Document Type : Original Article
Authors
1Department of Public Health and Preventive Medicine, Faculty of Medicine, Minia University, Egypt.
Abstract
Keywords
Introduction
Depression is considered a multifaceted condition with diverse biological and environmental causes and has therefore been bi-directionally associated with a 1.5 to 6-fold risk to develop cardiovascular diseases, diabetes, epilepsy, stroke, Alzheimer`s dementia and cancer1. In its worst cases, depression can ultimately result in disability2.
It is associated with leading causes of morbidity and mortality. As indicated in a literature review, depression shares common mechanisms (e.g. insulin resistance, higher plasma homo-cysteine levels, and endothelial dysfunction, etc.) with cardio-metabolic
disorders that could explain the link between these diseases. Depressive episodes may be recurrent or chronic and have a substantial impact on life functioning3.
It has been estimated that 4.7 and 7.3% of adults, around the world, suffer from depressive and anxiety disorders4.
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Little is known about the extent or severity of untreated mental disorders, especially in developing countries like Egypt. About 3.5% (2995824 cases) of Egyptian people had depression according to world population review. Depression in young people can limit employment and education opportunities and introduce potential drug and alcohol dependence. Aggression, violence and other antisocial behaviors are more likely to occur in people suffering depression and this can significantly increase the burden placed on family, friends and society in general5. |
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Nearly 15% of clinically depressed and treated persons eventually die by suicide. The percentage of death by suicide is estimated to be higher among untreated individuals6. The pathophysiology of depression is still vague, but existing evidence suggests that it is a complicated disease caused by the interaction of genetic, biological, and environmental factors, likely involving several mechanisms7. The risk factors include current or past smoking 8, heavy alcohol consumption, low income 9, unemployment 10, low social support 11, perceived stress 12, physical inactivity 13, sleep deprivation, and unhealthy diet14. An increase in competition and workload has also been documented in academic settings, in particular, among researchers in academic universities. Yet, given the chronicity and intensity of stressful experiences in the academic setting, research findings indicate a high prevalence of negative emotions, feelings of burnout, and depressive symptoms among these workers 15. Depression is mainly presented either by an absence of interest in all activities or a depressed mood. Moreover, depressed individuals may have decreased energy, difficulty thinking, lack of concentration, appetite or weight changes, suicide attempts, feelings of regret or uselessness, or repetitive self-destructive thoughts 16. |
Methods
A cross-sectional study among University staff and their assistants, was conducted from November 2020 to January 2022 in Minia University, Minia, Egypt.
The study was conducted after obtaining the approval of the ethical committee of the Faculty of Medicine, El-Minia University.
In this study, we recruited two hundreds and ten staff members and their assistants from different faculties of Minia University.
The number of staff members and their assistants in Minia University are about four thousand persons; prevalence of depression is 22.9 among staff members19. Using epi info, population size (for finite population correction factor or fpc) (N): 4000, Hypothesized % frequency of outcome factor in the population (p): 22.9% +/- %5, Confidence limits as % of 100(absolute +/- %)
(d): 5%, Design effect (for cluster surveys-DEFF): 1
Sample size n = [DEFF*Np (1-p)]/ [(d2/Z21-α/2*(N-1)+p*(1-p)]
At 95% confidence level, 194 subjects were required to establish the study.
In this study, we recruited 210 staff members and assistants, 31 from Faculty of Medicine, 64 from Faculty of Arts, 25 from Faculty of Nursing, 25 from Faculty of Tourism and Hotels, 31 form Faculty of Specific Education who agreed to participate in the study and give they were interviewed, and answered the study questionnaire.
The questionnaire included:
Socio demographic data: gender, age, marital status, personal income, number of children, residence; cigarette smoking, weight, waist circumference, residence, physical activity, caffeine intake and multivitamin use.
Occupational history: occupational position within the university (e.g., lecturer, research assistant, assistant professor, associate professor, and full professor), number of working hours and years of employment.
Personal medical history: chronic diseases, metabolic diseases and their treatment.
