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Depression among university students in Kenya: Prevalence and

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DOI: 10.1016/j.jad.2014.04.070

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 Journal of Affective Disorders 165 (2014) 120–125

Contents lists available at ScienceDirect

Journal of Affective Disorders

journal homepage: www.elsevier.com/locate/jad

Research report

Depression among university students in Kenya: Prevalence and

sociodemographic correlates
Caleb J. Othieno a,n, Roselyne O. Okoth b, Karl Peltzer c,d,e, Supa Pengpid c,e, Lucas O. Malla f
a
Department of Psychiatry, University of Nairobi, P.O. Box 19676, 00202 Nairobi, Kenya
b
Department of Psychiatry University of Nairobi, Kenya
c
ASEAN Institute for Health Development, Mahidol University, Thailand
d
Human Sciences Research Council, Pretoria, South Africa
e
University of Limpopo, Turfloop Campus, South Africa
f
Kenya Medical Research Institute, Wellcome Trust, Nairobi, Kenya

art ic l e i nf o a b s t r a c t

Article history: Background: Depression is a common cause of morbidity but prevalence levels among Kenyan university
Received 10 April 2014 students are poorly understood. A better understanding of depression and its correlates is essential in
Accepted 25 April 2014 planning for appropriate interventions in this population group.
Available online 4 May 2014
Method: A random sample of 923 University of Nairobi students (525 male and 365 female) were
Key words: interviewed using a questionnaire to record sociodemographic variables. Depressive symptoms were
Students measured using Centre for Epidemiological Studies Short Depression Scale (CES – D 10).
Depression Results: The mean age was 23 (s.d. 4.0). Using a cut-off point of 10, the overall prevalence of moderate
Risk factors depressive symptoms was 35.7% (33.5% males and 39.0% females) and severe depression was 5.6% (5.3%
males and 5.1% female). Depressive illness was significantly more common among the first year students,
those who were married; those who were economically disadvantaged and those living off campus.
Other variables significantly related to higher depression levels included year of study, academic
performance, religion and college attended. Logistic regression showed that those students who used
tobacco, engaged in binge drinking and those who had an older age were more likely to be depressed. No
difference was noted with respect to gender.
Limitations: This was a cross sectional study relying on self report of symptoms and could therefore be
inaccurate. Although the study was conducted in the largest university in the country that admits
students from diverse backgrounds in the country there could still be regional differences in other local
universities.
Conclusion: Depression occurs in a significant number of students. Appropriate interventions should be
set up in higher institutions of learning to detect and treat these disorders paying particular attention to
those at risk.
& 2014 Elsevier B.V. All rights reserved.

1. Introduction general population. There is also evidence that depression can

Although depression is a common health problem and has been
shown to have detrimental effects on the students' studies few
studies in Kenya have addressed the mental health problems in
Kenyan universities. It is estimated that mental, neurological and
substance use disorders account for 13% of the total global burden
of disease (Ustun et al., 2004; Kessler, et al., 2003; Reddy, 2010;
Ferrari et al., 2013) and that depression alone accounts for over
40% of the mental disabilities. Moreover, people with depression
have a 40–60% chance of dying prematurely compared to the
n
Corresponding author.
E-mail address: cjothieno@uonbi.ac.ke (C.J. Othieno).
predispose people to various diseases such as diabetes, myocardial
infarction, HIV infection and death from suicide (Rubin et al.,
2009; Nduna et al., 2010). The prevalence of depression varies
widely across cultures with developed countries recording higher
rates than those of developing countries (Kessler and Bromet,
2013). However, the associated risk factors are largely the same
including role transitions and low work performance. Given, that
effective treatments for depression is now available, it is unfortu-
nate that case identification and treatment remain low. Hence
there is need for stepping up the awareness campaigns and early
evidence based intervention (World Health Organization, 2013).
Prevalence rates of depression among students vary widely,
perhaps as a reflection of the different methodologies and
instruments used. For example, using the Center for Epidemiologic

