difference at the mean scores of mental health among professional students with ... 2001 using the Brief Symptom Inventory (BSI) and found in both.
Indian Journal of Health and Wellbeing 2012, 3(1), 305-309
© 2012 Indian Association of Health, Research and Welfare
Mental health among professional and non-professional students in India Matloob Ahmed Khan
Mahmoud Shirazi
Department of Psychiatry, School of Medicine Addis Ababa University, Ethiopia
Department of Psychology University of Sistan and Baluchestan, Iran
Md. Jasimuddin Khan Department of Psychology, Aligarh Muslim University, Aligarh, India The aim of this study was to examine the mental health among professional and non-professional students. A total of 200 respondents were recruited from Aligarh Muslim University. Mental health was measured by 56 items in mental health inventory designed by Srivastava and Jagdish (1983). Independent t-test was used for analyzing the data. The result shows that independent t-test found significant difference at the mean scores of mental health among students (professional and non-professional) with consideration of course. The independent t-test found no significant difference at the mean scores of mental health among professional students with consideration of residence and gender whereas significant difference was found among non-professional students' mental health with consideration of residence but no significant difference in terms of gender. Early detection for indications of mental health problems and understanding factors contributing to stress among students would promote better understanding of mental health in future and findings suggest that should do more researches about students' mental health.
Keywords: mental health, professional students and non-professional students The mental health problem of students in higher education is a widely discussed topic in recent times. Higher education plays important role to cope up with psychiatric problems, and to help students in developing their personal, social and intellectual potential, and thereby to make a productive contribution to society but in this case a caution is needed, otherwise it may create distress and develop illness, higher education demands on the individual. Therefore, the pre-existing emotional and psychiatric problems in some students become prominent in higher education, and they can influence others. Study asserts that the financial restrains, growing competitiveness and excessive will to succeed and material security exacerbate the condition of psychiatric problems among the students in college and university in recent years. It is recognized that mental health disorders affect different individuals regardless of culture, social status, sex and age. Mental health is a crucial dimension of overall health and an essential resource for living. It influences how we feel, perceive, think, communicate and understand. Without good mental health, people will not be able to show their full potential or play an active part in everyday life. Mental health issues can address many areas, from enhancing our emotional well-being, treating and preventing severe mental illness to the prevention of suicide. Wilkinson and O'Connor (1982) defined mental health as a congruent relationship between a person and his/her surrounding environments. Uner, Ozcebe, Telatar and Tezcan (2008) revealed that 56.8% of students were found to be at risk for mental health problems. The respondents were from Hacettepe University in Turkey and comprised first and third year students in all faculties of the university. Their age ranged from 16 to 46 years. Zaid, Chan and Ho (2007) studied the prevalence of emotional disorders using the English version of the GHQ-12 among respondents who were medical students at a private medical school in Ipoh, Perak, Correspondence should be sent to Dr. Matloob Ahmed Khan Department of Psychiatry, School of Medicine, Collage of Health Sciences, Post Box no-9018, Addis Ababa University, Addis Ababa, Ethiopia
Malaysia. The researcher indicated that the prevalence of emotional disorders among the medical students was high (46.2%). According to Yen, Hsu, Liu, Huang, Ko, Yen and Cheng (2006), poor mental health was influenced by demographic characteristics, a high level of family conflict and a low level of family support. The respondents in the study were junior high school students in isolated mountain area of Southern Taiwan. Hyun and Jenny (2006) examined mental health of graduate student. The results showed that almost half of graduate student respondents reported having had an emotional or stress-related problem over the past year, and over half reported knowing a colleague who had had an emotional or stress-related problem over the past year. Self-reported mental health needs were significantly and negatively related to confidence about one's financial status, higher functional relationship with one's advisor, regular contact with friends, and being married. Utilization of counseling services was positively associated with an index of depression symptoms, the number of semesters in school, and identifying as female. Those students who had experienced a significant mental health event in the past year and had higher functional