Background: Medical education can contribute to the development of depression in medical students which may have possible negative academic and professional consequences. The aims of this study were to explore the prevalence of depressive symptoms and their relationships to socio-demographic variables among a cross section of medical students of a private medical college in India. Methods: A cross-sectional anonymous questionnaire-based survey was conducted including all students from first to fourth year of a medical college in India. Beck depression inventory was used to assess the level of depression with a score of 12 or higher considered depressive. Additional questions regarding demographic variables were also included in the survey.  Data analysis was done on Epi info version 6. Results: A total of 336 students participated giving a response rate of 88%. A total of 49.1% students reported depressive symptoms. It was significantly higher in 1st year (59.3%) and 2nd year (65.6%), as compared to 3rd (34.4%) and 4th year (37.2%) students [p<0. 05].  Substance abuse(p<0.0001), first and second year of study, female sex and language of instruction other than English at 10+2 level were associated factors for the development of depressive symptoms [p<0.05]. A significant negative association was also found between regular exercise and depression (p<0.05). Conclusion: Depression may be a significant hidden problem in Indian medical students and mechanisms to identify and help students with mental health problems should be seriously considered

Lal, Amar

Singh, Ajit

Singh, Shekhar

English

CogPrints Cognitive Sciences Eprint Archive

Prevalence of Depression Among Medical Students of a Private Medical College in India

