Abstract
Objectives
While university life is characterized by the pursuit of greater educational opportunities and employment prospects, it can also be a trigger of mental health problems. This study aims to: (a) measure the prevalence of depression, anxiety, and stress among first-year undergraduate students in the University of Malaya, and; (b) determine the associated factors of depression, anxiety, and stress.
Methods
This cross-sectional study consisted of two phases: survey administration and physical assessment. In the first phase, data were collected electronically using a mobile application during the orientation week. The Depression, Anxiety and Stress Scale-21 (DASS-21) questionnaire was employed to assess respondents’ mental health status. In the second phase, anthropometric measurements which included height, weight, waist circumference, and blood pressure were taken.
Results
Of 1602 students, the prevalence of moderate to extremely severe depression was 21% (n = 341), anxiety 50% (n = 793), and stress 12% (n = 197). Findings showed that students who lived with non-family members were more likely to develop depression (OR: 1.846, 95% CI: 1.266–2.693), anxiety (OR: 1.529, 95% CI: 1.024–2.284), and stress (OR: 1.655, 95% CI: 1.110–2.468). Those with previous medical history were more likely to have anxiety (OR: 1.697, 95% CI: 1.097–2.626). Interestingly, students from the Southern region (OR: 0.667, 95% CI: 0.468–0.950) and from Sabah and Sarawak (OR: 0.503, 95% CI: 0.281–0.900) were less likely to report depression.
Conclusions
Future intervention programs should follow the socio-ecological model while addressing university students’ mental health needs.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
Change history
14 October 2019
An amendment to this paper has been published and can be accessed via a link at the top of the paper.
References
Agliata, A. K., & Renk, K. (2009). College students’ affective distress: the role of expectation discrepancies and communication. Journal of Child and Family Studies, 18(4), 396, https://doi.org/10.1007/s10826-008-9244-8.
Andrews, B., & Wilding, J. M. (2004). The relation of depression and anxiety to life‐stress and achievement in students. British Journal of Psychology, 95(4), 509–521. https://doi.org/10.1348/0007126042369802.
Antony, M. M., Bieling, P. J., Cox, B. J., Enns, M. W., & Swinson, R. P. (1998). Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample. Psychological Assessment, 10(2), 176–181. https://doi.org/10.1037/1040-3590.10.2.176.
Aysan, F., Thompson, D., & Hamarat, E. (2001). Test anxiety, coping strategies, and perceived health in a group of high school students: a Turkish sample. The Journal of Genetic Psychology, 162(4), 402–411. https://doi.org/10.1080/00221320109597492.
Beiter, R., Nash, R., McCrady, M., Rhoades, D., Linscomb, M., Clarahan, M., & Sammut, S. (2015). The prevalence and correlates of depression, anxiety, and stress in a sample of college students. Journal of Affective Disorders, 173, 90–96. https://doi.org/10.1016/j.jad.2014.10.054.
Broglia, E., Millings, A., & Barkham, M. (2017). Challenges to addressing student mental health in embedded counselling services: a survey of UK higher and further education institutions. British Journal of Guidance & Counselling, 46(4), 441–455. https://doi.org/10.1080/03069885.2017.1370695.
Brummett, B. H., Mark, D. B., Siegler, I. C., Williams, R. B., Babyak, M. A., Clapp-Channing, N. E., & Barefoot, J. C. (2005). Perceived social support as a predictor of mortality in coronary patients: effects of smoking, sedentary behavior, and depressive symptoms. Psychosomatic Medicine, 67(1), 40–45. https://doi.org/10.1097/01.psy.0000149257.74854.b7.
Canadian Mental Health Association (2008). The relationship between mental health, mental illness and chronic physical conditions. https://ontario.cmha.ca/documents/the-relationship-between-mental-health-mental-illness-and-chronic-physical-conditions/.
Cheung, T., Wong, S. Y., Wong, K. Y., Law, L. Y., Ng, K., Tong, M. T., & Yip, P. S. (2016). Depression, anxiety and symptoms of stress among baccalaureate nursing students in Hong Kong: a cross-sectional study. International Journal of Environmental Research and Public Health, 13(8), 779. https://doi.org/10.3390/ijerph13080779.
