Sándor Kalmár, M.D., Ph.D.

Introduction

This study is based on a part of an International Survey. In 2012-2013 Professor Aurel Nirestean, Emese Lukács (Tirgu Mures, Romania) and our colleagues made an examination in eight secondary schools and seven Universities in three countries. This article contains the examination of depressive symptoms and syndromes among university students. (Kalmár, 2012)

Depression as melancholia is known since the dawn of our civilization, and already Hippocrates considered it an illness of somatic origin, caused by the blackening of bile and its becoming excessive in expense of the other bodily humors. This way it poisons the blood, which is the nest of mind and soul (melan chole [greek] = black bile). Melancholia is a disturbed mental state somatic origin, an illness of mood, temperament, mind and body. This state is coupled with fear (phobia) and depression (dysthymia) (Földényi, 1992)

Depression is a complex phenomenon with diverse biological, psychological, physical and mental, social, cultural and spiritual roots, which indicates that depression can only be understood taking into account the dynamic interaction between multiple risk factors. If Depressive Disorders remain unrecognized, they restrict the development and wellbeing of adolescents. Depressive Disorders limit career opportunities for students. (Makara, 2007)

Suicidal behavior in major mood disorder patients occur mostly during major depressive episode (79-89%). It is a state-dependent phenomenon, and indicates the crucial role of recognition and treatment of depression in suicide prevention (Rihmer, Belső, Kiss, 2002; Mann et al. 2005). Reducing depression can be one of the strongest weapons against suicide, both at individual level and at population level.

Large number of suicides are associated with a recognizable mental disorder. In spite of this it is difficult, if not impossible to identity a single reason of suicide. (Kalmár, 2018)

Table 1 Suicide rate compared with mortality. 15-24 year old people (%) Hungary. 2000-2015. (Yearbook of Hungarian Statistics, 2015)

	2000	2001	2005	2009	2010	2012	2015
male	22.2	24.2	17.8	27.7	23.7	24.7	23.0
female	12.8	16.5	9.7	12.8	15.3	13.16	13.16
total	19.6	22.2	15.5	23.7	21.4	21.75	20.29

The number of suicides is high compared to mortality, especially among males.

Table 2 Suicide rate compared with mortality. (%) Hungary. 2015.

2015	14>	15-24	25-34	35-44	45-54	55-64	65-74	75<	total
male	0.6	23.0	22.9	13.37	5.62	2.26	1.18	0.8	2.19
female	0.39	13.16	12.68	8.17	2.98	1.47	0.65	0.27	0.7
total	0.5	20.29	20.1	11.65	4.75	1.98	0.96	0.48	1.42

 

Methods

We have examined 803 University students (201 boys, 602 girls) in seven different Universities and Colleges in Hungary, Romania and Serbia with testing i.) Beck Depression Inventory, shortened version, (BDI, A. Beck, Hungarian version: M. Kopp) ii.) Child Depression Inventory, (M. Kovács, 1981, Hungarian version: Ágnes Vetró) The CDI is used to evaluate depression in children and adolescents examining 27 signs & symptoms and five syndromes. iii.) Beck Hopelessness Scale. (HS, Beck et al, 1974, Hungarian version: Dóra Perczel Forintos) The BHS is a 20-item scale for measuring negative attitudes about the future and is an indirect measure of suicide. Beck originally developed this scale in order to predict who would commit suicide and who would not. This scale contains three major aspects of hopelessness: (1) feelings about the future, – affective factor – (2) loss of motivation, – motivation factor – and (3) expectations – cognitive factor.

In the current study we did not investigate psychiatric disorders, only signs and symptoms. We used self-report questionnaires for the assessment of depressive signs and symptoms and hopelessness. (Perczel Forintos D, Kiss Zs, Ajtay Gy, 2007)

Participant Universities and Colleges: 1. Primary Teacher Training College, Kecskemét, [TT-KMT] 2. Faculty of Mechanical Engineering and Automation, Kecskemét, [GAMF-Kmt] 3. The University of Pécs, [PÉCS] Faculty of Law, 4. Eötvös József Primary Training College, Baja, [BAJA] 5. University of Novi Sad Hungarian Teachers Training Faculty in Subotica, [TT-SUBOT] 6. University of Novi Sad Hungarian Kindergarten Training Faculty in Subotica, [KINDER-G-SUBOT] (Serbia) 7. University of Medicine and Pharmacy of Targu Mures [TM] (Romania)

Results: 

i.) According to the shortened Beck Depression Inventory: 60.9% (TT-KMT) – 75% (BAJA) of all students have mild, 4.3% (TT-SUBOT) – 15.4% (GAMF-Kmt) of all students have moderate, and 0.8% (GAMF-Kmt) – 2.1% (TT-SUBOT)  of all students have seriuos depressive symptoms. There were no serious depressive symptoms in two University (PÉCS, BAJA)

ii.)

