PREVALENCE OF DEPRESSION AMONG UNIVERSITY STUDENTS: A CASE STUDY OF UNIVERSITY OF NIGERIA MEDICAL CENTRE

CHAPTER ONE

INTRODUCTION

Abstract

Depression is a leading contributor to global disability and a significant threat to the academic performance, social functioning, and long-term wellbeing of university students. In Nigeria, where mental health services remain severely underfunded and stigma continues to limit help-seeking, the burden of depression among university students is substantial but inadequately documented at institutional levels. This study examines the prevalence and correlates of depression among students at the University of Nigeria Medical Centre (UNMC), Enugu. Drawing on recent Nigerian and African scholarship, the chapter presents the background to the study, problem statement, objectives, research questions, hypotheses, significance, scope, and definitions of key terms.

1.1 Background to the Study

Depression is a chronic and widespread mental disorder with persistent feelings of sadness, hopelessness, worthlessness, impaired thinking, fatigue, and in extreme cases, it will be characterized by suicidal ideation. Depression has been shown to affect over 280 million people worldwide and is a leading cause of disability in every corner of the world, as indicated by the World Health Organization (WHO, 2017). Of special concern among university students is the fact that, the process of transitioning secondary school to higher education is an important period of development where students experience academic pressure, social acclimatization, economic strain and loss of family support networks.

The prevalence of depression among university students is found worldwide with the prevalence ranging between 10 and 30 (Akinyemi et al., 2025). The burden is especially intense in the low- and middle-income nations, including Nigeria, with the studies indicating very high rates (around a quarter to a third of students report depressive symptoms). In a study of first-year pharmacy, medical, and nursing students at a Nigerian university, depression prevalence was found to be 71.8% and the prevalence of anxiety was 61.7% with only 24.9% of the participants indicating that they would seek professional psychological support (Aluh et al., 2022). These statistics highlight the seriousness of mental health issues in Nigerian university settings.

A meta-analytic approach in Nigeria has shown that depression is not discriminatory against disciplines, year of study or a geopolitical location though some groups of students are at high risk. According to Isara, Nwokoye and Odaman (2022), the levels of prevalence of depression in an undergraduate medical student at the University of Benin were found to fall under the severe range of 1.6% to 7 and mild depression of 25.2% to 71.8%. The study by Oguizu, Dominic and Oguizu (2024), which was carried out among the students at Kaduna State University, indicated a crude prevalence of depressive symptoms of 34.8, which is broadly consistent with the surveys of student mental health conducted globally, which indicate a prevalence of depressive symptoms among this demographic of 27.7%.

One of the largest federal universities in Nigeria, the University of Nigeria has a Medical Centre (UNMC) which is a primary access to healthcare by the vast student population of the institution. Students who present to UNMC present a broad spectrum of complaints related to physical and mental health yet depression is often not diagnosed, or misdiagnosed or not adequately treated as there is a low supply of trained mental health professionals and psychosocial support services at the facility which limits their ability to provide adequate care. It is not peculiar to UNMC; in general, in Nigerian universities, there is virtually no psychiatric service offered, and the stigma of mental illness is so strong that students will not favor presenting with symptoms of depression.

There is an extensive literature related to the correlates of student depression in Nigeria and they include academic stress and poor performance, financial hardship, relationship difficulties, body image concerns, exposure to sexual violence, and chronic illness. In a study carried out in Afe Babalola University between September and October 2024, Akinyemi et al. (2025) found significant relationships between body image concerns, obesity, intimate partner violence, and depression among students with sex mediating the relationships. The implications of such multidimensional results are that there is need to have holistic, gender-sensitive approaches to student mental health.

The mental health literacy (the understanding of recognizing and acting appropriately on mental health conditions) remains poor among university students throughout the world, especially in the sub-Saharan Africa. In The Lancet Psychiatry, Aluh et al. (2023) pointed out that mental health service utilization is significantly hindered by structural and attitudinal barriers in Nigeria, including poor attitudes toward mental health services and the lack of integrated mental health services on campuses. It is only after setting the right prevalence figures at the institutional level, which is also the objective of this paper.

1.2 Statement of the Problem.

Although there is overwhelming national and international evidence available on high depression prevalence among university students in Nigeria, there are very few institution specific studies that examine the burden, correlates and help seeking behaviour among university students in Nigeria. The University of Nigeria Medical Centre operates a student medical healthcare system across various disciplines, however there is no systematic screening programme of depression, and students with depressed moods may present with somatic complaints, which hides the underlying mood disorder.

