Running Head: DEPRESSION AMONG SLU MEDICAL STUDENTS 1

Prevalence of Depression among Medical Students of Saint Louis University

Mark Jethro F. Iñigo, Christian Clyde N. Apigo, Van Jasper P. Bautista,

Shiela Mhay B. Ecita, Jerleen Jill Q. Epler, Deogracias S. Espiritu II,

Mark Kenneth D. Gonnad, Radley Jed C. Pelagio, John Paolo M. Rodil

and Leah Ann P. Romaguera

Saint Louis University School of Medicine

DEPRESSION AMONG SLU MEDICAL STUDENTS 2

Abstract

Background: Medical students are susceptible to depression, owing to the heavy academic load,

lack of sleep, financial concerns, and exposure to patients’ suffering and death. Hence, this study

aims to estimate the total prevalence of depression among medical students of Saint Louis

University-School of Medicine, in relation to gender, year level, socioeconomic status (annual

household income, parental support, paternal and maternal education), academic performance,

and accommodation (living away from home).

Methods: A total of 240 medical students enrolled at the Saint Louis University-School of

Medicine during the second semester of the school year 2018-2019 participated in this study. A

cross-sectional design was utilized and assessment was done through the distribution of

questionnaires. Beck Depression Inventory II (BDI-II) was utilized in the measurement of

individual levels of depression.

Results: The overall prevalence of depression was found out to be 43.75%. Among those with

depression, 18.33% has mild, 16.25% has moderate and 9.17% has severe depression. The

prevalence of depression was comparatively less among medical students with grades ranging

from 75-79% and below 75% (63.5% and 62.5%, respectively) and the association was found to

be significant (P=0.000).

Conclusion: Majority of medical students in Saint Louis University are not depressed. Academic

performance adversely impacts depression symptomatology. The findings of this research

provide insights on focusing preventions to assess medical students with academic challenges.

Keywords: depression, medical students, Saint Louis University

DEPRESSION AMONG SLU MEDICAL STUDENTS 3

Prevalence of Depression among Medical Students of Saint Louis University

Mental health disorder is considered the fourth major health problem in the world[7,20] and

the third most common form of morbidity for Filipinos, especially among the youth, according to

the WHO and NSO, respectively.[20,24] Depression is a major problem in the world causing the

greatest disability and handicap.[10,20] According to DSM-V criteria, symptoms of depression

include depressed mood or markedly diminished interest or pleasure, significant change in

weight or appetite, change in sleep pattern, psychomotor agitation or retardation, fatigue or loss

of energy, feelings of worthlessness or excessive or inappropriate guilt, depressed central

working memory, diminished ability to think or concentrate, or indecisiveness, and recurrent

suicidal ideation or a suicide attempt.[2,13,16,19]

Worldwide, depression prevalence rate ranges from 2.6 to 29.5 percent. The Philippines has

the highest incidence of depression in Southeast Asia with 93 suicides for every 100,000

Filipinos.[24] Moreover, the suicide rate is noted to be 2.5 for men and 1.7 for women, per

100,000 population.[10] A meta-analysis study by Rotenstein (2016) showed a higher prevalence

among medical students as compared to the general population.[18] Recent research has revealed

that higher academic load, lack of sleep, exposure to patient’s suffering and death, student abuse,

living away from home and financial concerns make medical students more susceptible to

depression.[6,16,19] Year level may also be a predisposing factor in the prevalence of depression;a

recent study by Kumar and Jain (2017) showed a higher increase in the prevalence rate of

depression among 3rd and 4th year medical students compared to the prevalence among 1st and

2nd years.[8] The role of gender as a risk factor is debatable as different studies showed

contrasting results. Some studies show that the female population is twice more likely to be
DEPRESSION AMONG SLU MEDICAL STUDENTS 4

affected by depression than the male population, while some studies show no significant

association between gender and depression.[20]

In this study, the researchers aimed to estimate the total prevalence of depression among

Medical Students of Saint Louis University, and to correlate the following variables: gender,

year level, socioeconomic status, academic performance and accommodation as risk factors in

the development of depression among medical students.

Methods

Study Design

The study utilized a cross-sectional design in order to accomplish the objective of

determining the prevalence of depression among medical students currently enrolled at Saint

Louis University. This institution is one of the premier private medical schools in the country,

currently with 642 medical students. Eligibility criteria for this study required participants to be

enrolled and listed in the official records of the School of Medicine for the 2nd Semester, A.Y.

2017-2018, including both regular and irregular students. No exclusion criteria were employed.

Out of the total number of students, the sample size determined by OpenEpi version 3.01

was 240 with a confidence level of 95% [Appendix A]. Calculated distribution among

subgroupsset a number of 60 students per year level. Random numbers were then generated

through OpenEpi, and were used to randomly select from the official list of students obtained

from the school administration.