Table 3 Occurrence of depressive symptoms of 803 University students by CDI (%)

Signs & Symptoms (201m+602f)	boy: 1 point	boy: 2 point	girl: 1 point	girl: 2 point
1: Depressed mood	24.88	1.49	37.37	0.5
2: Lack of confidence	42.79	2.49	49.67	2.33
3: Self-respect disturbances	54.73	1.49	59.3	0.17
4: Anhedonia	27.36	0.99	21.76	1.16
5: Behaviour disturbance	1.94	2.49	11.13	0.5
6: Anxiety	25.37	3.48	29.07	1.99
7: Self-hate	21.89	1.49	19.93	1.0
8: Self-accusation	56.22	5.97	61.13	2.16
9: Suicidal thoughts	16.42	0.99	16.78	0.83
10: Crying	6.96	1.5	18.94	1.16
11: Irritability	30.85	3.98	31.06	2.49
12: Unsociable	26.87	2.98	22.42	1.16
13: Indecisiveness	38.31	2.98	44.68	1.99
14: Feeling of inadequacy	35.82	3.48	44.19	2.16
15: Lack of motivation	39.3	26.37	43.19	8.8
16: Insomnia /Sleep disturbances	17.91	2.98	23.26	1.83
17: Asthenia, fatigue	45.27	5.47	51.0	4.98
18: Decreased appetite	15.42	3.48	18.11	1.33
19: Hypochondriasis	18.41	8.95	18.27	7.81
20: Isolation	31.84	4.97	32.39	1.99
21: Depressed mood in the school	22.39	5.97	17.61	1.99
22: Loneliness	30.84	2.98	38.87	1.83
23: Learning disturbance	31.34	3.98	25.91	1.83
24: Inefficiency in behaviour	44.78	5.97	40.53	5.48
25: Lack of love	18.41	2.98	7.64	1.0
26: Adjustment disturbance	31.81	1.99	28.9	2.82
27: Bad tempered	8.46	2.49	7.08	0.83
Total	27.06	4.24	30.38	2.3

The occurance of depressive symptoms was 31.3 among boys (mild: 27.06%; serious: 4.24%) and 32.68% among girls (mild: 30.38%; serious: 2.3%)

Boys:

Two symptoms were higher than 60%. (8: Self accusation, 62.19%; 15: Lack of motivation, 65.67%)

Three symptoms were between 50.0% and 60.0%. (3: Self-respect disturbances, 56.22%; 17: Asthenia, fatigue, 50.74%; 24: Inefficiency in behavior, 50.75%.)

Two symptoms were between 40.0% and 50.0%. (2: Lack of confidence, 45.28%; 13: Indecisiveness, 41.29%)

Six symptoms were between 30.0% and 40.0%. (11: Irritability, 34.83%; 14: Feeling of inadequacy, 39.3%; 20: Isolation, 36.81%; 22: Loneliness, 33.82%; 23: Learning disturbance, 35.32%; 26: Adjustment disturbance, 33.8%)

Nine symptoms were between 20.0% and 30.0%. (1: Depressed mood, 26.37%; 4: Anhedonia, 28.35%; 6: Anxiety, 28.85%; 7: Self-hate, 23.38%; 12: Unsociable, 29.85%; 16: Insomnia/Sleep disturbance, 20,89%; 19: Hypochondriasis, 27.36%; 21: Depressed mood in the school, 28.36%; 25: Lack of love, 21.39%)

Five symptoms were under 20.0%. (5: Behavior disturbances, 5.43%; 9: Suicidal thoughts, 17.41%; 11: Crying, 8.46%; 18: Decreased appetite, 18.9%; 27: Bad tempered, 7.91%)

Girls:

One symptom was higher than 60%. (8: Self accusation, 63.69%)

Four symptoms were between 50.0% and 60.0%. (2: Lack of confidence, 52.0%; 3: Self-respect disturbances, 59.47%; 15: Lack of motivation, 51.99%; 17: Asthenia, fatigue, 55.98%)

Four symptoms were between 40.0% and 50.0%. (13: Indecisiveness, 46.67%; 14: Feeling of inadequacy, 46.35%; 22: Loneliness, 40.7%; 24: Inefficiency in behavior, 46.01%.)

