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Systematic Review

PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS

[version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved]
Ivaan Pitua1, Amelia Margaret Namiiro1, Raafidha Raizudheen1, Lorraine Apili1
Ivaan Pitua1, Amelia Margaret Namiiro1, Raafidha Raizudheen1, Lorraine Apili1
PUBLISHED 22 May 2024
Author details Author details
OPEN PEER REVIEW
REVIEWER STATUS

Abstract

Background

Depression is among the most common mental health disorders affecting social and academic progress of university students globally. However, the variations in prevalence reported by different published studies leaves the true burden of depression among medical students in Africa unknown.

Objectives

This study aimed at conducting a systematic review and meta-analysis to report the true estimate of prevalence of depression among medical students in Africa between 2012 and 2022.

Methods

Articles that reported prevalence of depression among medical students in Africa between 2012 and 2022 study period were searched for in PubMed, Google Scholar, African Journals Online, and Embase. Two investigators independently extracted the data for full review and eligible studies were considered for analysis after a consensus, quality of articles was assessed using JBI Critical Appraisal tool [1] for prevalence studies. R version 4.3.2 [2] was used to establish the pooled prevalence using a random effects model, funnel plot and Eggers test were used to check for publication bias.

Results

A total of twenty-six cross-sectional studies involving 11386 (Females: 6070, 53.3%) medical students, mean age 23, were included in this study. PHQ9 (n=10), DASS21 (n=7), BDI-II (n=5) were the most used screening instruments. The overall pooled prevalence of depression was 38% (p < 0.00). Sub-group analysis by instrument used i.e. DASS21, PHQ-9, BDI-II, revealed prevalence of 50% (p < 0.01), 39% (p < 0.01) and 32% (p < 0.01) respectively.

Conclusion

Nearly two-fifths of medical students in Africa suffer from depression. The findings emphasize the urgent need for research into the causes, alongside early diagnosis with standardized tools and targeted interventions to manage depression effectively among this demographic.

PROPERO (CRD42022372866).

Keywords

Depression, Depressive symptoms, Medical students, Africa

Corresponding author: Ivaan Pitua
Competing interests: No competing interests were disclosed.
Grant information: The author(s) declared that no grants were involved in supporting this work.
Copyright:  © 2024 Pitua I et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
How to cite: Pitua I, Margaret Namiiro A, Raizudheen R and Apili L. PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:523 (https://doi.org/10.12688/f1000research.149103.1) First published: 22 May 2024, 13:523 (https://doi.org/10.12688/f1000research.149103.1) Latest published: 22 May 2024, 13:523 (https://doi.org/10.12688/f1000research.149103.1)

1. Introduction

Over the last decade, there has been an increase in interest in university students’ mental health as depressive symptoms affect between 24 and 34 percent of university students worldwide and has also been reported to be more prevalent among health professions students than in the general population.3 In a recent study, up to 27.2% of medical students had depression globally affecting about a third of medical students worldwide.4 Understanding the burden of psychological morbidity among these students is critical and interventions are especially beneficial in resource-constrained contexts, such as low and middle-income countries (LMICs), where the best solution may not be readily available.5,6 Medical students in Africa have also been found to have a significant prevalence of depression, according to recent studies with more association with the female sex than their male counterparts (5). Olum et al noted a prevalence of 21.5% among medical students at Makerere University, which is similar to related research findings on medical students in Nigeria (17.4%)7 and Sudan (21.5%).8 Academic pressure, demanding workloads, concern about one’s own health, financial concerns, exposure to patients’ suffering, student abuse and mistreatment are all factors associated with psychological morbidity among medical students.9,10 Depression is also associated with higher suicide rates, which may explain why medical professionals have a higher suicide rate than the general population.10,11 Students who are experiencing extreme stress or depression require immediate attention; otherwise, their inability to cope successfully with the enormous stress of education may result in a cascade of personal and professional consequences.11–13 Students’ psychological distress can have a negative impact on their academic performance and quality of life, as well as contribute to alcohol and substance abuse, decreased empathy, and academic dishonesty.12,14 Given the risks and consequences of psychological morbidity on students, as well as the remarkable growth in medical student numbers in Sub-Saharan Africa over the last decade, there is a need to understand the pooled prevalence of depression among these students. However, previous systematic reviews evaluating the prevalence of depression among health professions’ students have been conducted on studies that were carried out in the Brazil,13 Pakistan,3 Canada and other European and Asian countries14 therefore, conducting a systematic review and meta-analysis of prevalence of depression among medical students in Africa is equally essential for informed preventive and treatment measures.

