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Depression among students: Critical review

Dastan T. Faeq
School of Psychology / University of Leicester


Depression is one of the most widespread diseases across the world and a major factor in
problems of mental health (Sarokhani et al., 2013). The issue of students mental health is a
global problem that covers all developed and non-developed societies, both modern and
traditional (Bayram & Bilgel, 2008). During their academic life young people face many
contradictions and obligations to succeed, especially at university (Arslan, Ayranci, Unsal &
Arslants, 2009). Also, university students should make the efforts to embrace new
experiences and changes in social aspects, and in behavioural, emotional, academic and
economic situations (Ginwright & James, 2002). Therefore, it is important to understand
concerns regarding students mental health. The mental health problems of students are
widely studied at different educational levels, such as college and university (Bayram &
Bilgel, 2008). A number of studies have indicated a high prevalence of mental health
problems among students, including depression, compared to the rest of the population
(Yusoff et al., 2013). More importantly, recent studies in this area indicate that the
psychological and mental problems of students continue to increase (Field, Diego, Pelaez,
Deeds & Delgado, 2012). For example, in the United States a national survey in 2005
mentioned that 86% of university counselling centres noted an increase in serious mental
health and psychological problems among university students (Gallagher, Weaver-Graham &
Tylor, 2005).
One of the most prevalent problems of mental health is depression, which is a serious
health problem among the student population (Ibrahim, Kelly, Adams & Glazebrook, 2013).
Moreover, depression has a significant impact on academic performance, academic
satisfaction and academic achievement (Arslan et al., 2009). A study by Wechsler, Lee, Kuo
and Lee (2000) reported that students with symptoms of depression achieve lower grades and
are less active in the classroom relative to students who do not have these symptoms. The
findings show that depression is a serious problem that requires psychological support for the


majority of students. So far, however, few investigations have been conducted on the recent
findings of depression among students. This paper reviews recent findings on the prevalence
of depression among students, and factors associated with students depression. A related
aim is to identify whether the prevalence of depression among students is higher than that of
the general population. The paper will also look at common causes, serious consequences
and the methodology of depression among students. Finally, findings will be discussed
together with suggestions for effective prevention and further studies.

Prevalence of depression among students

Depression is one of the most prevalent problems in the mental health of students at
different educational levels, such as high school, college and university (Arslan et al., 2009).
Previous studies have proposed that psychological morbidity, particularly depression, is a
common disorder among students (Adewuya, Ola, Olutayo, Mapayi & Oginni, 2006; Dahlin
et al., 2005). Studies of psychological problems encountered by counselling centres revealed
that depression was one of the five most common problems among college students. They
highlighted that depression accounted for 39% of problems, a higher rate than anxiety,
problems with romantic relationships, and the self-esteem of students across different settings
(Erdur-Baker, Aberson, Borrow & Draper, 2006; Green, Lowry & Kopta, 2003).
Recently, many studies have been carried out on the rate of depression among students
(Chen et al., 2013). They report that depression is a widespread problem and continues to
increase in the student population (Sarokhani et al., 2013). For instance, one study stated that
the rate of depression varied from 10% to 40% among university students in Turkey (Ustun
& Kessler, 2002). In addition, Green, Lowry and Kopta (2003) indicated that adult students


reported higher levels of symptoms of depression compared to the adult non-student

