Assessing the prevalence of depression and associated risk factors among healthcare students at the University of Malta

Abstract

This dissertation investigates the prevalence of depression and the associated demographic, academic, biological, lifestyle and social risk factors among undergraduate healthcare students aged 18 to 25 years at the University of Malta. Depression represents a major global public health challenge and is particularly prevalent among university students, with healthcare students consistently identified as an especially vulnerable group. Despite extensive international evidence, no previous local study has examined depressive symptoms across the full spectrum of Maltese university healthcare courses. This research fills an important gap and provides the first evidence-based assessment of depression in this vulnerable population. A cross-sectional quantitative design was employed using an anonymous online questionnaire distributed via the University of Malta registrar’s office, via email by KSU and on social media platforms by the relevant student associations. The survey incorporated validated instruments including the Patient Health Questionnaire-9 (PHQ9) to assess depressive symptom severity, alongside items from established, validated international questionnaires to evaluate key risk factors, such as physical and mental health conditions, sleep, exercise, substance use, social support, academic pressures and the impact of Long COVID-19. Statistical weighting was applied to the data to adjust for faculty, nationality and gender distribution. The study found a notably elevated prevalence of depression in the final cohort. Using the internationally accepted PHQ-9 threshold score of 10 or above, 42.7% of the weighted sample met criteria for probable major depressive disorder (MDD). This prevalence aligns with higher-end estimates reported globally in studies analysing mental health issues among healthcare student populations. In terms of potential risk factors, several possible associations were identified. Significant relationships were observed between higher depression severity and being an international student, as well as being enrolled in the Faculty of Health Sciences. Various lifestyle and social factors also showed significant associations with increased depressive symptom severity, including physical inactivity, shorter sleep duration, poor sleep quality, problematic social media use, tobacco smoking, weekday alcohol consumption and cannabis use. Additionally, a significant relationship was noted for those experiencing symptoms of Long COVID-19, as well as those individuals who reported experiencing a recent significant life event. It is critical to acknowledge that these findings are based on a very low response rate of 5.4%, which introduces a high degree of non-response bias and as a result, the final sample was not representative of the wider healthcare student population at UOM. The lack of statistical power also means that non-significant findings, such as those related to BMI or loneliness, must be interpreted with caution. Consequently, this study functions as an exploratory investigation that provides a preliminary baseline. These results underscore the importance of further research using more robust recruitment strategies to accurately determine the mental health needs of this cohort. The study also highlights the need for improved institutional support for research dissemination to further explore wellbeing in Malta’s healthcare student population and ensure a sustainable future healthcare workforce.