|Year : 2022 | Volume
| Issue : 2 | Page : 111-117
Prevalence of depression and associated factors among secondary school teachers in Medina region, Saudi Arabia
Faisal Saeed Safar Al-Qahtani
Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha, Saudi Arabia
|Date of Submission||15-Jun-2022|
|Date of Decision||15-Nov-2022|
|Date of Acceptance||16-Nov-2022|
|Date of Web Publication||27-Dec-2022|
Dr. Faisal Saeed Safar Al-Qahtani
Department of Family and Community Medicine, College of Medicine, King Khalid University, Abha
Source of Support: None, Conflict of Interest: None
Background: Depression is one of the most common psychiatric conditions seen in primary health care clinics. On the other hand, teaching is one of the most stressful jobs. Objective: The aim was to estimate the prevalence and risk factors of depression among secondary school teachers in the Medina region. Subjects and Methods: A cross-sectional descriptive study was conducted on a representative sample of secondary school teachers of both genders in the Medina region. A multistage cluster sample technique was implemented to recruit the participants. The data were collected using a self-administered Patient Health Questionnaire-9 (PHQ-9) depression questionnaire. Results: The study included 297 teachers. More than half of them (54.2%) were males and the vast majority (97.6%) were Saudis. Major depression, based on PHQ-9 depression questionnaire was reported among 8.4% of the participants, whereas minor depression was reported among 14.1% of them. Among the studied habitual factors, the smoking of Shisha and nonpracticing of physical exercise were significantly associated with depression among teachers. Regarding obstetric and gynecological factors, female teachers with a history of postnatal depression were more likely to have major and minor depression features than those without such history. Conclusion: Depression is a common health problem among secondary school teachers in Medina region affecting almost one quarter of them. Familial instability, shisha smoking, physical inactivity, heavy teaching load, and deficiency of educational competencies are strongly correlated with depression. Further studies are needed to explore the extent of the problem among teachers at different levels of teaching across the kingdom.
Keywords: Associated risk factors, depression, health problems, school teachers
|How to cite this article:|
Al-Qahtani FS. Prevalence of depression and associated factors among secondary school teachers in Medina region, Saudi Arabia. King Khalid Univ J Health Sci 2022;7:111-7
|How to cite this URL:|
Al-Qahtani FS. Prevalence of depression and associated factors among secondary school teachers in Medina region, Saudi Arabia. King Khalid Univ J Health Sci [serial online] 2022 [cited 2023 Mar 21];7:111-7. Available from: https://www.kkujhs.org/text.asp?2022/7/2/111/365755
| Introduction|| |
Depression is the most common mental disorder worldwide. It is also the most common psychiatric condition seen in primary health care clinics.,,, In the absence of screening, around half of the patients with major depression are identified only in the community. According to the World Health Organization (WHO), depression was expected in 2010 to be the second leading cause of disability worldwide by 2020. On the other hand, teaching is a stressful job and teachers were found to be more susceptible to stress compared to workers in many other occupations. According to the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-V) of Mental Disorders Fifth Edition, the prevalence of depression in developed countries (USA and Europe) was 18% and in developing countries (e.g., China, Mexico, and Brazil) was 9%. There was more regional variation in burden for major depressive disorder (MDD) than for persistent depressive disorder, with higher estimates in females, and adults of working age. This attributable burden would increase the overall burden of depressive disorders from 3.0% (2.2%–3.8%) to 3.8% (3.0%–4.7%) of global DALYs.” Furthermore, the WHO estimates that, unipolar major depression will be the first leading cause of disease burden by 2030. In the USA, Allegrante reported that 60% of teachers and faculty staff had depression. In Saudi Arabia, the second leading cause of DALYs was MDD (7.88%). One study conducted in the psychiatric outpatient clinics at King Fahad University Hospital, AlKhobar have shown that the frequency of depressive disorders was 19.3%. The majority of patients were between 20 and 49 years of age, with female respondence at a ratio of 1.7:1. In Abha, Al-Gelban have found the prevalence of depression among male teachers to be 25%. Few more studies were conducted in other cities of Saudi Arabia, showing the overall prevalence of psychiatric symptoms among teachers in Tabuk, Jeddah and Riyadh to be 59.4%, 38.2%, and 46%, respectively. Major depression occurs more often in patients with the following specific risk factors. Many studies showed a significant difference between male and female prevalence of depression in Saudi Arabia., In the USA, the lifetime prevalence rates for females and males were 17%–9%; respectively. Major depression is more common in younger than older adults living in the community., Many social and psychological factors are associated with depression, for example: adversity (stressful life events in the past year, parental loss, history of divorce, marital problems, low social support, and low education). This study was aimed to explore the extent of depression as a health problem among secondary school teachers in the Medina region.