2. Methods

2.1 Study design

The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines15 was used by the researchers. The study protocol was registered with PROPERO (CRD42022372866).

2.2 Eligibility criteria

Studies carried out between 2012 and 2022 reporting prevalence of depression among medical students in Africa.

2.3 Exclusion criteria

Review studies, case reports, case series and studies reporting disorders other than depression like anxiety, suicidal ideation and burn out were strictly excluded.

Similar studies carried out in continents other than Africa were also excluded from the review.

2.4 Search strategy/data sources

Relevant sources (PubMed, Google Scholar, African Journals Online and Embase) were used with help of a medical librarian, articles reporting studies conducted between 2012 and 2022 were considered. Only peer-reviewed articles in English were included, review articles, case reports and case series were excluded, cross-sectional studies were included. Authors whose articles were not free access were contacted by email, references to selected studies were searched for manually to obtain more relevant studies. Our search words included; depression, depression among medical students, depressive symptoms, African medical students, prevalence of depression, burden and incidence of depression.

2.5 Study selection process

Duplicates of eligible studies were screened off using EndNote v20.5 software and articles were included for full review by NAM and RR, any disagreement was settled by IP and LA. The articles were then shared among paired reviewers (NAM and RR) and (IP and LA), and the lead investigator IP settled disagreements among individuals during the process of synthesis (Figure 1).

7dde6fc7-4030-4fb1-a916-c79ceecca8da_figure1.gif

Figure 1. The PRISMA flow diagram.

2.6 Data management and extraction

An excel spreadsheet document was used to capture the following information from each study; Study, Study year, Country, Sampling technique, Sample size, Prevalence, Mean Age, Females, Males, Instrument used.

2.7 Quality assessment

Joanna Briggs Institute (JBI) checklist1 was used to evaluate the risk of bias. It is a 4-point Likert scale with the following questions; 1). Was the sample frame appropriate to address the target population? 2) Were study participants sampled appropriately? 3) Was the sample size adequate? 4) Were the study subjects and settings described in details? 5) Was the data analysis conducted with sufficient coverage of the identified sample? 6) Were valid methods used for the identification of the condition? 7) Was the condition measured in a standard reliable way for all participants? 8) Was there appropriate statistical analysis? 9) Was the response rate adequate, and if not, was the low response rate managed appropriately? “No”, “Yes”, “Unclear” and “Not applicable” are the responses and 1 point is assigned for a Yes, a score less than 5 qualified an article for exclusion (Table 1).

Table 1. Joanna Briggs Institute (JBI) checklist scores for included studies.