population. Other studies in this area have also found that the symptoms of depression range
from 27% and over, among students and these symptoms represent the most common
problems encountered by university counselling centres (Mobley, 2008).
Although the prevalence of depression in the student population compared to the general
population has not been well researched. A number of studies have looked at the rate of
depression among particular groups of students. A systematic review of published studies,
from January 1980 to May 2005 about the rate of depression in Canadian and US medical
students, reported higher levels of depression in the student population compared to the
general population (Dyrbye, Thomas & Shanafelt, 2006). However, based on this study we
cannot conclude that the prevalence of depression in students is higher than the general
population. This is because the study used only Canadian and US medical students, and the
sample of this systematic review only included 40 studies during the period January 1980 to
May 2005.
Another recent systematic review reported that depression in university students is much
higher compared to the general population (Ibrahim et al., 2013). Similarly, according to this
study, it cannot be concluded that the prevalence of depression is higher than the general
population because this study only focused on university students. Additionally, Dahlin,
Joneborg and Runeson (2005) found that the rates of depression in the general population
were lower relative to that of medical students at the Karolinska Institute in Sweden.
Likewise, a more recent study by Haldorsen, Bak, Dissing and Petersson (2014) found that
the prevalence of depression among Danish medical students was remarkably higher than the
Danish population as a whole.


A Nigerian study by Adewuya et al. (2006), about the prevalence of depression among
university students, found the rate of depression among Nigerian students was only 2.7%.
This is much lower compared to the rate of depression among Nigerian outpatients visiting
general clinics (25%), or compared to an older population sample (over 60 years) (18.3%) in
western Nigeria (Uwakwe, 2000). Another study (Rosal et al., 1997) stated that the level of
depression in the general population was approximately the same as medical students at the
University of Massachusetts. Additionally, a recent study on depression in Chinese
university students by Chen and his colleagues (2013) concluded that the prevalence of
depression was similar to that of the non-student population in the Chinese city of Harbin.
Over recent decades, a large number of studies have been conducted on the rate of
depression in medical students (Dyrbye, Thomas & Ahanafelt, 2005). Recent studies (Sidana
et al., 2012; Dahlin et al., 2005; Dyrbye et al., 2006) have reported that the rate of depression
in medical students is higher than that of the general population. In the literature it can be
clearly seen that medical students, as subjects, cover most of the studies about the prevalence
of student depression. Studies highlight that the rate of depression in medical students shows
a higher score relative to students of other degrees (Yusoff et al., 2013). Studies about the
prevalence of psychological distress among medical students indicated that the rate of
depression students at different medical institutions in different countries ranges between 7%
and 26% (Sidana et al., 2012), whereas at 39% among Indian medical students it is a serious
problem for students in India (Vaidya & Mulgaonkar, 2012, cited in Sidana et al., 2012).
A study in the United Kingdom reported that approximately one-third of medical
students (first-year) have mental health problems of depression and anxiety (Guthrie et al.,
1995 cited in Dyrbye, Thomas & Shanafelt, 2005). Other studies have mentioned that 12%
of medical students in the United Students have serious symptoms of depression measured by


DSM III standard (Zoccolillo, Murphy & Wetzel, 1986). Compared to law students,
Canadian medical students recorded higher rates of depression (Dahlin et al., 2005).

Student gender and depression

It can be expected that, in general, the prevalence of depression in females is higher than
that of males in the general population (Piccinell & Wilkinson, 2000). Nelon-Hoeksema,
Larson and Grayson (1999), in their study on gender differences of depression, reported that
the reasons for these differences remain unclear, whereas gender differences in depressive
disorders are well documented in many studies. More specifically, a twin study in this area
has shown that there is no relationship between gender difference in depression and genetic
risk, and that factors are more likely to relate to environmental aspects, namely family
history, social support, economic situation and life events (Tenant, 2002). In reviewing the
findings of gender differences of the prevalence of depression in students, the empirical
studies have reported different results. The majority of these studies have found that gender
is a major factor with regard to depression among students.
Several recent studies about have shown that there was no difference in the rates of
depression in male and female students. That means that gender does not play a role in the
rate of depression. For example, a recent study (Byaram & Bilgel, 2008) on the prevalence
of depression in Turkey has shown that there was no difference in the score rate with regard
to depression in male and female university students. Other recent studies by Arslan et al.
(2009) and Rosal, Ockene, Barrett and Hebert (1997), on the prevalence of depression in
university students, have found that there was no significant difference between the sexes.
Additionally, a more recent study (Yusoff et al., 2013), on the prevalence and factors related