| Subjects and Methods|| |
A cross-sectional descriptive study was conducted among secondary school teachers in the Medina region, which has the second holy mosque to Muslims after Makkah with a population of 1,300,000. There are 104 governmental secondary schools in the Medina region in which there are 3811 teachers. The sample size of 268 was calculated using Open Source Epidemiologic Statistics for Public Health (openEpi) tool based on point estimate of 25% from the review of literature considered 95% of confidence interval. A three-stage (multistage) clustering sample technique was adopted to include teachers from different areas of the city. Medina has four educational clusters (north, south, east, and west clusters). Randomly, one male and one female secondary school was chosen from each cluster, and then all teachers at each school were included in the study.
The Questionnaire: Patient Health Questionnaire (PHQ-9 depression questionnaire) with both sensitivity and specificity of 88%. The researcher used the validated Arabic version of PHQ-9. It contains 9 items in addition to other personal information. It is developed by Spitzer, Williams, Kroenke et al., with an educational grant from Pfizer Inc. No permission is required to reproduce, translate, display, or distribute it. Consent was taken from the respondents.
The Statistical Package for the Social Sciences software, version 22 (Armonk, N.Y., USA) was used for data entry and analysis. Analysis of data was done using the Chi-square test for examining the association between depression and other associated factors and a P < 0.05 was used as a cutoff point for statistical significance.
| Results|| |
The study included 297 teachers. More than half of them (54.2%) were males. Majority of the participants were Saudis (97.6%). More than two-thirds of them aged either between 30 and 39 years (37.4%) or between 40 and 49 years (39.4%). Most of the participants (78.8%) were married. Of those having children, 47.5% reported having between 4 and 6 children. The income of almost two-thirds of them (62%) ranged between 10000 and 15000 SAR/month [Table 1]. Most of teachers had bachelor's degree as the highest qualification, whereas only 2% were PhD holders. Most of the participants (76.1%) were graduated from college of education or having a certified educational academic degree. One-third of the teachers (33.7%) had between 13 and 18 teaching sessions per week and 30% had more than 18 teaching sessions per week. Experience in teaching exceeded 10 years among 44.2% of the teachers. Nearly half of the participants (49.8%) never had unpaid voluntary working hours/week, whereas 26.6% had irregular and 15.5% had between 1 and 4 unpaid voluntary working hours per week [Table 1].
|Table 1: Personal general and academic characteristics of the study population|
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About one-quarter of the teachers (23.9%) never performed regular physical exercise whereas 35.7% performed irregular physical exercise and 13.8% spent 3 or more hours per week performing regular physical exercise. The prevalence rates of cigarettes and shisha (hookah-waterpipes) smoking were 14.8% and 11.1%, respectively. The prevalence rate of drinking alcohol was 1.3% [Table 2].
Out of 136 female teachers, 8 (5.9%) were pregnant at the time of the study. Out of 112 who had children, 39 (34.8%) had between 3 and 6 children. Most of the female participants (77.9%) had premenstrual/menstrual mood swings. Postnatal depression was reported among 33.6% of them with a frequency of more than twice among 25.6% of them [Table 2].
As displayed from [Figure 1], 12.1% of the teachers involved in the study had diabetes mellitus and similarly 12.1% had hypertension, whereas 3.7% had hypothyroidism.
|Figure 1: Distribution of different chronic diseases among the participants|
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Slightly more than one-quarter of the study sample (27.3%) had a history of a psychiatric illness in the form of anxiety (15.8%), depression (11.8%), social phobia (4.7%) or schizophrenia (2%) as displayed in [Figure 2].
|Figure 2: Distribution of psychiatric illnesses among participants with previous history of psychiatric diseases (n = 81)|
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[Figure 3] shows that major depression, based on PHQ-9 depression questionnaire was reported among 8.4% of the study population, whereas minor depression was reported among 14.1% of them.
|Figure 3: Prevalence of depression, based on PHQ-9 questionnaire among secondary school teachers in Medina city. PHQ-9: Patient Health Questionnaire-9|
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There was a significant association between the depression and having difficulties at work and home [Table 3].
|Table 3: Habitual factors and difficulties at workplace associated with depression among secondary school teachers in Al-Madinah|
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Major depression was reported among 12.5% of teachers who never practiced physical exercise and 8.5% among those who practiced it irregularly compared to only 2.4% who practiced it 3 h or more per week. The difference was statistically significant, P = 0.041 [Table 3].
