Prevalence and predictors of depression among college going youth of Meghalaya: A cross-sectional study

Abstract

Backgrounds: 

College years are characterized by transitioning from pre-adult to adulthood, a period of turmoil, adjusting to the new condition, separation from parental supervision, independence, and countering new things throughout everyday life. Depression and health-risk behaviors, including alcohol, tobacco, and illicit drug, are often found in college students, particularly during their first year.

Aim: 

To study the prevalence and predictors of depression among college-going youth of Meghalaya, India.

Materials and Methods: 

A cross-sectional community-based study has been undertaken to find the prevalence of depression, alcohol use, and drug use in college-going youth in Shillong, Meghalaya. A random sampling technique was used for the selection of colleges, and total enumeration was used for the selection of college-going students. A total of 358 respondents were selected for the present study. Permission from the college authority was obtained, and written informed consent was taken from the students. The participants have been explained the purpose of the study and the samples were selected voluntarily. The present study’s data were analyzed and interpreted using Statistical Package for Social Sciences version 20.0. Socio-demographic datasheet, Beck Depression Inventory-II, Hamilton Anxiety Rating Scale, Alcohol Use Disorder Identification Test, and drug abuse screening test were administered.

Results: 

In the present study, 40.5% fall under the normal range of depression, while 38.3% had mild mood disturbance, 10.3% had borderline clinical depression, 9.7% had moderate depression, and severe depression was found in 1.1%. Alcohol use, drug use, and gender contribute significantly to the prediction of depression among college-going students (F[5,19.551] = 855.3, P = 0.000) accounting for 21.7% variance.

Conclusion: 

Our findings highlight the need for a college mental health program for early identification and screening of substance use and depression in college students.

INTRODUCTION

College years are characterized by transitioning from pre-adult to adulthood, a period of turmoil, adjusting to the new condition, separation from parental supervision, independence, and countering new things throughout everyday life. Research shows that depression is a common mental health issue in all age groups, including children.^[1,2] Depression is one of the leading causes of disease burden worldwide and is ranked as the second leading cause of disability. Around 4.4% of the world population suffers from depression, according to the estimates of the World Health Organization.^[3] Research studies have shown depression among college students is profoundly predominant.^[4,5] There is intense academic pressure commonly associated with escalations in various health-risk behaviors, including alcohol, tobacco, and illicit drug use.^[6-8] Mohamed et al.^[9] reported that substance use disorders are associated with high levels of anxiety and depression. During this period, the use of alcohol and drug among university students has been recognized as a global public health issue.^[10] Risk for the onset of alcohol dependence peaks at the age of 18 years. Moreover, alcohol use disorders are more prevalent among emerging and young adults than among any other age group. Approximately 9% of those ages 18–29 meet the criteria for alcohol dependence, more than twice the overall prevalence rate.^[11,12] A recent study^[13] conducted in India shows that lifetime use of alcohol was reported by 1168 (21.4%) students (men—726 [39%]; women—442 [12.6%]). The finding from the research study shows that there is excessive alcohol use and drug use among college students, which can lead to adverse health and social outcomes.^[14-16] Esmaeelzadeh et al.^[17] found that 14.7% of post-secondary students were diagnosed or treated for depression and 18.4% for anxiety within the past 12 months. Among current (past 30 days) substance use, it was reported that alcohol (69.3%), cannabis (17.9%), and tobacco (11%) were the most common. There was a significant association between depression and current tobacco and cannabis use among students.

A few studies have been conducted on college-going students in the northeast region. Especially, data from Meghalaya are significantly less. A survey of the prevalence of alcohol consumption in Northeast India among the general population shows that Meghalaya and Mizoram have the highest alcohol consumption, and the age group of alcohol consumption is between 25 and 44 years old.^[18] Thus, the present study was aimed to assess the prevalence of substance use and depression in college-going youth of Meghalaya, India. The finding from the study can help policymakers and health professionals deal with the immediate need for mental health support services for students.

AIMS AND OBJECTIVES

To study the prevalence of alcohol and drug use, depression, and anxiety in college going youth of Meghalaya, India.

Objectives

To evaluate the level of depression and anxiety among first-year college students.

To determine alcohol use and drug use among first-year college students.

To see the predictors of depression among first-year college students.

