (Percent)
Depression	None	32 (29.1)
	Mild	53 (48.2)
	Moderate	25 (22.7)
Gender	Males	79 (71.8)
	Females	31 (28.2)
ATKT	No	62 (56.4)
	Yes	48 (43.6)
Years lost in academics	No	95 (86.4)
	Yes	15 (13.6)
Lack of parental support	No	82 (74.5)
	Yes	28 (25.5)
Lack of sibling support	No	88 (80)
	Yes	22 (20)
Lack of economic support	No	60 (54.5)
	Yes	50 (45.5)
Interpersonal conflicts	No	79 (71.8)
	Yes	31 (28.2)
Characteristic	Mean (standard deviation)	Median (range)
Age (years)	20.7 (1.1)	21 (17–24)

Failed but allowed to keep term (ATKT)

As shown in Table 2, upon univariate ordinal logistic regression analysis, four variables were significantly associated with a greater risk of depression: lack of parental support, lack of sibling support, lack of economic support, and interpersonal conflicts. In the adjusted (multivariable) ordinal logistic regression analysis controlling for all independent variables, only lack of economic support and interpersonal conflicts retained their statistical significance (adjusted Nagelkerke R² of the final model was 22.2%). Students who had lack of economic support had 2.5 times (95% CI: 1.1– 5.5) greater odds of being in a higher depression category than those with economic support (P = 0.02). Similarly, students facing interpersonal conflicts had 3.1 times (95% CI: 1.2–7.9) greater odds of being in a higher depression category compared to those with no interpersonal conflicts (P = 0.02).

Table 2.

Predictors of depression: ordinal logistic regression (n=110)

	Unadjusted OR (95% CI)	Adjusted OR (95% CI)	P 1
Age (continuous)	1.1 (0.81-1.5)	1.1 (0.78-1.6)	0.52
Gender
Male (reference)
Female	0.81 (0.38-1.7)	1.02 (0.43-2.4)	0.97
ATKT
No (reference)
Yes	1.8 (0.88-3.7)	1.7 (0.75-3.7)	0.21
Years lost in academics
No (reference)
Yes	1.8 (0.65-5.1)	0.95 (0.31-2.9)	0.93
Lack of Parental support
No (reference)
Yes	3.5 (1.5-8.2)*	1.6 (0.54-4.6)	0.41
Lack of sibling support
No (reference)
Yes	2.6 (1.1-6.4)*	2.1 (0.68-6.2)	0.20
Lack of economic support
No (reference)
Yes	2.5 (1.2-5.1)*	2.5 (1.1-5.5)	0.02*
Interpersonal conflicts
No (reference)
Yes	3.8 (1.7-8.7)*	3.1 (1.2-7.9)	0.02*

CI, confidence interval; OR, odds ratio; ATKT, failed but allowed to keep term. *P<0.05 (CI does not include 1). ¹P-values are reported for the adjusted analyses. Adjusted model included all variables shown in the table

DISCUSSION

This study was undertaken to estimate the prevalence and risk factors of depression among engineering students. Our study participants were (79, 71.8%) male students and (31, 28.2%) female students. The All India Survey on Higher Education (year 2014–2015) had revealed that the male students enrolled in Bachelor of Engineering (B.E.) were 71.5% students and 28.5% were females. Thus, the proportion of male and female study participants in our study were comparable with the gender enrollment at B.E. course.

Our study found the prevalence of depression to be 70.9%. It also found that lack of economic support and interpersonal conflict to be strong, significant, and independent predictors of depression.

The prevalence of depression among college students has been reported to vary globally. In a systematic review of studies on the prevalence of depression in university students by Ibrahim et al.,[20] the reported prevalence rates ranged from 10% to 85%. In a study by Nezam et al.,[21] 40.3% of engineering students showed some depressive symptoms. In a study of medical students in Mumbai, India, Supe[22] observed the presence of perceived stress in 73% of students. The prevalence of 70.9% reported in our study seems to be consistent with the rates described above.

The students undergoing professional degree courses of longer duration such as the medical, dental, and engineering may be experiencing a greater degree of stress as compared to their counterparts in other streams with lesser course duration.[23] Stress is known to be associated with a higher risk of depression.[6,8] In the present study, lack of economic support and interpersonal conflicts emerged as the two independent predictors of depression in the adjusted ordinal logistic regression analysis. Students with lack of economic support had 2.1 times greater odds of being in a higher depression category compared to those who had economic support. This finding is like the one reported by Ediz et al.,[24] who evaluated depression and anxiety levels among medical students in Turkey and found that depression was more frequent in students facing economic problems. That study also reported that stress was 1.4 times more among students with a moderate economic situation and 2.1 times more among students with a poor economic situation as compared to students who came from a good economic background.

We also found that students facing interpersonal conflicts had 3.4 times greater odds of being in a higher depression category compared to those with no interpersonal conflicts. This is consistent with the findings reported by Zou et al.,[25] where students had a higher probability of being anxious and stressed who faced more “interpersonal relationship”-related problems.

In the present study, the students identified with depression were refereed to psychiatrist for the treatment of depression. If depression in college students is not identified and adequately treated, it can persist into the future. This study, therefore, emphasizes the importance of early identification of depression, that is, secondary levels of preventive measures in college students. It is imperative for mental health providers to provide regular services to college students.

Limitation of the study

The limitation of the study is although measures were taken to minimize the social desirability bias by ensuring privacy and identity of the study participants that were kept confidential, we cannot completely rule out the social desirability bias. Secondly, only 22% of variability was explained by the factors in the study. Thirdly, the small sample size and participation of a single college limit the generalizability of the study, and further multi-centric study with a larger sample size is needed.

CONCLUSION

The prevalence of depressive disorder in engineering college students is high and strongly associated with the lack of economic support and interpersonal conflicts. Hence, screening college students for depression and providing them with timely mental health care and support is of paramount importance.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.