Shisha (hookah) smokers were more likely to have major depression compared to nonshisha smokers (15.2% vs. 7.6%), P = 0.049.
Cigarette smoking and alcohol drinking were not significantly associated with depression among respondents [Table 3].
Major depression was reported among 13.2% of females and 4.3% of males in the studied sample of teachers. In addition, the majority of males (83.9%) compared to 69.9% of females had no depression. Overall, the association between teacher's gender and depression was statistically significant, P = 0.006.
Major depression was reported among 33.3% of widowed teachers compared to 5.1% of married teachers. In addition, 82.5% of married teachers compared to 33.3% of widowed teachers had no depression. The difference in the prevalence of depression between the two groups was statistically significant, P < 0.001.
Among divorced women, 50% of those divorced twice or more and 18.5% who were divorced once had major depression, P = 0.046.
Other studied personal factors (nationality, age, number of children, and income) were not significantly associated with depression [Table 4].
|Table 4: Personal general factors associated with depression and academic factors associated with depression among secondary school teachers in Al-Madinah|
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Major depression was reported among 9.7% of teachers who graduated from the college of education or those having a certified educational academic degree compared to only 4.2% of those who didn't have such qualifications. However minor depression was reported among 11.5% and 22.5% of teachers with and without graduation from college of education or having a certified educational academic degree, respectively.
These differences were statistically significant, P = 0.033. Major depression was reported among 11% of teachers who had >12 teaching sessions per week compared to only 3.4% of those who had 12 or less teaching sessions per week, P = 0.004.
Depression was not significantly associated with teacher's qualification, years of experience in teaching and the number of unpaid voluntrary working hours per week [Table 4].
| Discussion|| |
Depression among teachers may have adverse consequences on the whole teaching process and consequently bad consequences on the students as students of depressed teachers may become anxious or withdrawn, may have trouble regulating their emotions or dealing with challenges, and may develop behavioural problems or even become depressed themselves., Although teaching can be a stressful, emotionally demanding occupation, there are few trials aimed to protect teachers' psychological well-being and investigating the psychological needs of teachers. Based on the results of this study, the prevalence of PHQ-9-based depression was 22.5%; 8.4% major and 14.1% minor. In a study conducted among male secondary school teachers in Abha city (2008), a prevalence of 25% has been reported using Depression Anxiety Stress Scale-42. In another Saudi study conducted among female secondary school teachers in Tabuk city (2003), a prevalence of depression was 59.4% using General Health Questionnaire 30 (GHQ 30). In Baish, a study carried out among governmental school teachers (primary, intermediate and secondary) revealed a prevalence of psychiatric symptoms of 62.4% using GHQ 30. In Jeddah, Millat. reported a prevalence of 28% among schoolteachers and administrators using GHQ-Arabic version. The difference between these studies could be attributed to different population background characteristics as well as different study tools applied. Internationally, Allegrante reported that 60% of teachers and faculty staff had depression. The prevalence of depression reported in this study and in the other Saudi studies were higher than those reported among Saudi general population. In Southern region, using PHQ-9, a prevalence of 12% has been observed among patients attending family medicine clinics. Furthermore, in Riyadh, a prevalence of 20% was reported among primary health care patients using the same questionnaire. In accordance with this, Feitler and Tokar reported that high school teachers' GHQ-30 scores were double the scores of the general population. In the present study, female teachers were more likely to have depression compared to males. This finding is consistent with the findings of Adawi in Baish area, and Al-Shammari, et al. in Riyadh. This could be attributed to the possibility that females in the Saudi community tend to somatize their worries and stress more than males. Furthermore, they carry the major burden of the family beside their professional demands. In the present study, teacher's age was not significantly associated with depression. In another study carried out in Saudi Arabia, prevalence rates of psychiatric symptoms were significantly higher among younger age groups. They attributed their findings to the possibility that younger teachers might be more susceptible to stresses, instability, and potential conflict between old traditions and modern values brought about by the changes in life cycle. Higher prevalence of depression was observed among nonSaudi teachers as compared with Saudis; despite it was not statistically significant, it is a usual result since it is expected that foreigners are more likely to develop psychiatric disturbances. However, opposite to that has been reported in a study carried out in Baish area. As expected, depression was more reported among widowed or multi-divorced teachers than among married teachers who are likely enjoying more family stability. These findings were similar to the observations of other investigators., In the present study, teachers who had higher number of teaching sessions per week were more likely to be depressed, confirming the stressful nature of the job of a schoolteacher. Teachers who were neither graduates of a college of education nor holders of educational academic degrees were at a higher risk of being depressed. It might be that those graduated from a college of education or having a certified educational academic degree were better equipped to face stress at job and consequently less depressed.