to depression in 743 Malaysian university students, indicated that male and female students
show nearly same degree of symptoms of depression, and difference in gender was not a
significant factor in rates of depression. Similarly, findings from samples of Turkish
university students using Beck Depression Inventory and Public Health questionnaire
recorded the rates of depression between male and female students (Bostanci et al., 2005).
Also, a more recent study by Haldorsen et al. (2014) of Danish medical students reported that
female students recorded slightly higher rates compared to male students, but these
differences between the sexes was not significant.
However, a large number of studies about students symptoms of depression conclude
that male and female students do have different rates of depression. Most of these studies
indicate that the rate of depression is higher in female students compared to male students,
but the reason for this was not clearly identified. In a recent study by Adewuya et al. (2006),
on the prevalence of depression among Nigerian students using the interview instrument Mini
International Neuropsychiatric, there was a significant difference between the sexes in rates
of depression among university students, with rates in female students two times greater than
male students. Moreover, in the most recent systematic review by Ibrahim et al. (2013),
using the results of 24 recent articles from 1990 to 2010 about depression in university
students, a majority of these articles (16) reported gender differences in the prevalence of
depression among students. Fifteen of these articles showed that the rate of depression in
female students was higher in comparison to male students; only one article reported a higher
rate for men. In addition, Dahlin et al. (2005) and Ceyhan, Ceyhan and Kurtyilmaz (2009)
pointed out that female students had a greater risk of depression compared to male students.
Eisenberg, Gollust, Golberstein and Hefner (2007) observed the same result as they
mentioned that symptoms of depression were higher in female undergraduate students
compared to male undergraduate students.


Students age and depression

In terms of students age, some studies in particular looked at the relationship between
age and depression in students. A study on depression among Malaysian university students
pointed out that the prevalence of depression was higher in older students compared to
younger students (Shamsuddin et al., 2013). This result also was emphasized in other
studies; senior university students have greater rates of depression relative to beginners or
first year students (Bostanci et al., 2005; Khawaja & Duncanson, 2008).
In contrast, studies in this area (Bayram and Bilgel, 2008; Tomoda et al., 2000) have
shown that students in their final year of university have lower levels of depression compared
to new students. It is hypothesised that this difference in the above findings might be due to
using different samples of students, and different methods of measuring depression. It is
somewhat surprising that no relationship was found in this condition. One study indicated
that the level of depression in older students is nearly the same as younger students (Lester,
1990). This would indicate there is no significant relationship between a students age and
the prevalence of depression.

Students relationship status and depression

A recent meta-analysis study and systematic review (Sarokhani, 2013), of 35 studies
between 1995 and 2012 from Iran, reported a prevalence rate of 39% for single university
students and 20% for married university students. This study concluded that depression is
more widespread in single students than in married students at university. Moreover, the
same relationship was mentioned in a study of Japanese and American students; depression is
more common among single students than in married university students (Inaba et al., 2005).


It has been suggested that marriage has several advantages in protecting students from
depression. A common interpretation is that married students have higher levels of
confidence and emotional assistance (Sarokhani, 2013). In contrast, another study found that
the prevalence of depression in married students was higher compared to students who were
not married (Bayaram & Bilgel, 2008). The reason for this was not discussed, but it might be
said that single students have fewer responsibilities for family duties or everyday life.

