Self-reported depression in first-year nursing students in relation to socio-demographic and educational factors: a nationwide cross-sectional study in Sweden



Higher education has been associated with distress and depression in students, and concerns that the proportion students afflicted is increasing have been raised. Findings on student depression have often been based on age-homogeneous samples leaving the results vulnerable to a confounding of student experience, transition from adolescence to adulthood and age on depression. We investigated self-reported depression and its associations with sociodemographic and educational factors in a demographically diverse student population of first-year nursing students in Sweden.


A base-line survey in a nation-wide cohort of 1,700 first-year nursing students was conducted in the fall of 2002. The participants answered a mailed questionnaire containing questions on sociodemography, educational factors, and health. Depression was measured by the Major Depression Inventory and associations to sociodemographic and educational factors were tested in logistic regressions.


The overall response rate was 72.9%, and 10.2% (5.7% men, 10.7% women) reported depression. Younger age (<30), female gender, immigration from outside of Europe, high workload, dissatisfaction with education, low self-efficacy, and conflicts between personal and college demands were associated with high prevalence of depression. Prior work experience, less need for financial support, and work for pay during term time were related to low prevalence of depression. Older students and those who were parents reported home-college conflicts more often.


Nursing students as a group show high levels of self-reported depression but the prevalence is affected by age with a higher proportion depressed among younger students. Even though older students and those who were parents show less depression, they were more vulnerable to home–college conflicts. As older students and parents constitute a large proportion of nursing students, it is of importance to find ways to lessen the effects of the obstacles they encounter in the education.

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  1. 1.

    Ahmadi J, Toobaee S, Alishahi M (2004) Depression in nursing students. J Clin Nurs 13(1):124

    PubMed  Article  Google Scholar 

  2. 2.

    Allen TD, Herst DE, Bruck CS, Sutton M (2000) Consequences associated with work-to-family conflict: a review and agenda for future research. J Occup Health Psychol 5(2):278–308

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    American College Health Association. National College Health Assessment II: Reference Group Executive Summary Spring 2000–Spring 2008. Accessed on 27 January 2010

  4. 4.

    Arnett JJ (2000) Emerging adulthood. A theory of development from the late teens through the twenties. Am Psychol 55(5):469–480

    PubMed  Article  CAS  Google Scholar 

  5. 5.

    Bandura A (2001) Guide for constructing self-efficacy scales. Stanford University, Stanford

    Google Scholar 

  6. 6.

    Bandura A, Caprara GV, Barbaranelli C, Gerbino M, Pastorelli C (2003) Role of affective self-regulatory efficacy in diverse spheres of psychosocial functioning. Child Dev 74(3):769–782

    PubMed  Article  Google Scholar 

  7. 7.

    Bandura A, Pastorelli C, Barbaranelli C, Caprara GV (1999) Self-efficacy pathways to childhood depression. J Pers Soc Psychol 76(2):258–269

    PubMed  Article  CAS  Google Scholar 

  8. 8.

    Baumeister H, Harter M (2007) Prevalence of mental disorders based on general population surveys. Soc Psychiatry Psychiatr Epidemiol 42(7):537–546

    PubMed  Article  Google Scholar 

  9. 9.

    Bayram N, Bilgel N (2008) The prevalence and socio-demographic correlations of depression, anxiety and stress among a group of university students. Soc Psychiatry Psychiatr Epidemiol 43(8):667–672

    PubMed  Article  Google Scholar 

  10. 10.

    Bech P, Rasmussen NA, Olsen LR, Noerholm V, Abildgaard W (2001) The sensitivity and specificity of the Major Depression Inventory, using the Present State Examination as the index of diagnostic validity. J Affect Disord 66(2–3):159–164

    PubMed  Article  CAS  Google Scholar 

  11. 11.

    Beck DL, Hackett MB, Srivastava R, McKim E, Rockwell B (1997) Perceived level and sources of stress in university professional schools. J Nurs Educ 36(4):180–186

    PubMed  CAS  Google Scholar 

  12. 12.