relationships with their advisors were significantly more likely to utilize counseling services. Abdulghani (2008) revealed that there was a prevalence of stress among tertiary students and it was also found that there was severe stress among medical students, 57% and 19.6% respectively. The medical students in the study were from the College of Medicine at the King Saud University. The researcher used different kinds of tools to assess the stress level of respondents. The tools used were Beck's Depression Inventory, General Health Questionnaire and Kessler10 Psychological Distress (K10). In a study of over 3000 students at ten universities (Webb et al, 1996), Hospital Anxiety and Depression (HAD) questionnaire scores identified 12% of male and 15% of female students with measurable levels of depression? The University of Leicester's Student Psychological Health Project (Leicester University, 2002) surveyed more than a thousand second-year students in 1998 and 2001 using the Brief Symptom Inventory (BSI) and found in both
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years that 13% of undergraduates recorded scores suggesting they were moderately distressed by feelings of depression. Women scored significantly higher than men. Using the Beck Depression Inventory (BDI), 14% of students in a South African study were found to be moderately or severely depressed (Mkize et al., 1998). As in the general population, suicide is more common in male students than female students, both nationally and internationally (Collins & Paykell, 2000; Hawton et al., 1995a; Niemi & Lonnqvist, 1993; Silverman et al, 1997). However, studies of suicide have found that the female-to-male ratio was higher among students than that seen in the age-matched population. In his study of deliberate selfharm, Hawton et al. (1995b) found that females presented 2.6 times more frequently than males. Suicidal ideation was found to be unrelated to gender within student populations in the USA and Australia (Rudd, 1989; Schweitzer et al., 1995). Pickard et al. (2000) and Webb et al. (1996) found similar levels of drug misuse among males and females. Females are more likely to show increased evidence of emotional problems during the course of higher education (Fisher & Hood, 1988; Surtees & Miller, 1990). Fisher and Hood (1998) found that female students demonstrated increased levels of depression, anxiety and phobias compared with their male counterparts, but homesickness was unrelated to gender. In the UK and elsewhere, female students have been found to be more likely to demonstrate increased levels of psychological symptoms using a range of measures compared with their male colleagues (Grant, 2002; Hong et al., 1993; Rosal et al., 1997; Surtees et al., 2000; Tyrell, 1992; Watanabe, 1999). Those studying the arts have increased rates of deliberate selfharm (Hawton et al, 1995b) and higher GHQ scores (Springett & Szulecka, Lekarz, 1986; Watanabe, 1999). Surtees and Miller (1990) demonstrated high rates of psychological distress among medical students, particularly at the commencement of their course. O'Mahony and O'Brien (1980) found that medical (and dental) students were overrepresented among referrals to a student health psychiatrist. In Canada, medical students were found to be no more stressed than either other students or the general population (Helmers et al., 1997). A larger number of students from less privileged backgrounds now attend university, are less protected from the vagaries of life and are therefore more likely to suffer mental ill health. Roberts et al. (1999) have shown that financial problems are associated with poorer mental health in student populations. Dahlin, Joneberg and Runeson (2005) indicated that there was a significant difference in pressures experienced among first year, third year and sixth year medical students in Karolinska Institute Medical University, Stockholm. The analysis of the study found that first year students reported a highest degree of pressure compared to third year and sixth year students. Besides that, the study also found that women experienced higher levels of stress than men. The study also compared the differences of pressures experienced between medical students and the general student population in the university. The results revealed that medical students had higher depression levels compared to the general population. Mohan et al. (2002) assessed 10,312 urban people in India, with an instrument based on DSM-III R criteria at two points of time one year apart. The prevalence of tobacco, alcohol, cannabis and opioids use among males was 27.6%, 12.6%, 0.3% and 0.4%, respectively. The
