SOUSA, Thalita Bragato. ROMEIRO, Amanda Maria de Sousa. SANDIM, Lucíola Silva. Symptoms of depression in nursing students. Revista Científica Multidisciplinar Núcleo do Conhecimento. Year 06, Ed. 01, Vol. 02, pp. 78-88. January 2021. ISSN: 2448-0959, Access link: https://www.nucleodoconhecimento.com.br/health/symptoms-of-depression
Objectives: to verify symptoms of depression among nursing students at a private university. Methods: this is a descriptive cross-sectional study with a quantitative approach. Sample consisting of 79 students of the Bachelor’s Degree in Nursing. The sociodemographic questionnaire and the Hospital Anxiety and Depression Scale (HADS) questionnaire were applied. The ethical principles expressed in Resolution 510/2016 were respected. Results: the analysis of the results showed that depressive symptoms are present in 45.56% of the sample. Conclusion: the results contribute to the analysis of the mental health of nursing students, and the need to promote the psychological well-being of these students.
Keywords: Depression, mental health, nursing students, nursing.
Depression is a mental disorder of multifactorial cause, common found in more than 264 million people worldwide, reaching a large part of the population and becoming one of the main disorders that causes disabilities in people, especially when lasting and with moderate or severe intensity. It can become a serious health condition that can lead to suicide and often affects women more than men (WHO, 2020).
According to PAHO (2019), about 12,000 young people between the age of 15 and 24 die by suicide every year in the American continent, making it the third leading cause of death. In this same perspective, PAHO (2018) highlights that depression is one of the main disorders that causes disabilities in young adults. Although there are treatment and ways to prevent this disease, depression affects 5.8% of the Brazilian population (PAHO, 2017).
University students are part of a population prone to develop depressive symptoms, even if it is mild, due to the stressful factors experienced within the undergraduate course (information overload, teacher requirement, new adaptations to graduation, scarcity of time for leisure, family stressful factors, limitation of finances), these factors can trigger mental disorders. However, this experience within graduation requires greater student performance (PADOVANI et al., 2014).
It is necessary to consider that when these symptoms are identified early, it enables the prevention and diagnosis of mental disorders, such as depression (COELHO et al,.2010). As well as, the earlier diagnosed and treated, the greater the possibility that the future professional career of these students will not be affected (SILVA; DA COSTA, 2012).
However, depression is the most common mental disorder found in university students, however, it is necessary to conduct a study to evaluate the clinical picture of this population in order to propose interventions to improve the mental health of students (BRANDTNER; BARDAGI, 2009).
From this same perspective, De Morais et al. (2010), emphasizes the main symptoms related to depression in academia, such as decreased ability of reasoning, memorization, motivation and interest of the academic in relation to the study. These symptoms consequently drastically affect the student at the university level, harming their health and their studies.
Certainly depressive symptoms can harm the academic in his university and even his/her future professional, which may lead to a possible withdrawal from the course. (ALVES, 2014). Thus, this study aimed to verify the symptoms of depression in nursing students at a private university in the state of Goiás.
This is a cross-sectional research of descriptive character. The sample was composed of nursing students, duly enrolled in the institution, from all periods of the nursing course. Data collection was performed in groups aimed at nursing students, between October 5 and 29, 2020, through an online questionnaire, disseminated and applied through a digital tool called Google Forms.
To participate in the study, it was necessary that the participants had access to the Internet and to a device such as computer, mobile phone or tablet. After reading and approving the Free and Informed Consent Form, the questionnaires began to be completed. All the arrangements in relation to the ethical dimension of the study were taken in accordance with Ethics Resolution 510/2016. The study was approved by the Research Ethics Committee of the State University of Goiás (UEG), under opinion number 3,848,957.
For data collection, two research tools were used: the sociodemographic questionnaire, in order to characterize the sample through social, economic and academic factors, such as: age group, gender, color, financial dependence, salary income, occupation, workload, course and graduation period. To assess depression levels, the Hospital Anxiety and Depression Scale (HADS) was initially developed to identify symptoms of anxiety and depression in patients from non-psychiatric clinical hospitals, and later used in non-hospitalized patients and in individuals without disease.
