Transcript - Ahls

Depression, suicidal ideation and
anxiety among medical university
students in Central Vietnam
Prevalence and
possible contributing factors
A/Professor VO VAN THANG
Acting Director, Institute for Community Health Research,
Dean, Faculty of Public Health
Hue University of Medicine and Pharmacy, Viet Nam
Introduction
Introduction
Research worldwide showed:
• University students face emotional and behavioral
difficulties during the transition from adolescence to
adulthood.
• Medical students suffer from high stress and this can
lead to depression.
• Medical students may be more likely to experience
depression and anxiety compared to the general
population as well as other undergraduate groups.
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Introduction
• Estimates of the prevalence of mental
disorder among medical students:
USA/Europe: 8%-15%; Middle East: 4567%; Others: 21%-38%, depending on
methods of measurement.
• The prevalence of suicidal ideation
among medical students in US: 11.2%;
in Northern Europe: 14%; in China: 12%
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Introduction
In Vietnam
• There have been some small-scale surveys on
this topic with students from just one or two
universities.
• These studies examined the health status of
medical students in eight national universities
across all regions of Vietnam to provide
evidence for the need of mental health and
counseling services.
Previous Research: prevalence
• Psychological distress: ranging from 21% to 56%
• Depression is one of the most common health
problems for university students 35.2 – 38.4%
(CESD ≥16)
• 11.5% of medical students suffered from anxiety
disorder
• In Hue city: CES-D ≥ 16: 24.3% ; > 21: 11,9%;
> 25: 6,8%
A. K. Ibrahim, (2013), Vuong Diem Khanh Doan (2011) , Smith. C.K. (2011), Chandavarkar . U (2007)
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Background
Main research questions
1. What is the prevalence of depression, anxiety
and suicidal thinking among medical students?
2. What factors contribute to depression, anxiety
and self-harm?
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Background
Study method
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Study design & sample size
Cross-sectional study
Undergraduate medical students
1st Year
Study setting: Hue university of
Medicine & Pharmacy, Hue city,
Central Vietnam
Time: From 4/2013 – 7/2013
3rd Year
5th Year
Randomized
267 medical students
Y1A – Y3B – Y5C
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Methodology
Study`ethics
The study protocol and procedures were approval by
the scientific committee of the Hue University of
Medicine and Pharmacy and written consent was
obtained from all participants
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Methodology
Measurement: self-completed questionnaire
Variables
• Demography
• Potential risk factors: Adverse childhood experiences,
recent stressful life events; study hours; career choice,
parental expectations,
• Depression:
• Diagnosis instrument: Vietnamese version of the Center
for Epidemiological Studies -Depression Scale (CES-D)
• 20-item, four factors
• 4-point Likert scale
• Validated (Nguyen, Le, Dunne, 2007)
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Measurement
Anxiety:
Vietnamese version (Nguyen, Le, and Dunne 2007) .
13-item
3-point Likert scale
Suicidal behaviours : questions from the youth risk
behaviour survey (YRBS):
• Developed by the US CDC (Eaton et al., 2008; CDC,
2009)
• Three items for suicidal behaviours (thoughts,
planning and attempts)
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Methodology
Results
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Demographics
Data analysis conducted with 267 students (100% of
the potential participants):
• 1st year (37.1%), 3rd (33.7%) and 5th (29.2%).
• Male (50.2%) & Female (49.8%),
• Age 21.05±1.68,
• Almost all (95%) were Kinh ethnic group
• Urban family 50%;
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Methodology
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Methodology
Depression prevalence
CES-D ≥ 16: 49.81% (at risk for depression)
CES-D > 21: 18.7% ( substantial depressive symptoms)
CES-D > 25: 6.8% (depression)
Depressive symptoms are high in
Vietnamese medical students compared to
adults in the Hue population (Khanh 2011)
Anxiety Prevalence
Putting this in context…
On average, this is about
6 students in every classroom
Suicidal thinking Prevalence
• Suicidal thinking 10.49%;
• Suicidal planning 4.49% and:
• Suicidal attempt 1.50%
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Results
Suicidal ideation by gender
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12.03
12
10
8.96
8
6.02
6
2.99
4
2.26
0.75
2
0
SUICIDAL THINKING
SUICIDAL PLAN
male
SUICIDAL ATTEMPT
female
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Results
Depression: Multiple regression analysis
Independent variables
Gender
Depression (log)
β
SE
Male
Female
1.90*
1.25
Live together
Ref
-
3.71*
0.74
Ref
0.85
1.86*
3.02
0.97
2.29
1.47
1.47
1.31
2.63
1.38
Marital status of
Divorced / Separated
parent
Widowed
Officer
Self-manager
Occu. of mother
Farmer
Jobless
Housewife
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Depression: Multiple regression analysis
Independent variables
No. Academic hrs in
medical curriculum
GPA (10 score)
Stressful life events
Depression (log)
β
SE
0.97
0.23
<5,5
ref
5,5-6,4
0.22
0,45
6,5-7,4
013
0,48
7,5-8,4
0.11*
0,48
8,5-8,9
0.22*
0,52
0.77*
0,03
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Anxiety: Multiple regression analysis
Independent variables
Gender
Occu. of mothers
Male
Female
Officer
Self-manager
Farmer
Jobless
Housewife
Stressful life
events
Physical paint
Anxiety (log)
β
SE
Ref
-
1.13*
0.03
Ref
-
0,02
0.05
1.04*
0.03
1.20
0.11
1.01
0.04
0.77*
0.03
No
Ref
Yes
1.28*
0.04
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Discussion & Conclusion
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Discussion & Conclusion
Main points
• Although still a new topic in most universities in
Vietnam, this study confirms trends observed
worldwide.
• Many students carry with them a significant mental
health burden. In this study, for an example, about
10% had thought about suicide in the past year, and
half that number had made a plan, and 1 in every 70
students said they’d actually attempted suicide.
• Non-trivial levels of psychological distress were
reported by about one in six students
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Main points
• Factors significantly correlated with depression and
anxiety included study burden and enrolment to study
medicine that was somewhat against their own
preference (usually to meet parental expectations).
• Further research relevant to mental health promotion
should focus on the relationships between the student
and family factors, academic burden and recent
stressful life events
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RECOMMENDATION
• To promote students wellbeing, it’s
necessary to provide free and confidential
health service that include medical and
psychological care and counseling in
medical universities.
• Social skills are needed to develop within
learning environment during 6 years of
medical education.
Future …
No health without mental health
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