StudyType of studyWas the sample frame appropriate to address the target population?Were study participants sampled in appropriate way?Was the sample size adequate?Were the study subjects and the settings describes in detail?Was the data analysis conducted with sufficient coverage of the identified sample?Were valid methods used for identification of the condition?Was the condition measured in a standard reliable way for all participants?Was there appropriate statistical analysis?Was the response rate adequate, and if not, was the low response rate managed appropriately?
Alphonsus et al.,202216Cross-sectional studyYesYesYesYesYesYesYesYesYes
Dafaalla et al., 20168Cross-sectional studyYesYesYesYesYesYesYesYesYes
Dagnew et al., 20209Cross-sectional studyYesYesYesYesYesYesYesYesYes
Deborah et al., 202017Cross-sectional studyYesYesYesYesYesYesYesYesYes
Elsawy et al., 202018Cross-sectional studyYesYesYesYesYesYesYesYesYes
Falade et al., 202019Cross-sectional studyYesNoYesYesYesYesYesYesYes
Fawzy & Hamed, 201720Cross-sectional studyYesYesYesYesYesYesYesYesYes
Ibrahim et al., 201521Cross-sectional studyYesYesYesYesYesYesYesYesYes
Mebratu et al., 201922Cross-sectional studyYesYesYesYesYesYesYesYesYes
Melaku et al., 202123Cross-sectional studyYesYesYesYesYesYesYesYesYes
Mohamed et al., 201924Cross-sectional studyYesYesYesYesYesYesYesYesYes
Mwita et al., 202025Cross-sectional studyYesYesYesYesYesYesYesYesYes
Nelao et al., 202326Cross-sectional studyYesYesYesYesYesYesYesYesYes
Ngasa et al., 201727Cross-sectional studyYesYesYesYesYesYesYesYesYes
Njim et al., 201928Cross-sectional studyYesYesYesYesYesYesYesYesYes
Nkporbu et al., 201929Cross-sectional studyYesYesYesYesYesYesYesYesYes
Olum et al., 202030Cross-sectional studyYesYesYesYesYesYesYesYesYes
Osama et al., 202231Cross-sectional studyYesYesYesYesYesYesYesYesYes
Ossai, 20217Cross-sectional studyYesYesYesYesYesYesYesYesYes
Pillay et al., 201632Cross-sectional studyYesNoYesYesYesYesYesYesYes
Sherif et al., 202133Cross-sectional studyYesNoYesYesYesYesYesYesYes
Uzoechi et al.,202134Cross-sectional studyYesYesYesYesYesYesYesYesYes
Van et al., 201935Cross-sectional studyYesYesYesYesYesYesYesYesYes
Yousif et al., 201636Cross-sectional studyYesYesYesYesYesYesYesYesYes
Mohammed et al., 202237Cross-sectional studyYesYesYesYesYesYesYesYesYes
Worku et al., 202038Cross-sectional studyYesYesYesYesYesYesYesYesYes

Data analysis

R version 4.3.22 was used to perform a random effects model meta-analysis for prevalence of depression. Overall pooled estimate of prevalence was reported as percentage at 95% CI, determined by random effects model when I2 >50 was realized and results were shown in forest plots. Publication bias was visually assessed using corresponding funnel plot and an Eggers test was done to test asymmetry. A subgroup analysis based on screening tools used to diagnose depression was conducted, a comparison was made in relation to prevalence of depression considering p-value < 0.05 as significant.

3. Results

3.1 Study characteristics

26 cross-sectional studies involving 11386 (Females: 6070, 53.3%) medical students with a mean age of 23 met the inclusion criteria, this was out of a total of 87 related studies conducted between 2012 and 2022. Most of the studies were conducted in Nigeria (n=6) and Egypt (n=5). Ethiopia had 4 studies, while Sudan had 3. Both South Africa and Cameroon had 2 studies each, and Libya, Uganda, Namibia, and Tanzania had one study each. PHQ9 (n=10), DASS21 (n=7), BDI-II (n=5) were the most used screening instruments. Table 2 provides a summary of the studies reviewed.

Table 2. Characteristics of studies reporting prevalence of depression among medical students in Africa between 2012 and 2022.