http://dx.doi.org/10.1016/j.jad.2014.04.070
0165-0327/& 2014 Elsevier B.V. All rights reserved.
 C.J. Othieno et al. / Journal of Affective Disorders 165 (2014) 120–125
Studies Depression Scale a study among 26 third year medical
students in Hawaii found a prevalence rate of 59.1% (Thompson et
al., 2010). An earlier study using the same instrument but invol-
ving multiple sites and a sample of more than 2000 medical
students found that 12% had probable major depression and 9.2%
had probable mild-moderate depression (Goebert et al., 2009).
Among Egyptian university students a survey using a self-
report Arabic language version of Hamilton Rating Scale found that
71% of the students exceeded the cut-off point for mild depression
and 37.6 had moderate depression (Ibrahim et al., 2012a, 2012b).
In Ethiopia symptoms of depression were recorded in 23.6% of
1176 college students using the Patient Health Questionnaire
(PHQ-9) (Terasaki et al., 2009). In contrast, much lower levels of
depression were recorded by Adewuya et al. (2006) in Nigeria with
only 8.3% of the students meeting the criteria for depression.
A study of undergraduate students at Makerere University in
Uganda using the Beck Depression Inventory showed that newly
enrolled students joining the medicine course were less likely to
have depressive symptoms compared to those students joining
other general courses – 4% compared to 16.2% respectively (Ovuga
et al., 2006). The authors of the same study noted that the average
rate of depression in the university population was similar to that
in the secondary schools in the same country but lower compared
to rates reported from other countries such as Turkey (32.1%)
(Bostanci et al., 2005).
The few studies on depression among university students in
Kenya do not explicitly measure depressive levels. For example,
Ndetei (1987) while investigating the association between anxiety
and depression among medical and paramedical students focussed
only on the symptoms but not the actual diagnosis hence the level
of depression is not stated in the study. Nevertheless the author
notes that 43% of the students felt a need to seek help for their
symptoms (both anxiety and depression) (Ndetei, 1987). Similarly,
Kasomo (2013) despite using the BDI did not state the levels of
depression in his sample. The focus of that study was to investi-
gate the relationship between loneliness and depression. A study
done on paramedical trainees to determine the effectiveness of
psychoeducation recorded very high levels of depression among
the participants (minimal 20.6%, mild 12.6%, moderate 18.4%, and
severe 48.5%) (Muriungi and Ndetei, 2013).
1.1. Objectives
We aimed to assess the prevalence of depressive symptoms and
to describe the sociodemographic determinants among a sample
of University of Nairobi students.
2. Method
We obtained permission from the Kenyatta National Hospital
and the University of Nairobi Ethics and Research Committee.
University of Nairobi is the largest and oldest of the twenty-two
public universities in Kenya. It has six consists of six colleges:
College of Architecture and Engineering (Main Campus), College of
Humanities and Social Sciences (Main Campus), College of Health
Sciences (Kenyatta National Hospital), College of Education and
External Studies (Kikuyu Campus and Kenya Science Campus),
College of Agriculture and Veterinary Sciences (Upper Kabete
Campus), and the College of Biological and Physical Sciences
(Chiromo Campus). The Research targeted University of Nairobi
students. The total student population in the University of Nairobi
is 36,991 (22,734 male and 14,257 females) (University of Nairobi,
2013).
Each of the 6 colleges participated in the study in order to
achieve representativeness and to increase statistical power.
121
Proportional stratified sampling was used to ensure that the
colleges forming different student subpopulations were repre-
sented in the sample in same proportions as the population. The
sampling process proceeded in two steps. In the first stage, the
number of participants to be obtained from each college was
determined using calculations based on probability proportional
to size. Next, a sampling frame containing a list of all students was
compiled from each college. In the second step, a simple random
sample was selected within each college using computer gener-
ated random numbers and the available sampling frame.
We administered a purpose designed questionnaire to record
sociodemographic data including age, sex year of study, socio-
economic status and performance in studies. The Centre for
Epidemiological Studies Short Depression Scale (CES – D 10)
consists of 10 questions. It has been used in other parts of sub-
Saharan Africa. We used a cut-off point of 10. Those who had a
score of 11 and above were considered to probable depression
with scores between 11–20 and scores above 20 repre-
senting mild-moderate depression and severe depression respec-
tively (Andreasen et al., 1994; Mulrow et al., 1995; Kilbourne
et al., 2002).
2.1. Binge drinking was assessed with one question…
Traumatic experiences: participants were asked if they had
ever been hit by a sex partner, forced to have sex, physically
abused as a child, sexually abused as a child and diagnosed as
HIV positive. Traumatic experience items were coded as yes/no
(Sikkema et al., 2011).
For posttraumatic stress disorder we asked seven questions
related to the core features of the disorder: reexperiencing,
hyperarousal and avoidance. PTSD was considered present if the
subject answered yes to more than 4 out of the 7 questions
(Kimerling et al., 2006; Sikkema et al., 2011)
3. Results
We obtained data from 923 students (525 male and 365
female). The mean age was 23 years (s.d. 4.0). Majority (96.1%) of
the students were Black Africans and two thirds residing within
the campus. Ninety percent were single. Significantly more
females (15%) were married compared to the males (approxi-
mately 10%). Nearly half (48%) of the students rated themselves as
coming from families that were either not well off or were poor.
More males (73.7%) resided within the campus compared to 60% of
the females. Female students were more likely to be found living
off campus either alone or with parents or guardians. Less than
one percent of the students recorded their academic performance
as not satisfactory (Table 1).
Overall 41.33% of the students scored above the cut off point of
10 on the CES-D 30 scale, with 35.71 having mild – moderate
symptoms and 5.62% having severe depressive symptoms. Pro-
portionately more females had depressive symptoms compared to
males but the difference was not statistically significant. The
difference between the prevalence of binge drinking (defined as
drinking of 4 or 5 drinks at a sitting) among the male and female
students was not statistically different. However tobacco use was
significantly more common among the male students (17.29%
versus 8.22%) (Table 2).
Although there were only 101 students in the sample who used
tobacco nearly all of them had some form of depression (mild-
moderate: 73.27% and severe: 10.89). Depression levels also varied
according to year of study. The highest levels were recorded
among students in the first year followed by those in the third
year. Depression levels were also significantly higher among
122 C.J. Othieno et al. / Journal of Affective Disorders 165 (2014) 120–125

