Internal struggle !

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THE perils of morbidity and mortality posed by depression cannot be disregarded. According to Freud, depression is an exhibit of anger, fear or loss that causes one to adopt ‘learned helplessness’. Helples­sness prevails to the extent that cognitive perception of the outside world carries less importance.

Depressed persons live within their own thoughts and fears; the barrier is tough to break through. Depressive thoughts, internal conflicts, hopelessness, vulnerability, dimness, episodic emotional outbursts and de­­featism — all these symptoms come together.

But, contrary to Freud’s theory, it is important to note that depression is not just a ‘misty’ or ‘unpleasant’ state of mental health; it is a real disease that requires proper evaluation and treatment.


Medical students are more likely to experience depression.


Depression ranges across all ages, from childhood to dotage. Ages 15-18 are critical for observing gender differences in depression. Although the response of all genders to undesirable events carries equal volume, variations in reactions dichotomises the prevalence among men and women.

Psychosocial stressors such as interpersonal losses, family history, an impaired support structure, childhood abuse, chronic illness, loneliness, low economic status, unemployment and peer pressure are frequently observed as predisposing factors.

Suicide is a considerable risk in depression; it may initially present itself as ‘suicidal ideation’, followed by planning and/or failed attempts. The incidence rate is higher among ages 15-24. In most cases this is a well-planned act, not a sudden breakdown of mental capacities. When a person is no longer cognisant of life’s worth and there are continuous stressors and no professional help, suicide attempts often follow.

For university-going students, the burden of strict educational commitments appears as a significant stressor. Lagging behind peers in achieving goals and lack of timely successes are enormous challenges. Undesirable events can lead to passivity and weakened cognitive function. These are internal struggles faced by university students, partly created by the challenges and expectations of the modern age.


For university-going students, the burden of strict educational commitments appears as a significant stressor. Lagging behind peers in achieving goals and lack of timely successes are enormous challenges. Undesirable events can lead to passivity and weakened cognitive function. These are internal struggles faced by university students, partly created by the challenges and expectations of the modern age.


Medical students in particular go through rigorous studies, trainings and curricula. They require persistent stamina, professional skills, the ability to learn quickly, meet tight deadlines and succeed at multiple examinations. Due to increasing numbers of graduating medical students, attaining employment in a competitive field immediately after obtaining their degree is another stressor they must contend with. Nor can the high cost of medical education be overlooked. Accumulatively, such stressors cause depression to be higher among medical students.

Recent statistical data in several Asian countries and across the world show a higher prevalence of depression among medical students compared to students in other fields. And most medical students are between 18 to 25 years, a cohort predisposed to developing depressive disorders.

Meta-analysis from China and India reported the prevalence of depression to be 23.8pc and 29.1pc among medical students respectively. The global prevalence rate was found to be 28pc with a higher prevalence among first- and second-year medical students. Data from the US showed that 27pc of medical students were likely to experience depression or depressive symptoms.

Startlingly, local surveys suggest a higher prevalence of depression among students in Pakistani medical institutions, with rates well above 40pc. The studies carried out were, unfortunately, cross-sectional surveys and so causality cannot be established as to what factors led to such high figures.

Loss of young lives to depression is not an unknown fact in Pakistan, despite the absence of statistical data, underreporting and social stigma. What statistics exist should cause alarm, not only for medical institutions but also for the government, which must come up with concrete plans and interventions to create wider acceptance of depression as a disease, and provide timely, readily available evaluation and treatment.

Medical institutions must create an environment that integrates, facilitates and assesses students’ individual needs to avoid missing any warning signs. They must focus on creating mental health awareness among students. They must also offer better support provisions and regular counsellor meetings to assess the overall student body from both psycho-social and performance perspectives.

Rising fee structures must be looked into as many students might be facing financial obstacles. Faculty members must be allies not bullies; students need to be encouraged instead of humiliated in front of their peers. Institutions must have a proper leave system for students to avoid exhaustion.

A well-connected support system — in which the government, institutions, families, friends and society at large all play a role — must be created. This issue must be taken seriously.

The Article First Appeared In DAWN

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