    Beck DL, Srivastava R (1991) Perceived level and sources of stress in baccalaureate nursing students. J Nurs Educ 30(3):127–133

    PubMed  CAS  Google Scholar 

  13. 13.

    Blanco C, Okuda M, Wright C, Hasin DS, Grant BF, Liu S-M, Olfson M (2008) Mental health of college students and their non-college-attending peers: results from the National Epidemiologic Study on Alcohol and Related Conditions. Arch Gen Psychiatry 65(12):1429–1437

    PubMed  Article  Google Scholar 

  14. 14.

    Cotton SJ, Dollard MF, de Jonge J (2002) Stress and student job design: satisfaction, well-being, and performance in university students. Int J Stress Manag 9(3):147–162

    Article  Google Scholar 

  15. 15.

    Dahlberg K, Forsell Y, Damstrom-Thakker K, Runeson B (2007) Mental health problems and healthcare contacts in an urban and a rural area. Comparisons of two Swedish counties. Nord J Psychiatry 61(1):40–46

    PubMed  Article  Google Scholar 

  16. 16.

    Dahlin M, Joneborg N, Runeson B (2005) Stress and depression among medical students: a cross-sectional study. Med Educ 39(6):594–604

    PubMed  Article  Google Scholar 

  17. 17.

    Dutta AP, Pyles MA, Miederhoff PA (2005) Stress in health professions students: myth or reality? A review of the existing literature. J Natl Black Nurses Assoc 16(1):63–68

    PubMed  Google Scholar 

  18. 18.

    Dyrbye LN, Thomas MR, Shanafelt TD (2006) Systematic review of depression, anxiety, and other indicators of psychological distress among U.S. and Canadian medical students. Acad Med 81(4):354–373

    PubMed  Article  Google Scholar 

  19. 19.

    Eisenberg D, Gollust SE, Golberstein E, Hefner JL (2007) Prevalence and correlates of depression, anxiety, and suicidality among university students. Am J Orthopsychiatry 77(4):534–542

    PubMed  Article  Google Scholar 

  20. 20.

    Emslie C, Hunt K, Macintyre S (2004) Gender, work-home conflict, and morbidity amongst white-collar bank employees in the United Kingdom. Int J Behav Med 11(3):127–134

    PubMed  Article  Google Scholar 

  21. 21.

    European Commission (2009) Strategic framework for European cooperation in education and training. Europa—The official website of the European Union. Accessed on 27 January 2010

  22. 22.

    Evans W, Kelly B (2004) Pre-registration diploma student nurse stress and coping measures. Nurse Educ Today 24(6):473–482

    PubMed  Article  Google Scholar 

  23. 23.

    Forsell Y (2005) The Major Depression Inventory versus Schedules for Clinical Assessment in Neuropsychiatry in a population sample. Soc Psychiatry Psychiatr Epidemiol 40(3):209–213

    PubMed  Article  Google Scholar 

  24. 24.

    Frone MR (2000) Work–family conflict and employee psychiatric disorders: the National Comorbidity Survey. J Appl Psychol 85(6):888–895

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Frone MR, Russell M, Barnes GM (1996) Work–family conflict, gender, and health-related outcomes: a study of employed parents in two community samples. J Occup Health Psychol 1(1):57–69

    PubMed  Article  CAS  Google Scholar 

  26. 26.

    Frone MR, Russell M, Cooper ML (1992) Antecedents and outcomes of work–family conflict: testing a model of the work–family interface. J Appl Psychol 77(1):65–78

    PubMed  Article  CAS  Google Scholar 

  27. 27.

    Gallagher RP (2009) National Survey of Counseling Center Directors 2009. The international Association of counseling services. Accessed 27 January 2010

  28. 28.

    Gibbons C, Dempster M, Moutray M (2008) Stress and eustress in nursing students. J Adv Nurs 61(3):282–290

    PubMed  Article  Google Scholar 

  29. 29.

