Relationship between depressive symptoms and cumulative 24-hour urinary norepinephrine excretion level among undergraduate medical students in Uganda

Abstract

16 Background 17 Depression is a serious mental health problem in different parts of the world and has been reported 18 to be rising among undergraduate medical students. The incidence of depression has not only been 19 linked to psychosocial factors but also to biological factors, such as altered urinary levels of 20 norepinephrine. This study was carried out to determine the prevalence of depression among 21 undergraduate medical students in Uganda and examine the relationship between depressive 22 symptoms and 24-hour urinary norepinephrine excretion levels in the participants. 23 Methods 24 One hundred and sixteen undergraduate medical students (75 males and 41 females) of Kampala 25 International University, in southwestern Uganda were evaluated for depression using the 21-item 26 Beck Depression Inventory-II (BDI) questionnaire. Twenty-four-hour urine collections from each 27 participant were assayed for norepinephrine excretion levels. Descriptive statistics and Pearson 28 correlation coefficient were computed to examine the data obtained. Results30 The results of this study showed that, a total of 33 participants (28.4%) have depressive symptoms.31 Students with depressive symptoms had higher but not significant 24-hour urinary mean 32 norepinephrine excretion levels than those without depressive symptoms (121.97±51.48µg/day Vs 33 87.58±18.64 µg/day, P>0.05). There was a positive weak relationship between BDI scores and 24-34 hour urinary norepinephrine levels (r= 0.21, p = 0.28). Regression models accounting for socio-35 demographic characteristics indicated that, type of accommodation, marital status, relationship 3 36 with parents, educational sponsorship may be risk factors for depressive symptoms observed in 37 the participants. 38 Conclusions 39 These results suggest that increased urinary norepinephrine excretion and other psychosocial 40 factors may be associated with depressive symptoms. Measurements of 24-hour urinary 41 norepinephrine excretion may serve as an integrative parameter in diagnosing and management of 42 patients with depression. 4 43 Introduction 44 Depression is one of the most common mental disorders affecting people of different ages, gender 45 and socio-cultural settings in both developed and developing countries. It has been declared by the 46 World Health Organization as one of the global leading causes of morbidity and mortality 47 contributing significant economic burden on societies worldwide [1-5]. Studies have suggested 48 that medical students are at high risk of developing depression and this has been associated with 49 significant reduction in productivity, disruption in learning, poor interpersonal relationships with 50 peers and consequently poor academic grades and in some cases termination of schooling which 51 often leads to substance abuse and suicidal behavior [6-8]. Since depression among medical 52 students have such an obvious negative effect on function in medical school and later in clinical 53 practice, it is important to examine the prevalence, causes an...