Table 1
Characteristics of the University of Nairobi students' sample.

Variable Total Male Female P

N or M % or SD N or M % or SD N or M % or SD

All 923 525 365

Social demographic
Age
o20 200 23.39 122 24.11 78 22.35 0.079
20–24 515 60.23 311 61.46 204 58.45
25–29 84 9.82 49 9.68 35 10.03
30 & above 56 6.54 24 4.74 32 9.17

Year of study
First 185 21.17 128 25.40 56 15.60 0.018
Second 256 29.29 143 28.37 111 30.92
Third 195 22.31 107 21.23 85 23.68
Fourth 214 24.48 111 22.02 98 27.30
Fifth 23 2.63 14 2.78 9 2.51
Sixth 1 0.11 1 0.20 0 0.00

College
CAVS 66 7.17 41 7.69 25 6.70 0.013
CAE 149 16.18 101 18.95 45 12.06
CBPS 150 16.28 93 17.45 57 15.28
CEES 193 20.95 109 20.45 81 21.72
CHS 30 3.25 12 2.25 18 4.83
CHSS 333 36.16 177 33.21 147 39.41

Marital status
Married 90 9.96 35 6.67 54 14.79 0.0001
Single 813 90.03 490 93.33 311 85.21

Religion
Traditional religion 32 7.17 15 2.82 16 4.36 0.309
Christian protestant 487 16.18 298 56.12 185 50.41
Christian catholic 264 16.29 141 25.55 117 31.88
Hindu 11 20.96 5 0.94 6 1.63
Muslim 61 3.26 34 6.40 24 6.54
Buddhist 8 36.16 4 0.75 4 1.09
No religion 38 7.17 26 4.90 12 3.27
Other 12 16.18 8 1.51 3 0.82