StudyStudy yearCountrySampling techniqueSample sizePrevalenceMean ageFemalesMalesInstrument
Mebratu et al., 2019222017EthiopiaSystematic sampling2730.51-108165HADS
Ibrahim et al., 2015212014EgyptRandom sampling1640.58198282BDI-II
Yousif et al., 2016362015EgyptRandom sampling4420.6120270172DASS-21
Fawzy & Hamed, 2017202015EgyptRandom sampling7000.6521452248DASS-21
Dagnew et al., 202092019EthiopiaRandom sampling3830.3521115268BDI-II
Sherif et al., 2021332018LibyaRandom sampling2700.45-2700PHQ-9
Falade et al., 2020192019NigeriaPurposive sampling9440.1421642302HADS
Ossai, 202172021NigeriaRandom sampling5220.1723208314BDI-II
Pillay et al., 2016322016South AfricaConvinience sampling2300.16-16466Zung SDS
Van et al., 2020352018South Africa-4730.3622333140PHQ-9
Dafaalla et al., 201682016SudanRandom sampling4870.21-162325DASS-21
Osama et al., 2022312020SudanConvinience sampling10580.7521604454DASS-21
Olum et al., 2020302019UgandaRandom sampling3310.2223136195PHQ-9
Ngasa et al., 2017272015CameroonRandom sampling6180.3122286332PHQ-9
Njim et al., 2019282018CameroonRandom sampling4130.6621188225PHQ-9
Mohamed et al., 2019242017SudanConvinience sampling4400.22-223217PHQ-9
Deborah et al., 2020172019NigeriaPurposive sampling4080.4523207201DASS-21
Elsawy et al., 2020182016EgyptRandom sampling3900.45-195195BDI-II
Melaku et al., 2021232019EthiopiaRandom sampling2600.522296164DASS-21
Nelao et al., 2023262022NamibiaRandom sampling2290.442216465PHQ-9
Nkporbu et al., 2019292016NigeriaRandom sampling3050.0524138167Zung SDS
Uzoechi et al., 2021342018NigeriaRandom sampling2430.31-115128DASS-21
Alphonsus et al., 2022162020NigeriaRandom sampling3000.3222159141PHQ-9
Mwita et al., 2020252020TanzaniaRandom selection3530.41-162191PHQ-9
Mohammed et al., 2022372019/20EgyptMulti stage sampling7660.5621428338PHQ-9
Worku et al., 2020382019Ethiopia3840.04-163221BDI-II

Prevalence of depression

The overall pooled prevalence of depression was 38% (p < 0.00). Sub-group analysis by instrument used revealed prevalence of 50% (p < 0.01), 32% (p < 0.01) and 39% (p < 0.01) for DASS21, BDI-II, and PHQ-9 respectively Figure 2 and Figure 4.

7dde6fc7-4030-4fb1-a916-c79ceecca8da_figure2.gif

Figure 2. Forest plot of prevalence of depression.

PHQ = Primary Health Questionnaire, DASS = Depression Anxiety Stress Scale, BDI = Beck Depression Inventory, DASS21 = Depression, Anxiety and Stress Scale – 21, HADS = Hospital Anxiety and Depression Scale, Zung SDS = Zung Self-Rating Depression Scale.

7dde6fc7-4030-4fb1-a916-c79ceecca8da_figure3.gif

Figure 3. Funnel plot of prevalence of depression.

7dde6fc7-4030-4fb1-a916-c79ceecca8da_figure4.gif

Figure 4. Forest plot of prevalence of depression sub-grouped by screening tools used.

In assessing the potential for publication bias within our meta-analysis, we conducted Egger’s regression test. The test did not reveal statistically significant evidence of publication bias (p = 0.090), with the intercept from Egger’s test being 1.697 standard errors away from the null hypothesis of no bias (Z = 1.697). These findings suggest that our meta-analytic results are not markedly influenced by publication. Funnel plot of prevalence of depression shown in Figure 3.

4. Discussion

The present study reviewed 26 articles published of studies conducted between 2012 and 2022 (over a ten year period). Included were all studies reporting the prevalence of depression or depressive symptoms among medical students in Africa. A total of 11386 medical students were amassed from different medical schools across universities and colleges in Africa inclusive of 6070 females (53.3%) and 5316 males (46.7%). The studies were mainly carried out in the countries of Egypt, Nigeria, Ethiopia and South Africa, Namibia, Tanzania, Cameroon, Sudan and Uganda which gives a good representation of all regions across the African continent.

The overall pooled prevalence of depression was 38% (p < 0.00). Sub-group analysis by instrument used revealed prevalence of 50% (p < 0.01), 39% (p < 0.01) and 32% (p < 0.01) for DASS21, PHQ-9 and BDI-II respectively. A similar study conducted in India addressing the depression reviewed a total of 28 original studies published between 2014 and 2018.39 A total of 7046 medical students (3170 females) were considered and it reported a prevalence of 42.6% which is not significantly skewed from our findings though slightly higher than the outcome our analysis of 38%. The sample sizes of the studies considered in this review was ranging from 86 to 444 medical students, compared to our study (164 to 1058). The studies included reported prevalence ranging from 08.9% to 79.2% compared to our study that included articles reporting ranges from 4% to a worrisome 75%. These findings are significantly high and thus worrying as widespread depression is allied to decreased performance and higher incidences of long standing morbidity and even suicidal tendencies especially amongst this population in study.