Cognitive Sciences ePrint Archive

Original Article:
Prevalence of Depression Among Medical Students of a Private Medical College in India
Ajit Singh, Department of Orthopaedics , Rohilkhand Medical College, Bareilly, 
Amar Lal, Department of Psychiatry , Rohilkhand Medical College, Bareilly,
Shekhar, Department of Physiotherapy, Jaipur College of Physiotherapy, Jaipur.
Address For Correspondence:
Dr. Ajit Singh,
Department of Orthopaedics,
Rohilkhand Medical College,
Pilibhit by pass road , Bareilly, U.P. 243006.
E-mail: ajitsingh2409@gmail.com
Citation: Singh A, Lal A, Shekhar. Prevalence of Depression Among Medical Students of a Private Medical College in India. Online 
J Health Allied Scs. 2010;9(4):8
URL: http://www.ojhas.org/issue36/2010-4-8.htm
Open Access Archives: http://cogprints.org/view/subjects/OJHAS.html and http://openmed.nic.in/view/subjects/ojhas.html
Submitted: Jul 22, 2010; Accepted Dec 27, 2010; Published: Jan 20, 2011
Abstract:
Background:  Medical  education  can  contribute  to  the 
development of depression in medical students which may have 
possible negative academic and professional consequences. The 
aims of this study were to explore the prevalence of depressive  
symptoms  and  their  relationships  to  socio-demographic 
variables among a cross section of medical students of a private 
medical  college  in  India.  Methods: A  cross-sectional 
anonymous  questionnaire-based  survey  was  conducted 
including  all  students  from first  to  fourth  year  of  a  medical 
college in India. Beck depression inventory was used to assess 
the level of depression with a score of 12 or higher considered 
depressive.  Additional  questions  regarding  demographic 
variables were also included in the survey.  Data analysis was 
done on Epi info version 6.  Results: A total of 336 students 
participated giving a response rate of 88%. A total of 49.1% 
students  reported  depressive  symptoms.  It  was  significantly 
higher in 1st year (59.3%) and 2nd year (65.6%), as compared 
to  3rd  (34.4%)  and  4th  year  (37.2%)  students  [p<0.  05].  
Substance  abuse(p<0.0001),  first  and  second  year  of  study, 
female sex and language of  instruction other than English  at 
10+2  level  were  associated  factors  for  the  development  of 
depressive  symptoms  [p<0.05].  A  significant  negative 
association  was  also  found  between  regular  exercise  and 
depression  (p<0.05).  Conclusion: Depression  may  be  a 
significant  hidden  problem  in  Indian  medical  students  and 
mechanisms to identify and help students  with mental  health 
problems should be seriously considered. 
Key Words: Depression; India; Medical students
Introduction:
Depression is highly common and according to WHO by 2020, 
it would be the second-most prevalent condition worldwide.(1) 
There is considerable evidence that rates of depression and sui-
cide are higher in medical students and that these rates continue 
to remain elevated when these students become physicians.(2) 
Medical students are a valuable human resource for our future 
and depression in them leads to less productivity, reduced qual-
ity of life, learning difficulties and may negatively affect pa-
tient care.(3,4) Studies from other parts of world have shown a 
high  prevalence  of  depression  in  medical  students  (5-7)  but 
studies on Indian medical students are lacking. India has one of 
the largest numbers of medical colleges and medical students 
with majority of the students in private medical schools.  The 
present study was undertaken to determine  the prevalence of 
depression as part of larger project examining the health of a 
cross section of medical students of a private medical college in 
India and to look for related demographic characteristics  and 
contributing factors. 
Methods:
The study was carried in a private medical college in northern 
India with an annual intake of 100 MBBS students per year. 
The study design was reviewed and approved by the Institution-
al Ethical Committee. Students from all four years of the Ro-
hilkhand Medical College, Bareilly were eligible to participate 
in this study. A total of 381 medical students participated. Data 
was  gathered  by  an  anonymous  self-reporting  questionnaire, 
which were distributed separately to each of the four student 
grades during an appropriate lecture period, and collected at the 
end of each session. Participation in the study was on a volun-
tary basis and informed consent was obtained from the students 
after  the aims  and objectives of  the  study were explained to 
them. Students identified with clinically significant depression 
were offered counseling or appropriate help. The questionnaire 
was in the English language, which is the medium of instruc-
tion in all medical colleges in India. Students were instructed to 
exclude names and identifying information and questionnaires 
were filled using code number. Students were assured that res-
ults  of  survey  will  not  have  any  negative  repercussions  for 
them. The first section of the questionnaire focused on demo-
graphic items such as age, weight, height, marital status, year of 
study,  substance  use  (tobacco;  alcohol  consumption;  gutkha; 
sedative-hypnotics  and illicit  drugs  used in  last  six  months), 
years to get into medical school after 10+2, medium of instruc-
tion in school prior to medical college, whether they undertook 
any  regular  exercise  every  week.  The  degree  of  depressive 
symptoms was measured by Beck Depression Inventory (BDI) 
which has been used in previous such studies as a screening 
tool.(8) It is a 21-item self-administered instrument, rated on 4-
point scale ranging from 0 to 3 and the total score being 63. A 
score of 0-16 is considered as normal, 17-20-border line clinic-
al depression, 21-30 moderate depression, 31-40 severe depres-
sion and over 40 is extreme depression. Score of 12 and above 
is taken as depression. Predictive value of the selected cut-off 
point, 100% sensitivity, 99% specificity, 0.72 PPV, 1 NPV, and 
1
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98% overall diagnostic value [Laasa  et al. 2000].(9) BDI was 
chosen over BDI-II as it is available free and it can be com-
pleted in about ten minutes. Data entry and analysis was done 
on Epi info version 6.0. Descriptive analyses were performed to 
investigate the distribution of our data. 
Results:
A total of 336 students returned the  fully answered question-
naire,  representing an overall  response rate of 88 % after re-
moving badly answered questionnaires with roughly one-fourth 
from each year of MBBS class, 63% were males and 37% fe-
male  students.  Mean  age  of  students  was  20.2  years  (SD-
4.6). About half (49.1%) of the students had symptoms of de-
pression with 60% of total females and 42% of total males re-
ported  symptoms  suggestive  of  depression  (Table  1).  Mild 
symptoms of depression were found in 64.8% students, moder-
ate in 27.8% and severe in 7.4% students. It was seen that age,  
weight,  height,  number  of  years  after  10+2 to  gain  entry in 
medical school and dietary habits did not affect the prevalence 
of depression. Table 2 shows the OR and 95% CI of factors as-
sociated with depression among medical students. Depression 