Depression and academic performance

A number of studies have shown that symptoms of depression affect students
performance and achievement at university, college and school (Stark & Brookman, 1994,
cited in Shamsuddin et al., 2013). Findings in this area indicate that academic tasks cause a
high risk of mental health problems, especially depression in students (Ibrahim et al., 2013;
Sharif et al., 2011). A Turkish study found that depressed students have a poorer academic
performance compared to students who do not report symptoms of depression (Bostanci et
al., 2005). Owens, Stevenson, Hadwin and Norgate (2012), on anxiety and depression on
academic performance among students in the UK, found that depression has a negative
relationship with academic performance. They investigated that a higher level of depression
was associated with poorer academic performance.
Another study about the impact of depression on academic performance among
undergraduate students mentioned that depression has a strong and a negative relationship
with academic performance. This robust and risky relationship includes a number of negative
consequences for students (Hysenbagasi et al., 2005). Similarly, a recent study by Ceyhan et
al. (2009), on depression in university students, found that students who have a poor



academic achievement demonstrated considerably greater depressive symptoms compared to

students who indicated a high level of academic achievement. It also should be considered
that students depression is a serious risk to academic impairment, which continues and is
increased by depression during academic life (Heiligenstien & Guenther, 1996).
Another notable consequence of depression is that students who display a depressed
mood are likely to lose academic motivation and academic activity. Depressed students also
have many difficulties in academic tasks at university (Khawaja & Bryden, 2008). In
qualitative research by Anderson (2003), students mentioned that depression is one of the
main causes of their academic problems, including academic performance. Overall, studies
in this area reported a negative relationship between academic achievement or performance
and depression.
It is obvious that during their academic life, students have many goals, obligations and
expectations for the future. If some students fail to achieve their goals, meet expectations or
responsibilities, they are at a higher risk of suffering from depression and other psychological
and mental problems (Patchett, 2005, cited in Ceyhan et al., 2009). For this reason it is
assumed that poor academic success or performance is one of the main causes of depression
among students (Baker & Siryk, 1984). However, it is not easy to decide if depression is a
consequence of a low level of academic achievement or vice versa. Depression can have a
negative impact on cognitive functioning and this can impact negatively on academic
performance or achievement (Turner, Thompson, Huber & Arif, 2012).



Common causes of depression among students

The distinct causes of depression among students have not been investigated,
particularly in the previous studies. It is important to remember that the above studies have
shown high rates in the prevalence of depression (from 5% to 30%) in students across the
world (Ibrahim & Kelly, 2011). The large variation in this percentage has not been
mentioned, but it might be said that this is because the studies were performed in different
populations, societies and cultural backgrounds (Bayram & Bilgel, 2008; Dahlin at al., 2005).
Another factor in this large variation may be due to the studies using different methodologies
or tools to diagnose this problem among students (Ovuga, Boardman & Wasserman, 2006).
In the literature, studies have determined different factors of depression among students, but
there are some common causes of depression among students. This part of the review will
look at common factors in many of the studies about the prevalence of depression in students
during their academic career.
The first serious cause associated with the depression among students is socio-economic
status. A limited number of studies have investigated the effect of socio-economic factors on
depression in the student population (Ibrahim et al., 2013). Students socio-economic level
has been shown to play a significant role in the symptoms of depression in students (Sareen,
Afifi, McMillan & Asmundson, 2001).
A large cross-national (from 23 countries) study (Steptoe, Tsuda, Tanaka & Wardle,
2007) on the relationship between symptoms of depression and socio-economic background
of university students showed that family and personal income level, parental education and
family wealth, contributed to depression in students. Similarly, data from an analysis of
Egyptian studies on the relationship between socio-economic status and depression among
undergraduate students found that socio-economic background associated negatively with



