Prevalence of Depression, Anxiety and Stress Among Pharmacy Students in a Private and Public University in Rivers State
Chapter One
Purpose of the Study
The purpose of this study was to assess the prevalence and risk factors of depression, anxiety and stress among pharmacy students in public universities in Rivers state. Specifically, this study sought to:
- determine the prevalence of depression, anxiety and stress among pharmacy students in public universities in Rivers state,
- determine the prevalence of school environment risk factors of depression, anxiety and stress among pharmacy students in public universities in Rivers state,
- identify socio-demographic characteristics that predict depression, anxiety and stress among pharmacy students in public universities in Rivers state.
CHAPTER TWO
LITERATURE REVIEW
Introduction
The purpose of this study was to assess the prevalence and risk factors of depression, anxiety and stress among pharmacy students in public universities in Rivers state. The review of literature involved the systematic identification, location and analysis of documents containing information related to the research problem. It makes the researcher aware of the various contributions’ scholars have made in relation to the problem under study. Google Scholar, HINARI, PubMed, EBSCO HOST, ScienceDirect, Psycinfo and other database were searched for relevant literature. In addition, previously published literature, government documents and grey literature on the topic were reviewed and put it into perspective. Keywords used in the literature search included, mental health; nursing; depression; anxiety; stress and risk factors.
Concepts and theories underpinning the topic, empirical evidences in line with prevalence and risk factors of depression, anxiety and stress were reviewed. Demographic and occupational factors associated with depression, anxiety and stress were also reviewed.
Outline of Literature Review
The review of literature is presented in the following outline. First, I presented the overview of mental health service in Nigeria. This was followed by conceptual review involving depression, anxiety and stress. The theory underpinning the study was then reviewed, this was followed by the empirical review of the study which involved; prevalence of depression, anxiety and
stress, prevalence of school environment risk factors of depression, anxiety and stress, demographic factors associated with depression, anxiety and stress and occupational factors associated with depression, anxiety and stress among pharmacy students. Finally, I concluded the literature review with the conceptual framework for the study.
Overview of Mental Health Service in Nigeria
WHO defines mental health as a state of wellbeing that enables the individual to realise his or her potential, cope with stressors in the environment and contribute to his or her society (WHO, 2011). Mental health is considered to be one of the most important predictors of health in any community. Mental health affect every aspect of human life including personal, family, work life, impaired functioning and care giver burden (Khodadadi et al., 2016). The increase of pressure from society have become the source of mental health disorders among many people which makes it an important issue to consider (Adu-Gyamfi, 2017). Although the prevalence of mental illness in Africa is high, it has not been given the needed attention (Bird et al., 2011).
Globally, it is estimated that one out of every four persons will be diagnosed with a mental disorder at least once in his life time. In Nigeria, the estimated number of people who suffer from mental disorders is most of the time based on the estimates of WHO because there is no comprehensive data on the incidence of mental disorders in the country (Adu-Gyamfi, 2017; Roberts, Mogan, & Asare, 2014). WHO estimates 13% of adult population in Nigeria are likely to suffer from mild to moderate mental disorders, with about 3% of them likely to suffer from a severe form of mental disorder. However, only 2% of people with mental health problems in Nigeria have access to treatment, living a treatment gap of 98% (WHO, 2011).
Even though mental health has become a serious global health issue, mental health care in Nigeria is faced with several challenges leading to slow growth in the mental health service delivery. One major weakness in mental health delivery in Nigeria is low spending of government in the sector. The sector is severely under-funded by government and international donors. Development in the sector have been neglected by government and the private sector. There is lack of structures at the district and regional level for the provision of mental health care services. Even though children and adolescents represent about 40% of Nigeria’s population, mental health service for them is non-existent (Roberts et al., 2014; Wilson & Somhlaba, 2017).
Mental health infrastructure and services in Nigeria favour those living in the southern part of the country. Additionally, Nigeria like many low-and- middle-income-countries [LAMIC] is faced with shortage of mental health workforce (Asamoah, Osafo, & Agyapong, 2014). Consequences of poor mental health include discrimination and exclusion of people suffering from mental illness, low productivity, increase violence, drug abuse, suicide, increase crime rate and other social vices (Adu-Gyamfi, 2017).
