DEPRESSION, ANXIETY, STRESS, AND THEIR ASSOCIATED FACTORS AMONG CORPS MEMBERS SERVING IN KEBBI STATE
ABSTRACT BACKGROUND Depression, anxiety and stress,are not only health problems by themselves, but also associated with other negative health consequences. The national youth service is usually characterized by a number of new challenges and experiences which may require life style adjustments by the corps member. However, no previous study on psychological factors has been conducted among corps members. OBJECTIVE This study was conducted to determine the prevalence of depression, anxiety and stress and their associated factors among corps members serving in Kebbi state. METHODS A cross-sectional study was conducted among 264 corps members from four local government areas of the state. Selection of the local government areas and the individual participants was by simple random sampling. Data was collected from May to June 2014 using a self-administered questionnaire. Data analysis used chi-square test to identify the relationship between categorical variables and multivariate logistic regression to identify the independent factors for depression,anxiety and stress each. RESULTS The response rate was 97%. Most of the respondents were males (63.6%), single (85.5%), and above 20 years of age (71.6%).The overall prevalences of depression, anxiety and stress among the respondents were 36.4%, 54.5% and 18.2% respectively.The independent factors for depression were; being from the North central (0R=5.99; 95% CI: 2.194-16.354) or South-south;and the perception of earning enough income (0R=2.987;95% CI: 1.062-8.400). For anxiety, male gender (OR=0.411; 95% CI: 0.169-0.999); and being from the North central were significant risk factors (OR=3.731; 95% CI: 1.450-9.599). Being above 26 years of age was an independent risk factor for stress (OR=0.083; 95% CI: 0.018-0.381).Also, those who had ever schooled outside their towns of residence were less likely to be stressed compared to those who had never (OR=0.30; 95% CI: 0.110-0.855).All other factors did not show any significant association with any of the outcome variables in multivariate analysis. CONCLUSION In conclusion, the prevalences of depression, anxiety and stress are high among corps members serving in Kebbi state.There is need to expand the scope of this study to a national level so as to get a bigger picture of the problem. KEYWORDS:prevalence;depression,anxiety,stress,corps member,national youth service
INTRODUCTION
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sychological factors like depression, anxiety and stress have been associated with a number of negative outcomes. Results from a metaanalysis, provided moderate support for psychological factors (anxiety and depression) as predictors of 1 developing hypertension. Extremely severe depression has been associated with higher risks of prehypertension.2 A significant association has also been 3 reported between psychological stress and depression. Stress has also been reported to a small extent to predict 4 alcohol use. In Oman, higher rates of depression have been reported among University students compared to Corresponding Author: Dr Ahmed D. Balami, Department of Family Medicine, State Specialist Hospital Maiduguri, P.M.B. 1014, Maiduguri, Borno State. E-mail:
[email protected] Phone: 08065995665
people in the community; and it has been proposed that University life could have factors which might contribute to stress and trigger mal-adjustment that expresses as depression.5 A study among medical students in a government university in Malaysia revealed a prevalence of 35.9% for depression.6 The prevalences of moderate levels and above, for depression, anxiety and stress among students in a Turkish University were 27.1%, 47.1% and 27% 7 respectively. Higher prevalences have been reported among first year students in a Malaysian University using the same instrument (DASS) 38.0%, 79.6%; 2 29.7%. In a Nigerian University, using the Mini International Neuropsychiatric Interview, the prevalence of depressive disorders was quite lower 8 (8.3%).
