The Relationship Between Depression, Anxiety, and Attention-deficit/hyperactivity Disorder Among Medical Students in a Tertiary Institution

Abstract

Background: In sub-Saharan Africa, diagnosis of Attention Deficit Hyperactivity Disorder (ADHD) is commonly made in childhood with many cases going undiagnosed and unrecognized. The nature of ADHD symptoms is highly disruptive to the individual therefore by the time an adult diagnosis is made the impact on their wellbeing is quite significant. This study aimed at looking into the association between depression, anxiety, and ADHD among University of Nairobi medical students. Objectives: The broad objective of this study was to investigate the association between depression, anxiety, and ADHD among medical students at the University of Nairobi. Methodology: The study employed the use of a quantitative cross-sectional study design in which data was collected in the space of two weeks. A sample of 335 University of Nairobi students was assessed for adult ADHD, Depression, and Anxiety. A systematic sampling technique was used to recruit eligible study participants who were informed about the study through their respective class representatives. After contact was established a link with an online consent form was shared. The objective of the study was outlined by the researcher as well as the ethical considerations which included and was not limited to the consent form, confidentiality, benefits and risks as well as the right to decline or withdraw at any point during the exercise. Having consented, socio-demographic questionnaire, PHQ 9, GAD 7 and the ASRS v1.1 tools were self-administered , to assess depression, anxiety, and ADHD.. Those with a positive ADHD score and had opted for a call back were contacted and notified of their outcomes. They were taken through the referral process to receive further assistance. Recruitment was done during the normal school days and those who met the inclusion criteria were enrolled within the sample frame until the desired sample size of 335 was achieved. Data Collection & Analysis: Data was collected through Kobo Collect online questionnaire. The raw data was cleaned for errors and any inconsistencies in responses. Stata v14.2 was used for statistical analysis of the data. The quantitative data was analyzed using both descriptive analysis techniques as well as inferential statistics. Moreover, means and frequencies were also determined for the socio-demographic factors. In addition, Bivariate and Multivariate logistic regression analyses were used to establish the association between the variables under investigation and highlighted their levels of significance. Results: Three hundred and thirty-five (335) respondents were recruited into the study with 173 (51.64%) being females and 162 (48.35%) males. Those aged 18-22 comprised majority of the participants, being 211 (62.99%) of the group, followed by those aged 23-26 years 93 (27.76%), 27-30years 27 (8.06%), above 30 years 4(<2%). Presence and severity of ADHD were assessed using the WHO ASRS v1.1. with the screener, the prevalence of ADHD was 32.54%. Presence and severity of depression were assessed using the PhQ-9. 183 (54%) of the participants reported some form of depression ranging from moderate to severe levels. Participants with moderate depression were 87 (25.97%), moderately severe were 58 (17.31%) and those severely depressed were 38 (11%). In addition, presence and severity of anxiety were assessed using the GAD-7. Participants who reported moderate to severe symptoms of anxiety were 145 (43%) of the total sample. Minimal to no anxiety was reported by 109 (32.54%), 81 (24.18%) participants reported mild anxiety, 86 (25.67%) moderate anxiety with 59 (17.6%) showing severe symptoms of anxiety. Moreover, the association between ADHD, depression and anxiety was also analyzed drawing the xv following findings. Ordinal logistic regression showed that students who exhibit ADHD symptoms were 9.28 times significantly more likely to develop anxiety compared to those who don’t, p = 0.000; and 8.63 times significantly more likely to develop depression severity, p= 0. 000. Conclusion and Recommendations: This study illuminates and adds onto the body of scientific knowledge on the general canvas around adult ADHD and the relationship it bears with anxiety and depression among university students pursuing medicine. The prevalence rates reported are significantly higher than those in other similar studies across the world. Consequently pushing the agenda on attempting to understand risk factors towards the development of depression and anxiety as well as adult ADHD within the college of health sciences. Mental wellness programs, additional academic support programs, mental wellness programs and mentorship should be set in place to help alleviate emotional distress among students of higher learning. On the other hand those who present with academic and interpersonal difficulties should be taken through psychological assessment as part of the investigations on help inform interventions that would be deployed to them