symptoms of depression in students. This study concluded that students from families with a
low level of income and parental occupation have a tendency towards depression (Ibrahim et
al., 2013). More notably, the financial problems of students and their families have a
negative impact on depression in students (Andrews and & Wilding, 2004). The study
showed that students originally from the countryside recorded higher levels of depression
than students who live in cities (Bayram & Bilgel, 2008). Shamsuddin and his colleagues
(2013) reported that this might be due to an economic situation where families in rural areas
often have a lower economic status. Moreover, it might be explained that some students from
rural areas move away and leave their families while at university, and this might cause some
difficulties for some students.
Studies also show that students who are from a higher socio-economic position such as a
high level of social class, an educated background and economic situation, are more likely to
have a sense of control. This sense of control can provide students better protection against
mental health problems, namely depression, associated with moving to a university
environment (Lanchman & Weaver, 1998). Additionally, the educational level of students
parents could play role in depression associated with the university environment of students.
For example, Ibrahim et al. (2013) found that students with less educated family are 50% to
60% more likely to suffer from problems of depression compared to highly educated families
(father and mother). It is also reported that the fathers occupation has an effect on
depression in students. For instance, Ibrahim and Kelly (2011) found that students whose
father had a professional job are 60% more likely to obtain depressive disorders compared to
students whose father was an unskilled worker.
The second most common cause, reported as a serious factor for the rate of depression in
students, is living away from home or transition to new environment, such as university and



college. For some students, separation from home or family might cause psychological
distress, especially depression. This is due to problems and difficulties associated with living
in a new and different environment at university or college without social support (Asyan,
Thompson & Hamarat, 2001). It was also found that students who live at home with their
families are less likely to be affected by depression because their families provide more
support and enhanced protection against academic stress (Christie, Munro & Retting, 2002).
It is pointed out that although it is less costly for students to share accommodation, and gives
more social advantages, those share house students may be dissatisfied with their
environment and housemates, and there are more opportunities to be diverted away from their
studies. It is believed that this dissatisfaction leads to increased psychological distress such
as depression and stress.
Another problem with accommodation is that students who live alone may face problems
without social support, especially international students. A study by Haldorsen et al. (2014)
found that students dealing with social problems and psychological distress have a higher rate
of the symptoms of depression compared to students living with their family.
The above evidence shows that students, who live with their family and partners and
have the social support to deal with their problems, have a better chance of living without
depression while at university and college. Although the transition to college and university
is a successful step, and it is a good opportunity for students to have a better future, in poor
countries it might cause some students who move to university some social and psychological
problems, including depression. For example, Adewuya and his colleagues (2006) explained
that symptoms of depression in Nigerian students could be caused by poor academic
conditions, overcrowded classrooms, a poor quality of accommodation, and a lack of learning
materials and equipment.



An important finding mentioned in the recent study of Haldorsen et al. (2014) found that
the stress factors of students have a significant association with symptoms of depression. In
the previous study Haldorsen et al. (2014) concluded that increased stress in students led to
raised symptoms of depression. Similarly, Bayram and Bilgel (2008) emphasized the same
relationship between depression, stress and anxiety.
The third main cause of depression among students is study satisfaction. That means
that students who are not satisfied with their course of study have greater rate of depression
than students who are satisfied (Bayram & Bilgel, 2008). A possible interpretation for this
finding may be the students lack of interest and motivation in their major, because on some
occasions the students parents choose the subject for study (Chen et al., 2013). Another
recent study concluded that students who are content with their education are less likely to
suffer from depression and anxiety (Dahlin et al., 2005).
Interestingly, another cause of depression in school and college age students is body size
or body weight. Depression related to body size has been investigated by a number of studies
(Granberg, Simons, Gibbons & Melby, 2008). There is evidence of no relationship between
body weight and psychological distress in adult students. For example, a study by Granberg
and his colleagues (2008) on the relationship between depression and body size among 343
African-American middle-school females, found no link between symptoms of depression
and weight. That means that an unhealthy weight did not cause more symptoms of
depression among those female students. The authors explained that this finding may be due
to the belief that African-American girls are more likely to overestimate their weight.
On the other hand, an American study found that overweight students in a middle school
in Texas were more depressed compared to students of a normal weight (Schiefelbein,
Mirchandani, George, Castrucci & Hoelscher, 2010). This finding is also supported by