    Gladstone TR, Koenig LJ (1994) Sex differences in depression across the high school to college transition. J Youth Adolesc 23(6):643–669

    Article  Google Scholar 

  30. 30.

    Gorostidi XZ, Egilegor XH, Erice MJA, Iturriotz MJU, Garate IE, Lasa MB, Cascante XS (2007) Stress sources in nursing practice. Evolution during nursing training. Nurse Educ Today 27(7):777–787

    Google Scholar 

  31. 31.

    Grzywacz JG, Frone MR, Brewer CS, Kovner CT (2006) Quantifying work–family conflict among registered nurses. Res Nurs Health 29(5):414–426

    PubMed  Article  Google Scholar 

  32. 32.

    Gustavsson P, Svärdson Å, Lagerström M, Bruce M, Christensson A, Omne-Pontén M (2007) Longitudinell undersökning av sjuksköterskors tillvaro (in Swedish). Karolinska Institutet, Department of Neurobiology, Care Sciences and Society. Stockholm. Accessed on 27 January 2010

  33. 33.

    Haack MR (1988) Stress and impairment among nursing students. Res Nurs Health 11(2):125–134

    PubMed  Article  CAS  Google Scholar 

  34. 34.

    Hamill C (1995) The phenomenon of stress as perceived by Project 2000 student nurses: a case study. J Adv Nurs 21(3):528–536

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Hankin BL, Abramson LY, Moffitt TE, Silva PA, McGee R, Angell KE (1998) Development of depression from preadolescence to young adulthood: emerging gender differences in a 10-year longitudinal study. J Abnorm Psychol 107(1):128–140

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Hegge M, Larson V (2008) Stressors and coping strategies of students in accelerated baccalaureate nursing programs. Nurse Educ 33(1):26–30

    PubMed  Article  Google Scholar 

  37. 37.

    Henning K, Ey S, Shaw D (1998) Perfectionism, the imposter phenomenon and psychological adjustment in medical, dental, nursing and pharmacy students. Med Educ 32(5):456–464

    PubMed  Article  CAS  Google Scholar 

  38. 38.

    Högskoleverket—Swedish National Agency for Higher Education (2000) Utbildningar inom vård och omsorg—en uppföljande utvärdering (in Swedish). Stockholm

  39. 39.

    Jones MC, Johnston DW (1997) Distress, stress and coping in first-year student nurses. J Adv Nurs 26(3):475–482

    PubMed  Article  CAS  Google Scholar 

  40. 40.

    Kessler RC, Berglund P, Demler O, Jin R, Koretz D, Merikangas KR, Rush AJ, Walters EE, Wang PS (2003) The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA 289(23):3095–3105

    PubMed  Article  Google Scholar 

  41. 41.

    Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE (2005) Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry 62(6):593–602

    PubMed  Article  Google Scholar 

  42. 42.

    Kessler RC, Walters EE (1998) Epidemiology of DSM-III-R major depression and minor depression among adolescents and young adults in the National Comorbidity Survey. Depress Anxiety 7(1):3–14

    PubMed  Article  CAS  Google Scholar 

  43. 43.

    Kisch J, Leino EV, Silverman MM (2005) Aspects of suicidal behavior, depression, and treatment in college students: results from the spring 2000 national college health assessment survey. Suicide Life Threat Behav 35(1):3–13

    PubMed  Article  Google Scholar 

  44. 44.

    Kitzrow MA (2003) The mental health needs of today’s college students: challenges and recommendations. NASPA J 41(1):167–181

    Google Scholar 

  45. 45.

    Lindop E (1991) Individual stress among nurses in training: why some leave while others stay. Nurse Educ Today 11(2):110–120

    PubMed  Article  CAS  Google Scholar 

  46. 46.

