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 countries ¹⁴ 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.

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 professionals ^{10 , 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.

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.

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.