Cohen, B. E., Edmondson, D., & Kronish, I. M. (2015). State of the art review: depression, stress, anxiety, and cardiovascular disease. American Journal of Hypertension, 28(11), 1295–1302. https://doi.org/10.1093/ajh/hpv047.
Correll, C. U., Solmi, M., Veronese, N., Bortolato, B., Rosson, S., Santonastaso, P., & Stubbs, B. (2017). Prevalence, incidence and mortality from cardiovascular disease in patients with pooled and specific severe mental illness: a large-scale meta-analysis of 3,211,768 patients and 113,383,368 controls. World Psychiatry, 16(2), 163–180. https://doi.org/10.1002/wps.20420.
Druss, B. G., Zhao, L., Von Esenwein, S., Morrato, E. H., & Marcus, S. C. (2011). Understanding excess mortality in persons with mental illness: 17-year follow up of a nationally representative US survey. Medical Care, 49(6), 599–604. https://doi.org/10.1097/MLR.0b013e31820bf86e.
Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety, and other indicators of psychological distress among US and Canadian medical students. Academic Medicine, 81(4), 354–373. https://insights.ovid.com/pubmed?pmid=16565188.
Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. L. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534–542. https://doi.org/10.1037/0002-9432.77.4.534.
Elias, H., Ping, W. S., & Abdullah, M. C. (2011). Stress and academic achievement among undergraduate students in Universiti Putra Malaysia. Procedia-Social and Behavioral Sciences, 29, 646–655. https://doi.org/10.1016/j.sbspro.2011.11.288.
Fawzy, M., & Hamed, S. A. (2017). Prevalence of psychological stress, depression and anxiety among medical students in Egypt. Psychiatry Research, 255, 186–194. https://doi.org/10.1016/j.psychres.2017.05.027.
Ibrahim, A. K., Kelly, S. J., Adam, C. E., & Glazebrook, C. (2013). A systematic review of studies of depression prevalence in university students. Journal of Psychiatric Research, 47(3), 391–400. https://doi.org/10.1016/j.jpsychires.2012.11.015.
Ibrahim, M. B., & Abdelreheem, M. H. (2015). Prevalence of anxiety and depression among medical and pharmaceutical students in Alexandria University. Alexandria Journal of Medicine, 51(2), 167–173. https://doi.org/10.1016/j.ajme.2014.06.002.
Institute for Public Health (2006). Mental health status of Malaysians. The 3rd national and health morbidity survey, 2006. Development of Human Resources in Rural Areas, Bangsar, Kuala Lumpur.
Institute for Public Health (2011). The fourth national health and morbidity survey 2011. http://www.iku.gov.my/index.php/research-eng/list-of-research-eng/iku-eng/nhms-eng/nhms-2011-eng.
Institute for Public Health (2015). National health morbidity survey and morbidity survey 2015: methodology and general findings. http://www.iku.gov.my/images/IKU/Document/REPORT/nhmsreport2015vol1.pdf.
Islam, M. A., Low, W. Y., Tong, W. T., Yuen, C. W., & Abdullah, A. (2018). Factors associated with depression among university students in Malaysia: a cross-sectional study. KnE Life Sciences, 4(4), 415–427. https://doi.org/10.18502/kls.v4i4.2302.
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005). Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://doi.org/10.1001/archpsyc.62.6.593.
Kulig, C. E., & Persky, A. M. (2017). Transition and student well-being—why we need to start the conversation. American Journal of Pharmaceutical Education, 81(6), 100. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5607710/.
Latiff, L. A., Aszahari, M. A. A., Khalek, N. F. A., Fang, K. J., & Ibrahim, N. (2014). Prevalence of mental health problems and the associated factors among undergraduate students in a public university, Malaysia. International Journal of Public Health and Clinical Sciences, 1(1), 59–69.
Lazarevich, I., Camacho, M. E. I., Velázquez-Alva, Md. C., & Zepeda, M. Z. (2016). Relationship among obesity, depression, and emotional eating in young adults. Appetite, 107(1), 639–644. https://doi.org/10.1016/j.appet.2016.09.011.
Llido, L. O., & Mirasol, R. (2011). Comparison of body mass index based nutritional status using WHO criteria versus “Asian” criteria: report from the Philippines. PhilSPEN Online Journal of Parenteral and Enteral Nutrition, 1–8.
Lovibond, S. H., & Lovibond, P. F. (1995). Manual for the depression anxiety stress scales. 2nd ed. Sydney: Psychology Foundation of Australia.