Center for Epidemiologic Studies – Depression (CES–D) scale
Depression was measured by the Center for Epidemiologic Studies Depression Scale (CES-D)33. This scale consists of 20 items related to characteristic symptoms and behaviors of depression, with each item rated from 0 to 3. The items (example item: “I was bothered by things that usually don’t bother me”) had a 4-point response option ranging from rarely or none of the time (less than 1 day) to most or all of the time (5-7 days). The total score ranges from 0 to 60, with a higher score indicating greater depressive symptoms. The standard cut point 16 or more indicates clinically relevant depressive symptoms.
The study was approved by the ethics committee of Minia University Faculty of Medicine. Informed consent was taken from all participants.
Statistical Analysis:
The collected data were coded, entered to a computer and analyzed using the software, Statistical Package for Social Science, (SPSS) version 20. Qualitative data were presented as frequency distribution with its percentage; and for quantitative data, descriptive statistics with mean and standard deviation were calculated. Appropriate significant tests such as Chi-square test, Fisher's Exact and Z (test of proportion) test were used to compare between two proportions. Student’s t-test was used to compare between two means. P-values of <0.05 were considered significant.
Univariate and multiple logistic regressions were done for detection of factors associated with CES-D scale among studied variables.
Results
This study included 210 staff members and their assistants in Minia University. The age of the subjects ranged between 25-68 years (mean age 37.7±9.6). Males construct 31% of the studied sample, while females construct 69%.
Figure (1) showed that the majority (88.6%) of the studied sample had clinically relevant depressive symptoms among all studied sample.
Table (1) showed significant decrease of number of children less than three among participants with CES-D score more than 16 versus those with score less than 16 (56.2% vs 93.4%, p <0.001 respectively).
Table (2) showed that there was significant increase of body mass index among group with CES-D depression scale more than 16 versus those with scale less than 16 where mean BMI 23.3±3.1 versus 28.4±3.5, p <0.001
Among staff members of different faculties of Minia university, those from Faculty of Arts earned the highest percent among CES-D depression scale more than 16; 32.8% versus 12.5% among CES-D depression scale less than 16, p= 0.018 while faculty of nursing had the least percent (9.2% vs 29.2%).
There was no significant difference between two groups regarding scientific degree, working state, income, duration of working, working days per week, time to reach work place.
Univariate regression of socio-demographic data revealed that increasing number of children is considered as a protective factor against depression (OR= 0.576, C.I.95%= 0.357-0.930, P<0.001) and that increasing body mass index is considered significant risk factor of depression by CES-D depression scale (OR= 1.299, C.I.95%= 1.133-1.490, P <0.001).
Also, obesity was found to be as a risk factor for depressive symptoms (OR= 3.585, C.I.95%= 1.030-12.480, P=0.045).
Both overweight and obesity were found to be risk factors for depressive symptoms (CES-D score ≥16) OR= 6.145, C.I.95% = 2.156-15.009, P<0.001
Figure (1): CES-D depression scale of the studied sample of staff members and
their assistants in Minia University (October 2020 to January 2022)
Table (1): Relation of socio-demographic characteristics and CES-D score among studied staff members and their assistants in Minia University (October 2020 to January 2022)