Prior to the commencement of the study, ethical clearance was sought from the Saint Louis

University - Research Ethics Committee. Informed consent was also obtained from the students
DEPRESSION AMONG SLU MEDICAL STUDENTS 5

before letting them participate in the study. [Appendix H] Data for this research were collected

through the distribution of questionnaires to the participants. The survey was conducted on April

2018 at multiple sites, including Saint Louis University - School of Medicine, Saint Louis

University – Hospital of Sacred Heart, and Baguio General Hospital and Medical Center.

Distribution of the data gathering tool for the 1st, 2nd and 3rd year students took place at Saint

Louis University - School of Medicine. The survey for the 4th year clinical clerks was

administered in Saint Louis University – Hospital of the Sacred Heart and in Baguio General

Hospital and Medical Center, where they were making their clinical rounds. A certain number of

4th year students rotating in Jose R. Reyes Memorial Medical Center in Manila were also chosen

from the random selection process, but the researchers were not able to physically administer the

questionnaires due to distance and time constraints. To remedy this, informed consent was

obtained online, and questionnaires were administered and retrieved online as well. Data

collection was executed on the 2nd and 3rd week of April 2018, while data interpretation and

statistical analysis ensued on May 1-3, 2018.

The outcome of this study is the prevalence of depression, whereas variables include

Gender, Year Level, Socioeconomic Status (Annual household income, parental support,

paternal and maternal education), Academic Performance, and Accommodation (Living Away

from home). [Appendix I] The research is purely financed by the authors themselves.

Sociodemographic characteristics

The participants were asked to provide their age, sex, and year level as part of the socio-

demographic status. Determination of the parental socioeconomic status was synthesized by

adapting the method used by Park (2012) which included annual household income, parental
DEPRESSION AMONG SLU MEDICAL STUDENTS 6

support, and parental education.[14] Annual household income was divided into 5 categories using

the bracket employed by the Philippine Statistics Authority in classifying annual family income:

1) Under 40,000, 2) 40,000-59,999, 3) 60,000-99,999, 4) 100,000-249,999 and 5) 250,000 and

over.[17] Parental support was classified as 1) Both parents, 2) single parent and 3) None/Self-

support. Parental education was divided into paternal and maternal education and was

subclassified as 1) Elementary or less, 2) High school and 3) College or more. Accommodation

was categorized into 1) I live away from home and 2) I am living with my family or guardian.

Academic Performance

To establish the academic performance of the participants, 1st to 3rd year students were

asked to indicate their Grade Point Average (GPA) for the first semester of school year 2017-

2018. The academic performance of the fourth year students was measured by asking their grade

in the written part of the recent Comprehensive Oral and Written Examination held last January

2018. Categorization of grades was based on the rating system of Saint Louis University, as

stated in the official student handbook. The GPA range are as follows: 97-99, 94-96, 91-93, 88-

90, 85-87, 80-84, 75-79, and below 75.

Depression

Beck Depression Inventory II (BDI-II) was used for the psychometric part of the

questionnaire to assess for individual levels of depression.

The BDI-II is a 21-item self-report tool which assesses the existence and severity of

symptoms of depression consistent with the diagnostic criteria of depression listed in the

American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders

Fourth Edition (DSM-IV). BDI-II is the latest revision of BDI which was revised by substantial
DEPRESSION AMONG SLU MEDICAL STUDENTS 7

word modifications and the addition of items from the BDI and BDI-IA. Each of the 21 items is

scored on a four-point scale from 0 to 3, relating to the way the respondent has felt for the past

two weeks. On two items (16 and 18), seven options are provided for the assessment of appetite

and sleeping patterns.[25]

A total score of 13 and lower indicates minimal depression or normal, dictating the

number of non-depressed participants in the study. Total score of 14-19 is mild depression, 20-28

is moderate depression, and 29-63 is severe depression.

The content, concurrent, and structural validity of BDI to differentiate depressed from

non-depressed individuals has been established. The criterion-based validity showsgood

sensitivity and specificity for detecting depression.

Statistical Methods

The data were coded and entered into a Microsoft Excel spreadsheet and were analyzed

using the Statistical Package for the Social Sciences version 11.0 software (SPSS Inc., Chicago,

IL, United States). Chi-square test was used to determine the association between the prevalence

of depression and the individual variables.

Results

During the study period, 240 questionnaires were distributed to the randomly chosen eligible

participants, of which all were returned. Table 1 provides the summary statistics for the

descriptive characteristics of the medical students of Saint Louis University. The mean age of the

participants is 23.83 years. Two-thirds (66.7%) are females and the remaining are males (33.3%).

