Impact of Levels of Education on Depression and Anxiety in Iranian Students

Received 05 May, 2021

Accepted 14 Jan, 2022

Published 31 Mar, 2022

Depression and anxiety had been among the most common mental health concerns reported in students across academic levels. With increased globalization, the influx of international students pursuing various professional courses in different countries has increased manifold in recent years. A bulk of research investigating the factors that affect health and adjustment of international students describe the unique challenges faced by them in adapting to new cultural environment and making successful transition. The present research focused on examining depression and anxiety among male and female Iranian students in India. The study sample consisted 300 male and 300 female students totaling to 600 students who were pursuing graduate, post graduate, doctoral, and post-doctoral degrees. Beck Depression Inventory (Beck et al ., 2001) and IPAT Anxiety scale (Cattel, Krug, & Scheier, 1976) were used to assess depression and anxiety; respectively. Results indicated that education level did not have a significant impact on depression and anxiety implying that Iranian students in India experience similar levels of depression and anxiety irrespective of their varied educational background. However, gender-wise comparison reveals a statistically significant difference, with female students reporting higher rates of depression and anxiety than their male counterparts. Therefore, it is necessary to address depression and anxiety at the earliest during college years so as to arrest their negative impact on academic outcomes.

Depression and anxiety as psychological concerns standout as the most common ailments among students around the world. They are comorbid conditions that are often considered as central in issues of emotional health, well-being and adjustment, taking a toll on classroom behaviour and academic performance (Andrews & Wilding, 2010; Sarokhani et al., 2013). The American College Health Association (2013) confirms that depression and anxiety are more prevalent among college students than the general population. Unaddressed anxiety and depression can significantly impact students’ academic functions, as well as disrupt other areas of their lives.

Research investigations on the effects of depression on studiousness, learning executions, scholastic achievement and educational success state a significant influence of depressive conditions on academic dysfunction (Arslan, Ayranci, Unsal, & Arslants, 2009). Numerous assessments on rates of depression among students make the same affirmations about the negative impact of depression on learning outcomes (Chen et al., 2013). Green, Lowry, and Kopta (2003) noted that college students experience elevated amounts of manifest depression when compared to their non-academic counter parts. Inquires on anxiety and its influence on academic pursuits have yielded similar results regarding its disruptive effects on students. Grills-Taquechel, Fletcher, Vaughn, and Stuebing (2012) led a quantitative, non-experimental study to understand the connection between pressurizing academic challenges and nervousness in students. The results showed that they had a propelling impact on performance outcome. Nelson and Harwood (2010) reported that students are altogether more prone to experience the ill effects of scholastic tension. Tension, connected with large amounts of stress during student years can influence scholarly routine. Studies also show that abnormal amounts of academic anxiety can adversely influence working memory, thus intruding with performance (Owens, Stevenson, Norgate, & Hadwin, 2008).

Empirical reports from several decades confirm that depression and anxiety are among the leading causes of clinically significant psychological disorders (Tanaka & Huba, 1987), academic underachievement (Nail et al., 2015), loss of interest, emotional complications, and suicide (Kamble & Minchekar, 2018), maladaptive coping (American Psychiatric Association, 2013), dysfunctional lifestyle, changes in biological rhythms, and a lifelong pattern of frustration and failure. Depression and anxiety during student years mainly stream from academic pressure, performance anxiety, undue competition, excessive workload, poor time management, unmonitored schedules, unrealistic expectations, poor support system, and lack of leisure time. Parental anticipation, financial crunches, challenges of new relationships, having to be uprooted and placed in new location for studies may add and aggravate feelings of depression and anxiety. Biological predispositions, psychological assets, age, gender also have their own effect on the onset of depression and anxiety during student years (Bangasser et al., 2010; Kruisselbrink, 2013; Kumaraswamy, 2013).