The high prevalence of depression among medical students in Africa, as compared to the general population, raises critical questions about the unique stressors and challenges faced by these students. Academic pressures, demanding workloads, and exposure to patient suffering, previously identified as significant factors contributing to psychological morbidity among medical students.9,10 Furthermore, the significant association of depression with higher suicidal ideation and rates among medical professionals10,19,30 highlights the critical importance of early diagnosis, standardized screening, and effective management strategies. These findings advocate for the integration of mental health services and support systems within medical education, emphasizing the necessity of creating environments that not only recognize the mental health needs of students but also actively contribute to their well-being.

Our review also identified the PHQ-9, DASS-21, and BDI-II as the most adopted instruments employed across the studies. Each of these instruments brings distinct strengths to the understanding of depression among medical students. The PHQ-9’s alignment with DSM-IV criteria for depression ensures that it is clinically relevant, while the DASS-21’s broader scope captures a wide range of emotional distress, offering insights beyond mere depressive symptoms. The BDI-II’s focus on cognitive aspects allows for the exploration of thought patterns associated with depression, providing depth to the assessment. However, these tools also have limitations. The PHQ-9’s brevity might overlook nuanced aspects of depression experienced by medical students, especially those related to academic stressors. The DASS-21, while comprehensive, may dilute the focus on depression by encompassing anxiety and stress. The BDI-II’s emphasis on cognition may miss other crucial aspects, such as physical symptoms associated with depression.40–42

Comparatively, clinical diagnosis of depression, typically conducted through structured interviews based on DSM-5 criteria, offers a holistic assessment of the individual, considering both psychological and physical symptoms along with functional impairments.43–45 While the screening instruments provide a practical and accessible means of identifying symptoms of depression, they cannot fully replicate the depth of clinical diagnosis, which considers the patient’s complete medical history, co-occurring disorders, and the intricate interplay of symptoms over time.

4.1 Limitations of the study

The study focused on only published data which had reported different screening instruments and individual demographics, also the study variables inspected were not sufficient to explain heterogeneity. A study involving a larger population randomly screened by clinical diagnosis and formal expert interviews other than self-report questionnaires could achieve a more accurate estimate.

4.2 Future direction

Two suggestions are noted by the researchers; one is to carry out a multicenter study covering a large population using clinical diagnosis of depression and formal diagnostic interviews in place of self-report questionnaires. Secondly, we suggest studies to be carried out on other students pursuing nonmedical disciplines as well as these have been ignored by most researchers.

5. Conclusion

Nearly two-fifths of medical students in Africa suffer from depression. The findings emphasize the need for research into the causes, alongside early diagnosis with standardized tools and targeted interventions to manage depression effectively among this demographic.

Author contributions

Conceptualization: Ivaan Pitua (IP), Namiiro Amelia Margaret (AM)

Data curation: Ivaan Pitua (IP), Namiiro Amelia Margaret (AM), Raafidha Raizudheen (RR), Lorraine Apili (LA)

Data analysis: Ivaan Pitua (IP)

Initial report and manuscript draft: Ivaan Pitua (IP), Namiiro Amelia Margaret (AM), Raafidha Raizudheen (RR), Lorraine Apili (LA)

All authors reviewed the manuscript for intellectual content and approval of final manuscript.

Data availability

No data are associated with this article.