Residence
On campus 616 67.99 387 73.71 219 60 o 0.0001
Off campus (on your own) 216 23.84 108 20.57 103 28.33
Off campus (with parents and guardians) 74 8.17 30 5.71 43 11.78

Family background
Wealthy 54 5.99 19 3.64 34 9.34 0.0001
Quite well off 415 46.01 232 44.04 173 47.53
Not very well off 363 40.24 219 41.95 140 38.46
Quite poor 70 7.76 52 9.96 17 4.67

Academic performance
Excellent 113 14.58 74 16.26 38 12.30 0.4131
Very good 336 43.35 186 40.88 144 46.00
Good 275 35.48 162 35.60 109 35.28
Satisfactory 45 5.81 29 6.37 16 5.18
Not satisfactory 6 0.77 4 0.88 2 0.65

Depression
No depression 501 58.67 297 61.11 196 55.84 0.2598
Moderate 305 35.71 163 33.54 137 39.03
Severe 48 5.62 26 5.35 18 5.13
Seriously hurt during past 12 months 255 29 200 28.5 53 30.01 0.420
Sexually abused as a child 51 5.95 22 4.44 29 8.38 0.0273
Physically abused as a child 80 9.32 39 7.86 40 11.56 0.0909
Involvement in a physical fight 119 13.18 83 15.99 10 8.94 0.027
PTSD 146 15.67 97 15.39 48 16.10 o 0.0001
Ever diagnosed with HIV 26 3.04 10 2.03 14 4.05 0.1296

Substance use
Binge drinking 122 38.85 79 39.70 41 36.94 0.7211
Tobacco use 101 13.5 74 17.29 25 8.22 0.0006

CAE: College of Architecture and Engineering; CBPS: College of Biological and Physical Sciences. CEES: College of Education and External Studies; CHS: College of Health
Sciences, CHSS: College of Humanities and Social Sciences; CAVS: College of Agriculture and Veterinary Sciences.

students from the college of Education and External Studies and of depression in contrast to the students who belonged to the
lowest in the College of Health Sciences. With regard to religion Christian protestant churches and the Hindu religion. Other factors
the Catholic and Muslim students had comparatively lower levels significantly related to depression were living off campus with
 C.J. Othieno et al. / Journal of Affective Disorders 165 (2014) 120–125 123

Table 2
Prevalence of depression among a sample of University of Nairobi students.

Variable Total Depression (mild-moderate) P Depression (severe) P

N or M % or SD N or M % or SD N or M % or SD

All 923 305 35.71 48 5.62

Social demographic
Age 23.01 4.03 23.43 3.66 22.65 3.21

Gender
Male 533 58.83 163 30.58 0.1333 26 4.88 0.2278
Female 373 41.17 137 36.73 18 4.83

Year of study
First 185 21.17 62 33.51 o 0.0001 13 7.03 0.0004
Second 256 29.29 84 32.81 10 3.91
Third 195 22.31 69 35.38 10 5.13
Fourth 214 24.29 72 33.64 10 4.63
Fifth 23 2.63 3 13.04 0 0.00
Sixth 1 0.11 0 0.00 0 0.00

College
CAVS 66 7.17 21 31.82 o 0.0001 4 6.06 o 0.0001
CAE 149 16.18 52 34.89 9 6.04
CBPS 150 16.29 46 30.67 7 4.66
CEES 193 20.96 78 40.41 5 2.59
CHS 30 3.26 4 13.33 0 0.00
CHSS 333 36.16 104 31.23 23 6.91

Marital status
Married 90 9.97 32 35.56 o 0.0001 4 4.44 o 0.0001
Single 813 90.03 266 32.72 42 5.17

Religion
Traditional religion 32 3.50 10 31.25 o 0.0001 2 6.25 o 0.0001
Christian protestant 487 53.34 176 36.14 23 4.72
Christian catholic 264 28.92 78 29.55 12 4.55
Hindu 11 1.20 4 36.36 0 0.00
Muslim 61 6.68 16 26.23 4 6.55
Buddhist 8 0.88 0 0.00 0 0.00
No religion 38 4.16 15 39.47 3 7.89
Other 12 1.31 3 25.00 4 33.33