A number of studies on the prevalence of mental disorders in college students’ worldwide indicate the presence of moderate to high prevalence of depression and anxiety among them. And it is estimated that 12-50% of students meet at least one diagnostic criterion for one or more mental anomalies (Bruffaerts et al., 2018). Along with pressure to adjust to academic life, students confront frequent logical inconsistencies and commitments to succeed, particularly in college, which fuels emotional stress (Arslan, et al., 2009). According cross cultural reports on the estimates of depression in students across the board, it is seen to be a common issue that keeps on expanding in the academic population (Sarokhani et al., 2013). A study in Turkey expressed that the rate of depression fluctuated from 10% to 40% among college students. Another survey of distributed inspection that went on from January 1980 to May 2005 regarding the rates of depression in Canadian and US students revealed elevated amounts of depression in this populace in contrast to the entire inclusive community (Dyrbye, Thomas, & Shanafelt, 2006). Similar patterns are outlined in Sweden (Dahlin, Joneborg, & Runeson, 2005) Denmark (Haldorsen, Bak, Dissing, & Petersson, 2014) and other countries. It is stated that more than 66% of youngsters with mental health concerns do not discuss or seek help for emotional well-being issues (Castaldelli-Maia et al., 2012). Considering the vast prevalence of depression and anxiety in the academic population, its ill effects on academic performance and health, plus the exceptional difficulties encountered by overseas students, it is necessary to identify those who are at higher risk of developing mental health problems during college life and intervene at the earliest to ensure better functional outcomes.

The present study focuses on assessing depression and anxiety in male and female Iranian students pursuing higher studies at various educational levels in India. India, among all Asian countries has attracted large population of Iranian students for various academic degrees (Nooripour, Mohammadi, & Sargolzaei, 2013). The arrival of Iranian students in India in search of opportunities for higher education started in the late 20^th century. According to the Iranian parliamentary delegation, there were only about 74 Iranian students in India, which has now increased to more than 8,000. India provides 67 scholarships to Iranian students under different schemes, and every year around 40,000 Iranians visit India for various purposes (Chopra, 2004). As indicated by the Iranian logical attaché, the Iranian students in India are pursuing degrees in 64 different fields including professional, non-professional, technical, medical, paramedical, and social sciences.

With modernization, growth in information science and technology, students in current times have unprecedented access to academic, professional and vocational courses on a global level. According to a statistical estimate, till the last years, more than five million students were studying outside their home countries. This has opened up a new world diversity, opportunity as well as difficulties for international scholars. Though the prospect of travelling overseas is as exciting as can be, the challenge to adapt, adjust and settle in an unknown land can in itself evokes feelings of fear, depression and anxiety. Making necessary preparation to travel, understanding admission procedure, preparing documents, attending to a bulk of paperwork, managing finances, handling language barriers, making cultural adjustment in the host country can literally pressurize the student to the extent of exhaustion and burn out (Baklashovaa & Kazakovb, 2016; Chopra, 2004).

Investigations done on Iranian students seeking education in other countries shows that many of them experience significant mental stress related to academic issues. Jafari, Loghmani, and Montazeri (2012) in their research state that most Iranian students scored above threshold on the scale measuring psychological distress. Their study also reported higher psychological distress in students (44% more) compared to their peers in general population. A study by Khafaie, Khafaie, Salmanzadeh, and Radkar (2016) assessing the impact of immigration on health of Iranian students in India revealed that more than 50% of them were overweight and obese when compared to the time before migration. Their studies implicated the effects of stress, emotional pressure and life style adjustment as major factors leading to significant changes in physical health that produced adverse effects. Nooripour, Mohammadi, and Sargolzaei (2013) explored homesickness in Iranian students studying in India and identified that risk for mental breakdown had significant correlation with poor academic and social performance. Given these numbers, it is but important to understand the issues encountered by Iranian students in India to enable better understanding for policy making and devising remedial assistance for needy students at the right juncture. The present study intends to do the same. It is hypothesized that the level of depression and anxiety is high among Iranian students and this is influenced by educational level and gender.