annual incidence rates among males for any drug use and use of alcohol, tobacco, cannabis and opioids were 5.9%, 4.2%, 4.9%, 0.02% and 0.04%, respectively. Among females, the incidence of any drug use was 1.2%. Kartikeyan et al. (1992) assessed 9,863 people from an urban slum in India. The prevalence of drug dependence was 11% (83.7% for heroin, 10.7% for cannabis and 5.8% for opium). Mental ill health is on the rise in many countries in recent years, significantly so among our youth population. College students from the cream of student population, Studies have shown that about 50% students in India suffer from health problems. 15% of the students suffer from mental disorders like depression, anxiety, hysteria, somatoform disorders, adjustment reactions, and alcohol and drug abuse. In addition, many more students may have emotional problems related to their family and college life (Chandrasekhar et al., 2007). Over 16000 school and college student in India committed suicide in the last three years (Nanda, 2008). The purpose of this research is to study the differences of mental health in terms of demographic variables (gender, course and residence). The demographic variables such as residence (ruralurban), course (professional-nonprofessional) and gender (malefemale) are some of the determining variables that makes complex outcome of researches and they might have effect on mental health. Therefore, the present study aims to compare the differences of mental health in terms of demographic variables (gender, course and residence) of students (professional and non-professional). However, the present research is designed to search possible responses to these questions and hypothesis as given below:
Hypotheses of the study
Is there significant difference between the mean scores of students (professional and non-professional) mental health with consideration of course? H01: There would not be significant difference between the mean scores of students (professional and non-professional) mental health with consideration of course. n Is there significant difference between the mean scores of professional students' mental health with consideration of residence? H02: There would not be significant difference between the mean scores of professional students' mental health with consideration of residence. n Is there significant difference between the mean scores of professional students' mental health with consideration of gender? H03: There would not be significant difference between the mean scores of professional students' mental health with consideration of gender. n Is there significant difference between the mean scores of nonprofessional students' mental health with consideration of residence? There would not be significant difference between the mean scores of nonprofessional students' mental health with consideration of residence. n Is there significant difference between the mean scores of nonprofessional students' mental health with consideration of gender? H05: There would not be significant difference between the mean scores of nonprofessional students' mental health with consideration of gender.
n
Indian Journal of Health and Wellbeing 2012, 3(1) 305-309
Method Participants A Participants of 200 individuals were selected for this project, 100 professional and 100 non-professional students from Aligarh Muslim University', Aligarh, India.
consideration of residence. The result of the above table show the number of students, mean, standard deviation and standard error on professional students mental health with consideration to residence. Table 4: Significance of Mean Differences of mental health, with consideration of residence.
Instruments Mental Health Inventory (MHI): This scale was developed by Srivastava and Jagdish (1983). This scale consist of 56 items The reliability and validity coefficients were found significant as the value of split-half reliability coefficient was r=0.73 and validity i.e. construct validity was r=0.54 which confirm the standardization of the scale.
Results
307
Mental Health
Groups
N
Mean
S.D
df
t
Rural Urban
40 60
137.77 138.10
8.79 9.97
98
0.17
As it is shown in table 4, the professional students were compared with regards to scores on mental health with consideration of residence, because of (p=.867>0.01), there is no significant difference between two groups on mental health.
Research question 3
As stated earlier, the main purpose of this investigation was to study the differences of mental health in terms of demographic variables (gender, and residence) among students (professional and nonprofessional). For the purpose, independent samples t-test was used. All the analysis has been done by SPSS. In this study the percentage of males-females and professionalnonprofessionals students' was equal (100 or 50% respondents).
Is there significant difference between the mean scores of professional students' mental health with consideration of gender? To ascertain the answer of this question independent t-test was calculated. The result is as follow: Table 5: Descriptive statistics on professional students' mental health with consideration of gender Gender
N
Mean
SD
SE
Research Question 1
Mental Health
Is there significant difference between the mean scores of students (professional and non-professional) mental health with consideration of course? In order to examine this question, independent t-test was run. The result is as follow: Table1: Descriptive statistics on students (professional and nonprofessional) mental health with consideration of course.
Male Female
50 50
137.10 138.84
11.19 7.38
The result of the above table show the number of students, mean, standard deviation and standard error on professional students mental health with consideration to gender. Table 6: Significance of Mean Differences of mental health, with consideration of gender.