A plurality of the participants are single (97.9%) and has an income of 250,000 and over

(56.3%). There are equal number of students per year level. Most (84.6%) are supported by both
DEPRESSION AMONG SLU MEDICAL STUDENTS 8

of their parents. Minority of the respondents have mothers and fathers who did not graduate from

college, 8.6% and 5.9% respectively. Among the students, more are living away (54.2%)

compared to those living with family or a guardian (45.8%). The academic performance of

majority are within the range of 80-84 (57.1%) and 75-79 (26.3%). [Appendix B]

The overall prevalence of depression among medical students of Saint Louis University is

presented in Table 2. According to the cut off scores, 135 students (56.25%) scored as not

depressed (0-13). Moreover, 44 (18.33%) of the students were scored with mild depression (14-

19), another 39 (16.25%) with moderate depression (20-28), and the remaining 22 (9.17%) with

severe depression (29-63). [Appendix C]

The results of the statistical analysis are set out in Table 3. It is apparent in this table that the

prevalence of depression is highest among those medical students with an academic performance

of 79 and below, and it was found to be significant (p = 0.000). Other variables including sex,

year level, annual family income, source of support, paternal and maternal educational

attainment, and accommodation type did not show a significant association with depression

(p=>0.05). [Appendix D]

Discussion

This study set out with the aim of assessing the prevalence of depression among medical

students of Saint Louis University. The results indicate that overall, majority of the participants

are not depressed. This finding may be explained by the fact that the school is located in the

province of Benguet, thus offering a relatively more peaceful environment compared to the

highly urbanized cities like Metro Manila.

DEPRESSION AMONG SLU MEDICAL STUDENTS 9

In addition, the institution encourages participation in various extra-curricular activities. In

2005, Fredericks and Eccles published a paper in which they described that extracurricular

participation results in an improved academic performance as well as a developed psychological

and behavioral adjustment.[7] Medical students who join are more likely to use these events as an

avenue to break the routine of daily studying and to release the stress of medical school. It also

engages the students to build friendships and camaraderie which can serve as a buffer and a

source of emotional and social support.

Moreover, similarly with the use of Beck’s Depression Index, a study by Kumar showed a

higher prevalence rate of depression among medical students,[13] whereas another study by

Zoccolillo et al showed a lower occurrence of depression among the participants.[27] This

inconsistency may be able to demonstrate that there is no existing trend in the development of

depression among medical students and the results may vary according to the setting and the

different factors included in the study.

However, it is important to take note that the difference between the occurrence of depressed

and non-depressed students is paltry. Although the results showed that majority is not depressed,

the prevalence of depression among the subjects is still alarming. This poses a problem to those

who are affected, and no matter how insignificant the prevalence may be based on the p values,

these affected medical students still need help.

The second objective of this study seeks to determine the association between the prevalence

of depression and the variables such as gender, year level, socioeconomic status, academic

performance and accommodation. The survey did not ascertain any association between

depression and the aforementioned variables, except for the academic performance. The results
DEPRESSION AMONG SLU MEDICAL STUDENTS 10

revealed an inverse relationship between grades and depression: the higher the grade, the lower

the frequency of depression, and the lower the grade, the higher the frequency. It is rational to

surmise that decreasing academic performance levels might contribute to an increased likelihood

of depression which can be justified through the following explanations: perceived personal

failure, parental pressure, and societal expectations are among the possible reasons which can

drive an individual into depression. This is in congruence with the study done by Park, which

also suggested these factors. In addition, Soliman listed stress-inducing factors such as course

content, lack of time to study, studying at night and heavy demand on students, which can all

result in poor academic performance, and eventually in depression.[2]

In contrast to earlier studies by Kumar, et al (2012), Park, et al (2012), and Ngasa, et al

(2017), this study reveals no significant association between depression and year level.[8,14,22]

This may be justified by an explanation provided by Wiechers (1993) which states that when

stressors such as depression threaten a person’s self-concept, the brain sends signals to the body

to prepare itself to fight or flee.[26] In the case of medical students who have extensively prepared

themselves physically, mentally, and psychologically for the rigorous demands of medical

studies, they may be more equipped to face different types and levels of stressors. Moreover, in

our setting, extracurricular activities during the first and second year levels may present as an

outlet for the students to release stress. Another reason for this might be attributed to different

coping strategies that medical students have adapted and are mastering as they go along.

Another variable included in the study is socioeconomic status which was assessed using the

annual family income. In the study, no association was found between the annual family income

and the prevalence of depression. This analysis is in contrast with a study done by Freeman A.

(2016), wherein income appears to predict depression symptomatology across European

DEPRESSION AMONG SLU MEDICAL STUDENTS 11

countries.[5] One possible justification for this inconsistency is the role that cultural differences

play across different races. In 2017, a survey by a US-based polling firm demonstrated the

Philippines as the 7th most optimistic nation in the world. Filipinos are known to be optimistic

and resilient in the face of adversities and difficulties like that of family income. In addition,

financial support coming from relatives, friends, schools and scholarships may be present to help

meet individual needs.