MATERIALS AND METHODS

The present study was a cross-sectional community-based study to find the prevalence and predictors of depression among college-going youth in Shillong, Meghalaya, India. The population for this research was first-year undergraduate students from St. Edmunds College, Shillong, East Khasi Hills District, Meghalaya, India. Those who belonged to the age group of 18–24 years were selected as a sample. The participant was from the arts, science, commerce, social work, and computer application department. The researcher used random sampling (lottery method) as the technique for the selection of colleges. In accordance with this, we selected St. Edmunds College to conduct the research. For the selection of college-going students, we used the total enumeration method. A total of 358 respondents were selected for the present study. Permission from the college authority was obtained, and written informed consent was taken from the students. Data collection was performed over 10 months, from September 2018 to July 2019. The study was undertaken with the approval of the Scientific Committee and Institute Ethics Committee of LGBRIMH, Tezpur. The research ensured the confidentiality of all personal information relating to the youth in the investigation. The participants explained the study’s purpose, and samples were selected voluntarily. The present study’s data were analyzed and interpreted using Statistical Package for Social Sciences (SPSS), Version 23.0 (IBM Corporation, Armonk, NY, USA).

Tools used

Socio-demographic datasheet

A socio-demographic datasheet was used for collecting details regarding age, sex, ethnicity, and religion.

Beck Depression Inventory-II^{[ 19]}

The Beck Depression Inventory Scale-II (BDI) was used to measure the symptoms of depression. This BDI-II is 21 items self-report screening scale for measuring depression. The responses were made on a 4-point scale ranging from 0 to 3 based on the severity in the last 2 weeks. In BDI, the total score ranges from 0 to 9, indicating minimal depression, and 30–63 indicating severe depression. The higher score in BDI indicates more severe depression symptoms among the respondents.

Hamilton Anxiety Rating Scale (HAM-A)^{[ 20]}

The HAM-A was used to measure the severity of anxiety symptoms. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to pressure). The total score lies in range of 0–56 and each item is scored on a scale of 0 (not present) to 4 (severe).

Alcohol use disorder identification test^{[ 21]}

Alcohol use was measured using the Alcohol Use Disorder Identification Test (AUDIT). This measure has items that relate to alcohol consumption (e.g., quantity, frequency), alcohol dependence (e.g., failure to fulfill responsibilities, guilt), and alcohol-related problems (e.g., memory loss, injury). The version used in this study is self-report and contains ten items (e.g., “How often do you have a drink containing alcohol?”). Each item is rated on a scale of 0 to 4 (e.g., 0 = never to 4 = daily or almost daily). Scores of 8 and above indicate excessive or hazardous drinking.

Drug abuse screening test^{[ 22]}

Drug use among youth was measured using the Drug Abuse Screening Test (DAST-I 0; Skinner, 1982). This scale consists of 10 items (e.g., “Have you used drugs other than those required for medical reasons?”) and participants are asked to circle “yes” or “no.” Each “yes” response is worth one point. Item 3 is reverse scored such that selecting “no” indicates an inability to control one’s drug use. Thus, higher scores indicate more incredible drug abuse, with a score of 3 or above suggesting possible dependence.

RESULTS

In the current study, the total number of participants was 358, of which men account for 43.6% and women for 56.1%. As seen in the present study, the number of females is more than half that of males. The results showed that the number of tribal participants was high, with a total of 214 in number and a percentage of 59.8%. The nontribal comprises 139 in total number and consists of 38.8%. Predominantly Meghalaya is a Tribal-State; hence, the results of the current study could be explained in that context whereby tribal participation was among the majority; the dominating religion with the highest number in total was Christianity consisting of 55.6%, which accounted for more than half of the total, 21.8% reside in rural areas, 12.8% live in a semi-urban area, 65.5%, participants dwell in urban. Most participants come from a nuclear family type which amounts to 80.4%, followed by a typical family type of 16.5% [Table 1].

Table 1: - Socio-demographic profiles of the college-going youth (N = 358)

Variables	Mean	SD
Age	19.7626	1.19384
Variables	Frequency (N )	Percentage (%)
Sex
Male	156	43.6
Female	201	56.1
Ethnicity
Tribal	219	61.2
Nontribal	139	38.8
Religion
Christianity	199	55.6
Hinduism	98	27.4
Islam	3	0.8
Others	58	16.2
Domicile
Rural	78	21.8
Urban	234	65.4
Semi-urban	46	12.8
Family type
288	80.4	288
59	16.5	59
11	3.1	11

The participant’s alcohol consumption related to harmful and excessive use of alcohol was assessed using the Alcohol Use Disorders Identification Test (AUDIT). The finding shows that out of 358 participants’ the majority were at low risk, 82.4%, followed by 12.3% of participants with a risky use of alcohol. Of them, 4.2% were found to be at high risk or harmful levels, and 1.1% of participants were at increased risk [Table 2]. It was seen that 97.2% (348) participants do not have any problem related to drug use forming a majority; however, four participants account for 1.1%; in that, each has a moderate substantial and severe level of service, and 0.3% have an extreme level of addiction [Table 2].

