Depression in College Students

Although not everyone who is depressed will have suicidal ideas, the prevalence of suicidal ideation is quite high.

KOMPAS/HERYUNANTO

Illustration

The Ministry of Health has just revealed the results of screening for symptoms of depression in students of specialist medical education programs or PPDS. Data based on the Patient Health Questionnaire-9 (PHQ-9) shows that around 22.4 percent of PPDS students were detected as experiencing symptoms of depression and around 3.3 percent had ideas suicide/self-harm (Kompas, 16/4/2024).

Regarding this data, the Minister of Health asked for immediate treatment and a search for the cause.

This raises various questions within the community, whether the situation is already alarming enough? What are the causes? What are the solutions or anticipatory measures?

Epidemiological data

The prevalence (incidence rate) of depression in Indonesia is quite high. Several epidemiological data show varying prevalences, depending on the detection methods used and the characteristics of the examined population.

The results of the 2018 Basic Health Research (Riskesdas) using the Mini International Neuropsychiatric Interview (MINI) showed the prevalence of depression in the Indonesian population aged 15 years and over is around 6.1 percent. According to the World Health Organization (WHO), the prevalence rate of depression globally in the adult population worldwide is about 5 percent.

Also read: Depression, 3.3 Percent of Prospective Specialist Doctors Want to End Their Lives or Injure Theirself

Several other studies using the Center for Epidemiologic Studies Depression Scale (CES-D 10) on a similar population by Peltzer, K & Pengpid, S (2018) and Tri Damayanti et al. (2022) show a prevalence rate ranging from 21.8 to 23.14 percent.

The prevalence of depression among students in Indonesia is also quite high. Studies on students from various faculties at several well-known universities using the Beck Depression Inventory (BDI) show a prevalence of depression ranging from 41.5-54.7 percent (Uswatun Hasanah, 2020; Arif Tri Setyanto, et al., 2023). This is slightly higher compared to the results of a study by Peltzer, K & Pengpid, S (2015) on students from several universities in Africa, Asia, the Caribbean, and Latin America (around 36.8 percent).

How about the prevalence of depression among medical faculty students (FK) in Indonesia, especially in PPDS students? Research on FK S-1 students (pre-clinical) in several universities using BDI indicates a prevalence ranging from 35.63-51.4 percent (Ade Tsarina Indira, et al., 2020; Nilna Nur Faizah, et al., 2021; Verren Isella, et al., 2022).

A meta-analysis literature review by Douglas A Mata, et al (2015) from various epidemiological studies throughout the world shows that the prevalence of depression or depressive symptoms in PPDS students ranges from 20.9-43.2 percent. Meanwhile, the screening results that have just been revealed by the Indonesian Ministry of Health show that the prevalence of depression in PPDS students is around 22.4 percent.

What about the prevalence of suicide ideation in Indonesia? Several studies by Nova Riyanti Yusuf (2019) and the Global School-Based Health Survey (GSHS) (2015) among student populations show a prevalence of suicide ideation of 5-5.2%. Research on various faculties' students in several universities shows a prevalence range of 19.3-63.5% (Vania Diva & Airin, 2023; Taufik Ashal, et al., 2022; Amalia Khurotul, 2012; Ria Utami Panjaitan, et al., 2023).

The results of the Indonesian Ministry of Health's screening on PPDS students showed a prevalence of around 3.3 percent.

Depression and suicidal ideation

Depression is amoodor affective disorder when individuals experience a significant decrease in mood and loss of interest or pleasure in almost all activities.

This condition is also accompanied by a variety of psychological, physical, and cognitive symptoms that affect the individual's social or occupational functioning.

Several common symptoms of depression include feelings of sadness or a depressed mood that occur on most days (almost every day), loss of interest or pleasure in all or almost all activities, changes in weight or appetite, insomnia or hypersomnia almost every day, psychomotor agitation or retardation that is noticeable to others.