In another study by Sareen, et al. (2011), two main mechanisms have been postulated to be

associated with income and depression – social causation and social selection. In social

causation, increase in the risk for depression is related to stress and reduced capacity to cope.[21]

Thus, a possible explanation for the lack of significant association is that majority of medical

students have profound abilities to mentally and emotionally cope with their individual medical

career, whereas, social selection is another hypothesis which links depression with possible

genetic factors. Between the two, social causation theory is more important for depression as

substantiated by Dohrenwend et al (1992).[3]

There was no statistically significant association between gender and depression, which is

consistent with the studies done by Kumar and Safiri.[1,8] However, contrasting results are found

in studies by Park and Freeman as they both demonstrate a significant increase in depression

among female medical students as compared to males.[5,14] The results of our analysis, although

statistically insignificant, shows a higher prevalence rate among female medical students as

compared to males. Women often present with internalizing symptoms, and hormonal changes

and fluctuations are considered triggers for depression.[1]

DEPRESSION AMONG SLU MEDICAL STUDENTS 12

The living accommodation did not reveal an association with depression – this is parallel to

a previous study by Kumar.[8] This may be because medical students spend most of their time at

school and in studying, and even if they are living with their families, they have minimal

interaction with them, making living away from home no different from living with the family.

Unfortunately, these findings cannot be extrapolated to all studies, as these are subject to

certain limitations. For instance, this study only included medical students from one university.

Certain factors such as teaching methods and strategies, as well as the environment among

medical schools, were not assessed. Second, the cross-sectional nature of the study renders it

difficult to draw any clear conclusions regarding the direction of the relationship between

depression and academic performance. Third, profession enthusiasm was not evaluated among

the students. Lastly, although BDI-II is increasingly used in evaluating depressive states, subjects

are still capable of hiding their misery or exaggerating their depression for a personal reason.

It is also important to bear in mind the possible bias in this study. Based on the title of the

research, respondents may already be expecting a depression scale and they may answer the

questionnaire based only on their knowledge of depression, thus reflecting response bias. There

is also the possibility of measurement bias, wherein the respondents are reluctant to answer

truthfully items about grades and socioeconomic status; some may even fear judgement by the

researchers who will interpret the data based on the psychiatric evaluation.

Conclusion

Overall, this study reveals that majority of the medical students in Saint Louis University are

not depressed. In addition, it also strengthens the impression that there is an association between

low academic standing and depression in medical students of Saint Louis University. However,
DEPRESSION AMONG SLU MEDICAL STUDENTS 13

the research also shows that other factors such as sex, year level, family income,support, and

living away from home have no association with depression. The insights gained from this study

may be of assistance to understanding and tailoring preventive and screening methods for

subsequent interventions among particular student groups when it comes to psychological

conditions. This also reveals a potential problem in the educational system that may compromise

the students’ mental health which may lead to long-term problems.

Although this research established a correlation between depression and academic standing,

several questions still remain to be answered. One example is that if this holds true for students

enrolled in other medical schools in the country. Therefore, the researchers recommend that the

study be repeated using a different sample population to find out if the result will change or

remain the same. Furthermore, utilizing a different questionnaire may also be considered. In

addition, further researches can include other variables such as age and marital status, and if it

affects the prevalence of depression. Lastly, setting up an annual survey study could assess the

long-term prevalence of depression among the medical students of Saint Louis University.
DEPRESSION AMONG SLU MEDICAL STUDENTS 14

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DEPRESSION AMONG SLU MEDICAL STUDENTS 17

Appendices

Appendix A

Determination of the Sample Size using Open Epi.

DEPRESSION AMONG SLU MEDICAL STUDENTS 18

Appendix B

Descriptive characteristics of students of Saint Louis University School of Medicine (n = 240)

Variable Frequency Percent (%)

(n)
Age mean (SD) 23.83 2.26
Sex
80 Male 33.3
160 Female66.7
Year Level
60 1st year25.0
60 2nd year25.0
60 3rd year25.0
60 4th year25.0
Income
13 Under 40,000 5.4
9 40,000 – 59,999
3.8
29 60,000 – 99,999
12.1
54 100,000 – 249,999
22.5
135250,000 and56.3
over
Support
203 Both parents
84.6
33 Single Parent
13.8
4 None 1.7
PEDUC
4 Elementary or
1.7less
10 High School 4.2
226 College or more
94.2
MEDUC
1 Elementary or4 less
11 High School 4.6
228 College or more
95.0
Accomodation
130 Living Away
54.2
110 with family/guardian
Living 45.8
Academic Performance
9 88 and above
3.8
23 85-87 9.6
137 80-84 57.1
63 75-79 26.3
8 Below 753.3
*SD standard deviation
DEPRESSION AMONG SLU MEDICAL STUDENTS 19

