The inability of students to deal with stress may lead to mental health disorders, namely depression and anxiety.

STUDENTS at higher education institutions, both in Malaysia and abroad, often undergo stress, especially when faced with a deluge of assignments, projects, tests and exams, coupled with being away from their homes and families — seemingly part and parcel of campus life.

The inability to deal with stress, however, may lead to mental health disorders namely depression and anxiety.

According to Professor Dr Sherina Mohd Sidik, a family medicine senior consultant at Universiti Putra Malaysia’s (UPM) Department of Psychiatry, depression and anxiety have been found to be common among university students particularly those who are taking courses which are more exam-oriented and competitive, such as medicine, law and engineering.

“Studies done among medical students have found that the risk of having depression was almost one in three students and the risk of having anxiety was almost one in two students, prior to the exams. More alarmingly, suicidality which means having suicidal thoughts, suicidal ideation, suicidal plans and suicide attempts was found to be around seven per cent among students.

The causes of suicidality were depression, problems in love relationships and feelings of hopelessness,” she shared.

While these findings were from small studies, Dr Sherina said, it raises a need for concern and appropriate action to be taken.

“Mental health difficulties usually occur near exams, but they can actually occur at any time among students.

“There are other common causes of mental health problems apart from exams; such as relationship problems (usually love relationships, and also with friends, lecturers and family), financial problems, problems with studies especially failing exams, too much studying, and unmet expectations,” she explained.

Other predisposing causes of mental health problems among students could be genetic (family history of mental health problems), family problems, socio-economic status and living arrangements in the university.

One way to keep mental health disorders at bay is to have early detection.

Dr Sherina said there are currently many screening tools students and the general public can take that are able to detect cases at high risk for depression and anxiety.

“Many of these tools are available online. However, the students should know which are the suitable tools which they can use. These tools should be validated in Malaysia and have good accuracy in detecting depression and anxiety.

“For example, the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder Questionnaire (GAD7) are self-administered tools which can be used to detect high risk cases of depression and anxiety, respectively. They can be easily answered by the students on their own, are freely available on-line and can be downloaded easily,” she said, adding that she has validated both tools as part of a research she is currently conducting in Malaysia.

She cautioned it should be kept in mind that these tools should only be used for screening; which means that they only indicate whether a person is “at risk” of suffering from depression and / or anxiety.

“Any further diagnosis should be made by a doctor; preferably a psychiatrist or family medicine specialist. However, students can use these tools easily to assess whether they need professional help or not.”

Elaborating further on the research, Dr Sherina said it is based on a project involving a localised mental wellness online screening test that is aimed for university students.

“This project began as an international collaborative effort to determine the mental wellbeing and health-related quality of life among university students in Malaysia and Iran. Its objectives are to determine the health-related quality of life and factors associated such as depression and anxiety among university students.

“It was developed to compare the similarities and differences between the prevalence and factors associated with health-related quality of life among university students between the two countries,” said Dr Sherina.

The Malaysian part of the project is funded by UPM and will involve an online screening test to facilitate accessibility to the questionnaires, which include the Patient Health Questionnaire (PHQ-9) and Generalised Anxiety Disorder Questionnaire (GAD-7).

“This project has received ethics approval from the Malaysian Ministry of Education and data collection will begin in January 2019,” Dr Sherina revealed.

“The duration of the project is two years, and the target audience are university students, lecturers, stakeholders and the community at large. What we hope to achieve from this project is a better understanding of the magnitude of mental health problems among university students and how this impacts their quality of life.

“We will be collecting data from government and private universities throughout Malaysia, and the findings will be able to be representative of a national data. We can also determine risk factors of mental health problems which could affect the quality of life of these students,” she elaborated.

Moving forward, Dr Sherina said UPM’s plan is to develop, implement and evaluate an effective behavioural intervention online programme which can be used to reduce mental health problems.

“This will ultimately improve the mental wellness and quality of life of university students in Malaysia and beyond,” she said.

Asked about treatment of mental health disorders, Dr Sherina said it can be in the form of counselling, psychotherapy and medication.

“It is not necessary to start medication for all mental health problems; this depends on the severity of the problem.

Mild to moderate cases of depression and/or anxiety can be managed at the primary care setting. Severe cases of depression and/or anxiety have to be referred to a psychiatrist,” she said.

Any case which includes suicidal ideation or suicide attempts, harm to others, or psychotic features have to also be referred to a psychiatrist. This can be done at the hospital level or even at the primary care setting where some clinics have visiting psychiatrists. However, more severe cases may need admission into the hospital.

“There are no guaranteed measures to prevent mental illness. However, the best way is actually to live a healthy life. This can be achieved by eating a healthy diet, exercising regularly, as well as having a good balanced life in work and studies, social activities, personal time, and good support from family and friends,” she said.

Dr Sherina is also the deputy director of UPM’s Cancer Resource and Education Centre.

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