Since, there are not many studies done on assessing impact of education level on depression and anxiety among Iranian students studying in India. Students studying in different degrees may have different coping mechanism. Hence, this creates the research gap for the current study. As it is a challenging scenario for Iranian studies to come to a different country and do their education, this study aims to find out if there is any difference between Iranian students studying various degrees on depression and anxiety. Further, the study also aims to find out influence of gender on depression and anxiety.

METHOD

Sample
The study had 600 Iranian students as sample who pursuing various undergraduate (n = 300), post graduate (n =131), doctoral (n = 134), and post-doctoral (n = 35) degree in various universities in the city of Mysore and Bangalore. The sample was selected via stratified random sampling technique and consisted of equal number of male (n = 300) and female participants (n = 300). The majority of the sample comprised of undergraduates (50%), while 22.3% of them were pursuing PhD degree; 21.8% of them were from Postgraduate level, and 5.8% were registered in Post-doctoral course. The trend in educational qualification was found be similar for both male and female participants.

Instrument
Beck Depression Inventory. In the present study, BDI-II (Beck et al., 2001) is used to measure depression and the inventory consists of 21 items, to be rated on a 4-point scale ranging from 0 (symptom absent) to 3 (severe symptoms). The recall period based on symptoms experienced for depression is two weeks, as operationalized in the DSM-IV. The inventory yields a minimum score of 0 and maximum score of 63, divided into a range of 0–13 (minimal depression), 14–19 (mild depression), 20–28 (moderate depression), and 29–63 (severe depression) scores. The cut off score for clinical depression is 20 and higher scores on the inventory indicate greater symptom severity. BDI-II reports reliability estimates at .92 with outpatients and .93 for a non-clinical sample. It also demonstrates good construct, concurrent, and criterion validity (Beck et al., 2001; Santer, Ramsey, & Zuroff, 1994).

IPAT Anxiety Scale (Cattel et al., 1976). The IPAT Anxiety Scale (Cattell, Krug, & Scheier, 1976) is a brief measure of anxiety, consisting of 40 trichotomously scored items that are divided into two 20-item subscales. The first 20 items yield scores on covert anxiety while the remaining 20 assess overt anxiety. Based on the rating, the scale yields a score from 0 to 80 that specify total anxiety scores, overt-covert anxiety scores, and difference in overt-covert anxiety scores. The reliability and validity of the questionnaire has been found to be satisfactory. Internal consistency of the scale is reported to be .84 and .81 for total anxiety and .73, .76, .84 for covert, overt, and difference scores; respectively. The scale has good content as well as construct validity (Vitsari, Abdul-Wahab, Herawan, Othman, & Sinnadurai, 2011).

PROCEDURE

Data was collected via survey through direct administration of scales to 600 Iranian students pursuing higher education at various universities in Mysore and Bangalore. The participants were grouped based on education status and gender so as to assess the impact of educational level and gender on depression and anxiety. Individuals with impaired cognitive abilities and those who have already participated in similar studies earlier were not considered in the study. Participant consent was sought and only those who were willing to respond to the questionnaires were considered in the study. Confidentiality was assured and data was collected in line with all ethical considerations. Once the data was collected, it was analyzed for both descriptive and inferential statistics.

RESULTS

The below Tables indicate the results of different educational levels with respect to study variables. Moreover, the difference between male and female Iranian students were also investigated with reference to Beck’s Depression Inventory and IPAT Anxiety Scale.

Results presented in Table 1 given below shows that Iranian students at various educational levels did not significantly differ in their depression scores. Similarly, there are nonsignificant differences in anxiety scores of Iranian students at different educational levels.

Table 1:	Group Differences on Depression and Anxiety of Iranian Students at Different Educational Levels (N = 600)

Table 2:	Gender Differences on Depression and Anxiety Among Iranian Students (N = 600)

Results depicted in Table 2 shows that female Iranian students reflected higher levels of depression and anxiety as compared to male Iranian students.