Course Mental Health
N
Professional 100 Non-Professional 100
Mean
S.D.
S.E.M.
137.97 143.41
9.47 14.06
0.95 1.41
The results from above table show the number of students (professional and non-professional), mean, standard deviation and standard error on mental health with consideration to course. Table 2: Significance of Mean Differences of mental health, with consideration of course. Groups Mental Health
N
Professional 100 Non-Professional 100
Mean
S.D
df
t
137.97 143.41
9.47 14.06
198
3.209**
**p < 0.01 As it is shown in table 2, the students were compared with regards to scores on mental health with consideration of course, because of (p=.0020.01), there is no significant difference between two groups on mental health.
Research question 4 Is there significant difference between the mean scores of nonprofessional students' mental health with consideration of residence? For responding of this question independent t-test should be run. The result is as follows: Table 7: Descriptive statistics on non-professional students' mental health with consideration of residence. Residence
N
Mean
S.D.
S.E.M.
Rural Urban
53 47
147.72 138.55
12.59 14.17
1.73 2.07
Mental Health
Is there significant difference between the mean scores of professional students' mental health with consideration of residence? In order to examine this question, independent t-test was run. The result is as follow: Table 3: Descriptive statistics on professional students' mental health with consideration of residence.
The result of the above table show the number of students, mean, standard deviation and standard error on non-professional students mental health with consideration of residence. Table 8: Significance of Mean Differences of mental health, with consideration of residence.
Mental Health
Residence Rural Urban
N 40 60
Mean 137.77 138.10
S.D. 8.79 9.97
S.E.M. 1.39 1.29
Mental Health
Groups
N
Mean
S.D
df
t
Rural Urban
53 47
147.72 138.55
12.59 14.17
98
3.425**
**p < 0.01
Research question 2
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KHAN ET AL./ MENTAL HEALTH AMONG PROFESSIONAL
As it is shown in table 8, the non-professional students were compared with regards to scores on mental health with consideration of residence, because of (p=.0010.01), there is no significant difference between two groups on mental health.
Discussion As with any research, this study has limitations to consider. First, the population from which the research sample was drawn consisted of students from only one university. The results from this study, therefore, provide only a template on which to base further research and cannot be applied to the general populations of either students or faculty. The readers must remember that the makeup of the population of university students changes every year due to graduation, attrition and admission. In order for the recommendations based on the study to remain valid, the perceptions of this population must be re-evaluated after every few years to ensure that any changes within the population are reflected in appropriate changes in the interventions that are offered. If patterns within certain populations can be discovered through this continued evaluation, however, then it may be appropriate to establish general perceptions to provide a preliminary structure on which to frame future interventions. Based on the mental health (Professional and nonprofesional students) with consideration to course result shows significant difference between two groups that non-professional students have higher mean scores (M=143.41) of mental health in comparison to professional students' mean scores i.e. (M=137.97). As the professional students are supposed to pass through lot of competitions, hard work etc and even after qualifying are continuously under pressure for the fear of lack of grades, company placements and as per study by Dahlin et al. (2005) which indicated that there were significant differences in degree of pressure for fields of study with medical students having higher degrees of pressure than the general population. Hence the null hypothesis (H01) is rejected.
