ORIGINAL ARTICLE

 

Common mental disorders in university students: epidemiological approach about vulnerabilities

 

 

Carlos Fabiano Munir Gomes; Ronaldo José Pereira Junior; Josiane Viana Cardoso; Daniel Augusto da Silva

Fundação Educacional do Município de Assis, Instituto Municipal de Ensino Superior de Assis, Assis, SP, Brazil

Corresponding author

 

 

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ABSTRACT

OBJECTIVE: to identify the occurrence of mental disorders, common in students of a higher education institution and associate it with the socio demographic and academic caracteristics.
METHOD: it´s a data survey, exploratory, descriptive, quantitativeve approach, made with 378 university students from an institution in the inner city of São Paulo, applying the Self-Reporting Questionnaire. The data was analysed using the descriptive statistical analysis and instructions for the analysis of the instrument used.
RESULTS: 151 (39,9%) of the interviewed university students show a suspicious classification score for humor disorder, anxiety and somatization. Regarding the sociodemographic variables, the highest index was for women (43,7%), homosexuals (50,0%), black colored people (42,9%), in a stable union (50,0%). Regarding the academic variables, the highest index was between business administration students (57,5%), and morning shift students (44,0%).
CONCLUSION: the need to planning prevention and recovery strategies related to the occurency of common mental disorders in these people is clear, in view of the vulnerability they are exposed.

Descriptors: Mental Disorders; Students; Education, Higher; Epidemiology.

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Introduction

This study addressed the occurrence of mental disorders in university students of a higher education institution in São Paulo, in a representative show including students in different courses, as well as the factors associated with these events.

Or be two individuals, societies and countries is related to the occurrence of mental health, of course, of overloads of dozens, 12% are associated with mental disorders⁽¹⁾.

A mental disorder is a psychological pattern of clinical significance, which is usually associated with malaise or disability. In this sense, it is worth noting that a mental process and two changes in cognitive and affective processes, which resulted in disturbance of reasoning, behavior, understanding of the realization and adaptation of life conditions⁽²⁾.

It is a condition, which presents different symptoms, associated with their atypical thoughts, emotions and behaviors related to impact on the personal, family and social levels. These disorders are objectively delimited by the instability of the manifestations of symptoms that present moments of remission and exasperation. At the time of exasperation, delirium, hallucination and agitation may be manifested as one of its main symptoms⁽²⁾.

In health situations where the individual has symptoms of depression and /or anxiety of sufficient intensity to interfere with daily activities, however, without formal diagnosis, is called a common mental disorder^(3-5).

The prevalence of common mental disorders refers to their maintenance in the population, being characterized by changes in thinking and mood or behavioral changes associated with anxiety, distress and deterioration of psychic and somatic functioning. According to World Health Organization (WHO) estimates, common mental disorders affect about 30% of workers and severe disorders, about 5% to 10%^(4,6).

In college students, the highest anxiety index is prominent, revealing the academic daily life in follow-up of activities performed in their institution such as tests, seminars, work and internships. This anxiety situation can lead to lack of interest in studies and poor performance in these academic activities. Thus, anxiety is a psychological symptom where students feel helpless^(4,7).

Common mental disorders, including depression, anxiety and stress, correlate and end up impairing daily activities, and may also impair academic performance⁽⁸⁾.

The likelihood of a person developing mental disorders is usually related to the interaction between risk factors and protective factors. In general, health promotion measures aim to expand the conditions for a healthy life, considering the person as an integral being when contemplating the field of disease, therapy and health as a whole, either individually or socially, providing more humane conditions, better care, possibility of cure and reduction of suffering⁽²⁾.

With the data obtained through the evaluation of university students, there will be the possibility of contributing to the understanding and planning of prevention and recovery strategies related to the occurrence of common mental disorders in this population, considering the vulnerability to which it is exposed.

