Prevalence of depression among medical students in River Nile State Universities 2021 [version 1; peer review: awaiting peer review]

Studying medicine is uphill and tiring requiring long hours of study and, continuous dealing with patients and death. A medical student in River Nile state suffers from a high rate of depression due to academic stress, expectations of parents, and comparisons with peers. Medical education is stressful and exhausting for mental health and has a negative impact on academic, health, and social performance. It also affects the student’s future as a doctor and patient care. The aim of this study knowledge prevalence of depression and its relation to socio-demographic variables among medical students in River Nile State Universities. This cross-sectional study in River Nile State describes the prevalence of depression. We used random samples of students from the first to fifth years, including 335 questionnaires, the Hospital Anxiety, and Depression Scale (HADS) data tool, and an additional question regarding the demographic variable. We found a high prevalence of depression .77.9%(depression 38.8 and borderline depression 39.1%). There was no significant association between college and depression (p= 0.67) and no significant in depression scores among different academic year (p= 0.21), gender (p= 0.23), notionally (p=0.7), smoking (p=0.79), and showed associated drugs (p=0.5). There are some risk factors other than university and smoking that lead to depression The rate of depression is high among medical students. Students must be identified and assisted and taken seriously.


Introduction
Depressed mood is more pervasive, more likely to be experienced as unusual or atypical, associated with negative ideas (e.g. hopelessness, helplessness, pessimism about the future), and may influence behavior. its low self-esteem and low self-confidence with low mood. As experienced by most people, it generally lasts only minutes to days in non-clinical situations. 1 Depression is characterized by sorrow, pessimism, guilt, loss of passion, enjoyment and concentration, difficulty sleeping, appetite disturbance, and a sense of uselessness in your life. If depression lasts for a long time or it repeats, it significantly affects the person's practical, scientific and daily life. its intense depression can lead to suicide. Depressive disorder is divided into two main categories: major depressive disorder/its symptom include a sad mood, loss of enjoyment, fatigue, and the lethargy, depending on the number and severity of a depressive episode may be classified as gentle, moderate, or severe; and the other categories are Dysthymia depression, a persistent or chronic kind of gentle depression; the symptom of clinical depression or almost like a depressive episode, however tend to be less intense and last longer. 2 The population affected by depression are estimated to be more than 322 million globally suffer from depression or 4.4% from world population. 2 Many studies have showed that medical students have high level of distress compare to another. Medical school teachers need to understand that, and know the occurrence and causes of distress in their students because of its impact on the personality, well-being, and health of their students. 3 One of the reasons that can lead to depression is not completing the course before the exam, not knowing how to face the exam, or because there are less than a month for most exams, as well as students burdening themselves with expectations, the expectations of parents and comparisons with colleagues. 4 The other reasons for stress on students: are the short period of the study compared to the enormity of the curriculum, the change in the method of reading, the acceleration in medical science update, lack of proper guidance for communication/failing in exams, inadequate time for clinical phase, insufficient bedside teaching, social stress: relationship with peer groups, residence friends, leaving home pressure from classmates and change in the way of education, physical stress: unsuitable residence facilities, poor residence food, etc. 5 Medical education is generally considered stressful, and high rates of mental illness have been reported in medical students, ranging from stress and personal problems to suicidal ideas. 6 About one-third of the medical students worldwide suffer from depression or depressive symptoms. 7 It is serious to determine the prevalence of depression among medical due to increased rates of mental illness affecting their careers. 8 Depression increases physician suicide rates. At the same time, student sorrow negatively affects the academic level and professional development, which leads to a lack of academic integrity and drug abuse. Dent stress has been associated with a variety of negative outcomes, including general affect of health life. Strain impairs the quality of life of medical students, and the doctor-patient relationship also affects patient care and attention. 5

Study design
Descriptive Cross-sectional study design.
Study area: The area is in the state of the Nile River, one of the states of Sudan. In the faculty of medicine at Elsheikh Abdalla Elbadri University in Barbar city, the faculty of Medicine of the Nile Valley University in Atabara city, and the Faculty of Medicine of the University of Shendi in Shendi city.

Study population
Medical students at Elsheikh Abdallah Elbadri University, Nile Valley University, and Shendi University.
Inclusion criteria: Medical student.
Exclusion criteria 1. student previously leave depression.
Sample technique: Voluntarily sampling. The questionnaire was prepared in Google format, then the format was distributed to medical students' social media groups, volunteer participants conducted the format and complete it then submit also through google format.  Snaith 1983), the questionnaire contained 14 questions seven of them related to assessing depression and the another is for anxiety. The assessment has three catalogers first is normal and the degree lies from 0 to 7, the second is borderline which is lie from 8 to 10, and the final category is abnormal or cases (depression or anxiety or bipolar) and the score is 11 to 21.

Data analysis tool
The data was entered into the STATA program version13 (statistic program for analysis of data). The figure pie chart was used to present the prevalence of depression and anxiety and the table was used to describe the data, also we used chi squire, P-value value is considered to be significant if it is less the 0.05.

Ethical consideration
Ethical approval was conducted by ElSheikh Abdulla Elbadri University. Ethical principles and informed consent were considered before filling out a questionnaire.

Discussion
The current study aimed to measure the prevalence of depression among medical students in River Nile state there about half of students from Elsheikh Abdullah Elbadri university, and one third from Nile Valley university and the rest from Shendi university. there students from first year represent more than half of participants. Most of students who participate in the study were female. Around eight percent of participants were smoker, and not more than two percent of students were using substance abuse. Prevalence of depression is about forty percent, and same percentage for those in borderline depression. In this study found there was no significant association between college and depression, also there is no statistical significance in depression scores and school years, as was found in studies done in Khartoum university. 5 and Sudan international university. 9 While found significance in New Delhi 10 and Egypt. 11 The prevalence of depression was high among second and third years as compared to other; It may be due to pressure in studying due to taking the Intermediate Exam Universities in the second and third years. The decline in the fourth and fifth years due to adaptation to the environment and getting used to the pressure of study. In our study we found that gender was not significant, as was found in studies done in Sudan international university 9 and New Delhi. 10 while found significance in Egypt. 11 previous study According to a the prevalence of depression in China ranged from 13. 1 to 76.21% with mean 32.74%and in Egypt about 36% it is similar to this study. 11,12 the prevalence of depression in Sudan international university(67.%) which is very high compare to our result. 9

Conclusion
Measures such as early detection and prevention programs must play a role in verifying psychological support must be strengthened in the college through the dissemination of psychological knowledge and the provision of courses and lectures related to mental health, the establishment of an office for psychological counseling within the college. Limitations:Age and residence were asked in the questionnaire and then their association with depression was not determined.