Botega et. Al. (1995) was the one who translated and validated HADS for Portuguese, which consisted of a total of 14 questions. In this scale, it is verified that the odd ones are corresponding to anxiety symptoms (HAD-A), while the pairs refer to the symptoms of depression (HAD-D). Hads also has a score where the alternatives of each question are verified in 0, 1, 2 or 3 points, which when added are considered as cutoff points, for both symptoms, where the evaluation of these comprises three divisions: unlikely when there is a prevalence of 0 to 7 points; possible (questionable or uncertain) when there is a prevalence of 8 to 11 points; and probable when there is a prevalence of 12 to 21 points.
All the arrangements in relation to the ethical dimension of the study were taken in accordance with Ethics Resolution 510/2016. The study was approved by the Research Ethics Committee of the State University of Goiás (UEG), under opinion number 3,848,957.
The sample consisted of 79 nursing students, of which 90% (N=71) were female, with the average age of 23 years, of these 49% (n=39) are white, 57% (n=45) have employment, 54% (n=43) have an income of a minimum wage of R$ 998.00, family income 58% (n=46) 1 to 3 salaries, 84% (n=66) live with the family , 91% (n=72) did not change municipalities to perform their undergraduate course, 62% (n=49) performed extracurricular activities, and 52% (n=41) had their own transportation (Table 1).
Table 1. Absolute (n) and relative frequency (%) sociodemographic and behavioral characteristics of students in relation to the prevalence of depressive symptoms.
|It does not have||24||30|
|1 minimum wage||43||54|
|1 to 3 minimum wages||12||16|
|It does not have||6||8|
|1 minimum wage||10||13|
|1 to 3 minimum wages||46||58|
|3 to 6 minimum wages||16||20|
|Changed to study|
Source: From the authors, 2020.
In Figure 1, it can be seen that of the total of 79 students of the Undergraduate Nursing Course, of all grades, 17.72% (n = 14) had scores> 12 for probable symptoms of depression on the HAD scale, 27, 84% (n = 22) had scores> 8 for symptoms of possible depression and 54.43% (n = 43) had scores <7 for unlikely symptoms of depression.
Figure 1. Distribution of symptoms of depression among nursing students. Goiatuba – Go. Brasil, 2020. (n=79)
In this study, a higher prevalence of depressive symptoms was observed in female students. Although the students analyzed represent a relatively small sample, females (90%). In the population studied, most of these students presented unlikely symptoms of depression (54.43%). It is worth mentioning that the rest of the sample (45.56%) symptoms of depression.
With the prevalence of depressive symptoms in nursing students deserves more attention, because in their daily routine, they deal directly with people, with psychic suffering, pain, death, feelings marked by fear, uncertainties and many of the times anxiety (CARVALHO et al., 1999). Being susceptible to the development of depressive symptoms during graduation, having mood changes, relationship, sadness, appetite change, symptoms characteristic of depressive mental disorder (CAMARGO; SOUSA, OLIVEIRA, 2014). Therefore, the concern with the presence of depression and anxiety among nursing students is paramount (FUREGATO; SANTOS; SILVA, 2010).
According to the World Health Organization (WHO) it is estimated that about 4.4% of the world population suffers from depression and about 5.8% (11,548,577) of the Brazilian population also suffers from this mental disorder (WHO, 2020). An index of (17.72%) presented in this study as a probable depressive disorder, which is much higher than the Brazilian average in the general population. However, there is a higher probability of the onset of depressive symptoms, or depression itself, in academics and health professionals (BARBOSA et al., 2020).
It is then understood that depression is a common mental disorder usually with symptoms of extreme sadness that does not pass, great loss of interest and inability to perform activities that were normally pleasurable. However, some symptoms found in people who have depression are: energy loss; changes in appetite; sleep disorders; difficulty concentrating; indecision; restlessness; feeling of being insignificant, guilt or hopelessness; anxiety; and thoughts of suicide or causing harm to themselves. Mental disorders can affect which person and any age, such as depression. This disorder does not mean that the person is weak. It is a treatable disorder, and its treatment varies according to what the patient needs and medical conduct (PAHO, 2017).