DISCUSSION

The present study was carried out with an objective of investigating depression and anxiety experienced by students from Iran pursuing academic degrees in India. Based on literature review, it was hypothesized that Iranian students with different educational qualification would not differ significantly on depression and anxiety where as it was hypothesized that male and female Iranian students studying in India would differ significantly on depression and anxiety.

According to the findings of the study, though Iranian students report higher incidents of depression and anxiety, educational level does not seem to influence them. That is, irrespective of the degree sought, Iranian students exhibit similar occurrence of anxiety and depression. Studies in the past inquiring into the impact of educational level on distressing emotions have yielded mixed results. This is because, most studies focus on understanding depression and anxiety in specific academic group, while very few inquiries have systematically compared academic levels and its impact on depression and anxiety. Some studies that have assessed cross sectional academic population report moderate to severe symptoms of depression and anxiety in university students. But they do not provide comparative data on the levels of depression and anxiety between academic groups (Eisenberg, Gollust, Golberstein, & Hefner, 2007; Ramón-Arbués, et al., 2020; Torija, Pozo, Bravo, Hurtado, & Romero, 2016). The empirical results of the current research establish that depression and anxiety may persist in students irrespective of the course under study. This is because students, despite educational level and academic course chosen, experience similar scholastic pressure and challenge in terms of learning, performance and accomplishment. Hence, educational level may not actually predict the severity of felt depression and anxiety.

The study is in line with previous empirical reports that speculate the distinct influence of gender on depression and anxiety, with higher incidents of it in female then male population (Chen et al., 2013; Kessler, 2015). Depression and anxiety in international students are influence by a number of factors including gender, age, ethnicity, funding, duration of stay, social support, and proficiency in English language (Sümer, Poyrazli, & Grahame, 2008; Wu, Garza, & Guzman, 2015). The ability to adjust and cope in novel conditions requires much effort. When students travel overseas for educational attainments, most of them are unprepared for the cultural shocks that may be encountered, the change in life style and daily habits that need to be altered to suite the foreign culture, which is but necessary. Having to be uprooted from one’s comfort zone and familiar environment, the uncertainties and anticipation of having to adapt to a totally different and strange society, feelings of social isolation, challenges to shift core beliefs can overwhelm most individuals. Apart from these general factors that place enormous demands on the personal resources of the individual, having to settle down in academic institution that differs from one’s home country and succeed can itself evoke feelings of anxiety and depression. Most international students struggle through these emotional conflicts on a regular basis, and without adequate social support in a foreign land. Empirical evidences time and again ascertain the effects of depression and anxiety on academic performance, and in the long run, the irreversible damages these emotional stresses can cause to the physical and mental health of students.

LIMITATIONS AND SUGGESTIONS

The study included only gender and educational qualifications; therefore, it is recommended that other demographic variables can also be included for further studies. The study included only depression and anxiety, whereas further studies can focus on many other concepts such as stress, quality of life and other variables that might influence depression and anxiety.

IMPLICATIONS

Theoretically, the preset study adds to the existing literature on depression and anxiety among the academic populace. Practically, these findings can aid further research to focus on specific aspects that contribute to depression and anxiety in international students and devise ways to counter them. Since most empirical research substantiate the struggles of international students, it is time that colleges that offer admission to foreign students should provide care and assistance that aid in their transition, making it more easier and hassle free. Setting up help groups, organizing special programs, giving additional guidance time to time, improving student-faculty interaction, coming up with unique policies that assist international students can truly promote their adjustment and achievement, encouraging more students to explore academic opportunities abroad.

CONCLUSION

The present study made an attempt to understand the prevalence of anxiety and depression among Iranian students at different educational levels in India. The results of the study support previous findings on the pressure felt by international students in foreign land, which can adversely affect their health, wellbeing and academic efforts.