    Lister PG (2008) ‘It’s like you can’t be a whole person, a mother who studies’. Lifelong learning: mature women students with caring commitments in social work education. Soc Work Educ 22(2):125–138

    Article  Google Scholar 

  47. 47.

    Lo R (2002) A longitudinal study of perceived level of stress, coping and self-esteem of undergraduate nursing students: an Australian case study. J Adv Nurs 39(2):119–126

    PubMed  Article  Google Scholar 

  48. 48.

    Mastekaasa A (2006) Is marriage/cohabitation beneficial for young people? Some evidence on psychological distress among Norwegian college students. J Community Appl Soc Psychol 16(2):149–165

    Article  Google Scholar 

  49. 49.

    Mikolajczyk RT, Maxwell AE, El Ansari W, Naydenova V, Stock C, Ilieva S, Dudziak U, Nagyova I (2008) Prevalence of depressive symptoms in university students from Germany, Denmark, Poland and Bulgaria. Soc Psychiatry Psychiatr Epidemiol 43(2):105–112

    PubMed  Article  Google Scholar 

  50. 50.

    Nerdrum P, Rustoen T, Ronnestad MH (2006) Student Psychological Distress: a psychometric study of 1750 Norwegian 1st-year undergraduate students. Scand J Educ Res 50(1):95–109

    Article  Google Scholar 

  51. 51.

    Nolen-Hoeksema S (1987) Sex differences in unipolar depression: Evidence and theory. Psychol Bull 101(2):259–282

    PubMed  Article  CAS  Google Scholar 

  52. 52.

    Olsen LR, Jensen DV, Noerholm V, Martiny K, Bech P (2003) The internal and external validity of the Major Depression Inventory in measuring severity of depressive states. Psychol Med 33(2):351–356

    PubMed  Article  CAS  Google Scholar 

  53. 53.

    Parkes KR (1982) Occupational stress among student nurses: a natural experiment. J Appl Psychol 67(6):784–796

    PubMed  Article  CAS  Google Scholar 

  54. 54.

    Parkes KR (1985) Stressful episodes reported by first-year student nurses: a descriptive account. Soc Sci Med 20(9):945–953

    PubMed  Article  CAS  Google Scholar 

  55. 55.

    Pryjmachuk S, Richards DA (2007) Mental health nursing students differ from other nursing students: some observations from a study on stress and coping. Int J Ment Health Nurs 16(6):390–402

    PubMed  Article  Google Scholar 

  56. 56.

    Reay D (2008) A risky business? Mature working-class women students and access to higher education. Gend Educ 15(3):301–317

    Article  Google Scholar 

  57. 57.

    Rhead MM (1995) Stress among student nurses: is it practical or academic? J Clin Nurs 4(6):369–376

    PubMed  Article  CAS  Google Scholar 

  58. 58.

    Ross R, Zeller R, Srisaeng P, Yimmee S, Somchid S, Sawatphanit W (2005) Depression, stress, emotional support, and self-esteem among baccalaureate nursing students in Thailand. Int J Nurs Educ Scholarsh 2(1):1–15

    Google Scholar 

  59. 59.

    Royal College of Psychiatrists (2003) The mental health of students in higher education. The Royal College of Psychiatrists, London. Accessed 27 January 2010

  60. 60.

    Sam DL (2001) Satisfaction with life among international students: An exploratory study. Soc Indic Res 53:315–337

    Article  Google Scholar 

  61. 61.

    Schunk DH (1991) Self-efficacy and academic motivation. Educ Psychol 26(3–4):207–231

    Google Scholar 

  62. 62.

    Scott C, Burns A, Cooney G (1996) Reasons for discontinuing study: the case of mature age female students with children. High Educ 31(2):233–253

    Article  Google Scholar 

  63. 63.

    Smith HM, Betz NE (2002) An examination of efficacy and esteem pathways to depression in young adulthood. J Couns Psychol 49(4):438–448

    Article  Google Scholar 

  64. 64.