Although there are effective treatments for depression, less than half of those affected receive treatment and untreated depression becomes a serious disease that can lead to the person affected to suicide, about 800,000 people die each year by suicide (PAHO, 2018).
Three sociodemographic variables were associated with higher levels of depression in this study, which are female, period of course and housing. Females have a higher rate of depressive symptoms, which is a replication of what occurs with the general population (PAHO, 2020).
Thus, a study conducted with 194 nursing students at the Federal University of Santa Catarina, 5.67% of these students presented symptoms of depression (CÁCERES; CASCAES; BUCHELE, 2010). Corroborating this study, 114 students were evaluated where symptoms of depression were identified in 44% of the students. Through these studies it is necessary to consider that the symptoms of depression in nursing students are always in prevalence (FUREGATO; SANTOS; SILVA, 2010).
In other studies conducted with nursing students, a prevalence of 34.21% of depressive symptoms was identified in nursing students (BASTOS; MOHALLEM; FARAH, 2008). De Morais, Mascarenhas and Ribeiro (2010), verified the significant presence of depression symptoms in the sample studied, observed that approximately 40% of the total sample presented depressive symptoms.
The present study revealed that the group of female students with higher depressive symptoms is more prevalent within the nursing degree. However, the depressive symptoms presented by nursing students should not be discriminated against, but rather the need for care, and the elaboration of strategies to reduce symptoms within the course in question.
This study obtained some limitations, such as the small number of participants, the remote application of the questionnaires, the need for a more robust statistical analysis for the correlation and comparison of the data.
In view of the present study, it allowed the nursing students with depressive symptoms and their sociodemographic characteristics to be verified. In view of the results presented, a significant percentage of depressive symptoms present in the lives of these students can be observed.
The results indicate that the population is with a mean age of 23 years. These students are in adolescence, beginning their adult life, with little life experience. The studied population deserves significant attention, since of the 79 students of the Undergraduate Nursing Course, 36 (45.56%) symptoms indicative of depression.
With the results obtained from this study, it arouses the need to implement psychological support programs to students, in order to support students in the face of conflicting situations inherent to academic life and future professional activities, thus aiming to minimize the damage caused by mental suffering throughout the undergraduate course, promoting improvement in the performance of the academic and preventing possible dysfunctions and disorders.
ALVES, Tania Correa de Toledo Ferraz. Depressão e ansiedade entre estudantes da área de saúde. Revista de Medicina, v. 93, n. 3, p. 101-105, 2014. http://dx.doi.org/10.11606/issn.1679-9836.v93i3p101-105. Disponível em: https://www.revistas.usp.br/revistadc/article/view/103400. Acesso em: 05 de Maio de 2020.
BRANDTNER, Maríndia; BARDAGI, Marucia. Sintomatologia de depressão e ansiedade em estudantes de uma universidade privada do Rio Grande do Sul. Gerais: Revista Interinstitucional de Psicologia, v. 2, n. 2, p. 81-91, 2009. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1983-82202009000200004. Acesso em: 07 de Maio de 2020.
BARBOSA KKS, VIEIRA KFL, ALVES ERP, VIRGINIO NA. Sintomas depressivos e ideação suicida em enfermeiros e medicos da assistencia hospitalar. Rev Enferm UFSM. 2012; 2(3):515-22. doi: 10.5902/217976925910. Disponível em: https://periodicos.ufsm.br/index.php/reufsm/article/view/5910. Acesso em: 10 de Novembro de 2020.
BASTOS, J.; MOHALLEM, A.; FARAH, O. Ansiedade e depressão em alunos de enfermagem durante o estágio de oncologia. Einstein, v. 6, n. 1, p. 7-12, 2008. Disponível em: http://apps.einstein.br/revista/arquivos/pdf/594-einstein%20v6n1%20port%20p7-12.pdf. Acesso em: 05 de Dezembro de 2020.