The study is justified by the importance of the relationship between body and mind that can influence student learning. A person will not be able to evolve in their learning by experiencing somatic factors⁽¹⁾.

Common mental disorders in college students are often assumed to be based on overload, double life, and academic pressure, with fatigue, forgetfulness, insomnia, irritability, and difficulty concentrating as major factors.

This study aimed to identify the occurrence of common mental disorders in students of a higher education institution and, from an epidemiological perspective, correlate the sociodemographic and academic vulnerabilities that may influence and be determinant for the occurrence of common mental disorders.

 

Method

This is a cross-sectional, exploratory, quantitative study, conducted with university students in a higher education institution in a city in the Midwest of São Paulo State.

One opted for a proportional stratified random probability sampling model so that there were representatives of all undergraduate courses offered by the institution. The population of university students regularly enrolled in the educational institution was 2,164, and the sample calculated with 95% confidence and 5% margin of error was 326 participants. 378 university students participated, who composed the final sample.

Data collection took place during the third quarter of 2017, in classrooms or internal spaces of the institution that provided privacy for its development.

A semi-structured questionnaire was applied to identify sociodemographic data and the Self-Report Questionnaire, an instrument developed by the World Health Organization and validated in Brazil^(9-10).

The Self-Report Questionnaire is an instrument that has 20 questions with binary answers developed as a tracking tool for common mental disorders. However, it is important to note that this instrument does not imply formal psychiatric diagnosis, but indicates relevant psychological distress and deserves the attention of mental health professionals ^(9-10). Data was analyzed using simple descriptive statistical analysis.

All research participants signed the Free and Informed Consent Term (FICT), agreeing to participate, and then responded to the respective instruments for this study in accordance with the specific legislation for research with human beings⁽¹¹⁾.

The research project was submitted to the Research Ethics Committee of the Amaral Carvalho Hospital and approved under Opinion No. 2.105.047, of June 07, 2017, in compliance with Resolution 466/12 of the National Health Council and the Ministry of Health ⁽¹¹⁾.

 

Results

Of the 378 university students interviewed, 151 (39.9%) had a classification score for a suspected case of mood, anxiety and somatization disorders. Considering that, when applying the Self-Report Questionnaire, the score variation for suspected cases is eight to 20 points, which, of the university students who scored for suspected cases of mood disorders, anxiety and somatization, the score variation in this study was also eight to 20 points, with an overall mean score of 5.9, and a mean of suspected cases of 10.5.

The association between sociodemographic characteristics and common mental disorders is presented in Table 1, which demonstrates sociodemographic variables and the tracking of common mental disorders through the application of the specific instrument, including the results of non-suspicious cases, suspicious cases, and test. Pearson's chi-square (Table 1).

 

 

Of the 378 students evaluated, 222 (58.7%) were female and had a higher rate of suspected cases of common mental disorders (43.7%), compared to male students, 156 (41.3%), with 34.6% of suspected cases. However, the average score of suspected cases between women and men was 10.8 and 10.1, respectively, which shows a similar result of intensity.

In the association between suspected cases of common mental disorders and sexual orientation, it is observed that college students who declared themselves homosexual had a higher rate of suspected cases (52.9%), with an average of 10.7.

Skin color revealed that students who declare themselves black (42.9%), white (41.2%) and brown (36.2%) are the highest rates of suspected cases of common mental disorders. There were no suspected cases in yellow-skinned and indigenous students.

Regarding marital status, the highest rate of suspected cases for common mental disorders was present in university students in stable union (50.0%), with an average of 12.0%.

The association between academic characteristics and common mental disorders is presented in Table 2, which shows the academic variables and the tracking of common mental disorders through the application of the specific instrument, including the results of non-suspicious cases, suspicious cases, and Pearson's chi-square test (Table 2).