Five symptoms were between 30.0% and 40.0%. (1: Depressed mood, 37.87%; 6: Anxiety, 31.06%; 11: Irritability, 33.55%; 20: Isolation, 34.38%; 26: Adjustment disturbance, 31.72%)

Seven symptoms were between 20.0% and 30.0%. (4: Anhedonia, 22.92%; 7: Self-hate, 20.93%; 11: Crying, 20.1%; 12: Unsociable, 23.58%; 16: Insomnia/Sleep disturbance, 25,09%; 19: Hypochondriasis, 26.08%; 23: Learning disturbance, 27.74%)

Six symptoms were under 20.0%. (5: Behavior disturbances, 5.43%; 9: Suicidal thoughts, 17.61%; 18: Decreased appetite, 19.44%) 21: Depressed mood in the school, 19.6%; 25: Lack of love, 8.64%; 27: Bad tempered, 7.91%)

Table 4 Suicide thoughts and intention (by CDI) of 803 University students (%)

(201m+602f)	boy (%)		girl (%)
9. SUICIDE	thoughts (1)	intention (2)	thoughts (1)	intention (2)
1. TT-KMT	0.0	0.0	20.72	0.87
2. GAMF-Kmt	21.33	1.33	12.73	0.77
3. PÉCS	25.0	0.0	21.74	0.0
4. BAJA	20.0	0.0	0.0	0.0
5. TT-SUBOT	21.82	0.0	22.55	0.0
6. KINDER-G-SUBOT	16.67	0.0	27.27	2.27
7. TM	8.0	2.0	11.57	1.65

There was no suicide intention among boys in five, and among girls in three Universities.

Table 5 Depressive syndromes (by CDI) of 803 University students (%)

CDI (201m+602f)	boy (%)		girl (%)
	mild (1)	serious (2)	mild (1)	serious (2)
A: Negative mood	30.01	3.23	36.19	1.72
B: Interpersonal problems	22.51	2.36	17.4	1.33
C: Ineffectiveness	40.84	9.08	41.03	4.07
D: Anhedonia	25.63	4.55	27.29	2.87
E: Negative self-esteem	25.37	2.29	27.18	1.46
Total	28.77	4.25	29.81	2.29

28.77% of the boys & 29.81% of the girls have mild, and 4.24% of boys & 2.29% of girls have serious depressive syndromes. The worst syndrome is the C: Ineffectiveness. 40.84% of boys & 41.03% of girls have mild and 9.08% of boys & 4.07% of girls have serious syndromes. 

Table 6 A: Negative mood syndrome (by CDI) of 803 University students (%)

(201m+602f)	boy (%)		girl (%)
A: Negative mood	mild (1)	serious (2)	mild (1)	serious (2)
1. TT-KMT	20.75	0.0	43.09	2.4
2. GAMF-Kmt	34.23	5.33	30.6	0.6
3. PÉCS	45.75	0.0	44.22	2.17
4. BAJA	26.6	0.0	33.36	4.54
5. TT-SUBOT	34.86	1.5	39.38	1.47
6. KINDER-G-SUBOT	27.83	8.33	39.02	2.66
7. TM	27.0	2.34	33.3	1.93

 

Table 7 B: Interpersonal problems syndrome (by CDI) of 803 University students (%)

(201m+602f)	boy (%)		girl (%)
B: Interpersonal problems	mild (1)	serious (2)	mild (1)	serious (2)
1. TT-KMT	12.5	0.0	16.89	0.45
2. GAMF-Kmt	20.33	3.33	13.64	0.45
3. PÉCS	18.75	0.0	9.78	0.0
4. BAJA	30.0	5.0	11.4	0.0
5. TT-SUBOT	23.86	0.0	17.4	1.47
6. KINDER-G-SUBOT	12.5	4.17	22.16	2.27
7. TM	29.0	3.0	18.39	2.48

 

Table 8 C: Ineffectiveness syndrome (by CDI) of 803 University students (%)

(201m+602f)	boy (%)		girl (%)
C: INEFFECTIVENESS	mild (1)	serious (2)	mild (1)	serious (2)
1. TT-KMT	62.5	0.0	41.89	6.53
2. GAMF-Kmt	48.67	15.67	40.45	3.64
3. PÉCS	62,5	0.0	53.26	7.61
4. BAJA	5.0	5.0	36.4	4.5
5. TT-SUBOT	44.32	12.5	38.97	3.43
6. KINDER-G-SUBOT	62.5	4.17	44.32	6.25
7. TM	33.0	3.5	39.05	3.01

 

Table 9 D: Anhedonia syndrome (by CDI) of 803 University students (%)