All data can be accessed from Figshare: Checklist for ‘Prevalence of depression among medical students in Africa: A systematic review and meta-analysis’, doi.org/10.6084/m9.figshare.25699332.v1. 46

Extended data

Figshare: Prevalence of depression among medical students in Africa: A systematic review and meta-analysis, DOI: doi.org/10.6084/m9.figshare.25699332.v1. 46

This project contains the following extended data:

  • 1. Search strategy-Extended data.docx

  • 2. Figure 1. The PRISMA Flow Diagram.jpeg

  • 3. Figure 2. Forest plot of prevalence of depression.jpeg

  • 4. Figure 3. Funnel plot of prevalence of depression.jpeg

  • 5. Table 1. Joanna Briggs Institute (JBI) checklist scores for included studies.jpeg

  • 6. Table 2 Characteristics of studies reporting prevalence of depression among medical students in Africa between 2012 and 2022.jpeg

  • 7. PRISMA Flowchart - Extended data.docx

  • 8. Sample Data extraction tool-Extended data.docx

  • 9. Figure 4. Forest plot of prevalence of depression sub-grouped by screening tools used.jpeg

  • 10. JBI_Critical_Appraisal-Checklist_for_Prevalence_Studies2017_0.pdf

Reporting guidelines

The authors followed the PRISMA guidelines for reporting prevalence studies. Checklist can be accessible through Figshare: Checklist for ‘Prevalence of depression among medical students in Africa: A systematic review and meta-analysis’, doi.org/10.6084/m9.figshare.25699332.v1. 46

Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0).

Acknowledgements

Not applicable.

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Pitua I, Margaret Namiiro A, Raizudheen R and Apili L. PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:523 (https://doi.org/10.12688/f1000research.149103.1)
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ApprovedThe paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approvedFundamental flaws in the paper seriously undermine the findings and conclusions
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Reviewer Report 21 Aug 2025
Zartashia Kynat Javaid, Government College University Faisalabad, Faisalabad, Punjab, Pakistan 
Not Approved
VIEWS 2
https://doi.org/10.5256/f1000research.163515.r398127
I appreciate the efforts to carry out this research. There are amendments to improve. Justify the time duration. Why not recent years included as they are of significant importance. Introduction is missing in many aspects. Terms not clearly defined. Literature review ... Continue reading
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Javaid ZK. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:523 (https://doi.org/10.5256/f1000research.163515.r398127)
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https://f1000research.com/articles/13-523/v1#referee-response-398127
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Reviewer Report 19 Aug 2025
Hengki Yandri, Institut Agama Islam Negeri Kerinci,, Jambi, Indonesia 
Approved with Reservations
VIEWS 6
https://doi.org/10.5256/f1000research.163515.r398124
Sampling Method Limitations
In the Methods section, even though the JBI checklist is used, if any studies were rated "No" on sampling criteria, the authors should briefly discuss the potential impact of this limitation on the pooled prevalence. ... Continue reading
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Yandri H. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:523 (https://doi.org/10.5256/f1000research.163515.r398124)
The direct URL for this report is:
https://f1000research.com/articles/13-523/v1#referee-response-398124
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Reviewer Report 13 Jun 2024
Gerasimos N. Konstantinou, Centre of Addiction and Mental Health, Toronto, Canada 
Approved
VIEWS 4
https://doi.org/10.5256/f1000research.163515.r281807
The rationale and objectives of the study are well-defined and presented clearly in the manuscript. The authors effectively set the stage by discussing the significance of understanding depression among medical students and highlighting gaps in existing literature. To further enhance ... Continue reading
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Konstantinou GN. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved]. F1000Research 2024, 13:523 (https://doi.org/10.5256/f1000research.163515.r281807)
The direct URL for this report is:
https://f1000research.com/articles/13-523/v1#referee-response-281807
NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article.
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Alongside their report, reviewers assign a status to the article:

Approved
The paper is scientifically sound in its current form and only minor, if any, improvements are suggested
Approved with reservations
A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
Not approved
Fundamental flaws in the paper seriously undermine the findings and conclusions

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  1. Gerasimos N. Konstantinou, Centre of Addiction and Mental Health, Toronto, Canada
  2. Hengki Yandri, Institut Agama Islam Negeri Kerinci,, Jambi, Indonesia
  3. Zartashia Kynat Javaid, Government College University Faisalabad, Faisalabad, Pakistan

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    Alongside their report, reviewers assign a status to the article:
    Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested
    Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.
    Not approved - fundamental flaws in the paper seriously undermine the findings and conclusions
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