 

 

Regarding the courses offered by the institution chosen for the study, there is a high rate of suspicious cases for common mental disorders among Business Administration students (57.5%), with an average of 10.8, followed by students from the Nursing course (43.8%), with an average of 10.4, and students of the Systems Analysis course (40.0%), with an average of 9.3.

The study shift also revealed a significant imbalance in the rates of suspected cases of common mental disorders in college students, with higher rates in morning students (44.0%), followed by night students (39.8%) and full time students (27.3%).

 

Discussion

Among the students interviewed, the index of suspected cases for common mental disorders was 39.9%, similar to the survey conducted in Recife (PE), where 35% of university students had the same situation⁽¹²⁾. In Jequié (BA), the prevalence of common mental disorders was 32.2%⁽¹³⁾. However, research conducted in the municipalities of Campo Grande (MS) and Dourados (MS) showed a lower rate of suspected cases of common mental disorders in college students than 25%⁽¹⁴⁾.

This scenario allows us to state that the university students participating in this study had a higher rate of suspected cases of common mental disorders compared to the rates of suspected cases in other states of Brazil.

One reason for the high rates of common mental disorders refers to the lifestyle of college students, consisting of the large amount of compulsory activities to be performed at the university, as well as the overload, a product of a double life consisting of academic pressure and work load⁽¹⁵⁾.

Still, environmental change, characteristic of the transition from high school to higher education, is an important factor for the development of stress⁽¹⁾.

In other words, the university student routine can lead to illness due to a number of factors linked to the large amount of time that is required to be made available to academic activities and to the demands related to these activities. Still, the unavailability of leisure time, which is a protective factor, reflects emotional impairment, fatigue and sleep disturbance⁽¹⁶⁾.

The high rate of common mental disorders in college students can be affirmed when compared to other extracts of the population, such as health workers (21%)⁽¹⁷⁾.

It is important to understand the respective vulnerabilities to the university student, however, these questions would not justify the fact of presenting a higher index for suspected cases in this region, as they are characteristic experiences in university students as a whole. Thus, there is a need for studies that deepen this gap of regional differentiation.

Regarding gender identification, in 43.7% of the university students participating in this study, there was a suspicion for common mental disorders, higher than 34.6% of men. Regarding the statistical analysis, the result found, even if it does not deduce statistically different behavior between the sexes, is close to this reality (p=0.076).

Similar fact was found in a study conducted in Botucatu (SP) where women had higher index for common mental disorders (46.8%) compared to the index for men (42.4%). However, this difference was not significant⁽¹⁸⁾.

This scenario can also be observed in a study conducted with high school students where the highest rate of common mental disorders was in women (38.4%). It was also observed that the rates of suspicion increased with age for students of both sexes⁽¹⁹⁾.

In the association between suspected cases of common mental disorders and sexual orientation, it is observed that college students who declared themselves homosexual had a higher rate for suspected cases (52.9%). There was no specific investigation to understand this fact in this population. Thus, further studies are necessary to address this differentiation in intensity of common mental disorders.

There are different results in published studies on the association between mental disorders and skin color. In this study, the highest rate for common mental disorders was for college students who reported being black-skinned (42.9%), followed by white-skinned (41.2%) and brown students (36.2%).

National studies show higher rates, with significant difference, in people of black and brown skin color and lower index of person of white skin color^(20-22).

Pointing out the factors for this change of scenery is important in understanding the factors related to regional differences or even the implementation of individual health actions.

Differently from a systematic review about the factors of illness in health students, where having children is a protective factor against mental disorders, In this study, students who claimed to have children had a higher rate of suspicion of common mental disorders when compared to students without children⁽¹⁶⁾.

In this study, factors related to religion showed no significant difference regarding the suspicion of mental disorders, a result similar to a study conducted in the city of São Paulo where no significant differences were found between religiosity and common mental disorders⁽²³⁾. However, the absence of religion is an important risk factor for the development of mental disorders⁽¹⁶⁾.