Residence
On campus 616 67.99 200 32.46 o 0.0001 38 6.16 o 0.0001
Off campus (on your own) 216 23.84 69 31.94 4 1.85
Off campus (with parents and guardians) 74 8.17 28 37.84 4 5.41

Family background
Wealthy 54 5.99 12 22.22 o 0.0001 1 1.85 o 0.0001
Quite well off 415 46.01 133 32.05 10 2.41
Not very well off 363 40.24 116 31.95 32 8.82
Quite poor 70 7.76 36 51.43 4 5.71

Academic performance
Excellent 113 14.58 41 36.28 o 0.0001 6 5.31 o 0.0001
Very good 336 43.35 114 33.92 19 5.65
Good 275 35.48 78 28.36 15 5.45
Satisfactory 45 5.81 11 24.44 2 4.44
Not satisfactory 6 0.77 3 50.00 1 16.66

Alcohol use
Never used alcohol 509 57.91 151 29.66 0.0001 27 5.30 0.0001
Normal drinker 225 25.59 83 36.88 0.399 17 7.55 0.858
Binge drinking 122 38.85 42 34.42 0.0029 4 3.28 0.0707
Tobacco use 101 13.5 74 73.27 0.0001 11 10.89 0.0268
Ever diagnosed with HIV 26 3.04 15 57.69 o 0.0001 5 19.23 o 0.0001

parents or guardians, poor family background, poor academic
performance and tobacco use (Table 3).
4. Discussion
The findings indicate that depressive symptoms are common
and affect over 40% of the students. This rate is comparable to
figures from other studies (Goebert et al., 2009; Ibrahim et al.,
2012a, 2012b), but lower than the rates found in West African
students (Adewuya et al., 2006). The high rates of depression also
reflect those found in Kenyan secondary schools and higher
institutions of learning in Kenya (Khasakhala et al., 2012). Severe
depression was recorded in 5.6% (5.3% males and 5.1% female)
which is slightly higher than that reported in a large study among
Chinese students (Chen et al., 2013). In addition, we found that
depressive illness was significantly more common among the first
year students, those who were married; those who were econom-
ically disadvantaged and those living off campus. Other variables
significantly related to higher depression levels included year of
study, academic performance, religion and college attended.
Logistic regression showed that those students who used tobacco,
124 C.J. Othieno et al. / Journal of Affective Disorders 165 (2014) 120–125

Table 3
Logistic regression predicting depression.

Variable Crude odds ratio (95% CI) Adjusted odds ratio (95% CI)

Social demographic
Gender
Female 1.29 [0.99,1.70] 1.09[0.40,2.94]
Age 1.03[1,1.07]n 1.27[1.06,1.59]n

Year of study
Second 0.85[0.58,1.26] 0.47[0.09,2.24]
Third 1[0.66,1.51] 2.44[0.42,1.63]
Fourth 0.91[0.61,1.36] 0.69[0.12,4.2]
Fifth 0.22[0.05,0.67] 0.71[0.02,1.9]
Sixth – –

College
CAE 1.14[0.37,1] 0.18[0.0094,2.59]
CBPS 0.9[0.49,1.64] 0.31[0.02,4.76]
CEES 1.24[0.7,2.22] 0.34[0.02,5.46]
CHS 0.25[0.07,0.74] –
CHSS 1.01[0.59,1.76] –

Marital status
Single 0.91[0.59,1.44] –

Religion
Christian protestant 1.15[0.56,2.48] –
Christian catholic 0.86[0.41,1.89] –
Hindu 0.95[0.21,3.87] –
Muslim 0.81[0.33,2.01] –
Buddhist – –
No religion 1.50[0.58,3.97] –
Other 2.33[0.61,9.53] –

Residence
Off campus (on your own) 0.81[0.58,1.12] 0.36[0.095,1.27]
Off campus (with parents and guardians) 1.21[0.74,1.97] 0.17[0.008,1.48]

