Measuring depression and anxiety prevalence among Iraqi healthcare college students using hospital anxiety and depression scale

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Depression, Anxiety, Anxiety Disorders, Students, Medical, Students, Pharmacy, Academic Success, Sleep, Exercise, Social Support, Workload, Prevalence, Linear Models, Cross-Sectional Studies, Iraq


Objective: The study aimed to 1) measure the prevalence of depression and anxiety among Iraqi pharmacy and medical students at a number of universities in Baghdad using Hospital Anxiety and Depression Scale (HADS) and 2) investigate the association between various sociodemographic factors and students’ HADS scores.

Methods: This study was based on a cross-sectional descriptive design in four universities in Baghdad, Iraq. Depression and anxiety were screened using an Arabic version of the HADS. An online survey was administered via Qualtrics to convenience samples of students at four colleges of pharmacy and a college of medicine between March and June 2018. Multiple linear regression was used to identify factors associated with depression and anxiety symptoms among the participants.

Results: The researchers received 750 usable surveys. The participating students spent more time browsing social media (6.64 hours/day) than studying (1.92 hours/day) and exercising (2.83 hours/week). Approximately forty-six percent (45.9%) of the participants had scores that indicated depression symptoms and one-quarter (24.8%) had scores that indicated depression borderline symptoms. More than one-half (52.1%) of the participants had scores that indicated anxiety symptoms, while 20.1% had scores that indicated anxiety borderline symptoms. According to the multiple linear regression analysis, more depression and anxiety symptoms were significantly (p-value <0.05) associated with higher study hours weekly and lower sleep hours at night, academic achievement, and colleagues and family social support during exams.

Conclusions: Pharmacy and medical students may be vulnerable to depression and anxiety because of long study hours.. To reduce their levels of anxiety and depression, they may need more social support, more exercise, more sleep, less social media use and a lower academic workload.