Families can provide strong emotional support and encourage open communication about the feelings and difficulties faced by students.

In addition, there is also tiredness or loss of energy almost every day, a sense of worthlessness or excessive or inappropriate guilt, difficulty concentrating or thinking, and/or indecisiveness, as well as thoughts of death or suicide, or attempted suicide.

A diagnosis of depression usually requires the presence of some of these symptoms for a duration of at least two weeks and accompanied by changes in previous functioning.

Depression has a strong connection with suicidal ideation. Individuals who suffer from depression often experience feelings of hopelessness and helplessness. This can trigger thoughts of suicide as a way to end the suffering. Depression can also reduce a person's ability to cope with stress. This condition causes them to feel like they have no other choice but to take such action.

Although not all people who experience depression will have suicidal ideation, the prevalence of suicidal ideation is quite high among those with depression. Studies show that most individuals who attempt or die by suicide have a history of depression. About 2-15 percent of depression patients have suicidal ideation.

Causative factor

In general, there are internal and external factors that can influence the high incidence of depression in society, especially students.

Several studies have indicated a higher prevalence of depression in younger populations, females, those with lower economic status, unemployed individuals, and those who face higher stressors. Other factors include poor health status, lower levels of social and religious trust, smoking habits, frequent consumption of soft drinks, experiencing separation or divorce, engaging in heavy physical and mental activities, and having chronic diseases like hypertension and cancer.

Specifically for the incidence of depression in students, several main factors that often influence include: (1) academic pressure (competition with peers, educational burden, worries about future careers); (2) life transitions (challenges of adapting to new environments); (3) financial problems; (4) mental health and physical (previous mental and physical health conditions).

In addition, (5) history of alcohol and psychotropic drug use; (6) social pressure and expectations (academic achievement targets); as well as (7) access to mental health resources (lack of access to mental health services, stigma of mental health issues).

Anticipatory efforts

The high prevalence of depression among resident doctors revealed by the RI Ministry of Health also occurs in the student population of other faculties at various universities in Indonesia, as well as in the general population. Therefore, comprehensive and widespread efforts need to be made in various populations, not only inclusive to resident doctors.

Educational institutions need to provide counseling services on campus that are equipped with trained counselors and psychologists to assist students experiencing stress or depression.

The government needs to create mental health policies by implementing and promoting policies that support mental health, including ensuring accessibility and availability of mental health services in companies. In addition, providing funding and resources for mental health programs on campus and providing training for mental health professionals.

The government needs to regularly carry out awareness campaigns to reduce the stigma surrounding depression and mental health, as well as increase awareness about the importance of mental health.

Educational institutions need to provide counseling services on campus equipped with counselors and psychologists who are trained to help students who experience stress or depression. Apart from that, we also created a peer support program so that students can support each other in facing academic and personal pressure. Educational institutions need to regularly hold workshops and seminars on stress management techniques, life balance and mental health.

Health institutions need to integrate mental health services into primary health services to facilitate access for students who need assistance. In addition, it is necessary to regularly provide training to general practitioners and medical staff on how to identify and respond to depression symptoms in students. They also need to work together with universities to conduct screenings and early interventions for at-risk students.

The community can also help to reduce the stigma surrounding depression by openly discussing mental health and supporting related initiatives. Communities can create programs or community support groups to assist students who feel isolated or struggle socially. Families can provide strong emotional support and encourage open communication about the feelings and difficulties faced by students.

In addition, families must pay attention to signs of behavioral or emotional changes in their children and encourage them to seek professional help if necessary.

Students should learn stress management techniques, such as mindfulness and meditation, increase religiosity through religious education and performing religious practices regularly, maintain a healthy diet, sleep, and exercise routine. Students should actively seek help when they feel unable to cope on their own and use the resources available at the university.

Gea Pandhita S,Neurologist; Head of the Neuroscience and Clinical Epidemiologist Laboratory, Faculty of Medicine, Muhammadiyah University, Prof. Dr. Hamka