Family background
Quite well off 1.66[0.88,3.31] 5.03[0.54,69]
Not very well off 2.17[1.15,4.34]n 3.38[0.35,45.8]
Quite poor 4.21[1.96,9.46]n 1.14[0.025,42.9]

Academic performance
Very good 0.92[0.49,1.03] 1.34[0.28,6.55]
Good 0.72[0.60,1.42] 1.46[0.29,8.16]
Satisfactory 0.57[0.26,1.18] 2.9[0.15,26.4]
Not satisfactory 2.81[0.53,20.86] –

Alcohol use
Binge drinking (4 or 5 drinks at a sitting) 1.31[0.83,2.09] 3.86[1.27,12.9]n

Tobacco use 1.65 [1.08,2.52]n 1.06[0.25,4.62]

Sexual behavior
Number of partners past 12 months 1.05[0.97,1.15] 0.83[0.58,1.19]

Use of condom with partner

Less than half of the time 1.50[0.90,2.48] 1.68[0.28,10.7]
Half of the time 1.54[0.92,2.59] 1.21[0.16,9.3]
More than half of the time 1.64[0.96,2.79] 0.98[0.14,6.68]
Every time 1.04[0.72,1.49] 1.49[0.37,6.48]
Ever diagnosed with STI 1.93[1.23,3.06]n 2.9[1.73,21.3]n
Ever diagnosed with HIV 5.66[2.38,15.63]n 4.34[2.11,11.17]n
Ever made someone pregnant/been pregnant before 19 years 1.44[0.41,5.28]n 1.20[1.01,5.66]n
Ever been hit by a sexual partner 3.25[1.92,5.66]n 5.02[2.11,9.63]n
Ever been forced to have sex 4.59[2.87,7.53]n 3.02[1.79,8.70]n
Physically abused as a child 1.76[1.11,2.81]n 5.56[3.44,16.2]n
Sexually abused as a child 2.39[1.35,4.31]n 4.11[1.07,13.0]n
PTSD 2.53[1.22,3.5]n 3.99[1.13,9.5]n

Injury
I was attacked, assaulted, or abused by someone 3.52[1.20,11.59]n 5.02[2.4,17.33]n

n
Denotes significance at 5%.

engaged in binge drinking and those who had an older age were
more likely to be depressed. Some of these findings are similar to
that of other studies among Kenyan adolescents that found high
rates of comorbidity with substance use (Khasakhala et al., 2013).
However unlike other studies from Kenya that recorded higher
prevalence of depression among females we did not find any
difference with respect to gender. Chen et al. (2013) also did not
find any differences related to gender. Other similarities with the
Chinese study are that older students, those who were economic-
ally disadvantaged and those who were dissatisfied with their
studies were more likely to be depressed. Economic disadvantage
was also shown to be an important determinant of depression in
 C.J. Othieno et al. / Journal of Affective Disorders 165 (2014) 120–125
American college students (Eisenberg et al., 2007). Unlike some
studies we did not find high prevalence of depression among
medical students. The highest prevalence was recorded among the
students from the College of education and External Studies.
This is probably linked to the fact that most of them would be
older and larger proportion residing outside campus – both factors
were linked to depression in this study.
5. Limitations
This was a cross sectional study relying on self report of symp-
toms and could therefore be inaccurate. Although the study was
conducted in the largest university in the country that admits
students from diverse backgrounds in the country there could still
be regional differences in other local universities.
6. Conclusion
The study shows that depression affects a large number of
students and identifies groups of students who may be more at
risk of developing depressive illness, such as those in the first year
of study or those who live outside the campus and students from
poor family backgrounds. More studies are needed to explore the
risks and how they can be minimized. Appropriate interventions
could be put in place using such information.
Role of funding source
Self funded.
Conflict of interest
None.
Acknowledgment
To the students who participated in the study, the administration of the
University of Nairobi, especially Registrar Academics for facilitating the study;
Cherryl Ojjerro, Rachel Maina, Eston Nyakiya, Julius Oduor and Amelia Awoko who
assisted with the data collection.
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