The prevalence of mental illness among professional students, including substance abuse, may differ from the general population in a few notable respects (Nadelson et al 1983). For example, professional students use alcohol, benzodiazepines, and prescription opiates at a higher rate than similar age-matched cohorts (Baldwin et al 1991). Entrance requirements for professional courses may select students with obsessive and narcissistic traits or an irrational fear of failure (Wold & Karlin, 1994). Subsequent crisis and increased stress may elicit maladaptive behaviors, possibly leading to depression. Based on professional students mental health with consideration to residence result shows no significant difference between two groups that urban students have higher mean scores (M=138.100) of mental health in comparison to rural students' mean scores i.e. (M=137.775). This finding is supported by the findings of Reddy and Nagarathanamma (1993). Their study revealed no difference between urban and rural students with regard to their mental health status. Mental Health status was measured by using Thorpe and Clark's Mental Health analysis questionnaire. Hence the null hypothesis (H02) is not rejected. Based on professional students mental health with consideration to gender result shows no significant difference between two groups that female students have higher mean scores (M=138.840) of mental health in comparison to male students' mean scores i.e. (M=137.100). This finding is similar to the findings of Reddy and Nagarathanamma (1993). Their study revealed that females and males in the sample slightly differed from each other with regard to their mental health status. Mental Health status was measured by using Thorpe and Clark's Mental Health analysis questionnaire. Hence the null hypothesis (H03) is not rejected. Based on nonprofessional students mental health with consideration to residence result shows significant difference between two groups that rural students have higher mean scores (M=147.7170) of mental health in comparison to urban students' mean scores i.e. (M=138.5532). This finding is supported by the findings of Connell, Irvine, and Rodney, (1982). Their study found that there were significant differences between rural and urban adolescents. This study found significant differences between rural and urban students on mental health and it may be due to the fact that the features of rural communities, that tend to evoke images of tranquility such as beautiful landscapes, privacy from neighbors, and harmony with nature, actually minimize mental health disorders among rural students. Thus the null hypothesis (H04) is rejected. Based on nonprofessional students mental health with consideration to gender result shows no significant difference between two groups that female students have higher mean scores (M=145.92) of mental health in comparison to male students' mean scores i.e. (M=140.90). This finding contradicts with the findings of Humprey, McCarthy, Popham, Charles, Garland, Gooch, Hornsby, Houghton and Muldoon (1998). Their study indicated that there was a significant difference in stress or GHQ-36 scores in terms of gender. Gender is one of the most important determinants of mental health (Ratner, et al., 1994). Research consistently shows that male students engage infewer health promoting behaviours and have less healthy life style
Indian Journal of Health and Wellbeing 2012, 3(1) 305-309 than those of women (Kandrak, et al., 1991; Lonnquist, et al., 1992; Rossi, 1992; Walker, et al., 1988). Collage male students specifically, engage in far fewer health-promoting behaviour then collage women do (Oleckno & Blacconiere, 1990), and the failure among males in general, to adopt health promoting behaviour increases their risk for poor mental health. Hence, the null hypothesis (H05) is accepted.
Conclusion These studies found that majority of students are mentally healthy. The main objective in this study was to look at the mental health of students in terms of demographic variables. In sum, the findings in this study were in line with findings of past research. This study does conclusively indicate and point to several factors that could influence mental health status among students. As a consequence, to prevent further problems that could result from poor mental health, various efforts should be taken. This is important because past research found that poor mental health status could result in negative effects such as feeling hopeless, suicidal behaviour (Kay, Li, Xiao, Nokkaew & Park, 2009), and lower GPA (Puskar & Bernardo, 2007). Furthermore, policy makers in field of mental health i.e. Ministry of Health should ensure that there is adequate and proper mental health services for those having indications of mental health problems. Finally, it is suggested that future researchers broaden the scope of this study by examining other factors that could influence the mental health status among students'. In so doing, this would result a better understanding of mental health among professionalnonprofessional students' in the future.