another study from the United States from 1980 to 2002. It indicated a high rate of
depression in overweight and obese teenagers and children, and this high rate continues to
increase (Ogden et al., 2006). Additionally, some studies highlighted that obesity or being
overweight has a positive relationship with depression in adolescents in the United States
(Jorm et al., 2003). Jorm and his colleagues also showed that these studies also looked at
gender differences in overweight adults. They found that female adults in the United States
were more depressed compared to male adults. A possible interpretation of this phenomenon
may refer to findings that boys are less likely to overestimate their weight, and think they do
not weigh enough, whereas most girls overestimate their weight (Strauss, 1999).
From the above evidence, it might be true that adults and younger students who have a
healthy or normal weight are less depressed than adult students who have an unhealthy or
abnormal weight. Indeed, adult female students are more likely to show symptoms of
depression. Furthermore, Ceyhan and Kurtyilmaz (2009) found that students who are
satisfied with their body shape are less depressed than students who are displeased with their
body shape.

Serious consequences
It is clear that depression has a substantial negative consequence for students as
individuals in society. Few studies have been performed about the impact of depression on
students personal ability and academic career. It is suggested that depression can lead to
many mental and physical disorders, which are big threats for students who make up an
important part of the population in the community (Bayram & Bilgel, 2008). Hysenbegasi et
al. (2005) stated that depression might cause problems for the future occupations of students



by delaying access or difficulties in choosing a career. Another study by Field et al. (2012)
reported that depression brings various mental problems, which lead to psychological, social
and physical problems for students during and after their academic life. It is believed the
major problems in students depression include poor self-assessment, lack of pleasure and
interest in everyday life, problems in eating and sleeping, and suicidal thoughts (Arslan et al.,
Additionally, this disorder has many negative effects associated with personal, cognitive,
and emotional problems, notably, decision making and problems of time management (Chen
et al., 2013); poor academic achievement and low level of exam performance (Hysenbegasi et
al., 2005); decreased attention and drug abuse; over consumption of alcohol and increased
levels of smoking in adults and university students (Yusoff et al., 2013); and negative effects
on everyday work and achievements (Sobocki, Lekander, Borgstrom, Dtrom & Runeson,
2007). Most importantly, the most serious consequence of depression is the threat of suicide
in students. An earlier study on suicide in students explained that depression is the most
prevalent cause of suicide attempts among students (Eisenberg et al., 2007). Unfortunately,
however, there is no exact data showing the rate of suicide among students worldwide. The
study mentioned that 2.7% of depressed students tried to commit suicide, while 9.5% to 10%
had suicidal thoughts (Dahlin et al., 2005; Kisch, Leino & Silverman, 2005).

Research methods of students depression

In reviewing the research methods, it is noted that almost all studies in this area used the
two main methods to investigate depression among students. In recent studies, quantitative
research methods were mostly used to detect depression among students, using different tools



to collect data and statistical analysis. In review the methodology, I will mention the two
most common methods with a few studies as examples that used the different methods.
First, in most of the quantitative studies a self-report questionnaire was used as a
psychometric tool to collect the data from the student population. The Beck Depression
Inventory (BDI) was widely used to assess symptoms of depression among students
(Bostanci et al., 2005). This instrument was developed by Beck, Ward, Mendelson, Mock,
and Erbaugh (1961) (Ceyhan et al., 2009). However, this self-report inventory was not
specifically designed to measure depression among students, though it is believed this
instrument is suitable to collect data from students (Bostanci et al., 2005). Another common
self-report inventory is The University Student Depression (USDI). This instrument was
specifically designed for students by Khawaja and Bryden (2006) (Sharif et al., 2011). Other
common instruments used included the Major Depression Inventory (MDI), Depression,
Anxiety and Stress Scale (DASS), and the Major Depressive Disorder (MDD) (Dahlin et
al., 2005; Yusoff et al., 2013; Tomoda et al., 2000).
Second, few systematic reviews and meta-analysis studies have been carried out to
investigate depression in students. Recently, Sarokhani et al. (2013) conducted a metaanalysis research and systematic review on the prevalence of depression in university
students. They used the data from Iranian 35 studies about depression in university students
between 1995 and 2012. In addition, Dyrbye et al. (2006) performed a systematic review of
40 published studies from 1980 to 2005 on depression and other types of psychological
distress in Canadian and US medical students. Ibrahim et al. (2013) carried out a systematic
review of 24 published studies from different countries between 1990 and 2010 on the
prevalence of depression among students.