In the analysis of the difference in behavior for suspected cases of common mental disorders, in the absence or presence of physical pathologies, a tendency towards equality was observed (p=0,995).

Concerning the academic variables, it was observed that undergraduate Business Administration students had a higher rate of common mental disorders, followed by Nursing and Systems Analysis students.

It is important to highlight that 57.5% of the participants enrolled in the Administration course had a suspicious result of common mental disorders, which shows the immediacy of intervention in this population.

Nursing students showed variation in the rates of common mental disorders according to the region where they live. This fact can be affirmed when comparing the results of this study with those of a study conducted in Rio Grande (RS), which presented an index of 25% of students with common mental disorders, and another study in Araçatuba (SP), with 55%^(1,24).

The lowest rate in this study was in medical students, as 27.3% of students had results for suspected common mental disorders. Situation inferior when compared to the results of studies in Jequié (BA), with 32.3%, and in Botucatu (SP), with 44.9%^(13,18).

Significant scarcity is observed in the literature regarding the publication of studies that have as their object of investigation the university students who are in a different area of health, this fact raises this need, reinforced when there are high rates of suspicion of common mental disorders in this population.

In addition to the need for studies, not least is the development of educational public policies that address all university students.

Overall, the most prominent risk factors are drug abuse, depression, genetic inheritance, physical illness, trauma, personality traits, sleep disorders and stress. Most mental disorders begin before age 24, affecting one in five people. Therefore, it is of utmost importance to establish healthy habits and relationships^(25-26).

About healthy habits, including physical activity, a study conducted with students from a federal university found that inactive students were three times more likely to develop common mental disorders when compared to active students. They also state that the absence of healthy habits, the practice of physical activity and the coexistence with various stressors in higher education constitute graduation as a risk phase for common mental disorders⁽¹⁵⁾.

In addition, a healthy teaching environment, composed of student-centered teaching strategies, favors and encourages student participation in the learning process, a situation that can contribute to the psychological health of students⁽¹⁸⁾.

 

Conclusion

In college students, a large portion of the population has a classification score for a suspected case of mood, anxiety, and somatization disorders, the common mental disorders, which in this study were generally present in 39.9% of participants.

The need for planning prevention and recovery strategies related to the occurrence of common mental disorders in the Brazilian university population is clear, given the vulnerability to which it is exposed.

It is emphasized, considering the high rate of suspected cases of common mental disorders presented, which are in line with other studies, and that this occurrence may be related to specific situations of this phase of life, the need to implement local student care policies that include addressing mental health issues and considering this information in their study planning.

The limitations of this study include the fact that data collection was performed in a single higher education institution in a certain Brazilian city, a situation that does not allow to extend the findings to the entire university population. However, it should be considered that the exposed knowledge is promising in helping to understand the development of common mental disorders in the university population and in planning interventions and future investigations on the theme that address the gaps identified in this study.

 

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Corresponding author:
Daniel Augusto da Silva
E-mail: daniel.augustoo@live.com

Received: Apr 23^rd 2019
Accepted: Aug 12^th 2019

 

 

Authors' contributions: Study design and planning: Carlos Fabiano Munir Gomes, Ronaldo José Pereira Junior, Josiane Viana Cardoso, Daniel Augusto da Silva. Data collection: Carlos Fabiano Munir Gomes, Ronaldo José Pereira Junior, Josiane Viana Cardoso, Daniel Augusto da Silva. Data analysis and interpretation: Carlos Fabiano Munir Gomes, Ronaldo José Pereira Junior, Josiane Viana Cardoso, Daniel Augusto da Silva. Manuscript writing: Carlos Fabiano Munir Gomes, Daniel Augusto da Silva. Critical revision of the manuscript: Carlos Fabiano Munir Gomes, Ronaldo José Pereira Junior, Josiane Viana Cardoso, Daniel Augusto da Silva.
All authors approved the final version of the manuscript.
Conflict of interest: the authors declare no conflict of interest.