Prevalence and correlates of depression among college nursing students in China

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Summary

This study aims to assess the prevalence of depression and examine potential risk factors correlated to depression among nursing college students in China. Between September and November 2012, a total of 763 college nursing students were randomly selected to participate in a survey, which included the Center for Epidemiologic Studies Depression Scale (CES-D). The result showed that 22.9% (95% CI: 20.0%–25.9%) of participants reported high score on the CES-D (16 or above). Risk factors significantly associated with depression in the univariate analysis were academic performance, academic stress, interest in majors, occupational future, interpersonal relationship, frequency of exercise, self-reported health status, social support, educational level of father, relationship with parents and making decisions without interference by parents. Backward multivariate logistic regression analysis revealed that lower academic stress, and better occupational future were strongly related to lower risk of depression, followed by active use of social support, full making decision power, better relationship with father and higher self-reported health status. The findings suggested that in order to prevent depression among college nursing students, school- and family-based strategies should be developed and implemented.

Introduction

Depression is considered as a multi-problematic disorder that leads to impairment in inter-personal, social, and occupational functioning and is often associated with suicide among college students (Farabaugh et al., 2012, Ibrahim et al., 2013, Wilcox et al., 2010), and even as the greatest risk factor for suicide and a logical starting point with respect to identification of at-risk individuals (Konick and Gutierrez, 2005). For example, in 2006, the American College Health Association reported that 10% of college students seriously considered suicide and nearly suffered from significant depression. About 95% of students who commit suicide are clinically depressed, causing great suffering not only to themselves, but also to family members and people living around them. Therefore, in recent years, a great deal of attention has been placed on the prevalence and correlates of depression in college students worldwide (Aselton, 2012, Christensson et al., 2011).

In light of prior studies, the prevalence of depression among college students varies largely across settings, depending on cultural backgrounds and study instruments (Ibrahim et al., 2013). Several studies have found that the rates of depression ranges from 7.6% to 22% among American and Indian young adults (Roberts et al., 2010, Sidana et al., 2012) and from 3.7% to 14.8% among Chinese college students (Jin et al., 2009). Furthermore, a review paper of Herman et al. (2011) showed that the prevalence of depression in the three largest U.S. ethno racial groups (African American, European American, and Hispanic) was conflicting. In this review, some studies found the levels of depressive symptoms among African Americans or Hispanics were higher than European Americans, while other studies demonstrated no differences or the differences varied depending on how depression was defined.

Being in the medical field, nurses are faced with heavier academic pressure and psychological stressors and future medical practice. They are at a higher risk for depression as other professions in the same field (Ibrahim et al., 2013, Quince et al., 2012, Sidana et al., 2012). Nursing students are likely to become nurses, with occupational stress and the ambiguities of the profession, who most directly and frequently interact with patients and affect those patients by their behavior and attitudes. Therefore, their wellbeing cannot be taken lightly. Some studies have indicated that depression may decrease the function of nurses and disturbs the nurse–patient's relationship (Ahmadi et al., 2004, Uras et al., 2012). Depression among nurses has attracted great attention from hospital and society (Christensson et al., 2011, Furegato et al., 2008, Lawlor et al., 2005).

To our knowledge, there are limited studies on depression regarding prevalence and correlates among college nursing students in China (Ni et al., 2010). Notably, the medical education systems are diverse in different countries (Hsieh et al., 2011). In China, majority of the nursing students are female and fresh graduates from senior or junior school, aged from 16 to 25 and not married. This population of nursing students is very different from the participants who are married, and/or with prior work experiences in other studies (Christensson et al., 2011, Furegato et al., 2008, Lawlor et al., 2005). Therefore, there is a need to assess the prevalence and risk factors of depression among contemporary nursing students in China. Thus, this study aims to examine the prevalence of depression and to identify various possible factors (e.g. family socioeconomic status, academic, career prospect, social support as well as self evaluation of health status) related to depression in Chinese college nursing students.

Section snippets

Participants

A cross-sectional design was used in this study and the students were randomly selected by multi-stage cluster sampling approach. Firstly, two out of the six nursing colleges in six medical universities in Guangzhou of Guangdong Province, south of China were selected. Secondly, five and fifteen classes were sampled in the two selected nursing colleges respectively, which corresponded to 80% of the students, and finally a total of 763 students from the 20 classes were invited to participate in

Results

The overall prevalence of depression in the college nursing students was found to be 22.9% (95%CI: 20.0%–25.9%). In males, the prevalence was 17.6% (14.7%–20.5%), lower than 23.8% (15.5%–32.1%) in females. The mean score of CES-D was 2.5 times higher in the depressed group (CES-D scored 16 or above) than in the non-depressed group (21.5 ± 4.94 vs. 8.4 ± 4.01, p < 0.001).

In the univariate analysis, 16 variables were observed to be significantly associated with less depression (all p-values < 0.05):

Discussion

This study showed that 22.9% participants had depressive symptoms. Poor perspective toward career prospect and stress from academic performance strongly increased the rate of depression among college nursing students. Having a good relationship with parents and making decisions without interference by parents were negatively associated with depression. Other risk factors such as frequency of exercise, self-reported health status, parents' education level, subjective social support, interest

Conclusions

Although much work remains to be done before one can determine the causality of depression among nursing students, the current study definitely provided valuable contribution to the literature. This study was able to identify risk factors, which were significantly related to depression among nursing students in China. This study also suggested several important practical implications for the health care profession or the authorities of medical college to consider suitable strategies at the

Contributors

Authors Ying Xu and Yi Yang designed the study and wrote the protocol. Authors Juan Qi, Shaofeng Chen and Pide Zhang undertook the collection of data. Authors Ying Xu and Xinli Chi wrote the first draft of the manuscript. All authors contributed to and have approved the final manuscript.

Conflicts of Interest/Disclosure Statement

All authors have no personal or financial conflicts of interest to declare.

Acknowledgments

The project was funded by the Foundation of the Ministry of Education of China for Young Teachers [Grant no: 11YJCZH204]. The authors would like to thank all instructors and their assistants for their help during the course of the investigation, and also all of the operators who contributed to the study.

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