Table 2: - Prevalence of alcohol use among college students

Audit category	Frequency	Percentage (%)
Low risk	295	82.4
Risky level/moderate risk of harm	44	12.3
High-risk or harmful level	15	4.2
High risk/dependence likely	4	1.1
Total	358	100.0
Drug abuse screening test—DAST	Frequency	Percentage (%)
No problem	348	97.2
Low level	1	0.3
Moderate level	4	1.1
Substantial level	4	1.1
Severe level	1	0.3
Total	358	100.0

Among the current participants, the rate of those with mild anxiety constitutes the maximum at 63.4%, followed by mild-to-moderate anxiety at 31.6%, and 5.0% of the participants had moderate-to-severe anxiety levels [Table 3].

Table 3: - Prevalence of anxiety among college students

Anxiety	Frequency	Percentage (%)
Mild anxiety	227	63.4
Mild to moderate anxiety	113	31.6
Moderate to severe	18	5.0
Total	358	100.0

In the present study, 40.5% fall under the normal range of depression, whereas 38.3% have mild mood disturbance, borderline clinical depression made up 10.3% of the total population, followed by moderate depression (9.7%), and severe depression was found in 1.1% [Table 4].

Table 4: - Prevalence of depression among college students

Depression	Frequency	Percentage (%)
Normal	145	40.5
Mild depression	137	38.2
Borderline depression	37	10.33
Moderate depression	35	9.7
Severe depression	4	1.1
Total	358	100

Depression has a significant positive correlation with alcohol use (r = .252, P = 0.01) and drug use (r =.2.259, P = 0.01) [Table 5].

Table 5: - Correlation between depression, alcohol use, drug use, and age

	Age	Alcohol use	Drug use
Depression	-.039	.252 **	.259 **

^** Correlation is significant at the 0.01 level (2-tailed)

We conducted a regression analysis to explore the predictors of depression. As shown in Table 6, alcohol use, drug use, and gender contribute significantly to the prediction of depression among college-going students (F[5,19.551] = 855.3, P = 0.000) accounting for 21.7% variance. The remaining 78.30% was attributed to a variable not included in the study. Alcohol use strongly contributes to the variance of depression (β = .402, t = 5.648, P = 0.000). Also, drug use with (β = 1.448, t = 3.926, P = 0.000) and gender (β = 5.422, t = 7.245, P = 0.000) contribute strongly to depression variance.

Table 6: - Regression analysis summary of alcohol use, drug use, age, socioeconomic status, and gender on depression (n = 358)

Model summary
R	R 2	Adjusted R 2		Std. the error in the estimate
.466	.217	.206		6.61420
	Sum of squares	df		Mean square	F	Sig.
Regression	4276.648	5		855.330	19.551	.000
Residual	15399.188	352		43.748
Total	19675.835	357
Coefficients
Unstandardized coefficients				Standardized Coefficients	t	Sig.
Variables		B	Std. Error (SE)	Beta
Constant		–1.974	6.294		–.314	.754
Alcohol use		.402	.071	.296	5.648	.000
Drug use		1.448	.369	.198	3.926	.000
Gender		5.422	.748	.363	7.245	.000
Age		.161	.298	.026	.540	.590
Socioeconomic status		.313	.294	.051	1.067	.287

DISCUSSION

The finding shows that out of 358 participants, the majority were at low risk, 82.4%, followed by 12.3% of participants with a risky use of alcohol, 4.2% were found to be in a high risk or harmful level, and 1.1% in a high risk. A study conducted in North India among college student by Chaudhary et al.^[23] reveal that 87.3% are non-problem drinkers, 6.8% of the alcohol users are hazardous, 2.3% are harmful, and 3.6% are dependent on the pattern of alcohol consumption among the students using disorders identification test (AUDIT). The findings of this study support the current research. Also, Thakur et al.^[24] analysis indicates that the prevalence of everyday and regular use of alcohol among the respondents was 13.8% which supports the present research in terms of daily use. In a survey carried out by Verenkar and Vaz,^[25] among college students in Goa prevalence of alcohol consumption was found to be 39.4%, 82.3% were light drinkers, and 17.7% were identified as heavy drinkers. Hazardous alcohol consumption was determined in 46.7% of alcohol consumers 20.9% of alcohol consumers showed signs of alcohol dependence. The prevalence of alcohol consumption among adolescents in Kerala is 15%, and 25.3% of drinkers reported hazardous alcohol use.^[26] Their findings are not consistent with that of the present research. In the current study, although hazardous and alcohol dependence is much lesser than in the previous study, this could be due to the respondents’ geographical area, cultural background, religion, and socioeconomic status. The Khasi culture allowed alcohol consumption during social gatherings and rituals in the community and family. However, abuse is not acceptable. A study on the prevalence of alcohol consumption in Northeast India (2016) among the general population shows that Meghalaya and Mizoram have the highest alcohol consumption, and the age group of alcohol consumption is between 25 and 44 years old.^[18] Thus, the population of the study and age could be a reason for the lesser number of hazardous uses of alcohol consumption among the college student in the current study. The present study’s finding shows that 1.1% of the participants had a moderate substantial and severe level of use of drugs, and 0.3% had an extreme drug addiction. The epidemiological research indicates young people in the age range of 18–29 years are the most likely to use marijuana or other illicit drugs relative to different age groups.^[27-29] Prakash et al.^[30] found that 8.60% have tried some substance of abuse such as marijuana (5.51%), LSD (1.10%), cocaine (1.32%), and others (1.76%). Among the substance users including adolescents and young adults, 1.54% used it regularly, 1.76% occasionally, and 2.20% only once. Tsering et al.^[31] reported that out of 416 students, 52 (12.5%) used or abused any substances, irrespective of time and frequency in their lifetime. The report on the magnitude of substance abuse in India (2019), published by the Ministry of Social Justice and Empowerment, Government of India, stated that the Meghalaya prevalence of use of alcohol was 3.4% and dependence was present in 0.9% of the respondents, cannabis (1.68% of current user and 0.15% dependence), opioid (6.34% dependence), sedatives (0.85 current users of sedatives), inhabitants (0.8% users), and cocaine (0.05% current uses of cocaine).^[32]