Physical inactivity is one of the well-documented modifiable risk factors for depression, epidemiological evidence supports the hypothesis that the risk of depression is inversely associated with physical activity. Regular practicing of physical exercise improves short- and long-term psychosocial well-being through reducing feelings of anxiety, stress, and depression., In accordance with that, the present study observed that teachers who never or even irregularly practice physical activities were more likely to have depression compared to those who practices physical activities regularly and frequently.
The available evidence suggests that cigarette smoking increases the risk of symptoms of depression with two possible mechanisms, one involving common risk factors, and the second a direct causal link. The causes of this relationship are not clear. However, it was reported that nicotine in cigarette smoke causes changes to the neurotransmitter activity in the brain, which consequently increases the risk of depression. In the current study, although cigarette smoking was not associated with depression, shisha smoking was significantly associated with it.
Based on the findings of the present study, teachers with a history of anxiety or social phobia were more likely to have questionnaire-based major depression. In addition, it is well known that depression, anxiety, and stress were strongly, positively, and significantly correlated.
A history of depressive disorder significantly increases the risk of postpartum major depression. Major depression and postpartum depression are the two forms of clinical depression as they share common symptoms. In the current study, female teachers who had a history of postpartum depression were more likely to express questionnaire-based depression.
The present study had some limitations as it was a cross-sectional nature doesn't permit identifying the temporal relationship between depression and its risk factors. It includes only secondary school teachers which impacts the generalizability of results. On the other hand, the study has some strength such as tackling an important topic rarely tackled before in our community which is depression among teachers, it includes a relatively good number of teachers and utilizes a valid questionnaire to survey depression.
| Conclusion|| |
Depression is a common health problem among secondary school teachers in the Medina region affecting almost one quarter of them. Female teachers, widowed or frequently divorced, those having more teaching sessions per week, shisha smokers, physically inactive teachers, female teachers with history of postnatal depression, and those neither graduated from a college of education nor had a certified educational degree were more likely to have depression than others.
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Conflicts of interest
There are no conflicts of interest.
| References|| |
Kessler RC, Ormel J, Petukhova M, McLaughlin KA, Green JG, Russo LJ, et al
. Development of lifetime comorbidity in the World Health Organization world mental health surveys. Arch Gen Psychiatry 2011;68:90-100.
Spitzer RL, Kroenke K, Williams JB. Validation and utility of a self-report version of PRIME-MD: The PHQ primary care study. Primary care evaluation of mental disorders. Patient health questionnaire. JAMA 1999;282:1737-44.
Ansseau M, Dierick M, Buntinkx F, Cnockaert P, De Smedt J, Van Den Haute M, et al
. High prevalence of mental disorders in primary care. J Affect Disord 2004;78:49-55.
Linzer M, Spitzer R, Kroenke K, Williams JB, Hahn S, Brody D, et al.
Gender, quality of life, and mental disorders in primary care: Results from the PRIME-MD 1000 study. Am J Med 1996;101:526-33.
Roca M, Gili M, Garcia-Garcia M, Salva J, Vives M, Garcia Campayo J, et al
. Prevalence and comorbidity of common mental disorders in primary care. J Affect Disord 2009;119:52-8.
Mitchell AJ, Vaze A, Rao S. Clinical diagnosis of depression in primary care: A meta-analysis. Lancet 2009;374:609-19.
Smith A. The scale of perceived occupational stress. Occup Med (Lond) 2000;50:294-8.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th
ed (DSM-5). Arlington, VA: American Psychiatric Association; 2013.
Ferrari AJ, Charlson FJ, Norman RE, Patten SB, Freedman G, Murray CJ, et al
. Burden of depressive disorders by country, sex, age, and year: Findings from the global burden of disease study 2010. PLoS Med 2013;10:e1001547.
Allegrante JP. School-site health promotion for faculty and staff: A key component of the coordinated school health program. J Sch Health 1998;68:190-5.
Memish ZA, Jaber S, Mokdad AH, AlMazroa MA, Murray CJ, Al Rabeeah AA, et al
. Burden of disease, injuries, and risk factors in the Kingdom of Saudi Arabia, 1990-2010. Prev Chronic Dis 2014;11:169.