The service year is usually just after graduation, and as reported by Al-Busaidiet al.5 among University students, it is also likely that the national youth service could also trigger mal-adjustments that could express as various psychological problems. The national youth service is a one year mandatory programme graduates undergo before being assimilated into the labour market. Corps members are basically posted to parts of the countries different from theirs. It comprises of an initial three weeks orientation programme which holds at the orientation camp (one present in each of all the thirty six states and the federal capital, Abuja). It entails military drills, martial arts, man o' war, social activities and lectures, to prepare corps members for their service year. Corps members are then posted to their various places of primary assignments in the various local government areas of the states, where they complete the remaining service year. For many, the service year is their first experience staying outside their towns of residence. For many, it is also their first time staying away from their parents. For many also, it is their first experience as employees. These and many other changes which the corps member experiences, are likely to be associated with adjustment problems which are likely to have an effect on the corps member's psychological state. The main objective of this research was to determine the prevalence of depression, anxiety and stress and their associated factors among corps members serving in Kebbi state. METHODOLOGY Kebbi State is one of the thirty six states of Nigeria created in 1991 and located in the North-west. It is basically a Hausa state but also has other minority ethnic groups like Fulani, Zabarma, Dakkaree.t.c. It consists of twenty one local government areas with basically an agrarian economy. A cross sectional study design was used in this study. All corps members serving in Kebbi state constituted the study population and the criteria for inclusion into the study was to be a corps member serving in Kebbi state and to be in the state at the time of the study. The two-proportions formular by Lwanga and Lomeshow (1991) 9, was used to calculate the sample size which gave a minimal sample size of 143 participants. Simple random sampling was conducted in four local government areas (BirninKebbi, Koko/Besse, Bunzaand Ngaski) which were selected at random. Recruitment of participants was done basically during the weekly Corpers Welfare Association (C.W.A.) meetings. Permission was sought to carry out the research from the N.Y.S.C. State co-ordinator through
the Zonal Inspector and through the Local Government Inspector of Koko local government and informed verbal consent also obtained from the individual participants after appropriate explanation. The dependent variables in this study were: depression, anxiety and stress; while the independent variables were: age group, gender, geo-political zone, history of schooling away from town of residence, income, smoking and alcohol consumption. Structured questionnaire was used for data collection which consisted of two parts. The first part about relevant biodata, social and behavioural history; while the other part was the Depression Anxiety and Stress (DASS 21) Questionnaire which consisted of 21 questions; 7 for each of the 3 emotional states. It basically assesses the severity of the core symptoms of these emotional states. The DASS 21 Scoring template was used to identify items which belonged to a particular emotional state. Questions number 3, 5, 10, 13, 16 and 17 were for depression; questions number 2, 4, 7, 9, 15, 19 and 20 were for anxiety; while questions number 1, 6, 8, 11, 12, 14 and 18 were for stress. Respondents indicated the presence of a symptom over the previous week and gave a scoring which ranged from 0 (did not apply to me at all over the last week) to 3 (applied to me very much or most of the time over the past week). The final scores obtained for each item groups on the DASS 21 were multiplied by 2 to calculate the final score since it is the short version of the long form with 42 items. Each respondent was then classified according to his/her level of depression, anxiety and stress based on their scores. Data was analysed using SPSS Version 20. Descriptive statistics (frequency and percentage) was used to summarise categorical data. Age, which is a continuous variable, was converted into categorical. Chi square test was used to measure association between the independent variables. All hypotheses tests were two-sided and level of significance , was set at 0.05. Logistic regression was used to obtain predictors of pre-hypertension; and odds ratio and 95% confidence intervals were used for association between independent and dependent variables. RESULTS Data collection was carried out from May to July 2014. The response rate was (264) 97%, as only 7 out of the 271 respondents went away with the questionnaire without returning it making the total number of 264 respondents. Only batches C and A were present at the time of the study and had a proportion of 56.8% and 43.3% respectively.
Characteristics of respondents and its association with their behaviours. The highest number of respondents was from BirninKebbi, 93 (35.2%), while Koko/Besse, Ngaski and Bumza contributed to 26.1%, 22.7% and 15.9% of the total respondents respectively. Tables 1 and 2 show the distribution of respondents by their sociodemographic characteristics and behavioural characteristics respectively. Most of the respondents were males (63.6%), single (85.2%), above 26 years of age (71.6%), and from the North (55.7%). Thirty six did not state their ages. Corps members from the Northeast had the highest percentage among them, of those who had ever schooled outside their towns of origin (81%); while the North-west had the least (25%). There was a statistically significant association between 2 region of origin and schooling outside =26.66;df=5; p
