INTRODUCTION

University students are susceptible to various health problems. Depression is amongst these problems and according to World Health Organization (WHO) report, its general prevalence is about %5.^1-3  As medical schools are considered stressful environments⁴, It is believed that medical students experience more depression and mental illnesses than the rest.^4-8 Higher stress rates could be due to special exams, academic demands and increasing psychological pressure.⁹ Depression and anxiety, also, depend on various phases of medical education.¹⁰ As an example, first-year students suffer from separation from their families, dormitory problems or disorientation to the university environment that can lead to higher risk of depressive symptoms.¹¹ Some studies suggest that during medical training the mental health of students can be deteriorated.^12,13 Another reason could be the transition of medical students from basic science lessons to the clinical level.² Poor motivation and emotional disorders can make medical students fail their courses and can lead to depression, as well. On the other hand, new educational methods seem to be designed to have profound effects on medical students’ motivation.^14,10

Depression, as a relatively common disorder, is capable of affecting working performance and students’ personal lives.¹⁵ It could be presented by mood alteration and sadness. The symptoms can further change thinking, attitude and motivation. Most of these people will feel disabled later.¹⁶ Therefore, evaluation and in-time treatment of this illness and its symptom can protect many students from its harmful repercussions.

Although there might be much information about medical students’ depression in Iran, but there is not enough data referring to depressive-symptom rate in medical students who are educated with the new methods, such as early clinical exposure (ECE) method. It seems that implementation of ECE method can convert medical education courses to a more dynamic process. This method provides an early confrontation of medical students with patients before the beginning of their clinical courses and is responsible for medical stress.¹⁴  

Therefore, regarding the importance of depressive-symptom effects on medical students, and its dependence on different regional and educational methods, this study was conducted to evaluate those symptoms and the probable effects of new teaching methods on the mental health of the medical students of the Sabzevar University of Medical Science using a validated University Student Depression Inventory (USDI) questionnaire.

Study population:

This cross-sectional survey was conducted in Sabzevar University of Medical Science in 2012. The present research has been approved by Sabzevar University of Medical Science research committee (code number: 39201010/05). The only inclusion criterion for this study was being a medical student at any educational level. The only exclusion criteria in our study were incomplete form submission and 

methods:

the presence of any psychiatric disorder, described as taking any anti-depression medication within the last 6 months or any documented evidence of such. Fortunately, none of our participants suffered from those disorders. All the 75 medical students agreed to fill the questionnaire form voluntarily. After taking verbal consent and explaining the purpose of our study, the forms were given to students. However, only 31 students completely filled out the form. In each form the participants were asked to report their age, gender, years of study, marital status, grade point average and residency mode.

Study instruments:

University Student Depression Inventory (USDI) was used to evaluate the depressive symptoms among medical students; USDI is a 30-item test which measures student depressive symptoms. Participants had to answer how often they experienced each item in the past two weeks in a 5-point Likert scale from 1 “not at all” to 5 “all the time”. This test was shown to have strong positive relation with Depression Anxiety Stress Scales (DASS).¹⁷

It seems that students’ depression is somehow different from other people. For example, changes in sleep rhythms and appetite, which is asked in other depression questionnaires, can’t be beneficial in evaluation of their depressive symptoms, since these alterations can be made by students’ daily homework and duties. Other questionnaires seem to emphasize more on clinical aspects of depression and would be more helpful in determining students with severe rather than mild depression. USDI, on the other hand, seems to be better than other depression questionnaires due to the exclusion of some factors such as the above-mentioned topics, and paying more attention to the educational environment. Reliability and validity of the Persian version of the USDI questionnaire was assessed by Hejazi et al. (2007). This questionnaire proves to have an acceptable validity based on the Chronbach’s alpha analysis (Chronbach’s alpha was reported 0.93 for the overall scale while the value ranged between 0.83 and 0.94 for the sub-categories). The reliability was assessed using the Pearson correlation coefficient between two trials, which resulted in the r=0.86.¹⁸

Statistical analysis:

Descriptive statistics were used to identify mean and standard deviation of continuous variables. Independent t-test was used to compare USDI scores and cumulative grade point average (CGPA) among genders and 2^nd-, 4^th- and 7^th-semester students. One way ANOVA was used to compare USDI and CGPS scores among mode of residence and semester categories regarding the normal distribution of data. Pearson correlation was used to identify the correlation between USDI score and CGPA. The confidence interval was considered as 95% and p values less than 0.05 were considered as statistically significant. Statistical analyses were performed using the Statistical Package for the Social Sciences (SPSS) program version 19.00.

A total of 31 medical students participated in the study. Among the participants, 12 students (38.7%) were in second semester, 10 (32.3%) and 9 (29.0%) students were studying in the 4^th and 7^th semester, respectively. Only one student was married and most of the students (74.2%) stayed

RESULTS

at the university dormitory.  Among the students who lived in the dormitory 11 were male and 12 were female, while 2 male and 3 female students lived in their houses. Mean cumulative grade point average (CGPA) of the students was 15.66 ± 1.09. Comparison of CGPA between study semesters and residence categories are illustrated in Table 1.

Mean total USDI score of participants was 60.71 ± 22.55. While mean score of females were higher than males, there was no significant difference in total USDI score between Male and female participants (p=0.84) or the semester (p=0.26) (Table 1). There was, either, no significant difference in term of USDI total score among the three study semester categories (p=0.34) (Table 1).

There was not any significant association between USDI 

questions’ results and gender (p>0.05). There was no significant correlation between USDI score and CGPA of study participants r(22)=0.11, p=0.62.

Moreover, there was no significant difference in terms of lethargy mean score amongst genders after running independent t-test (p=0.78). Lethargy scores were significantly higher among students in 4^th-semester than 2^nd and 7^th-semesters. There was no significant difference in terms of cognitive/emotional mean score among genders after running independent t-test (p=0.60) (Table 2). Cognitive/ emotional mean score was significantly higher amongst students in 7^th-semesters (Table 2), As well as academic motivation mean score amongst the ones in 4^th-semester compared to 2^nd- and 7^th-semester students (Table 2).