In 2012, a new Mental Health Act (846) was passed in Nigeria to improve mental services. The focus of the Act is to change the approach of mental health care from institutional care to community based. This was aimed at reducing stigma and discrimination against mentally ill people, and improve access to mental health care delivery in Nigeria. The Mental Health Act advanced the provision of mental health care especially with treatment and prevention of mental disorders (Roberts et al., 2014; Wilson & Somhlaba, 2017). However, access to mental health still remains a challenge to many Nigerians especially, those in the northern and rural part of the country. There are only three public universities in Rivers state and they are all located in the southern part of the country. This situation makes access to mental health care difficult for people who leave in the northern sector of the country.
The national standards for mental health service in Australia indicate that, mental health service works in partnership with its community to promote mental health and address prevention of mental health problems and or mental illness (Australian Department of Health, 2010). Similarly, the Mental Health Act (846) of Nigeria also encourage community involvement in mental health care delivery. However, this has not been fully realized as mental health infrastructure in the communities remain inadequate to support the provision of mental health care in the communities. In addition, superstition, stigma, cultural and religious believes serves as a barrier to the integration of mental health care in to communities in Nigeria.
The World Health Organization states that, quality improvement for mental health services should involve the following; improved child and adolescent mental health, research and evaluation of mental health services, adequate financing of mental health services, improved planning and budgeting for service delivery and proper organization of service delivery (World Health Organization, 2005). Nigeria have taken steps to improve the quality of mental health services by establishing the Mental Health Authority to plan and organize mental health service in the country. However, a lot more needs to be done in the area of child and adolescent mental health, research and evaluation of mental health service and providing adequate financing for the provision of mental health services in Nigeria.
CHAPTER THREE
RESEARCH METHODS
The purpose of this study was to assess the prevalence and risk factors of depression, anxiety and stress among pharmacy students in public universities in Rivers state. This chapter focused on the research methodology and design selected for this study, which included the techniques used for data collection and analysis. Description of the procedures used in collecting data will enable readers of this study appreciate the particular strengths and limitations of the study. This included, description of the research design, study area, population, sampling procedure, data collection instruments, data collection procedure, data processing and analysis and ethical consideration.
Population
A study population comprise the total number of cases from which a sample is drawn (Ogah, 2013). A target population is the entire population the researcher is interested to study. It is a group of people who have common characteristics that the researcher is interested to study. The accessible population comprise cases from the target population that the researcher will have access to as respondents of the study (Polit & Beck, 2010). The target population for this study included pharmacy students who are in the three public universities in Rivers state namely Rivers state University, University of port Harcourt and Ignatius Ajuru University. For the purpose of this study, the accessible population consists of a total of 993 pharmacy students in the public universities in Rivers state. It comprises 462 pharmacy students from Rivers state University, 210 pharmacy students from University of port Harcourt and 321 pharmacy students from the Ignatius Ajuru University (Rivers state University, 2023; University of port Harcourt, 2023; Ignatius Ajuru University, 2023).
Population for this study included; all professional pharmacy students who are in the three public universities and have worked for at least six months. Pharmacy students who are on any form of leave; annual leave; maternity leave; sick leave, study leave, casual leave at the time of the study were excluded from the study.
CHAPTER FOUR
RESULTS AND DISCUSSION
introduction
This chapter presents the results of the analyses and discussion of the findings of the study. The purpose of this study was to assess the prevalence and risk factors of depression, anxiety and stress among pharmacy students in public universities in Rivers state. The study specifically focused on (a) the prevalence of depression, anxiety and stress among pharmacy students, (b) the prevalence of school environment risk factors of depression, anxiety and stress among pharmacy students and (c) socio-demographic characteristics that predict depression, anxiety and stress among pharmacy students in public universities in Rivers state.
The study employed a cross-sectional research design. The chosen instrument for data collection was a questionnaire. The data was analysed using descriptive statistics (frequencies, percentages, mean and standard deviation) and multinomial logistic regression.