This lack of institutionalized evidence implies that mental health resources distribution at UNMC is determined by the general impressions rather than by the evidence based insights. In addition, the stress factors of education unique to health sciences - long hours of study, clinical placements, exposure to patient suffering, and competitive educational settings - may expose students of health sciences to increased health risk relative to other groups. This paper aims at bridging this knowledge gap by establishing the prevalence and correlates of depression among UNMC students and exploring their mentalities regarding seeking professional mental health.

1.3 Objectives of the Study

The general objective is to determine the prevalence and correlates of depression among students registered at the University of Nigeria Medical Centre.

The specific objectives are:

1. To determine the prevalence of depression among University of Nigeria students presenting at UNMC, using a validated screening tool.
2. To identify the sociodemographic, academic, and psychosocial correlates of depression in the study population.
3. To assess students' willingness to seek professional mental health support and identify barriers to help-seeking.
4. To compare depression prevalence rates across academic disciplines, year of study, and gender.
5. To propose recommendations for institutional mental health policy at the University of Nigeria.

1.4 Research Questions

1. What is the prevalence of depression among University of Nigeria students presenting at UNMC?
2. What sociodemographic, academic, and psychosocial factors are significantly associated with depression in this population?
3. What is the level of willingness to seek mental health support, and what barriers exist?
4. Are there significant differences in depression prevalence by discipline, year of study, and gender?
5. What institutional interventions can effectively reduce the burden of depression among UNMC students?

1.5 Research Hypotheses

H1: The prevalence of depression among University of Nigeria students is significantly higher than the general Nigerian adult population baseline.

H2: Female students exhibit significantly higher rates of depression than male students.

H3: Higher year-of-study levels and health sciences disciplines are independently associated with elevated depression prevalence.

1.6 Significance of the Study

The findings of this study have direct implications for student welfare policy at the University of Nigeria and comparable federal universities. By generating institution-specific prevalence data, the study provides a quantitative evidence base for UNMC to justify investment in mental health screening, counselling services, and staff training. For health sciences education in Nigeria, the study illuminates how academic programme design may inadvertently contribute to student mental health deterioration. For national mental health policy, the study adds to the growing body of evidence supporting the integration of campus mental health services within Nigeria's revised National Mental Health Act. The study also contributes to global scholarship on student depression in LMICs, a domain identified by Aluh et al. (2023) as requiring substantially more research attention.

1.7 Scope and Limitations of the Study

The study covers students registered with UNMC across all years of study and academic disciplines during one academic session. Depression will be assessed using the Patient Health Questionnaire-9 (PHQ-9), a validated and widely used screening instrument. Limitations include self-report bias inherent in depression screening tools, possible underrepresentation of students who do not present at UNMC, and the cross-sectional design that limits causal inference. Cultural factors influencing the expression and interpretation of depressive symptoms among Nigerian students will be discussed as part of the study's contextual analysis.

1.8 Definition of Terms

Depression:

A common and serious mood disorder characterized by persistent depressed mood, loss of interest or pleasure in activities, fatigue, cognitive difficulties, and in severe cases, recurrent thoughts of death or suicide, causing significant functional impairment (APA, 2022).

Prevalence:

The proportion of a population found to have a particular condition at a specific point in time or over a defined period, expressed as a percentage.

Mental Health Literacy:

The knowledge and beliefs about mental disorders that aid their recognition, management, and prevention.

Help-Seeking Behaviour:

The active process by which individuals experiencing psychological distress or mental health symptoms engage with formal (clinical/professional) or informal (peers, family, religious) support systems.

PHQ-9 (Patient Health Questionnaire-9):

A validated nine-item self-report screening tool designed to assess the severity of depressive symptoms, widely used in both clinical and research settings.

University Medical Centre:

A healthcare facility located within or affiliated with a university campus, providing primary and secondary health services to enrolled students and staff.

References

Akinyemi, O., Ekundayo, O. K., Fasokun, M., Ogunyankin, F., Ifoto, O. S., Alatise, O. D., ... & Okonta, P. (2025). Body image, obesity, and sexual coercion: Impacts on depression among students at a Nigerian university. PLOS ONE, 20(6), e0319308. https://doi.org/10.1371/journal.pone.0319308

Aluh, D. O., Okoro, R. N., & Oyejide, O. H. (2022). Prevalence of depression and anxiety, and attitudes toward seeking help among first-year pharmacy, medical, and nursing students at a Nigerian university. Currents in Pharmacy Teaching and Learning, 14(6), 717–724. https://doi.org/10.1016/j.cptl.2022.06.001

Aluh, D. O., & Caldas de Almeida, J. M. (2023). The need for mental health research in Nigeria. The Lancet Psychiatry, 10(5), 310–311. https://doi.org/10.1016/S2215-0366(23)00077-5

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