References Abdulghani, H. M. (2008). Stress and Depression among Medical Students: A Cross Sectional Study at a Medical college in Saudi Arabia. Pakistan Journal of Medical Sciences, 24(1), 12-17. Baldwin, D. C., Hughes, P. H., Conrad, S. E., Storr, C. L., & Sheehan, D. V. (1991). Substance use among senior medical students: a survey of 23 medical schools. Journal of the American Medical Association, 265, 2074-2078. Chandrashekhar, T. S., Pathiyil, R. S., Binu, VS., Mukhopadhyay, C., Ray, B., & Ritesh., G. M. (2007). Psychological morbidity, sources of stress and coping strategies among undergraduate medical students of Nepal. BioMed Central Medical Education, 7, 26. Collins, I. P., & Paykel, E. S. (2000). Suicide among Cambridge university students 19701996. Social Psychiatry and Psychiatric Epidemiology, 35, 128-132. Connell, H. M., Irvine, L., & Rodney, J. (1982). The prevalence of psychiatric disorder in rural school children. Australia New Zealand Journal of Psychiatry, 16, 43-46. Dahlin, M., Joneberg, N. & Runeson B. (2005). Stress and Depression among Medical Students: a Cross-Sectional Study. Medical Education, 39, 594-604. Fisher, S.. & Hood, B. (1988). The stress of transition to university: a longitudinal study of psychological disturbance, absent-mindedness and vulnerability to homesickness. British Journal of Psychology, 78, 425-441. Grant, A. (2002). Identifying students' concerns: taking a whole institutional approach. In N. Stanley & J. Manthorpe (Eds.), Student Mental Health Needs: Problems and Responses. London: Jessica Kingsley. Hawton, K., Haigh, R., Simkin, S., et al/ (1995b). Attempted suicide in Oxford University students, 19761990. Psychological Medicine, 25, 179-188. Hawton, K., Simkin, S., Fagg, J., et al/ (1995a). Suicide in Oxford university students 1976-1990. British Journal of Psychiatry, 166, 44-50. Helmers, K. F., Danoff, D., Steiner, Y., et al (1997). Stress and depressed mood in medical students, law students and graduate students at McGill University. Academic Medicine, 72, 708-714. Hong, S. M., Faedda, S., & Zacharia, M. (1993). Are university students more depressed than non- university students? Psychological Reports, 73, 991-994. Humphrey, R., McCharthy, P., Popham, F., Charles, Z., Garland, M., Gooch, S., Hornsby, K., Houghton, C., & Muldoon, C. (1998). Stress and the Contemporary Student. Higher Education Quarterly, 52(2), 221-242. Hyun, & Jenny, K. (2006). Graduate Student Mental Health: Needs Assessment and Utilization of Counseling Services. Journal of College Student Development, 47, 247- 266. Jagdish, A., & Srivastva, A. K., (1995). Mental Health Inventory, Manovaigyanik Prikashan Sansthan, Varanasi. Kandrack, M., Grant, K. R., & Segall, A. (1991). Gender differences in health related
309
behaviour: Some unanswered questions. Social Science Medicine. 32, 579-590. Kartikeyan, S. K., Chaturvedi, R. M., & Bhalerao, V. R. (1992). Role of the family in drug abuse. Journal of Postgraduate Medicine, 38, 5-7. Kay, N., Li, K., Xiou, X., Nokkaew, N. & Park, BH. (2009). Hopelessness and Suicidal Behaviour among Chinese, Thai and Korean College Students and Predictive effects on the World Health Organization's WHOQOL-BREF. International Electronic journal of Health Education, 12, 16-32. Leicester University (2002). Student Psychological Health Project. http://www.le.ac.uk/edsc/sphp. Lonnquist, L. E., Weiss, G. L., & Larsen, D. L. (1992). Health value and gender in predicting health protective behavior. Women Health. 