Depression in college: depressive symptoms and personality factors in Beijing and Hong Kong college freshmen
Introduction
Depression is becoming the most common mental health problem affecting college students these days [1]. Recent reports of suicides and violent incidents on campus in the United States have added urgency to the development of effective prevention and intervention programs. Severe symptoms of depression in students not only lead to lack of motivation and energy to engage in academic activities but also may put the students at risk of a wide variety of consequences, some of which can be debilitating or even fatal. In a survey of American college students, up to 53% reported having experienced depression since beginning college, and 45% reported feeling so depressed in the last school year that it was difficult to function [2]. A survey of university students in Japan found rates of 50% for adjustment disorder with depressed mood, 20% to 30% for major depression, and 20% for dysthymia according to Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria [3]. A resent survey of universities in Hong Kong found that 20.9% of first year tertiary education students had clinically significant depression by Depression Anxiety Stress Scales (DASS) [4]. Although many surveys have been done to examine the prevalence of depression in college students, differences between surveys are difficult to interpret because of sampling and methodological differences. The present study is the first attempt to compare the prevalence rates of current depressive symptoms in college freshmen in Beijing and Hong Kong, 2 Chinese communities with very different histories.
Many studies have investigated personality features in the etiology and presentation of depression in the general population [5], [6]. However, there is a paucity of research that directly examines the personality features as risk factors in college student depression. Cross-cultural differences make it difficult to apply Western-based diagnostic criteria to study personality dysfunction in China [7], [8]. In addition to the lack of research in Chinese personality factors in depression in general, little is known about the role of personality factors in depression among Chinese college students.
Neuroticism is a personality factor that has been consistently found to be strongly predictive of depressive episodes [9], [10], [11], [12]. It is also widely viewed as a vulnerability marker for major depression [13]. Neuroticism measures a person's emotionality or emotional instability and vulnerability to stress. High neuroticism means higher propensity to emotional instability, vulnerability, and hypersensitivity when facing stress or life events. High neuroticism scores have been reported to be related to the onset of depression, higher levels of depression severity [14], and worse outcome, especially over long-term follow-up [15].
Another personality factor most closely related to risk of depression is self-esteem. This term was first introduced at the end of the 19th century. It refers to a person's subjective appraisal of himself or herself as intrinsically positive or negative. Maurice Rosenberg [16] defined self-esteem in a stable sense of personal worth or worthiness that can be measured by self-report testing. Self-esteem has been thought to play a role in the etiology, maintenance, and recovery of depression [17]. However, empirical studies of the relationship between self-esteem and depression have yielded inconsistent results [18], and again, there has been a lack of research on these personality factors in college students with depressive symptoms.
Perfectionism is defined as a high standard of performance that is accompanied by the tendency of critical self-evaluations [19]. Viewing perfectionism from a more negative perspective, Burns [20] defines perfectionists as “people who strain compulsively and unremittingly toward impossible goals and who measure their own worth entirely in terms of productivity and accomplishment.” Frost and colleagues developed the Frost Multidimensional Perfectionism Scale (FMPS). It assesses the dimensions of concern over mistakes (COM), personal standards (PS), parental expectations (PE), parental criticism (PC), doubts about actions (DA), and organization (O). Personal standards and O are classified as positive perfectionism and are associated with good work habits, striving, and high achievement, whereas the others are considered as negative perfectionism [21]. There is a large body of consistent evidence that shows perfectionism to play an important role in a wide range of mental disorders, especially depression and suicide, and to be a factor for depression that also disrupts the efficacy of antidepressant treatments [10], [22], [23]. Research on the association between perfectionism and depression in college students has shown that some dimensions of perfectionism are strongly associated with depressive symptoms [19], [24]. It has been proposed that depressed college students are more likely than depressed individuals in the general population to have parents with very high expectations and high levels of control [25].
Understanding the relationship between personality variables and depression in college students could provide a more rational basis for targeted preventive measures. In this study, we investigated whether depressed students show higher neuroticism scores, lower self-esteem, and higher scores of negative perfectionism than do nondepressed students.
Section snippets
Sampling and procedure
Surveys were conducted in Hong Kong from mid-September to the end of October in 2006 and in Beijing from the beginning of November to mid-December in 2006. In Hong Kong, we used both hard copies and Web questionnaires. Out of a total of 2700 first year students invited to take part from one university in Hong Kong, 802 (28.7%) completed the survey, among which 422 took part in the Web survey and 380 took part in the hard-copy survey. In 2 key universities of Beijing, among the 1194 first year
Prevalence of current depressive symptoms
In Beijing, there were 961 students included in the prevalence calculation after exclusion of incomplete data and those not fulfilling the inclusion criteria. The mean ± SD age of the students was 18.2 ± 1.5 years; the proportion of men was 54.7%. The 2-week prevalence of depressive symptoms among Beijing freshmen is presented in Table 1. Approximately 24.6% of all freshmen had CES-D scores exceeding 16, whereas 8.9% reported a score of 25 or higher. There was no prevalence difference between
Discussion
To study the nature of depression in college students, we compared 2 distinct populations of Chinese college freshmen. In Beijing, 24.6% of freshmen have significant depressive symptoms according to the CES-D cutoff point of 16, although it is unknown which subject would fulfill Diagnostic and Statistical Manual of Mental Disorders or other diagnostic criteria for major depression. A cutoff of 16 or higher on the CES-D was reported to have a 33% predictive value for the detection of true major
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