BOTEGA, Neury J. et al. Mood Disorders Among Inpatients In Ambulatory And Validation Of The Anxiety And Depression Scale Had [transtornos Do Humor Em Enfermaria De Clínica Médica E Validação De Escala De Medida (had) De Ansiedade E Depressão.]. Revista de saude publica, 1995. Disponível em: http://repositorio.unicamp.br/handle/REPOSIP/96111. Acesso em: 05 de Maio de 2020.
CAMARGO, Raquel de Moura; SOUSA, Cleciane de Oliveira; OLIVEIRA, Maria Liz Cunha de. Prevalência de casos de depressão em acadêmicos de enfermagem em uma instituição de ensino de Brasília. Revista Mineira de Enfermagem, v. 18, n. 2, p. 392-403, 2014. Disponível em: http://www.reme.org.br/artigo/detalhes/935. Acesso em: 20 de Novembro de 2020.
CARVALHO, Maria Dalva de Barros et al. Expectativas dos alunos de enfermagem frente ao primeiro estágio em hospital. Revista da Escola de Enfermagem da USP, v. 33, n. 2, p. 200-206, 1999. Disponível em: https://www.scielo.br/scielo.php?pid=S0080-62341999000200012&script=sci_arttext&tlng=pt. Acesso em: 22 de Novembro de 2020.
CÁCERES, Ana Patrícia Bustillos; CASCAES, Andreia Morales; BÜCHELE, Fátima. Sintomas de disforia e depressão em estudantes de enfermagem. Cogitare Enfermagem, v. 15, n. 4, 2010. http://dx.doi.org/10.5380/ce.v15i4.20356. Disponível em: https://revistas.ufpr.br/cogitare/article/view/20356. Acesso em 05 de Dezembro de 2020.
COELHO, Ana T. et al. Qualidade de sono, depressão e ansiedade em universitários dos últimos semestres de cursos da área da saúde. Neurobiologia, v. 73, n. 1, p. 35-9, 2010. Disponível em: https://www.researchgate.net/profile/Rubens_Reimao/publication/236943130_Sleep_quality_depression_and_anxiety_in_college_students_of_last_semesters_in_health_areas_courses/links/0deec51a4a98ad9d76000000.pdf. Acesso em: 10 de Maio de 2020.
DE MORAIS, Lerkiane Miranda; MASCARENHAS, Suely; RIBEIRO, José Luís Pais. Diagnóstico do estresse, ansiedade e depressão em universitários: desafios para um serviço de orientação e promoção da saúde psicológica na universidade: um estudo com estudantes da Ufam-Brasil. 2010. Disponível em: https://repositorio-aberto.up.pt/bitstream/10216/63895/2/86909.pdf Acesso em: 05 de Dezembro de 2020.
FUREGATO, Antonia Regina Ferreira; SANTOS, Jair Lício Ferreira; SILVA, Edilaine Cristina da. Depressão entre estudantes de dois cursos de enfermagem: autoavaliação da saúde e fatores associados. Revista Brasileira de Enfermagem, v. 63, n. 4, p. 509-516, 2010. https://doi.org/10.1590/S0034-71672010000400002. Disponível em: https://www.scielo.br/scielo.php?pid=S0034-71672010000400002&script=sci_arttext. Acesso em: 02 de Dezembro de 2020.
FARO, André. Análise Fatorial Confirmatória e Normatização da Hospital Anxiety and Depression Scale (HADS). Psicologia: Teoria e Pesquisa, [s.l.], v. 31, n. 3, p.349-353, set. 2015. FapUNIFESP (SciELO). http://dx.doi.org/10.1590/0102-37722015032072349353. Disponível em: https://ri.ufs.br/handle/riufs/1911. Acesso em: 05 de Maio de 2020.
FERNANDES, Márcia Astrês et al. Prevalência de sintomas ansiosos e depressivos em universitários de uma instituição pública. Revista Brasileira de Enfermagem, v. 71, p. 2169-2175, 2018. http://dx.doi.org/10.1590/0034-7167-2017-0752. Disponível em: https://www.scielo.br/scielo.php?pid=S0034-71672018001102169&script=sci_arttext. Acesso em: 03 de Novembro de 2020.
