The Prevalence and Co-Occurrence of Depresion, Anxiety and Attention Deficit Hyperactrivity Disorder Among Medical Students in a Tertiary Institution- A Cross Sectional Study

Background: One of the key areas in the 2030 agenda for sustainable development is universal good health and wellbeing. This objective encompasses beyond universal health coverage, access to effective, quality and affordable medical care across all health priorities which include communicable and non-communicable illnesses. Over the past decade there has been mounting concern over the increase of mental health challenges globally indiscriminately. In comparison to the general population, medical students, who are tasked to help meet this SDG, exhibit significantly higher rates of mental health difficulties with depression and anxiety being the most common. Numerous studies have also been conducted to explore the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among medical students whose outcomes have equally been alarming.  Objectives: The broad objective of this study was to investigate the association between depression, anxiety, and ADHD among medical students at the University of Nairobi.  Methodology: Quantitative cross-sectional study design was conducted. Yamane's formula was used to determine the stratified cluster sampling method inclusive of all undergraduate academic years in the study of medicine.Systematic sampling was used to recruit eligible study participants who were informed through their respective class representatives totaling the desired sample of 335. The study objective and ethical considerations were explained. After consenting, a link to an online questionnaire incorporating socio-demographic questionnaire, PHQ 9, GAD 7 and the ASRS v1.1 was shared to them, to assess them for depression, anxiety, and ADHD.  Data Collection & Analysis: Data was collected through Kobo Collect online questionnaire and analyzed through Stata v14.2.  Results: 335 respondents were recruited into the study with 51.64% being females and 162 48.35% males. Those aged 18-22 comprised majority of the participants at 62.99%, followed by 23-26 years at 27.76%, 27-30 years 8.06% and above 30 years <2%. Presence and severity of ADHD, assessed using the WHO ASRS v1.1. With the screener, the prevalence of ADHD was 32.54%. Presence and severity of depression were assessed using the PhQ-9. 54% of the participants reported some form of depression ranging from moderate to severe levels. In addition, presence and severity of anxiety were assessed using the GAD-7. Participants who reported moderate to severe symptoms of anxiety were 43% of the total sample. Ordinal logistic regression showed that students who exhibit ADHD symptoms are 9.28 times significantly more likely to develop anxiety compared to those who don’t, p = 0.000; and 8.63 times significantly more likely to develop depression severity, p= 0. 000.  Conclusion and Recommendations: The prevalence rates reported are significantly higher than those in other similar studies across the world. Consequently pushing the agenda on attempting to understand risk factors towards the development of depression and anxiety as well as adult ADHD within the college of Health Sciences.