CHAPTER FIVE
SUMMARY, CONCLUSIONS AND RECOMMENDATIONS
Overview of the Study
This study was conducted to assess the prevalence and risk factors of depression, anxiety and stress among pharmacy students in public universities in Rivers state. A cross-sectional research design was used for this study.
Thisstudyfocusedon(a)prevalenceofdepression,anxietyandstress,(b) prevalenceofschool environmentriskfactorsofdepression,anxietyandstress,
The instrument consists of five sections: Section A (Socio- demographic characteristics), Section B (Risk factors for Depression, Anxiety and Stress), Section C (Beck’s Depression Inventory), Section D (Beck’s Anxiety Inventory), Section E (Perceived Stress Scale). Data generated from the questionnaire were coded and analysed descriptively (frequencies, percentages, mean, standard deviation). A multinomial logistic regression analysis was used to establish socio-demographic characteristics that predict depression, anxiety and stress.
Summary of Key Findings
- It was found that majority of mental health pharmacy students (over 90 percent) experienced minimal depression and low levels of This suggests that the mental health pharmacy students experienced little to no exhibition of self-accusations, sense of failure, lack of satisfaction and feelings of guilt. Also, a larger percentage of the mental health pharmacy students experienced low to moderate stress levels.
- This study findings showed that conditions at the workplace such as heavy workload, conflict and violence can be associated with a high risk of developing mental health condition. Mental health pharmacy students were generally not satisfied with their current school, probably due to their conditions of work such as heavy workload and few equipment available for use.
Conclusions
On the basis of the results obtained in this study, the following conclusions were drawn. The study generally indicated that over 90 percent of mental health pharmacy students had minimal depression and low anxiety. It could, therefore, be concluded that, to a great extent, mental health pharmacy students had little to no exhibition of self-accusations, sense of failure, lack of satisfaction and feelings of guilt. It was generally shown that, a larger percentage of the mental health pharmacy students had low to moderate stress levels.
On the school environment risk factors of depression, anxiety and stress among pharmacy students, the study reported that, heavy workload, conflict and violence at the school environment can be associated with a high risk of developing mental health condition among pharmacy student in the three public universities in Rivers state.
Mental health pharmacy students with degree are more likely to experience depression than those with diploma however, mental health pharmacy students with diploma are more likely to experience anxiety and stress than those with degree. The challenges faced by mental health pharmacy students in obtaining higher education such lack of study leave, financial difficulties coupled with lack of recognition of their certificate after higher education may increase their risk of experiencing depression, anxiety and stress. It can be concluded that mental health pharmacy students at Ignatius Ajuru University experience minimal anxiety and stress levels as compared to those working at Rivers state University and University of port Harcourt.
Recommendations
In view of the above research findings and the conclusions arrived at, the following recommendations are made.
- Majority of mental health pharmacy students experienced minimal depression, low anxiety and stress It is recommended that the management of the public universities especially Rivers state University and University of port Harcourt give timely in-service training on management of depression, anxiety and stress even though mental health pharmacy students depression, anxiety and stress level is low. The purpose of this is to help mental health pharmacy students experience very minimal level of depression, anxiety and stress to improve pharmacy student’s quality of life, patients care and service delivery.
- Heavy workload, conflict and violence at the school environment were associated with high risk of developing mental health conditions among mental health pharmacy students. It is therefore, recommended that, the management of the public universities organize training for mental health pharmacy students on conflict resolution and management of violence to reduce the risk of developing depression, anxiety and stress.
- Mental health pharmacy students with higher educational level were more likely to have higher level of It is therefore, recommended that mental health pharmacy students with higher education level should be given training on management of depression. This would help highly educated mental health pharmacy students to reduce the level of depression they experience at the workplace.
- Higher levels of education are associated with lower levels of anxiety and stress among mental health pharmacy students. It is recommended that, the Ministry of Health, Mental Health Authority and the management of the three public universities institute measures to facilitate the easy enrolment of mental health pharmacy students into higher level of education to reduce their stress and anxiety levels.
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