|
Socio-demographic characteristics |
Group I CES-D Score <16 N=24 |
Group II CES-D Score ≥16 N=186 |
Test statistic |
p-value |
|
|
Age (in years) |
≤35 years >35 years |
12(50%) 12(50%) |
108(58.1%) 78(41.9%) |
χ2 0.565 |
0.542 |
|
Mean ±SD |
39.7±11.5 |
37.4±9.3 |
(t) 1.256 |
.264 |
|
|
Sex |
Males Females |
9(37.5%) 15(62.5%) |
56(30.1%) 130(69.9%) |
χ2 0.544 |
0.461 |
|
Residence |
Urban Rural
|
21(87.5%) 1(4.2%)
|
144(77.4%) 27(14.5%)
|
Fishers exact 1.819 |
0.412 |
|
Marital status |
Single Married |
7(29.2%) 17(70.8%) |
63(33.9%) 123(66.1%) |
χ2 0.212 |
0.645 |
|
BMI: |
Mean ±SD |
23.3±3.1 |
28.4±3.5 |
(t) 16.740 |
<0.001* |
|
Number of children |
Less than 3 3 or more |
9(56.2%) 7(43.8%) |
113(93.4%) 8(6.6%) |
χ2 19.990 |
<0.001* |
|
Number of persons at home |
Range Mean ±SD |
1-6 4.6±1.4 |
1-8 4.2±1.4 |
(t) 2.342 |
.127 |
|
Smoking status |
Yes No |
0(0%) 24(100%) |
8(4.3%) 178(95.7%) |
χ2 1.073 |
0.300 |
|
Presence of chronic disease |
Yes No |
5(20.8%) 19(79.2%) |
29(15.6%) 157(84.4%) |
χ2 0.430 |
0.512 |
|
Consuming fast food more than once per week |
Yes No |
9(37.5%) 15(62.5%) |
69(37.1%) 117(62.9%) |
χ2 0.001 |
0.969 |
|
Taking muli-vitamin supplements |
Yes No |
10(41.7%) 14(58.3%) |
65(34.9%) 121(65.1%) |
χ2 0.418 |
0.518 |
|
Physical activity more than one hour per week |
Yes No |
13(54.2%) 11(45.8%) |
96(51.6%) 90(48.4%) |
χ2 0.056 |
0.814 |
X2= chi-squared, *= significant difference at <0.05
Table (2): Relation of occupational and CES-D score among studied staff members and their assistants in Minia University (October 2020 to January 2022)
|
Variables |
Group I CES-D Score <16 N=24 |
Group II CES-D Score ≥16 N=186 |
Test statistic |
p-value |
|
|
Faculty |
Medicine |
6(25%) 3(12.5%) 2(8.3%) 7(29.2%) 1(4.2%) |
25(13.4%) 61(32.8%) 29(15.6%) 18(9.7%) 24(12.9%) |
Fisher exact 12.485 |
0.018* |
|
Arts |
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|
Specific Education |
|||||
|
Nursing |
|||||
|
Tourism and Hotels |
|||||
|
Scientific degree |
Professor |
2(8.3%) 0(0%) 3(12.5%) 13(54.2%) 6(25%) |
14(7.5%) 12(6.5%) 41(22%) 93(50%) 26(14%) |
Fisher exact 3.742 |
0.408 |
|
Assistant professor |
|||||
|
Lecturer |
|||||
|
Assistant lecturer |
|||||
|
Denominator |
|||||
|
Working state |
Working On vacation |
24(100%) 0(0%) |
180(96.8%) 6(3.2%) |
χ2 0.797 |
0.372 |
|
Income |
Sufficient Insufficient |
16(66.7%) 8(33.3%) |
104(55.9%) 82(44.1%) |
χ2 1.004 |
0.316 |
|
Duration of working (years) |
Range Mean ±SD Median (IQR) |
2-32 8.7±7.8 6(5-8) |
2-34 7.7±4.1 7(5-9) |
(U) -0.648 |
.517 |
|
Working days per week |
Range Mean ±SD |
2-6 3.7±1.1 |
1-6 3.8±1.3 |
(t) .003 |
.959 |
|
Time to reach work place (in minutes) |
Range Mean ±SD |
10-240 55.4±60.0 |
2-240 39.8±42.0 |
(U) -1.740 |
.082 |
|
Median (IQR) |
47.5(20-60) |
25(15-60) |
|||
X2= chi-squared, t= independent sample t-test, U= Mann-Whitney, IQR= interquartile range, SD= standard deviation, *= significant difference at <0.05
Table (3): Univariate regression of socio-demographic data (October 2020 to January 2022):
|
Variables |
Odds ratio |
95% C.I. for odds ratio |
p-value |
|
Number of children |
0.576 |
0.357-0.930 |
0.024* |
|
BMI |
1.299 |
1.133-1.490 |
<0.001* |
|
BMI categories: |
|||
|
Normal |
(ref) |
|
|
|
Overweight |
5.038 |
1.906-13.317 |
0.001* |
|
Obese |
9.100 |
2.140-34.357 |
0.001* |
|
Obesity (BMI >30) |
3.585 |
1.030-12.480 |
0.045* |
|
BMI >25 |
6.145 |
2.156-15.009 |
<0.001* |
Discussion
To our knowledge, our study represents the first study to provide not only depressive symptoms (i.e. CES-D scale) prevalence, but also information regarding risk factors associated with depression among university staff and their assistants in Minia city, Egypt.