Depression among college students is quite prevalent. In the present study, 38.3% had mild mood disturbance, borderline clinical depression made up 10.3%, moderate depression made up 9.7%, and severe depression was found in 1.1% of the participants. Shah and Pol^[5] conducted a prospective study among college students aged 18–25 years, using the Beck’s Depression and Anxiety Inventory, and found that depression was prevalent in about 48.30% of the students. In contrast, anxiety was overall in 50% of these students. Islam et al.^[33] reported that college-going students were experiencing heightened depression and anxiety. Around 15% of the students reportedly had moderately severe depression, whereas 18.1% suffered from anxiety. Deb et al.^[34] stated that 37.7%, 13.1%, and 2.4% of students suffered moderate, severe, and extremely severe depression.

Depression has a significant positive correlation with alcohol use and drug use in the present study. Further, regression analysis shows that alcohol use, drug use, and gender contribute significantly to the prediction of depression among college-going students (F[5,19.551] = 855.3, P = 0.000) accounting for 21.7% variance. Ramón-Arbués et al.^[35] stated that smoking, being a woman, and consuming alcohol frequently were significantly associated with symptoms of stress. Frequent consumption of alcohol was significantly associated with anxiety symptoms. Leino and Kisch^[36] studied the correlates and predictors of depression in college students. Logistic regression analyses demonstrated that women or those students in an emotionally abusive relationship were predictive of having depression. Further, Esmaeelzadeh et al.^[37] found significant associations between depression, tobacco use and cannabis use, and anxiety and alcohol use among students. Self-reported heavy, problem drinkers experienced significantly higher BDI scores.^[38] Change in depressive symptoms was associated with real alcohol problems, impaired control, self-perception, self-care, academic/occupational, and physiological dependence problems.^[39]

Limitation

First, we selected one college from one geographical location. This sample of students was primarily of tribal ethnicity from Meghalaya, and no other ethnic group was present in the study. Second, we assessed depression, anxiety, alcohol, and drug use via a self-reported questionnaire but did not clinically confirm the findings. Thus, rates of depression and anxiety symptoms and alcohol and drug use may be either over-or underestimated in the present study. Third, the cross-sectional nature of the study design limits our ability to examine the interaction of mental health and alcohol and drug use over time.

CONCLUSION

Hence, significant college students are involved in high-risk behavior, that is, alcohol and drug use. Anxiety and depression are pretty prevalent among college students. The finding shows that alcohol use, drug use, and gender contribute significantly to the prediction of depression among college-going students. Multisite research needs to be conducted from different geographical regions to generalize the study result. A college mental program is required on campus to deal with alcohol and drug use problems and mental health problems. The emphasis should encourage students to seek help from appropriate health centers and community services.

Ethical consideration

Clearance/approval from the Scientific Advisory Committee (SAC) of LGB Regional Institute of Mental Health, Tezpur, Assam, India, was obtained for undertaking the proposed research project vide letter No. MGMIHS/Res/02/2017-18/186 Dated 23rd March 2018. The proposal was performed by the ethical standards of the 1964 Declaration of Helsinki. All participants provided their written informed consent before participating in the study. This study is a part of M. Phil’s dissertation titled “Body Image, Romantic Relationship, Psychological Adjustment, and Substance Use in college-going students” vide letter no.LGB/ACA/SAC/2589/15/2844 dated 12/7/18.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.