Appendix C

Overall prevalence of the medical students of Saint Louis University School of Medicine

(n = 240)

Variable n %
No Depression (0-13) 135 56.25
Mild Depression 44 18.33
Moderate Depression 39 16.25
Severe Depression 22 9.17
DEPRESSION AMONG SLU MEDICAL STUDENTS 20

Appendix D

Prevalence of depression according to associated factors (n=240)

Number of Number of students Prevalence

Variable P value
Students with depression (%)
Sex
Male 80 30 37.5 0.214
Female 160 75 46.9
Year Level
1st year 60 31 51.7
2nd year 60 26 43.3 0.502
rd
3 year 60 25 41.7
th
4 year 60 23 38.3
Income
Under 40,000 13 7 53.8
40,000 – 59,999 9 4 44.4
0.957
60,000 – 99,999 29 12 41.4
100,000 – 249,999 54 24 44.4
250,000 and over 135 58 43.0
Support
Both parents 203 83 40.9
0.103
Single parent 33 20 60.6
None 4 2 50.0
PEDUC
Elementary or less 4 1 25.0
0.694
High School 10 5 50.0
College or more 226 99 43.8
MEDUC
Elementary or less 1 1 100
0.117
High School 11 2 18.2
College or more 228 102 44.7
Accommodation
Living away 130 56 43.1
0.922
Living with 110 49 44.5
family/guardian
Academic Performance
88 and above 9 0 0.0
85-87 23 9 39.1
0.000*
80-84 137 51 37.2
75-79 63 40 63.5
Below 75 8 5 62.5
*P value less than 0.05 is considered as significant
DEPRESSION AMONG SLU MEDICAL STUDENTS 21

Appendix E

Project Team and Management Plan

Researcher Roles

Iñigo, Mark Jethro F. Team leader, principal investigator, distribution of duties,

financial concerns, preparation of questionnaires, statistical

analysis, discussion and conclusion, editing of research paper

Apigo, Christian Clyde N. Encoding of data, statistical analysis, discussion, conclusion

Bautista, Van Jasper P. Preparation of questionnaires, discussion and conclusion

Ecita, Shiela Mhay B. Distribution and collection of questionnaires, financial

concerns, research results, editing of the research paper

Epler, Jerleen Jill Q. Distribution and collection of questionnaires, research results,

discussion and conclusion, editing of the research paper

Espiritu, Deogracias II S. Encoding of data, research introduction

Gonnad, Mark Kenneth D. Distribution and collection of questionnaires, research results

Pelagio, Radley Jed C. Distribution and collection of questionnaires, statistical

analysis, research methodology

Rodil, John Paolo M. Encoding of results, research abstract and methodology,

editing of research paper

Romaguera, Leah Ann P. Encoding of results, research discussion and conclusion,

editing of research paper

DEPRESSION AMONG SLU MEDICAL STUDENTS 22

Appendix F

Management Plan

Management of finances January 15 to 20, 2018

Protocol approval by SLU-REC April 2, 2018

Preparation of questionnaires April 9-11, 2018

Distribution and collection of questionnaires April 12-27, 2018

Encoding of data April 28-30, 2018

Interpretation and analysis of results May 1-3, 2018

Final report May 30, 2018

DEPRESSION AMONG SLU MEDICAL STUDENTS 23

Appendix G

Cover Letter for Informed Consent Form and Questionnaire

Dear Respondent:

You are cordially invited to take part in our study on “Prevalence of Depression among
Medical Students of Saint Louis University”. By answering honestly, the items in the attached
questionnaire, you will help us attain our research objectives.

The researcher/s do not anticipate that taking this survey will pose any risk or inconvenience to
you. Moreover, all information collected will be used only for research purposes and will be kept
confidential. You will not be personally identified as a respondent in the study nor will any
connection be made to you as an individual respondent in any report or publication that will arise
from the study.

Your participation is strictly voluntary. By responding to this survey, you would have signified
your willingness to take part in the study. Should you be interested in the results of the study, the
researchers will be most willing to share these with you.

If you have any comments or questions, please contact the researcher/s through:

Mark Jethro F. Iñigo

(+63) 945-351-3903 / jethroinigo@gmail.com

Additionally, if you have any concerns about your treatment as a participant in this study,
please call or write:

Mrs. Ana Fe B. Revilla

Chair, Research Ethics Committee
Saint Louis University
Tel.: (074) 444-8246 to 48 – local 339
Email: afbrevilla@slu.edu.ph

The chairperson may ask your name for proper identification. However, all information about
you as well as your concern/complaint will be kept in confidence.