ORGANIZAÇÃO PAN AMERICANA DA SAÚDE. Folha informativa – Depressão. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5635:folha-informativa-depressao&Itemid=1095. Acesso em: 25 de Maio de 2020.
ORGANIZAÇAO PAN AMERICANA DA SAÚDE. Folha informativa – saúde mental dos adolescentes. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5779:folha-informativa-saude-mental-dos-adolescentes&Itemid=839. Acesso: em 23 de Maio de 2020.
ORGANIZAÇÃO PAN AMERICANA DA SAÚDE. Metade de todas as mortes entre jovens nas Américas podem ser evitadas, constata novo relatório da OPAS. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5883:metade-de-todas-as-mortes-entre-jovens-nas-americas-podem-ser-evitadas-constata-novo-relatorio-da-opas&Itemid=839. Acesso em: 23 de Maio de 2020
ORGANIZAÇÃO PAN-AMERICANA DA SAÚDE. Depressão. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5635:folha-informativa-depressao&Itemid=1095. Acesso em: 06 de Maio de 2020.
ORGANIZAÇÃO PAN-AMERICANA DA SAÚDE. Depressão: o que você precisa saber. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5372:depressao-o-que-voce-precisa-saber&Itemid=822. Acesso em: 06 de Maio de 2020.
ORGANIZAÇÃO PAN-AMERICANA DA SAÚDE. Aumenta o número de pessoas com depressão no mundo. Disponível em: https://www.paho.org/bra/index.php?option=com_content&view=article&id=5354:aumenta-o-numero-de-pessoas-com-depressao-no-mundo&Itemid=839https://www.paho.org/bra/index.php?option=com_content&view=article&id=5354:aumenta-o-numero-de-pessoas-com-depressao-no-mundo&Itemid=839. Acesso em: 25 de Maio de 2020.
PADOVANI, Ricardo da Costa et al. Vulnerabilidade e bem-estar psicológicos do estudante universitário. Revista brasileira de terapias cognitivas, v. 10, n. 1, p. 02-10, 2014.Doi: http://dx.doi.org/10.5935/1808-5687.20140002. Disponível em: http://pepsic.bvsalud.org/scielo.php?script=sci_arttext&pid=S1808-56872014000100002. Acesso em: 08 de Dezembro de 2020.
SILVA, Rodrigo Sinnott; DA COSTA, Letícia Almeida. Prevalência de transtornos mentais comuns entre estudantes universitários da área da saúde. Encontro: Revista de Psicologia, v. 15, n. 23, p. 105-112, 2012. Disponível em: https://revista.pgsskroton.com/index.php/renc/article/view/2473. Acesso em: 05 de Novembro de 2020.
WORLD HEALTH ORGANIZATION. Depression and Other Common Mental Disorders. Disponível em: https://apps.who.int/iris/bitstream/handle/10665/254610/WHO-MSD-MER-2017.2-eng.pdf;jsessionid=242FF07C383A40421F905DDFBFA856E7?sequence=1. Acesso em: 06 de Maio de 2020.
WORLD HELTH ORGANIZATION. Depression. Disponível em:https://www.who.int/news-room/fact-sheets/detail/depression. Acesso em: 23 de Maio de 2020.
WORLD HELTH ORGANIZATION. Depression and Other Common Mental Disorders: Global Health Estimates. Disponível em: http://www.who.int/mental_health/management/depression/prevalence_global_health_estimates/en/. Acesso em: 07 de Dezembro de 2020.
 Nursing academic.
 Nursing academic.
 Guidance counselor. PhD in progress in Gerontology. Master’s degree in Nursing. Professional Master’s degree in Intensive Care. Specialization in Specialization in quality management in health services. Specialization in Graduate Studies Lato Sensu in Urgency and Emergency. Specialization in Graduate Studies Latu Senso in General ICU. Graduation in Nursing.
Submitted: December, 2020.
Approved: January, 2021.