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1. WHO. Depression and Other Common Mental Disorders: Global Health Estimates. (accessed Jan 28, 2021).
2. WHO Department of Mental Health and Substance Abuse. Depression: A global public health concern. (accessed Jan 28, 2021).
3. AlAlwan MA. Health Situation in Iraq: challenges and priorities for action. Baghdad: Ministry of Health; 2019.
4. WHO. Depression (accessed Jan 28, 2021).
5. Quek TT, Tam WW, Tran BX, et al. The Global Prevalence of Anxiety Among Medical Students: A Meta-Analysis. Int J Environ Res Public Health. 2019;16(15):2735.
6. Ibrahim MB, Abdelreheem MH. Prevalence of anxiety and depression among medical and pharmaceutical students in Alexandria University. Alexandria J Med. 2015;51(2):167-173.
7. Auerbach RP, Mortier P, Bruffaerts R, et al. WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders. J Abnorm Psychol. 2018;127(7):623-638.
8. GBD 2017 Disease and Injury Incidence and Prevalence Collaborators. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet. 2018;392(10159):1789-1858.
9. WHO. Depression: Let’s talk. (accessed Jan 28, 2021).
10. Ray ME, Coon JM, Al-Jumaili AA, Fullerton M. Quantitative and Qualitative Factors Associated with Social Isolation Among Graduate and Professional Health Science Students. Am J Pharm Educ. 2019;83(7):6983.
11. Wahab I, Jamludin N, Abdul Qader AM, et al. Prevalence of depression among undergraduate pharmacy students in Malaysia. Int J Pharm Res. 2020;12(3):2033-2042.
12. Ngasa SN, Sama CB, Dzekem BS, et al. Prevalence and factors associated with depression among medical students in Cameroon: a cross-sectional study. BMC Psychiatry. 2017;17(1):216.
13. Zigmond AS, Snaith RP. The hospital anxiety and depression scale. Acta Psychiatr Scand. 1983;67(6):361-370.
14. Bocéréan C, Dupret E. A validation study of the Hospital Anxiety and Depression Scale (HADS) in a large sample of French employees. BMC Psychiatry. 2014;14:354.
15. Marfell NR. Measuring depression and anxiety in medical students: Is HADS an appropriate tool? (accessed Jan 28, 2021).
16. Royal College of Psychiatrists. Mental health of students in higher education. (accessed Jan 28, 2021).
17. de Almeida Macêdo E, Appenzeller S, Lavras Costallat LT. Assessment of the Hospital Anxiety and Depression Scale (HADS) performance for the diagnosis of anxiety in patients with systemic lupus erythematosus. Rheumatol Int. 2017;37(12):1999-2004.
18. Hartung TJ, Friedrich M, Johansen C, Wittchen HU, Faller H, Koch U, et al. The Hospital Anxiety and Depression Scale (HADS) and the 9-item Patient Health Questionnaire (PHQ-9) as screening instruments for depression in patients with cancer. Cancer. 2017;123(21):4236-43.
19. Ayis SA, Ayerbe L, Ashworth M, C DAW. Evaluation of the Hospital Anxiety and Depression Scale (HADS) in screening stroke patients for symptoms: Item Response Theory (IRT) analysis. Journal of affective disorders. 2018;228:33-40.
20. Snaith ASZRP. The Hospital Anxiety and Depression Scale. Acta psychiatrica Scandinavica. 1983.
21. Al-Jumaili AA, Aljuboori SB, Kubba AA, Fathel R, Talab H. Evaluate factors influencing depression in Baghdad: Using Deck-Depression Inventory. Innov Pharm. 2019;10(3):2036.
22. Al-Jumaili AA, Hussain SA, Sorofman B. Pharmacy in Iraq: history, current status, and future directions. Am J Health Syst Pharm. 2013;70(4):368-372.
23. Ibrahim IR, Wayyes AR. Pharmacy practice in Iraq. In: Fathelrahman AI, Ibrahim MIM, Wertheimer AI, eds. Pharmacy Practice in Developing Countries. Boston: Academic Press; 2016.
24. Banks S, Dinges DF. Behavioral and physiological consequences of sleep restriction. J Clin Sleep Med. 2007;3(5):519-528.
25. Itani O, Jike M, Watanabe N, Kaneita Y. Short sleep duration and health outcomes: a systematic review, meta-analysis, and meta-regression. Sleep Med. 2017;32:246-256.
26. Yu J, Rawtaer I, Fam J, et al. Sleep correlates of depression and anxiety in an elderly Asian population. Psychogeriatrics. 2016;16(3):191-195.
27. Zhai L, Zhang H, Zhang D. Sleep duration and depression among adults: a meta-analysis of prospective studies. Depress Anxiety. 2015;32(9):664-670.
28. Schou Andreassen C, Billieux J, Griffiths MD, et al. The relationship between addictive use of social media and video games and symptoms of psychiatric disorders: A large-scale cross-sectional study. Psychol Addict Behav. 2016;30(2):252-262.
29. George LK, Blazer DG, Hughes DC, Fowler N. Social support and the outcome of major depression. Br J Psychiatry. 1989;154:478-485.
30. Gariépy G, Honkaniemi H, Quesnel-Vallée A. Social support and protection from depression: systematic review of current findings in Western countries. Br J Psychiatry. 2016;209(4):284-293.
31. Al-Jumaili AA. Iraq Pharmaceutical Country Profile 2020. (accessed Jan 28, 2021).
32. Andrews B, Wilding JM. The relation of depression and anxiety to life-stress and achievement in students. Br J Psychol. 2004;95(Pt 4):509-521.
33. Al-Jumaili AA, Al-Rekabi MD, Alsawad OS, et al. Exploring Electronic Communication Modes Between Iraqi Faculty and Students of Pharmacy Schools Using the Technology Acceptance Model. Am J Pharm Educ. 2017;81(5):89.
34. Al-Jumaili AA, Ahmed KK, Al-Jalehawi AK, et al. Evaluating the use of informational technologies by students of healthcare colleges for academic purposes over a five-year period. Educ Inf Technol (Dordr). 2021;1-21.
35. Ahmed K, Salman S, Abbas WA, Alkaisy S, Kathem S. Sudden Transition of Pharmacy Education from Traditional to Distance Learning in the Era of COVID-19: Action Steps of a Leading Pharmacy School in Iraq. Iraqi J Pharm Sci. 2020;29(2):271-278.
36. Woods HC, Scott H. #Sleepyteens: Social media use in adolescence is associated with poor sleep quality, anxiety, depression and low self-esteem. J Adolesc. 2016;51:41-49.