Madlan, L., Bahari, F., & Ardillah, F. (2012). Stress and coping skills among university students: a preliminary research on ethnicity. Southeast Asia Psychology Journal, 1, 31–37.
Mahmoud, J. S. R., Staten, R. T., Hall, L. A., & Lennie, T. A. (2012). The relationship among young adult college students’ depression, anxiety, stress, demographics, life satisfaction, and coping styles. Issues in Mental Health Nursing, 33(3), 149–156. https://doi.org/10.3109/01612840.2011.632708.
Malaysian Clinical Practice Guideline Secretariat (2008). Clinical practice guidelines: management of hypertension (3rd Edition). https://www.google.com/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&ved=2ahUKEwjWwK-kZbkAhULLY8KHY15DJAQFjABegQIARAC&url=http%3A%2F%2Fwww.acadmed.org.my%2Fview_file.cfm%3Ffileid%3D245&usg=AOvVaw0PFvMmDKuZ0__9qkpZ2m8K.
Merikangas, K. R., Nakamura, E. F., & Kessler, R. C. (2009). Epidemiology of mental disorders in children and adolescents. Dialogues in Clinical Neuroscience, 11(1), 7–20. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2807642/.
Ministry of Education Malaysia (2013). National education statistic: higher education sector 2013. Kuala Lumpur: Perpustakaan Negara Malaysia.
Ministry of Education Malaysia (2015). National education statistic: higher education sector 2013. Kuala Lumpur: Perpustakaan Negara Malaysia.
Mohammed, H., Hayati, K. S., & Salmiah, M. S. (2016). Coping with depression, anxiety, and stress: a cross-sectional study among Malaysian students in a public university. IOSR Journal of Dental and Medical Sciences, 15(11), 83–95. https://pdfs.semanticscho-lar.org/8d68/9ef340b84128b1be1f49b056a08145c6b82b.pdf.
Musa, R., Fadzil, M. A., & Zain, Z. (2007). Translation, validation and psychometric properties of Bahasa Malaysia version of the Depression Anxiety and Stress Scales (DASS). ASEAN Journal of Psychiatry, 8(2), 82–89. https://pdfs.semanticscholar.org/938a/0a163ad44895574460661aa2c4da4e585cf5.pdf?_ga=2.49201574.1422936327.1566871640-1423192651.1562614702.
Mustaffa, S., Aziz, R., Mahmood, M. N., & Shuib, S. (2014). Depression and suicidal ideation among university students. Procedia-Social and Behavioral Sciences, 116, 4205–4208. https://doi.org/10.1016/j.sbspro.2014.01.917.
Noaparast, E. B. (2011). Social capital, family supports and mental health among a female group in Tehran. Procedia-Social and Behavioral Sciences, 30, 2449–2451. https://doi.org/10.1016/j.sbspro.2011.10.477.
Nordin, N. M., Talib, M. A., Yaacob, S. N., & Sabran, M. S. (2010). A study on selected demographic characteristics and mental health of young adults in public higher learning institutions in Malaysia. Global Journal of Health Science, 2(2), 104. https://doi.org/10.5539/gjhs.v2n2p104.
Patel, V. (2007). Mental health in low-and middle-income countries. British Medical Bulletin, 81–82(1), 81–96. https://doi.org/10.1093/bmb/ldm010.
Patten, S. B. (2017). Age of onset of mental disorders. Canadian Journal of Psychiatry. Revue Canadienne de Psychiatrie, 62(4), 235–236. https://doi.org/10.1177/0706743716685043.
Peleg, O., Deutch, C., & Dan, O. (2016). Test anxiety among female college students and its relation to perceived parental academic expectations and differentiation of self. Learning and Individual Differences, 49, 428–436. https://doi.org/10.1016/j.lindif.2016.06.010.
Phang, C., Sherina, M., Zubaidah, J., Noor Jan, K., Firdaus, M., Siti Irma, F., & Normala, I. (2015). Prevalence of psychological stress among undergraduate students attending a health programme in a Malaysian university. Pertanika Journal of Science & Technology, 23(1), 29–35. http://www.pertanika.upm.edu.my/Pertanika%20PAPERS/JST%20Vol.%2023%20%281%29%20Jan.%202015/%283%29%20JST-0454-2012.pdf.