    Stewart-Brown S, Evans J, Patterson J, Petersen S, Doll H, Balding J, Regis D (2000) The health of students in institutes of higher education: an important and neglected public health problem? J Public Health Med 22(4):492–499

    PubMed  Article  CAS  Google Scholar 

  65. 65.

    Timmins F, Kaliszer M (2002) Aspects of nurse education programmes that frequently cause stress to nursing students—fact finding sample survey. Nurse Educ Today 22(3):203–211

    PubMed  Article  Google Scholar 

  66. 66.

    Tomoda A, Mori K, Kimura M, Takahashi T, Kitamura T (2000) One-year prevalence and incidence of depression among first-year university students in Japan: a preliminary study. Psychiatry Clin Neurosci 54(5):583–588

    PubMed  Article  CAS  Google Scholar 

  67. 67.

    Tully A (2004) Stress, sources of stress and ways of coping among psychiatric nursing students. J Psychiatr Ment Health Nurs 11(1):43–47

    PubMed  Article  CAS  Google Scholar 

  68. 68.

    Vaez M, Kristenson M, Laflamme L (2004) Perceived quality of life and self-rated health among first-year university students: A comparison with their working peers. Soc Indic Res 68(2):221–234

    Article  Google Scholar 

  69. 69.

    Vaez M, Laflamme L (2002) First-year university students’ health status and socio-demographic determinants of their self-rated health. Work 19(1):71–80

    PubMed  CAS  Google Scholar 

  70. 70.

    Vaez M, Ponce de Leon A, Laflamme L (2006) Health-related determinants of perceived quality of life: a comparison between first-year university students and their working peers. Work 26(2):167–177

    PubMed  Google Scholar 

  71. 71.

    Warbah L, Sathiyaseelan M, Vijayakumar C, Vasantharaj B, Russell S, Jacob KS (2007) Psychological distress, personality, and adjustment among nursing students. Nurse Educ Today 27(6):597–601

    PubMed  Article  CAS  Google Scholar 

  72. 72.

    Wardle J, Steptoe A, Gulis G, Sartory G, Sek H, Todorova I, Vogele C, Ziarko M (2004) Depression, perceived control, and life satisfaction in university students from Central-Eastern and Western Europe. Int J Behav Med 11(1):27–36

    PubMed  Article  Google Scholar 

  73. 73.

    Webb E, Ashton CH, Kelly P, Kamali F (1996) Alcohol and drug use in UK university students. Lancet 348(9032):922–925

    PubMed  Article  CAS  Google Scholar 

  74. 74.

    Weitzman ER (2004) Poor mental health, depression, and associations with alcohol consumption, harm, and abuse in a national sample of young adults in college. J Nerv Ment Dis 192(4):269–277

    PubMed  Article  Google Scholar 

  75. 75.

    Verger P, Combes J-B, Kovess-Masfety V, Choquet M, Guagliardo V, Rouillon F, Peretti-Wattel P (2009) Psychological distress in first year university students: socioeconomic and academic stressors, mastery and social support in young men and women. Soc Psychiatry Psychiatr Epidemiol 44(8):643–650

    PubMed  Article  Google Scholar 

  76. 76.

    Williams RA, Hagerty BM, Murphy-Weinberg V, Wan J (1995) Symptoms of depression among female nursing students. Arch Psychiatr Nurs 9(5):269–278

    PubMed  Article  CAS  Google Scholar 

  77. 77.

    Wittchen H-U, Jacobi F (2005) Size and burden of mental disorders in Europe—a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 15(4):357–376

    PubMed  Article  CAS  Google Scholar 

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Christensson, A., Vaez, M., Dickman, P.W. et al. Self-reported depression in first-year nursing students in relation to socio-demographic and educational factors: a nationwide cross-sectional study in Sweden. Soc Psychiatry Psychiatr Epidemiol 46, 299–310 (2011).

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  • Depression
  • Undergraduate students
  • Nursing
  • Epidemiology
  • Socio-demographic factors