was significantly higher in 1st year and 2nd year students, as 
compared to 4th year and 3rd years students (p<0.05). Students 
with substance abuse were more likely to report symptoms sug-
gestive  of  depression  (OR=4.34;  95%CI  2.62-7.29).  Female 
students were more likely to reported symptoms suggestive of 
depression as compared to their male counterparts (OR=2.07; 
95%CI 1.32-3.27). Similarly, students facing language problem 
in their  MBBS course because English not  being medium of 
teaching in 10+2 were more likely to report symptoms suggest-
ive of depression. On the other hand students who undertook 
regular physical exercise were only 0.5 times likely to suffer 
from depression.
Table 1: Cases of depression according to year of study and gender
Year of study Number of students DepressionMale Female Total Male (%) Female (%) Total (%)
1st year 58 28 86 30 (58.8) 21 (41.2) 51 (59.3)
2nd year 50 32 82 31 (57.4) 23 (42.6) 54 (65.6)
3rd year 59 31 90 16 (51.6) 15 (48.4) 31 (34.4)
4th year 45 33 78 13 (44.8) 16 (55.2) 29 (37.2)
Total 212 124 336 90 (54.5) 75 (45.5) 165 (49.1)
Table 2: OR and 95% CI of risk factors associated with depression among medical students.
Risk factor n Odds Ratio 95% Confidence Interval p-value
Female sex 75 2.07 1.32 - 3.27 0.001
1st year 51 1.74 1.05 - 2.87 0.029
2nd year 55 2.66 1.58 - 4.53 <0.001
Substance abuse 76 4.34 2.62 - 7.29 <0.001
Language problem* 93 1.61 1.05 - 2.49 0.029
Regular physical exercise† 39 0.54 0.34 - 0.88 0.012
* Language of teaching other than English at 10+2 level before entry in medical school
† Minimum 30 minutes of exercise on at least three days per week in preceding six months was considered as having regular exercise.
OR = Odds Ratio, CI= Confidence Interval 
Discussion:
Symptoms  suggestive  of  depression  were found  in 49.1% of 
our medical students which corresponds with prevalence rates 
found in other developing countries. A study on undergraduate 
Chinese medical students found nearly half of them were de-
pressed with 2% having severe depression.(10) This percentage 
is low as compared to the findings of 60%-70% prevalence of 
anxiety and depression in medical students of Pakistan.(5,11) 
Studies from western world report prevalence rates of depres-
sion in the range of 14–24%.(6,12) Depression was present in 
39.9% of students of a public sector medical college in Mumbai 
(13), India, which is lower than our findings.  The reason might 
be the difference of instrument used to assess depression and 
also possibly because of the fact that students of private medic-
al colleges are at increased risk of developing depression.(14) 
This  may also be due to the different characteristics of  each 
medical school and its students and teachers. Previous studies 
had probably lower rates as students tend to give dishonest re-
sponses during such surveys because of concerns on animosity 
and potential negative repercussions.(15) We assured students 
about  anonymosity  and  encouraged  them to  give  honest  re-
sponses which may explain differences in results.
The prevalence of depressive symptoms was high among newly 
entered students (1st and 2nd year) as compared to the senior 
students. This finding correlates with results of previous stud-
ies.(5,6,12) This could be due to stress of new study environ-
ment and greater degree of work load with obligations to suc-
ceed , homesickness as most of them might live far from home 
for the first time, change in their sleeping and eating habits, fin-
ancial indebtedness, lack of leisure time. A decrease in symp-
toms of 3rd and 4th year medical students can be explained by 
a gradual adaptation to the environment and the study course.
Female students were more likely to report symptoms suggest-
ive of depression as compared to male students which are con-
sistent with western reports.(12) A possible explanation for this 
finding  is  due  to  the  fact  that  women  articulate  depressive 
symptoms,  even very minor  ones, more easily then men, and 
that the excess could actually be due to this fact as much as to a 
true expression of greater distress.(16) The number of female 
students doing any regular exercise was also very less and this 
may also contribute to higher rates of depression among them 
as regular physical exercise was negatively correlated with de-
pression  (Table  2).  Previous  research has shown  that  leisure 
activities including physical exercise reduce stress and depres-
sion in students.(17)Students indulging in substance abuse were 
four  times more likely to report  symptoms suggestive  of  de-
pression compared to students who did not use substance abuse. 
Whether substance abuse is the cause of higher rates of depres-
sion or depressed students self medicate with substance abuse is 
not clear. Previous studies have found that a significant number 
of  students consider substance abuse as a coping mechanism 
against stress and stress is positively correlated with develop-
ment of depression in medical students.(14) Substance abuse in 
medical  students  concurrent  with  depression  is  a  matter  of 
grave  concern  and preventive  education  and counseling  pro-
grams in medical curriculum are needed.
There was an interesting finding in this survey which has not 
been reported earlier. We found that students facing language 
problem in their MBBS course because English  not being me-
dium of teaching in 10+2 were more likely to report symptoms 
suggestive of depression.
A limitation of  this  cross-sectional  study is inability  to draw 
cause-effect associations between the studied variables. No data 
on  psychological  status  of  students  before  entering  medical 
school and population based data in India are available to com-
pare our results with general population. One more limitation 
with anonymous self reported questionnaires is inaccurate re-
porting. 
2
Depression may be a significant hidden problem in Indian med-
ical students and mechanisms to identify and help students with 
mental health problems should be seriously considered. There-
fore, an effective system for the prediction of the development 
of depression in medical students needs to be developed and in-
terventions aimed at reducing the incidence of depression needs 
further research. 
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3


An inventory for measuring depression. Arch Gen Psych.

Depressive symptoms and depressed mood among Chinese medical students in Hong Kong. Compr Psychiatry

Depressive symptoms in medical students and residents: a multischool study. Acad Med.

Organization. Mental and neurological disorders. Fact sheet No.

Physicians who do not take sick leave: hazardous heroes?

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The depressed physician: a different kind of impairment.

The Prevalence and Impact of Depression Among Medical Students: A Nationwide Cross-Sectional Study in South Korea. Acad Med.

The use of the Beck Depression Inventory to screen for depression in the general population: a preliminary analysis.

Ajit Singh,

Amar Lal,

Shekhar,

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Prevalence of Depression Among Medical Students of a Private Medical College in India

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