Depression and type D personality among undergraduate medical students.

CONTEXT: Academic pressure, though established, is an unavoidable cause of depression in medical students. Role of Type D personality as determinant of depression is a new approach to the problem. AIM: Determination of relationship between Type D personality and Depression among medical students. SETTING AND
DESIGN: Undergraduate students (both male and female, total 150) of Midnapore Medical College.
MATERIALS AND METHODS: Beck Depression Inventory for depression and DS 14 for type D personality. STATISTICAL ANALYSIS: The scores were expressed as mean + SD. The significance of difference between the scores was done by Fisher's 2 sample t test. RESULTS AND
CONCLUSION: Prevalence rate of depression was 45.3%, which was mostly of mild type (34%). Type D personality was present in 70% cases of which 15.3% had only negative affectivity, 23.3% had only social inhibition and 31% had both the components. Both depression & Type D personality were present in 36% cases. Negative affectivity component was significantly associated with depression which could be therapeutically controlled.

INTRODUCTION

The World Health Organization has identified depressive disorders of adolescence as “priority mental health disorder.” Globally, its prevalence rate is 15 to 20% and recurrence rate is 60-70% whereas in India it is reported as 11.2%. However, studies have reported that 50% of cases remain undiagnosed. The consequences of this depression are serious, causing suicide, school dropout, and drug abuse etc., Often adolescent depression leads to adult depression.[1]

Young medical students are no exception to this trend. Studies have already reported that depression is the most common mental disease affecting them.[2] The rate of depression and suicide have been found to be higher in medical students than other undergraduate students. Academic burden, though have been identified as source of depression,[3] cannot be changed. So other determinants of depression should be worked out which could be treated and contribute for benefit of the students.

One situation is handled by different students in different ways which largely depends on the personality of the students. Recently, a new type of personality, type D had been established which can be regarded as psychopathological condition as these individuals are at increased risk of developing psychiatric disorders like depression, anxiety, post traumatic stress disorder, panic or phobic disorder, and medical disorders like cardiovascular disease and stroke.[4] It involves those who tend to experience negative distress and who do not express these in social interaction. Thus, type D personality is based on two stable personality traits, negative affect (NA) and social inhibition (SI), and gives an interaction between them.

Negative affect is the tendency to experience negative emotions like depressed or low mood, hopelessness, anger, and anxiety etc., Those people scoring high on negative affect are not only dysphoric, but also have negative views about self, future, world, and present many somatic symptoms. SI is an avoidance of potential dangers involved in social interacting situations. They fell uncomfortable, shy, tense, and inhibited while interacting with people.[5]

In this backdrop, the present study was undertaken to find out the prevalence of depression and type D personality among medical students and to find out whether they bear any significant correlation or not.

MATERIALS AND METHODS

A total of 150 undergraduate medical students of different academic years of Midnapore Medical College were selected. Students known to suffer from hypothyroidism or diabetes were excluded from this study. Students who were taking antihypertensive drugs, beta blockers, anticonvulsants, or corticosteroids were not included in this study. Students of all academic years were included in the study.

Each of them was presented with one copy of questionnaire to assess depression (Beck Depression Inventory) and one copy of questionnaire to assess Type-D personality (DS 14). Informed consent was taken from each participant after explaining them the objectives of the study. The study was approved by Ethical Committee.

The data were collected between September, 2008 and November, 2008 and analyzed subsequently.

Beck Depression Inventory is a 21 item self administered inventory where 1 statement is to be chosen from each item. The scores have to be summed up to identify not only the presence of depression but also its severity. (Score 0-9=no depression, 10-25=mild depression. 16-24=moderate depression, more than or equal to 25=severe depression).[6]

DS 14 contains 14 items which were instructed to answer in Likert scale (five point scale; where 0=false, 1=mostly false, 2=neutral, 3=mostly true, 4=true). Sum of question numbers 2, 4, 5, 7, 9, 12, 13 denoted negative affect and sum of question numbers 1, 3, 6, 8, 10, 11, 14 denoted SI. Those scoring high on either or both subscales taking cut off value as10 was considered as Type D.[7]

All the data were tabulated. Depression score and Score of type D personality were expressed in Mean±SD. Significance of association of depression and Type D personality was done by Fisher's 2 sample t-test. A P value of less than 0.05 was considered to be significant.

RESULTS

Table 1 shows distribution of study population and Table 2 shows age and sex distribution of study population, which includes 150 medical students (male=104, 69.3% and female=46, 30.7%) studying in different academic years in Midnapore Medical College. Their age ranged from 18 to 26 years. Most of the students (67.3%) were within 18-20 years age group studying in 1st to 3rd year.

Table 1

Distribution of study population according to academic year

Table 2

Distribution of study population according to age and sex

Table 3 shows distribution of Type D personality in students with depression. Among the study population, 45.3% was found to suffer from depression. Most of them (34%) had mild depression whereas moderate and severe depression was found in 6 and 5.4%, respectively. It has been found that 36% of study population had Type D personality along with depression which was mostly mild type. The table also shows correlation scores of depression and Type D personality.

Table 3

Distribution of study population and scores of depression as well as Type D personality

DISCUSSION

The boundary between depressive disorder and the human distress is a gray zone. As the diagnosis of depression is made by self rating scale and not by clinical examination, there is chance that prevalence of 45.3% is inflated data. But Vaidya and Malgaonkar[2] reported a prevalence of depression as 39.44% among 109 medical students of T. N. Medical College, Mumbai. A study from Pakistan reported that 60% students suffer from anxiety and depression.[8] Contrary to the early belief, it has now proved beyond doubt that adolescents and young can become victim of depression.[9] Depression in them usually involves social and interpersonal difficulties which directly lead to self esteem problem. Students of this age group have to deal with new social demands as well as academic demands. Depression often results in lower academic performance, behavior problem, and poor socialization. Dramatic behavior such as aggression and an obsession or fascination with death often accompanies their depression.[10]

DS 14 have been shown to be valid and reliable measure associated with increased symptoms of anxiety and depression independent of socio demographic and clinical risk factors.[11] Type D individuals are known to experience hostility, anxiety, anger, depressed mood, tension, and a negative view of themselves. People with Type D personality are unable to express the emotions which lead them feeling tense, insecure, and socially uncomfortable.[12] It has been found that 70% of study population had either one or both the components (Negative affectivity (NA) and SI) of Type D personality. No study to our knowledge has reported prevalence of type D personality in any community or such distribution pattern. Negative affect (NA) component of Type D personality had been found to be significantly correlated with depression of all grades when compared with subjects without depression. But when compared among each other (mild vs. moderate, moderate vs. severe), none was found to be significant. However, SI component was never found to be significant. (Mild vs. normal, moderate vs. normal, and severe vs. normal). Thus, our study shows that NA component is more significantly related to depression. This seems to be an important finding as studies have revealed that the prevalence of cardiac events in persons who score high in NA but not in SI is more than for individuals scoring high in both the components, NA and SI.[13] Thus, early identification of a subject with Type D personality can be helpful both for his physical and mental well being.

However, the personality scale has not been standardized Indian population which can be considered as limitation of this study.

CONCLUSION

Medical students with depression and Type D personality if identified early can be managed by behavioral therapy, emotional support, interpersonal psychotherapy, and social skill training etc., This may help the young medicos to overcome their difficulties and lead a healthier life.