Abumadini MS. Depressive disorders in psychiatric outpatient clinic attendees in Eastern Saudi Arabia. J Family Community Med 2003;10:43-7.
Al-Gelban KS. Psychiatric morbidity among Saudi secondary schoolteachers. Neurosciences (Riyadh) 2008;13:288-90.
Al-Kabbaa AF, Al-Jehani M, Salih MA. Prevalence of minor psychiatric morbidity among female teachers in Girls secondary schools in Tabuk City, Saudi Arabia. J Family Community Med 2003;10:31-6.
Milaat W. Stress in schools; Prevalence of hidden psychiatric illness among Jeddah school workers. Saudi Med J 1997;18:240-3.
Al-Fares E, Al-Shammari SA, Al-Hammed MY. Prevalence of psychiatric disorders in academic primary care department in Riyadh. Saudi Med J 1992;13:49-53.
Kendler KS, Gardner CO, Prescott CA. Toward a comprehensive developmental model for major depression in men. Am J Psychiatry 2006;163:115-24.
Adawi MA. Prevalence of Psychiatric symptoms among governmental school teachers in Baish Area, Kingdom of Saudi Arabia. Med J Cairo Univ 2011;79:125-8.
Al-Shammari SA, Khoja TA, Al-Sabaei A. Anxiety and depression among primary care patients in Riyadh. Int J Ment Health 1993;22:53-64.
Hasin DS, Goodwin RD, Stinson FS, Grant BF. Epidemiology of major depressive disorder: Results from the national epidemiologic survey on alcoholism and related conditions. Arch Gen Psychiatry 2005;62:1097-106.
Williams DR, González HM, Neighbors H, Nesse R, Abelson JM, Sweetman J, et al.
Prevalence and distribution of major depressive disorder in African Americans, Caribbean blacks, and Non-Hispanic whites: Results from the national survey of American life. Arch Gen Psychiatry 2007;64:305-15.
Green JG, McLaughlin KA, Berglund PA, Gruber MJ, Sampson NA, Zaslavsky AM, et al
. Childhood adversities and adult psychiatric disorders in the national comorbidity survey replication I: Associations with first onset of DSM-IV disorders. Arch Gen Psychiatry 2010;67:113-23.
Mundia L. The status of a trainee teacher with mental-health problems: Dilemmas on inclusion and exclusion in higher education. Glob J Health Sci 2010;2:172-83.
Jeon L, Buettner CK, Snyder AR. Pathways from teacher depression and child-care quality to child behavioral problems. J Consult Clin Psychol 2014;82:225-35.
Abdelwahid HA, Al-Shahrani SI. Screening of depression among patients in family medicine in South Eastern Saudi Arabia. Saudi Med J 2011;32:948-52.
Becker S, Al Zaid K, Al Faris E. Screening for somatization and depression in Saudi Arabia: A validation study of the PHQ in primary care. Int J Psychiatry Med 2002;32:271-83.
Zung WW, Broadhead WE, Roth ME. Prevalence of depressive symptoms in primary care. J Fam Pract 1993;37:337-44.
Bertakis KD, Helms LJ, Callahan EJ, Azari R, Leigh P, Robbins JA. Patient gender differences in the diagnosis of depression in primary care. J Womens Health Gend Based Med 2001;10:689-98.
Feilter FC, Toka E. Getting a handle on teacher stress. How bad is the problem? Educ Leadersh 1982;39:456-8.
Warburton DE, Nicol CW, Bredin SS. Health benefits of physical activity: The evidence. CMAJ 2006;174:801-9.
Cassidy K, Kotynia-English R, Acres J, Flicker L, Lautenschlager NT, Almeida OP. Association between lifestyle factors and mental health measures among community-dwelling older women. Aust N Z J Psychiatry 2004;38:940-7.
Boden JM, Fergusson DM, Horwood LJ. Cigarette smoking and depression: Tests of causal linkages using a longitudinal birth cohort. Br J Psychiatry 2010;196:440-6.
Klungsøyr O, Nygård JF, Sørensen T, Sandanger I. Cigarette smoking and incidence of first depressive episode: An 11-tyear, population-based follow-up study. Am J Epidemiol 2006;163:421-32.
Hirst KP, Moutier CY. Postpartum major depression. Am Fam Physician 2010;82:926-33.
Jolley SN, Betrus P. Comparing postpartum depression and major depressive disorder: Issues in assessment. Issues Ment Health Nurs 2007;28:765-80.
[Figure 1], [Figure 2], [Figure 3]
[Table 1], [Table 2], [Table 3], [Table 4]