This study included 210 staff members and their assistants in Minia University. The age of the subjects ranged between 25-68 years (mean age 37.7±9.6). Males construct 31% of the studied sample, while females construct 69%.
Prevalence of depressive symptoms was reported at 88%, which was very high compared to other previous studies from different countries.
Consistencies on the prevalence rates of self-reported mental health conditions in the literature have shown mixed variations. A study among faculty members from the USA reported that the prevalence of depression was 28.3%, which is lower than that reported in the current study 17.
The prevalence of perceived symptoms of depression, among the respondents of staff in a Malaysian public university was 28.7% 18.
Also, university staff from Southwest Ethiopia showed lower depression (22.9%) than reported in this study19.
Mental health surveys conducted among public university staff at different institutions found that the prevalence of depression, anxiety, and stress ranged between 21.7% and 70.5%20,21.
Variations in the prevalence rates of depression could be attributed to the utilization of different study tools across different studies, which were adopted for a variety of study populations or occupational settings.
Our study found no significant association with age, in contrast to a study done by Akhtar-Danesh and Landeen, 2007 22and found that younger aged employees were at higher odds of having depressive symptoms as compared to older age groups.
Previous studies regarding the association of age and symptoms of depression produced mixed results. While some studies found a negative relation between age and depression, studies from developed countries consistently found that the odds of depression decreased with age.
In contrast, investigations from developing countries generally did not establish any causal associations between depression and age 23. Studies found a linear interaction between depression and age, which was most commonly seen amongst those with impaired health 24 and those with lower education in older aged groups25. It could be postulated that those in older age groups tend to have higher income with longer service duration, thus exhibiting lower odds of psychological conditions, which most likely may be due to financial and job stability among those older age groups 26.
There was no significant association between sex and depressive symptoms in this study in contrast to other studies from different countries, which found that women had higher odds of having symptoms of depression as compared to men 26,27.
The link between depression and women can be explained from a socioeconomic as well as from a biological point of view. The difference in socioeconomic characteristics such as education and income may have resulted in higher rates of depression among women 28. Women and men react differently to stressors and may be more vulnerable to develop depression and anxiety related disorders 29. Biological factors, such as hormonal imbalances, may also play a role, which could have resulted in higher odds of depression among women.
It is still not clear whether depression leads to obesity in response to changing appetite and medicines or obesity contributes to depressive disturbances.
Consistent with the literature findings, body weight (kg) and BMI (kg/m2) of the depression group were significantly higher than non-depressed group in our study.
BMI was significantly higher in women with depression but not in men, matching a study by Oh et al who studied the association between macronutrients intake and depression in the United States and South Korea30
Payne et al who did a study on a sample of older adults with depression against control group and found that the depression group reported a significant higher BMI than the control group. The majority of literature demonstrates high prevalence of depression in people with high BMI31.
In a study conducted with 3186 adult males and 3003 adult females, depressed participants were found to have higher waist circumferences. Besides body weight and BMI, we have found that waist circumference was higher in female participants with depression compared to non-depressed group 32.
Conclusion:
Prevalence rate of depressive symptoms among staff members in Minia University is 88.6%. Increasing number of children is considered as a protective factor against depression (OR= 0.576, C.I.95%= 0.357-0.930, P<0.001) and that increasing body mass index is considered significant risk factor of depression by CES-D depression scale (OR= 1.299, C.I.95%= 1.133-1.490, P <0.001).
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