Depression, suicidal ideation and anxiety among medical university students in Central Vietnam Prevalence and possible contributing factors A/Professor VO VAN THANG Acting Director, Institute for Community Health Research, Dean, Faculty of Public Health Hue University of Medicine and Pharmacy, Viet Nam

Introduction Research worldwide showed: University students face emotional and behavioral difficulties during the transition from adolescence to adulthood. Medical students suffer from high stress and this can lead to depression. Medical students may be more likely to experience depression and anxiety compared to the general population as well as other undergraduate groups. 2 Introduction

Estimates of the prevalence of mental disorder among medical students: USA/Europe: 8%-15%; Middle East: %; Others: 21%-38%, depending on methods of measurement. The prevalence of suicidal ideation among medical students in US: 11.2%; in Northern Europe: 14%; in China: 12% 3 Introduction

In Vietnam There have been some small-scale surveys on this topic with students from just one or two universities. These studies examined the health status of medical students in eight national universities across all regions of Vietnam to provide evidence for the need of mental health and counseling services. Introduction

Psychological distress: ranging from 21% to 56% Depression is one of the most common health problems for university students 35.2 – 38.4% (CESD ≥16) 11.5% of medical students suffered from anxiety disorder In Hue city: CES-D ≥ 16: 24.3% ; > 21: 11,9%; > 25: 6,8% 5 A. K. Ibrahim, (2013), Vuong Diem Khanh Doan (2011), Smith. C.K. (2011), Chandavarkar. U (2007) Previous Research: prevalence Background

1.What is the prevalence of depression, anxiety and suicidal thinking among medical students? 2.What factors contribute to depression, anxiety and self-harm? 6 Main research questions Background

7 Study method

8 Cross-sectional study 267 medical students Y1A – Y3B – Y5C Randomized Study setting: Hue university of Medicine & Pharmacy, Hue city, Central Vietnam Time: From 4/2013 – 7/ st Year3 rd Year5 th Year Study design & sample size Methodology Undergraduate medical students

` 9 The study protocol and procedures were approval by the scientific committee of the Hue University of Medicine and Pharmacy and written consent was obtained from all participants Study ethics Methodology

Variables Demography Potential risk factors: Adverse childhood experiences, recent stressful life events; study hours; career choice, parental expectations, Depression: Diagnosis instrument: Vietnamese version of the Center for Epidemiological Studies -Depression Scale (CES-D) 20-item, four factors 4-point Likert scale Validated (Nguyen, Le, Dunne, 2007) 10 Measurement: self-completed questionnaire

11 Anxiety:  Vietnamese version (Nguyen, Le, and Dunne 2007).  13-item  3-point Likert scale Suicidal behaviours : questions from the youth risk behaviour survey (YRBS): Developed by the US CDC (Eaton et al., 2008; CDC, 2009) Three items for suicidal behaviours (thoughts, planning and attempts) Measurement Methodology

12 Results

13  Data analysis conducted with 267 students (100% of the potential participants): 1 st year (37.1%), 3 rd (33.7%) and 5 th (29.2%). Male (50.2%) & Female (49.8%), Age 21.05±1.68, Almost all (95%) were Kinh ethnic group Urban family 50%; MethodologyDemographics

14 Methodology

Depression prevalenceDepression prevalence CES-D ≥ 16: 49.81% (at risk for depression) CES-D > 21: 18.7% ( substantial depressive symptoms) CES-D > 25: 6.8% (depression) Depressive symptoms are high in Vietnamese medical students compared to adults in the Hue population (Khanh 2011)

Anxiety PrevalenceAnxiety Prevalence

Putting this in context…Putting this in context… 17 On average, this is about 6 students in every classroom

Suicidal thinking 10.49%; Suicidal planning 4.49% and: Suicidal attempt 1.50% 18 Suicidal thinking Prevalence Results

19 Suicidal ideation by genderResults

Independent variables Depression (log) βSE Gender Male Female1.90*1.25 Marital status of parent Live togetherRef- Divorced / Separated 3.71*2.29 Widowed Occu. of mother OfficerRef- Self-manager Farmer1.86*1.31 Jobless Housewife Depression: Multiple regression analysis

21 Depression: Multiple regression analysis Independent variables Depression (log) βSE No. Academic hrs in medical curriculum GPA (10 score) <5,5ref 5,5-6,40.220,45 6,5-7,40130,48 7,5-8,40.11*0,48 8,5-8,90.22*0,52 Stressful life events0.77*0,03

Independent variables Anxiety (log) βSE Gender Male Ref- Female 1.13*0.03 Occu. of mothers Officer Ref- Self-manager 0, Farmer 1.04*0.03 Jobless Housewife Stressful life events0.77*0.03 Physical paint NoRef Yes1.28* Anxiety: Multiple regression analysis

23 Discussion & Conclusion

24 Although still a new topic in most universities in Vietnam, this study confirms trends observed worldwide. Many students carry with them a significant mental health burden. In this study, for an example, about 10% had thought about suicide in the past year, and half that number had made a plan, and 1 in every 70 students said they’d actually attempted suicide. Non-trivial levels of psychological distress were reported by about one in six students Main points

25 Factors significantly correlated with depression and anxiety included study burden and enrolment to study medicine that was somewhat against their own preference (usually to meet parental expectations). Further research relevant to mental health promotion should focus on the relationships between the student and family factors, academic burden and recent stressful life events Main points

RECOMMENDATION To promote students wellbeing, it’s necessary to provide free and confidential health service that include medical and psychological care and counseling in medical universities. Social skills are needed to develop within learning environment during 6 years of medical education.

Future … No health without mental health 27