REFERENCES

1. American College Health Association. (2013). National college health assessment II: Reference group executive summary. Journal of American Health College, 56(5), 469-479.
2. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. Arlington, VA: American Psychiatric Publishing.
3. Andrews, B., & Wilding, J. M. (2010). The relation of depression and anxiety to life-stress and achievement in students. The British Journal of Psychology, 94(4), 509-521.
4. Arslan, G., Ayranci, U., Unsal, A., & Arslantas, D. (2009). Prevalence of depression, its correlates among students, and its effect on health-related quality of life in a Turkish university. Upsala Journal of Medical Sciences, 114(3), 170-177.
5. Baklashovaa, T. A., & Kazakovb A. V. (2016). Challenges of international students’ adjustment to a higher education institution. International Journal of Environmental & Science Education, 11(8), 1821-1832.
6. Bangasser, D. A., Curtis, A., Reyes, B. A. S. Bethea, T. T., Parastatidis, I., Ischiropoulos, H., Van Bockstaele, E. J., & Valentino, R. J. (2010). Sex differences in corticotrophin-releasing factor receptor signaling and trafficking: Potential role in female vulnerability to stress-related psychopathology. Molecular Psychiatry, 15(9), 877-904.
7. Beck, R., Perkins, T. S., Holder, R., Robbins, M., Gray, M., & Allison, S. (2001). The cognitive and emotional phenomenology of depression and anxiety: Are worry and hopelessness the cognitive correlates of NA and PA? Cognitive Therapy and Research, 25(8), 829-838
8. Bruffaerts, R., Mortier, P., Kiekens, G., Auerbach, R. P., Cuijpers, P., Demyttenaere, K., Green, J.G., Nock, M. K., Kessler, R. C. (2018). Mental health problems in college freshmen: Prevalence and academic functioning. Journal of Affective Disorders, 225(1), 97-103.
9. Castaldelli-Maia, J. M., Martins, S. S., Bhugra, D., Machado, M. P., Andrade, A. G., Alexandrino-Silva, C., Baldassin, S., & de Toledo, T. C. (2012). Does ragging play a role in medical student depression - cause or effect? Journal of Affective Disorders, 139(3), 291-297.
10. Cattell, R. B., Krug, S. E., & Scheier, I. H. (1976). Handbook for the IPAT Anxiety Scale Questionnaire: Self-analysis form. Champaign: Institute for Personality & Ability Testing.
11. Chen, L., Wang, L., Qiu, X. H., Yang, X. X., Qiao, Z. X., Yang, Y. J., & Liang, Y. (2013). Depression among Chinese university students: Prevalence and socio-demographic correlates. PloS One, 8(3), e58379.
12. Chopra, R. M. (2004). Indo-Iranian cultural relations in the 20th century. Indo-Iranica, 57(1), 1-4.
13. Dahlin, M., Joneborg, N., & Runeson, B. (2005). Stress and depression among medical students: A cross-sectional study. Medical Education, 39(6), 594-604.
14. Dyrbye, L. N., Thomas, M. R., & Shanafelt, T. D. (2006). Systematic review of depression, anxiety and other indicators of psychological distress among US and Canadian medical students. Academic Medicine, 81(4), 354-373.
15. Eisenberg, D., Gollust, S. E., Golberstein, E., & Hefner, J. l. (2007). Prevalence and correlates of depression, anxiety, and suicidality among university students. American Journal of Orthopsychiatry, 77(4), 534-542.
16. Green, J. L., Lowry, J. L., & Kopta, S. M. (2003). College students versus college severity of college students' psychological concerns: A comparison of clinical and nonclinical national samples. Professional Psychology: Research and Practice, 37(3), 317-325.
17. Grills-Taquechel, A. E., Fletcher, J. M., Vaughn, S. R., & Stuebing, K. K. (2012). Anxiety and reading difficulties in early elementary school: Evidence for unidirectional- or bi-directional relations? Child Psychiatry and Human Development, 43(1), 35-47.