Thank you very much.

DEPRESSION AMONG SLU MEDICAL STUDENTS 24

Appendix H

Informed Consent Form

This informed consent form is for 1st to 4th year medical students of Saint Louis University,
Baguio, Benguet, and we are inviting you to participate in the research titled “Prevalence of
Depression among Medical Students of Saint Louis University”.

The principal investigators of this study are third year medical students currently enrolled at the
same school. The names of the investigators are the following: Iñigo, Mark Jethro F., Apigo,
Christian Clyde N., Bautista, Van Jasper P., Ecita, ShielaMhay B., Epler, Jerleen Jill Q., Espiritu,
Deogracias II S., Gonnad, Mark Kenneth D., Pelagio, Radley Jed C., Rodil, John Paolo M., and
Romaguera, Leah Ann P.

This Informed Consent Form has two parts:

• Information Sheet (to share information about the study with you)
• Certificate of Consent (for signatures if you choose to participate)

You will be given a copy of the full Informed Consent Form

Part I: Information Sheet

Introduction
We are 3rd year students of the Saint Louis University School of Medicine. We are doing research
on the prevalence of depression among all year levels in our school. We are going to give you
information and invite you to be a part of this research. You do not have to decide today whether
or not you will participate in the research. Before you decide, you can talk to anyone you feel
comfortable with about this research. You may also ask us, the researchers, whose names are
stated above if you have questions about the study.

Purpose of the research

Depression is a common mental disorder that can become chronic or recurrent and lead to
inability to perform everyday responsibilities. At its worst, depression can lead to suicide.
Depressive disorders often start at a young age; they reduce people’s functioning and often are
recurring. For these reasons, depression is the leading cause of disability worldwide in terms of
total years lost due to disability. For a stressful environment like the medical school, the risk of
having depression is also alarming, considering that it is a stronghold for aspirants in the field of
health care. Studies show high prevalence of depression among medical students, and this poses a
great problem to the medical community, wherein continuous learning must be levied as a
consequence of the ever-changing field of medicine. We want to learn the prevalence of
depression in our own institution in order to give the administration proper information for future
plans of taking measures in addressing it.

Type of Research Intervention

This will involve the use of questionnaires which contains general data about the participant, and
personal information which will be used to assess the emotional status, including depression, of
medical students.
DEPRESSION AMONG SLU MEDICAL STUDENTS 25

Participant Selection
You are being invited to take part in this research because you are a medical student of Saint
Louis University, and after being chosen in a random selection process from the school records,
you have been encouraged to represent this population to contribute much to our understanding
and knowledge about the prevalence of depression in this institution.

Voluntary Participation
Your participation in this research is entirely voluntary. It is your choice whether to participate or
not. You may change your mind before, during and after participating in the study if you agreed
earlier. If you feel that the questions are rather offensive or emotionally disturbing, you may
retract your consent and stop answering the questionnaire.

Procedures
A. We are asking you to help us determine the prevalence of depression in our school. We are
inviting you to take part in this research project. If you accept, you will be asked to answer a
questionnaire containing a series of questions about your personal thoughts, including feelings of
sadness, guilt and others. General information will also be asked. Procedures to be done are
primarily intended for research.

B. You will fill out a survey which will be provided and collected by our team. The study will
involve a questionnaire which will first ask the general information you. This will include your
age, marital status, gender and year level. We will require you to fill in information about the
annual household income of both of your parents and their highest educational attainment. You
also need to specify whether you are living with your family or not. We will also be requiring you
to fill in your final grades for the subjects from last semester, which will be indicated in
questionnaire. The second part of the will ask about your personal thoughts, including feelings of
sadness, pessimism, past failures, loss of pleasure, guilty feelings, self-dislike and others. All
questionnaires will be collected a day after distribution.

Duration
The study will not take much of your time, as you only have to fill-up said questions. The
questionnaire is only six pages, and it will only take about 5-10 minutes to answer. The
questionnaires will be collected one day after distribution, in order for you to check and verify
your answers in the questions about socioeconomic factors and academic performance.

Risks
The questions are personal and you may feel uncomfortable talking about some of the topics, as it
assesses one’s emotional aptitude, and is used to diagnose depression. You do not have to answer
any question or take part in the survey if you do not wish to do so, and that is also fine. You do
not have to give us any reason for not responding to any question, or for refusing to take part in
the interview.

Benefits
There will be no inducement, benefit or any form of compensation to you. However, your
participation will help us on our research and determine the prevalence of depression in this
institution.
DEPRESSION AMONG SLU MEDICAL STUDENTS 26

Reimbursements
You will not be provided any incentive to take part in the research.

Confidentiality
We will not be sharing information about you to anyone outside of the research team. The
information that we collect from this research project will be kept private. Any information about
you will have a number on it instead of your name.