19(2/3), 69-85. Mkize, L. P., et al (1998). Prevalence of depression in a university population. Curationis, 21, 32-37. Mohan, D., Chopra, A., & Sethi, H. (2002). Incidence estimates of substance use disorders in a cohort from Delhi, India. Indian Journal of Medical Research, 115, 128-135. Nadelson, C. C., Notman, M. T., & Preven, D. W. (1983). Medical student stress, adaptation, and mental health. In: Scheiber SC, Doyle BB, eds. The Impaired Physician. New York, NY: Plenum Book Co. 75-93. Niemi, T., & Lonnqvist, J. (1993). Suicides among university students in Finland. Journal of American College Health, 42, 64-66. Oleckno, W. A., & Blacconiere, M. J. (1990). Wellness of college students and differences by gender, race, and class standing. College Students Journal, 24(4), 421-429. O'Mahony, P. & O'Brien, S. (1980). Demographic and social characteristics of university students attending a psychiatrist. British Journal of Psychiatry, 137, 547-550. Pickard, M., Bates, L., Dorian, M., et al (2000). Alcohol and drug use in second-year medical students at the University of Leeds. BioMed Central Medical Education, 34, 148-150. Prashant k. Nanda. (2008). Tha Indian News, May 2nd, 2008. Puskar, K. R. & Bernardo, L. M. (2007). Mental Health and Academic Achievements: Role of School Nurses. Journal for Specialists Pediatric Nursing, 12(4), 215-223. Ratner, P. A., Bottorff, J. L., Johnson, J. L., & Hayduk, L. A. (1994). The interaction effects of gender within the health promotion model. Research in Nursing & Health, 17, 341-350. Reddy, S. V., & Nagarathanamma B. (1993). Mental health status among rural and urban students: a comparative study. Journal of the Indian Academy of Applied Psychology. 19(1-2), 25-30. Roberts, R., Golding, J., Towell, T., et al. (1999). The effects of economic circumstances on British students 'mental health. Journal of American College Health, 48, 103-109. Rosal, M. C., Ockene, I. S., Ockene, J. K., et al. (1997). A longitudinal study of students' depression at one medical school. Academic Medicine, 72, 542-546. Rossi, J. S. (1992). Stages of change for 15 health risk behaviors in an HMO population. Presented at the Thirteenth Annual Scientific Sessions of the Society of Behavioral Medicine; New York. Rudd, M. D. (1989). The prevalence of suicidal ideation among college students. Suicide and Life- Threatening Behaviour, 19, 173-183. Schweitzer, R., Klayich, M., McClean, J., et al. (1995). Suicidal ideation and behaviours among students inAustralia. Australian & New Zealand Journal of Psychiatry, 29, 473-479. Silverman, M. M., Sloane, P., Raffel, F., et al. (1997). The Big Ten Student Suicide study: a 10-year study of suicides on Midwestern university campuses. Suicide and Life-Threatening Behaviour, 27, 285-303. Springett, N. R., Szulecka, & Lekarz, T. K. (1986). Faculty differences among undergraduates on arrival at university. British Journal of Medical Psychology, 79, 309-320. Surtees, P., & Miller, P. M. (1990). The Interval General Health Questionnaire. British Journal of Psychiatry, 157, 679-686. Surtees, P., Wainwright, N., & Pharoah, P. (2000). Student Mental Health, Use of Services and Academic Attainment. Report to the Review Committee of the University of Cambridge Counselling Service. Tyrell, J. (1992). Sources of stress among psychology undergraduates. Irish Journal of Psychology, 13, 184-192. Uner S., Ozcebe H., Telatar T.G., & Tezcan S. (2008). Assessment of Mental Health of University Students with GHQ-12. Turk J Med Sci, 38(5), 437-446. Walker, S. N., Volkan, K., Sechrist, K. R., & Pender, N. J. (1988). Health promoting lifestyles of older adults: Comparisons with young and middle-aged adults, correlates and patterns. Advances in Nursing Science. 11, 76-90. Watanabe, N. (1999). A survey of mental health of university students in Japan. International Medical Journal, 6, 175-179. Webb, E., Ashton, C. H., Kelly, P., et al. (1996). Alcohol and drug use in UK university students. Lancet, 348, 922-925. Willkinson, C. B., & O'Connor, W. A. (1982). Human ecology and mental illness. American journal of psychiatry, 8, 985-990. Wold, P., & Karlin, S. (1994). Psychiatric issues in physician impairment. Rhode Island Medical Journal. 77, 351-353. Yen, C. F., Hsu, C. C., Liu, S. C., Huang, C. F., Ko, C. H., Yen, J. Y., & Cheng, C. P. (2006). Relationships among Mental Health Status, Social Context, and Demographic Characteristics in Taiwanese Aboriginal Adolescents: A Structural Equation Model. Psychiatry and Clinical Neurosciences, 60, 575-583. Zaid, Z. A., Chan, S. C., & Ho J. J. (2007). Emotional Disorders among Medical Students in a Malaysian Private Medical School. Singapore Medical Journal, 48(10), 895-899.