18. Haldorsen, H., Bak, N. H., Dissing, A., & Petersson, B. (2014). Stress and symptoms of depression among medical students at the University of Copenhagen. Scandinavian Journal of Public Health, 42(1), 89-95.
19. Jafari, N., Loghmani, A., Montazeri, A. (2012). Mental health of medical students in different levels of training. International Journal of Preventive Medicine, 3(1), 107-112.
20. Kamble, R. J., & Minchekar, V. S. (2018). Academic stress and depression among college students. International Journal of Current Research, 10(12), 76429-76433.
21. Kessler, R. C. (2015). Anxious and non-anxious major depressive disorder in the World Health Organization and World Mental Health Surveys. Epidemiology Psychiatry Science, 24(3), 210-226.
22. Khafaie, M. A., Khafaie, B., Salmanzadeh, S., & Radkar, A. (2016). Health behavior of Iranian students in India: Impact from migration. Journal of Pharmaceutical Research and Allied Sciences, 5(2), 26-31.
23. Kruisselbrink, F. A. (2013). A suffering generation: Six factors contributing to the mental health crisis in North American higher education. College Quarterly, 16(1), 78-90.
24. Kumaraswamy, N. (2013). Academic stress, anxiety and depression among college students: A brief review. International Review of Social Sciences and Humanities, 5(1), 135-143.
25. Nail, J., Christofferson, J., Ginsburg, G., Drake, K., Kendall, P., McCracken, J., & Sakolsky, D. (2015). Academic impairment and impact of treatments among 56 youth with anxiety disorders. Child & Youth Care Forum, 44(3), 327-342.
26. Nelson, J. M., & Harwood, H. (2010). Learning disabilities and anxiety: A meta-analysis. Journal of Learning Disability, 44(1), 3-17.
27. Nooripour, R., Mohammadi, A. Z., & Sargolzaei, M. (2013). Self-efficacy and homesickness in Iranian students in India. Indian Journal of Health and Wellbeing, 4(5), 1054-1056.
28. Owens, M., Stevenson, J., Hadwin, J. A., & Norgate, R. (2008). Anxiety and depression in academic performance: An exploration of the mediating factors of worry and working memory. School Psychology International, 33(4), 11427433.
29. Ramón-Arbués, E., Gea-Caballero, V., Granada-López, J. M., Juárez-Vela, R., Pellicer-García, B., & Antón-Solanas, I. (2020). Prevalence of depression, anxiety and stress and their associated factors in college students. International Journal of Environmental Research and Public Health, 17(9), 7001.
30. Santor, D. A., Ramsay, J. O., & Zuroff, D. C. (1994). Nonparametric item analyses of the Beck Depression Inventory: Evaluating gender item bias and response option weights. Psychological Assessment, 6(3), 255-270.
31. Sarokhani, D.,Delpisheh, A.,Veisani, Y.,Sarokhani, M. T., Manesh, R. E., & Sayehmiri, K. (2013). Prevalence of depression among university students: A systematic review and meta-analysis study. Depression Research and Treatment, 37(2), 157-168.
32. Sümer, S., Poyrazli, S., & Grahame, K. (2008). Predictors of depression and anxiety among international students. Journal of Counseling & Development, 86(4), 429-437.
33. Tanaka, J., & Huba, G. (1987). Assessing the stability of depression in college students. Multivariate Behavioral Research, 22(1), 5-19.
34. Torija, S. T. C., Pozo, M. D. R. H., Bravo, Y., Hurtado, A. C., & Romero, M. (2016). Prevalence of anxiety symptoms in a sample of college students at a faculty of health sciences in Mexico. Psychological Testing, 11(2), 12-22.
35. Vitasari, P., Abdul Wahab, M. N., Herawan, T., Othman, A., & Sinnadurai, S. K. (2011). Validating the instrument of study anxiety sources using factor analysis. Procedia - Social and Behavioral Sciences, 15, 3831-3836.
36. Wu, H., Garza, E., & Guzman, N. (2015). International student’s challenges and adjustment to college. Education Research International, 5(1), 2-10.