Sharing the Results

The data gathered from you will be purely confidential.The knowledge that we get from this
research will be shared with you before it is made widely available to the public. We intend to
publish this at PeJARD (Philippine e-Journal for Applied Research and Development) and
present this at conferences or seminars during the Research and Inventions month of Saint Louis
University.

Right to Refuse or Withdraw

As a participant, you will be protected and you do not have to take part in this research if you do
not wish to do so. If you may find the questions disturbing and emotionally exhausting, you may
also stop participating in the research at any time you choose, and you may approach the
investigators and ask for help. It is your choice and all of your rights will still be respected.

Who to Contact
If you have any questions, you can ask them now or later. If you wish to ask questions later, you
may contact any of the following:

IÑIGO, Mark Jethro F. 09453513903 / jethroinigo@gmail.com

APIGO, Christian Clyde N.
BAUTISTA, Van Jasper P.
ECITA, Shiela Mhay B.
EPLER, Jerleen Jill Q.
ESPIRITU, Deogracias II S.
GONNAD, Mark Kenneth D.
PELAGIO, Radley Jed C.
RODIL, John Paolo M.
ROMAGUERA, Leah Ann P.
09568869034 / clydeapigo@gmail.com
09271507905 / vanjasper_12@yahoo.com
09955444085 / shiecita@gmail.com
09262643218 / jerleenepler08@gmail.com
09273779717 / deo.espiritu.23@gmail.com
09179356851 / gonad_markkenneth@yahoo.com
09556182688 / radleyjedpelagio@gmail.com
09279471228 / jpmrodil@gmail.com
09068567514 / laromagueraa@gmail.com

This proposal has been reviewed and approved by the Saint Louis University – Research Ethics
Committee (SLU-REC), which is a committee whose task it is to make sure that research
participants are protected from harm. If you wish to find about more about the SLU-REC,
contact MRS. ANA FE B. REVILLA, Chair of the SLU-REC, Tel.: (074) 444-8246 to 48 – local
339 Email: afbrevilla@slu.edu.ph

Part II: Certificate of Consent

I have been invited to participate in a research study with the aim of determining the prevalence
of depression in the School of Medicine of Saint Louis University. I have read the foregoing
information, or it has been read to me. I have had the opportunity to ask questions about it and
DEPRESSION AMONG SLU MEDICAL STUDENTS 27

any questions I have been asked have been answered to my satisfaction. By signing below and
returning this form. I consent voluntarily to be a participant in this research study. I commit to
answer the questions as accurately and truthfully as possible.

Print Name of Participant (OPTIONAL) ___________________

Signature of Participant ___________________
Date ___________________
Day/month/year

I have witnessed the accurate reading of the consent form to the potential participant, and the
individual has had the opportunity to ask questions. I confirm that the individual has given
consent freely.

Print name of witness _______________ Thumb print of participant

Signature of witness _______________
Date _______________
Day/month/year

Statement by the researcher/person taking consent

I have accurately read out the information sheet to the potential participant, and to the best of my
ability made sure that the participant fully understands what s/he is being asked to do in the
research project.

I confirm that the participant was given an opportunity to ask questions about the study, and all
the questions asked by the participant have been answered correctly and to the best of my ability.
I confirm that the individual has not been coerced into giving consent, and the consent has been
given freely and voluntarily.

A copy of this ICF has been provided to the participant.

Print Name of Researcher/person taking the consent_________________________

Signature of Researcher /person taking the consent__________________________
Date ___________________________
Day/month/year
DEPRESSION AMONG SLU MEDICAL STUDENTS 28

Appendix I

Questionnaire

PART I: GENERAL INFORMATION

Age: _____________
Marital Status: Single Married/Cohabiting Divorced/Widowed
Sex (Encircle): Male Female
Year Level (Encircle): 1 2 3 4
Socio-Economic Factors: (Encircle the letter which applies to you in the current situation):
Annual Household Income
A. Under 40,000
B. 40,000 - 59,999
C. 60,000 – 99,999
D. 100,000 – 249,999
E. 250,000 and over
Parental support:
A. Both parents
B. Single Parent
C. None
Paternal Education
A. Elementary or less
B. High school
C. College or more
Maternal Education
A. Elementary or less
B. High school
C. College or more

Accommodation/Living Condition
A. I live away from home.
B. I am living with my family/guardian.