(201m+602f)	boy (%)		girl (%)
D: Anhedonia	mild (1)	serious (2)	mild (1)	serious (2)
1. TT-KMT	18.75	0.0	28.6	2.93
2. GAMF-Kmt	27.84	6.17	25.69	2.04
3. PÉCS	34.05	6.25	27.17	6.52
4. BAJA	10.0	0.0	34.1	5.7
5. TT-SUBOT	32.41	4.0	28.68	3.19
6. KINDER-G-SUBOT	31.33	4.17	29.27	3.98
7. TM	23.76	5.0	25.21	2.17

 

Table 10 E: Negative self-esteem syndrome (by CDI) of 803 University students (%)

(201m+602f)	boy (%)		girl (%)
E: Negative self-esteem	mild (1)	serious (2)	mild (1)	serious (2)
1. TT-KMT	15.0	0.0	28.6	2.93
2. GAMF-Kmt	34.4	3.47	28.73	1.09
3. PÉCS	35.0	0.0	32.17	3.48
4. BAJA	12.0	0.0	30.9	0.0
5. TT-SUBOT	37.27	1.82	30.2	1.57
6. KINDER-G-SUBOT	30.0	10.0	41.82	1.82
7. TM	16.4	1.6	19.67	1.49

 

Table 11 Depressive syndromes (by CDI) of 803 University students vs. 932 Secondary school students (%) (Kalmár, 2015)

CDI (201m+602f)	boy (%)		girl (%)
	University	Sec-school	University	Sec-school
A: Negative mood	33.24	36.41	37.91	47.23
B: Interpersonal problems	24.87	31.06	18.73	26.17
C: Ineffectiveness	49.92	61.22	45.01	58.85
D: Anhedonia	30.18	36.36	30.16	34.79
E: Negative self-esteem	27.66	33.11	28.64	43.32
Total	33.02	40.37	32.1	42.11

There were less Depressive syndromes among university students than secondary school students.

iii.) According to the Beck Hopelessness Scale 14.9% (TT-SUBOT) – 31.3% (BAJA) of all students have mild hopelessness, 3.7% (PÉCS) – 18.8% BAJA) of all students have high hopelessness, and 0.9% (TT-KMT) -3.7% (PÉCS) of all students have serious hopelessness. There was no serious hopelessness in two Universities. (BAJA, KINDER-G-SUBOT)

High and serious hopelessness is very dangerous.

Conclusion

Depressive signs and symptoms and Depressive syndromes are high among University students. It is important because the foundation of lifelong mental health begins in the early years. Approximately 75% of mental disorders manifest firstly in adolescence. Those suffering from psychological, psychiatric and behavior disturbances among the youth can be estimated at 10-24%, but this figure may be higher in underprivileged groups.

We must pay attention to prevention and treatment of depressive signs, symptoms, and depressive syndromes among University students because these are the basis of the future affective disorders which can be prevented.

References

Földényi L: Melankólia. Akadémia Kiadó, Budapest. 1992.

Kalmár S.: (2012) ”Examination of some important factors in the development of personality. Spirituality, religiousness, psychological vulnerability, mental state (psychological immune system, depression, anxiety, hopelessness), alcohol-consumption, smoking, psychoactive substance abuse and using of superstitious mascot-figures (things that bring luck) among adolescents and young adults. Hungary, Romania, Serbia”. International Survey. Tirgu Mures, 5^th November 2012.

Kalmár S. Examination of depressive signs and symptoms among 932 students in eight different secondary schools. Hungary. 2015. www.internetandpsychiatry.com

Kalmár S. A háziorvosi Szolgálat és a pedagógusok lehetőségei az öngyilkosság megelőzésében. Medicina Könyvkiadó. Medicina Könyvkiadó. 2018.

Makara P. szerk. (2007) Mentális egészségfejlesztési stratégia – pozitív egészség-fejlesztés és primér prevencia. OEI, Budapest.

Mann J.J, Apter A, Bertolote J, Beautrais A, Currier D, Haas A, Hegerl U, Lonquist J, Malone K, Marusic A, Mehlum L, Patton G, Philips M, Rutz W, Rihmer Z, Schmidtke A, Schaffer D, Silverman M, Takahashi Yoshitomo, Varnik A, Wasserman D, Yip P, Hendin H. (2005) Suicide Prevention Strategies. A Systematic Review, JAMA, 294: 2064-2074.

Perczel F. D. Kiss Zs. Ajtay Gy.: Kérdőívek, becslőskálák a klinikai pszichológiában. Országos Pszichiátriai és Neurológiai Intézet. 2007.

Rihmer Z, Belső N, Kiss K. (2002) Strategies for suicide prevention. Current Opinion in Psychiatry, 15: 83-87

Yearbook of Health Statistics, (2015)