The prevalence of depression among students is clearly emphasized by the above recent
findings. Various studies have shown different rates of depression in students in different
countries. Some recent studies have reported that the rate of depression among students is
higher than in the general population, and a number of studies have emphasized this level of
prevalence compared to the general population (Dahlin et al., 2013; Dyrbye et al., 2006;
Green et al., 2003; Haldorsen, et al., 2005; Ibrahim et al., 2013). Other studies have reported
contrasting results in depression among students. They found that rates of depression in
students are not greater, and are nearly the same as the general population (Uwakwe, 200;
Chen et al., 2013).
However, the majority of findings report a higher rate of depression in the student
population. It is difficult to decide whether the rate of depression among students is higher or
lower than the general population. These studies were performed among students from
different countries that have different cultures, economic levels and academic environments.
Moreover, the studies used different instruments of measurement and different research
methods to investigate this problem (Sarokhani et al., 2013). One notable finding is that
some studies mentioned the highest rate of depression is found in medical students relative to
non-medical students (Yusoff et al, 2013). Medical training, which is a stressful, with large
amounts of work, is reported as the main reason for this high rate among medical students
(Dyrbye et al., 2005; Yusoff and Rahim, 2011). However, medical training is crucial and
demanding for students in medical departments.
Regarding gender differences, this paper highlighted that a large number of studies
indicate that the rate of depression in females is higher than in male students. A possible
interpretation for this phenomenon is that females are at a higher risk of depression, which



may be due to their biopsychological features including social, emotional and physiological
factors (Dyrbye et al., 2006; Zaid, Chan & Ho, 2007). As indicated above, most of the
studies in this area find that older students are more depressed than younger students. A
significant reason, suggested for this problem in older groups of students, might be due to
uncertainty about the future, looking for employment and job concerns (Bostanci et al.,
Another subject reviewed in this paper is the link between a students relationship status
and depression. As mentioned, studies show different results in this situation, but the
majority report that single students have more problems with depression than married
students. With regards to academic performance this is the main priority of students during
their academic career. As discussed, poor academic performance has a negative contribution
on depression in students. So far, the relationship between academic performance and
depression remains unclear and is not well documented. Some studies have concluded that it
is more likely that depression results in poor academic performance, rather than a low level of
academic performance resulting in depression.
The main causes of depression have not been well researched due to the different causes
of depression in different societies across the world. In general, it is believed that the causes
of depression in students are due to complicated interactions between social, physiological,
developmental and psychological factors (Lack & Green, 2009). In reviewing the relevant
papers some common causes of depression among students are: separation from home, socioeconomic level, poor academic performance, and body shape or weight, especially among
adult students.
To prevent and reduce the rate of depression in students, effective services in mental
health should be offered. These services can offer effective skills to manage academic stress;



furthermore, problem solving strategies and additional social support can be given. A lack of
social support, especially for students who study abroad and live away from home, can cause
depression. Moreover, students awareness of depression and other psychological distress
can be improved through seminars and workshops. Counselling centres at different
educational institutions should give high quality services about depression through
counselling programmes.
Considering the common prevalence of depression among students, and its negative
impact on students abilities, future research should investigate the psychometric properties
of common instruments that measure depression, as some are not designed to detect
depression in students. Moreover, as discussed above, international students are at high risk
of depression. Therefore, a further longitudinal study with a large number of samples could
examine in more detail depression and associated factors in international students.



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