Academic Performance
Based on your First (1st) semester SY 2017-2018 Grade Point Average (GPA), please choose the
one that applies: *For fourth (4th) year students please use your grade in the written part of the
Comprehensive Oral and Written Exam (COWE)\
 97-99  85-87
 94-96  80-84
 91-93  75-79
 88-90  Below 75
Running Head: DEPRESSION AMONG SLU MEDICAL STUDENTS 29

PART II

Instructions: Please read each group of statements carefully, and pick out one statement in each
group that best describes the way you have been feeling DURING THE PAST TWO WEEKS,
INCLUDING TODAY. Circle the number beside the statement you have picked. If several
statements in the group seem to apply equally well, circle the highest number for that group. Be
sure that you do not choose more than one statement for any group.
1. Sadness
0 I do not feel sad.
1 I feel sad much of the time.
2 I am sad all the time.
3 I am so sad or unhappy that I can't stand it.
2. Pessimism
0 I am not discouraged about my future.
1 I feel more discouraged about my future than I used to be.
2 I do not expect things to work out for me.
3 I feel the future is hopeless and will only get worse.
3. Past Failure
0 I do not feel like a failure.
1 I feel I have failed more than I should have.
2 As I look back, I see is a lot of failures.
3 I feel I am a total failure as a person.
4. Loss of Pleasure
0 I get as much pleasure as I ever did the things I enjoy.
1 I don't enjoy things as much as I used to.
2 I get very little pleasure from the things I used to enjoy.
3 I can’t get any pleasure from the things I used to enjoy.
5. Guilty Feelings
0 I don't feel particularly guilty.
1 I feel guilty over many things I have done or should have done.
2 I feel quite guilty most of the time.
3 I feel guilty all of the time.
6. Punishment Feelings
0 I don't feel I am being punished.
1 I feel I may be punished.
2 I expect to be punished.
3 I feel I am being punished.
7. Self-Dislike
0 I feel the same about myself as ever.
1 I have lost confidence in myself.
2 I am disappointed in myself.
3 I dislike myself
DEPRESSION AMONG SLU MEDICAL STUDENTS 30

8. Self-Criticalness
0 I don't criticize or blame myself more than usual.
1 I am more critical of myself than I used to be.
2 I criticize myself for all of my faults.
3 I blame myself for everything bad that happens.
9. Suicidal Thoughts or Wishes
0 I don't have any thoughts of killing myself.
1 I have thoughts of killing myself, but I would not carry them out.
2 I would like to kill myself.
3 I would kill myself if I had the chance.
10. Crying
0 I don't cry any more than usual.
1 I cry more than I used to.
2 I cry over every little thing.
3 I feel like crying, but I can’t
11. Agitation
0 I am no more restless or wound up than usual.
1 I feel more restless or wound up than usual.
2 I am so restless or agitated that it’s hard to stay still.
3 I am so restless or agitated that I have to keep moving or doing something.
12. Loss of Interest
0 I have not lost interest in other people or activities.
1 I am less interested in other people or things than before.
2 I have lost most of my interest in other people or things.
3 It’s hard to get interested in anything.
13. Indecisiveness
0 I make decisions about as well as ever.
1 I find it more difficult to make decisions than usual.
2 I have much greater difficulty in making decisions than I used to.
3 I have trouble making any decisions.
14. Worthlessness
0 I don't feel I am worthless.
1 I don’t consider myself as worthwhile and useful as I used to.
2 I feel more worthless as compared to other people.
3 I feel utterly worthless.
15. Loss of Energy
0 Ihave as much energy as ever.
1 I have less energy than I used to have.
2 I don’t have enough energy to do very much.
3 I don’t have enough energy to do anything.
16. Change in Sleeping Pattern
0 I have not experienced any change in my sleeping pattern.
1a I sleep somewhat more than usual.
DEPRESSION AMONG SLU MEDICAL STUDENTS 31

1b I sleep somewhat less than usual.

2a I sleep a lot more than usual.
2b I sleep a lot less than usual.
3a I sleep most of the day.
3b I wake up 1-2 hours early and can’t get back to sleep.
17. Irritability
0 Iam no more irritable than usual.
1 I am more irritable than usual.
2 I am much more irritable than usual.
3 I am irritable all the time.
18. Changes in Appetite
0 I have not experienced any change in my appetite.
1a My appetite is somewhat less than usual.
1b My appetite is somewhat greater than usual.
2a My appetite is much less than before.
2b My appetite is much greater than usual.
3a I have no appetite at all.
3b I crave food all the time.
19.Concentration difficulty
0 I can concentrate as well as ever.
1 I can’t concentrate as well as usual.
2 It’s hard to keep my mind on anything for very long.
3 I find I can’t concentrate on anything.
20. Tiredness or Fatigue
0 I am no more tired or fatigued than usual.
1 I get more tired or fatigued more easily than usual.
2 I am too tired or fatigued to do a lot of the things I used to do.
3 I am too tired or fatigued to do most of the things I used to do.
21. Loss of Interest in Sex
0 I have not noticed any recent change in my interest in sex.
1 I am less interested in sex than I used to be.
2 I am much less interested in sex now.
3 I have lost interest in sex completely.