Ramli, M., Mohd Ariff, F., Nora, M., Rosnani, S., Aidil Faszrul, A., & Musa, R. (2012). Psychometric properties of Bahasa Malaysia version of the Depressive Anxiety and Stress Scales 42-item (DASS-42). Age, 19(20), 21–22.
Reiss, F. (2013). Socioeconomic inequalities and mental health problems in children and adolescents: a systematic review. Social Science & Medicine, 90, 24–31. https://doi.org/10.1016/j.socscimed.2013.04.026. Supplement C.
Salam, A., Yousuf, R., Bakar, S. M. A., & Haque, M. (2013). Stress among medical students in Malaysia: a systematic review of literatures. International Medical Journal, 20(6), 649–655.
Sarokhani, D., Delpisheh, A., Veisani, Y., Sarokhani, M. T., Manesh, R. E., & Sayehmiri, K. (2013). Prevalence of depression among university students: a systematic review and meta-analysis study. Depression Research and Treatment, 2013, 373857. https://doi.org/10.1155/2013/373857.
Shamsuddin, K., Fadzil, F., Ismail, W. S. W., Shah, S. A., Omar, K., Muhammad, N. A., & Mahadevan, R. (2013). Correlates of depression, anxiety and stress among Malaysian University students. Asian Journal of Psychiatry, 6(4), 318–323. https://doi.org/10.1016/j.ajp.2013.01.014.
Sidik, S. M., Rampal, L., & Kaneson, N. (2003). Prevalence of emotional disorders among medical students in a Malaysian university. Asia Pacific Family Medicine, 2(4), 213–217. https://doi.org/10.1111/j.1444-1683.2003.00089.x.
StataCorp. (2013). Stata statistical software: release 13. College Station, TX: StataCorp LP.
Teh, C. K., Ngo, C. W., Zulkifli, R. A., Vellasamy, R., & Suresh, K. (2015). Depression, anxiety and stress among undergraduate students: a cross sectional study. Open Journal of Epidemiology, 5(04), 260–268. https://doi.org/10.4236/ojepi.2015.54030.
Trueman, M., & Hartley, J. (1996). A comparison between the time-management skills and academic performance of mature and traditional-entry university students. Higher Education, 32(2), 199–215.
Wahlbeck, K., Westman, J., Nordentoft, M., Gissler, M., & Laursen, T. M. (2011). Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. The British Journal of Psychiatry, 199(6), 453–458. https://doi.org/10.1192/bjp.bp.110.085100.
World Health Organization (2018). Adolescent mental health. https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health.
Zaid, Z. A., Chan, S. C., & Ho, J. J. (2007). Emotional disorders among medical students in a Malaysian private medical school. Singapore Medical Journal, 48(10), 895–899. http://smj.sma.org.sg/4810/4810a3.pdf.
Acknowledgements
We would like to thank our respondents, the University of Malaya Student Affairs Division and University of Malaya Admissions and Records Section for their support. We thank the research team members for their input and contribution in data collection.
Author Contributions
N.S.: analyzed the data, interpreted the results and drafted the paper; N.D.: collaborated in the writing and editing of the final version of the manuscript; A.Y.: assisted with data analyses and aided in writing and editing; C.C.: organized the data collection process and aided in writing and editing; T.S.: contributed to research methodology, questionnaire development and editing; S.R.: collaborated on the study design and assisted in editing the paper; M.D.: designed and executed the study, collaborated in writing and editing.
Funding
The study was funded by Ecological Approach towards Healthy Campus at University of Malaya Grant (RU009-2014).
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of Interest
The authors declare that they have no conflict of interest.
Ethical Approval
All procedures in this study were performed in accordance with ethical standards, and ethical approval was obtained prior to study. The study was approved by the University of Malaya Medical Centre medical review board (MECID No: 20156-1401).
Informed Consent
Informed consent was obtained from all participants.
Additional information
Publisher’s note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Amir Hamzah, N.S., Nik Farid, N.D., Yahya, A. et al. The Prevalence and Associated Factors of Depression, Anxiety and Stress of First Year Undergraduate Students in a Public Higher Learning Institution in Malaysia. J Child Fam Stud 28, 3545–3557 (2019). https://doi.org/10.1007/s10826-019-01537-y
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10826-019-01537-y