Factors Affecting Clinical Depression and its Effect on Academic Performance among Undergraduates: A Literature Review

Madhura Perera^*, Jacquline Tham and Ferdous Azam
^*Correspondence: Madhura Perera, Graduate School of Management, Management & Science University, University Drive, Off Persiaran Olahraga, 40100 Shah Alam, Selangor, Malaysia, Tel: + 0763158200, Email:

Keywords

Clinical depression • Undergraduates • Academic performance • Factors • Empirical review • Mental health support

Introduction

Background and rationale for the review

Depression is a serious mental health concern that has now become a leading mental health disorder affecting at least 280 million people worldwide (World Health Organization [1]. Depression is becoming a key component in the overall cost of diseases across the globe adding more pressure and burden on the world health care budgets (World Health Organization [2]. As literature reveals, depression generally hinders one’s ability to function properly in many ways that include the interactions a person would have and develop with his/her own self, family members, educational and social contacts, occupational and in similar and related areas leading to the recurrent thoughts of hopelessness, suicides and finally death (World Health Organization [2].

As per the Diagnostics and Statistical Manual of Mental Disorders (DSM- 5) if a person experience lack of interest or lack of pleasure as usual in almost all activities for a period of two weeks or more it is considered as a depressive episode in medical terms whereas it includes issues with sleeping, appetite, energy, concentrating and psychomotor agitation as well as recurrent thought of death or suicide [3]. As stated by Morin [4]. The cause of depression is to be more explored and one’s state of brain neurology, certain levels of hormones, impacts from genetics, certain life experiences and physical health are to act an important role in this regard. Depression not only have impact on one’s health but also on the total state of a nation causing issues on individuals, families, organizations, and society leading to high levels of unemployment. World Health Organization [2]. The total economic burden globally caused due to depression is estimated to be around $210.5 billion per year while forty eight percent to fifty percent of the costs are being proportioning to the absenteeism and loss productivity at work due to depression [5].

Depression will also lead to suicides and suicides caused by depression is an alarming factor specially when it comes to the age group of 15 to 25 years old (World Health Organization [1]. Among this specific age group, suicide have been identified to be the fourth main reason of death taking almost 46,000 lives of the young adults across the world (UNICEF, 2021; World Health Organization [1]. Out of these total young adults in between the age of fifteen to twenty-five, majority comprises with young adults who undertake college or university education [6]. They also resemble the most predominating cohort of individuals who usually experience and suffer from different mental health concern such as depression leading towards self-harm and suicides at the end [7]

The prevalence of depression among undergraduates is relatively higher when compared to the public [8]. According to Mohammad M [9], students at universities are more likely to experience mental health issues mostly in common to de-pression and are to have long lasting impacts on their lives. Depression impacts on all aspects of one’s life mainly including effecting on the achievement at school, work life productivity, relationships having with family members and one’s close friends and on the ability to contribute to the interaction with the community (World Health Organization [2]. As per Johansson F, et al. [10] nearly sixty percent of university students would leave their universities in short run without fully completing their enrolled degree programs because of depression. Though, a considerable amount of stress is required to encourage and motivate students to reach their academic goals, excessive levels of stress caused through depression can result in loss of attention, decreased levels of problem solving and decision making leading to self-harm and suicidal intentions [11]. With the COVID-19 pandemic, the statistics on the global mental health disorders have surged drastically from 2019 to 2020 where around 76.2 million of new cases of depression have reported all over the world while specially in relation to the female population in the world where it is stated that around 35 million women have reported to be depressed than usual during the nationwide curfew and lockdowns imposed in most of the cities (Institute for Health Metrics and Evaluation [12]. It is found that younger people between the age of 20 to 24 had recorded a total of additional 1,118 cases of depression per 100,000 [13] (Tables 1-4).

As a result of major depression or clinical depression during undergraduate time it can create a wider array of reciprocating problems. In this way, depression can badly disturb the future of a student both professionally and personally [14]. When an individual is depressed in an achievement driven environment such as in higher education, the low grades may lead towards considering themselves as failures with relatively poor levels of self-esteem that can negatively impact their present and future. When clinically driven depression is untreated and left alone this untreated depression can lead towards more serious present and future problems.

To address and treat depression in this way, better understanding the factors affecting of depression and having an understanding on how depression can impact on academic achievement matters. Yet, there is still a limited number of empirical studies conducted both globally and locally on this domain of factors affecting depression and how depression can impact on academic achievement and there is a dearth of literature specially relating to the undergraduates in Sri Lanka. As per Zada S, et al. [7], Islam S, et al. [15] and Amarasuriya SD, et al. [16] there is a considerable absence of previous empirical studies examining the factors affecting depression among university undergraduates where only a limited number of empirical studies have been done during the recent years assessing the clinical depression in an academic setting.

Literature Review

As per such limitedly available literature, in 2006 it was identified that Sri Lankan undergraduates recorded highest depression rates in that period in the world Perera B, et al. [17] where young female students are identified as the highest risk group by then Torabi MR and Perera B [18]. Moreover the findings of Liyanage reveals that the university students in Sri Lanka had a higher level of psychological distress where the academic pressure was reported to be the main contributing factor on this. In a 2013 survey, it was identified that around 7.4% of Sri Lankans suffered from major depression while as estimated by the World Health Organization in 2015, it has been identified that there had been at least 802,321 cases of depression been reported in Sri Lanka [19]. It is estimated that approximately 800,000 amounting to 4.1% of the population suffer from depression [20]. There has been an increase of 9.2% in the number of young adults who have sought medical advice for behavioral and emotional disorders in Sri Lanka [19]. Also, in the same study they have stated that suicides caused due to depression has been high making Sri Lanka one of the countries with the highest suicide rates in the world [17]. Fernando N, et al. [21] State, depression was the fifth leading cause of years lived with disability in Sri Lanka as published in the Global Burden of Disease study in 2015. In relation to this disease burden, the total number of years lived with such disability due to depression has increased over the past in the Sri Lankan context and during the year 2015 itself Sri Lanka has lost nearly 103,113 of life years because of depression [22]. Also, in comparison to other Districts, Colombo District records the highest number of years lived with such disability due to depression.

Discussion

The limitedly available empirical studies have examined into depression in quanti-tative methods such as in Zada S, et al. [7] Islam S, et al. [15] Kodagoda ASK and Meegoda MKDL [23] Olum R, et al. [24,25] Amarasuriya SD, et al. [26] Khurshid S, et al. [27] and Amarasuriya SD, et al. [16] Lack of in-depth and narratively driven understanding on factors affecting depression in a higher educational environment has currently resulted in limited findings in this area making it necessary for more research to be conducted in this regard. This empirical gap in this area of focus has also led towards widening of the knowledge gap in this domain of factors affecting clinical depression and its effects on the academic performance in an academic setting speially in relation to the Sri Lankan undergraduates. Due to this considerable knowledge gap in this area, it demands more immediate and serious attention been invested over this concern. More knowledge in factors affecting clinical depression and its effects on the academic performance is needed to be discovered and developed to better understand this global epidemic of depression which adds up to the global burden of diseases as highlighted by the World Health Organization [1]. Therefore, in this paper, it has aimed to summarize the past recent empirical literature on the domains of factors affecting clinical depression and its effects on academic performance among undergraduates in Sri Lanka to facilitate the future research in this area. As there is a dearth of compiled literature looking into both the factors affecting depression and impact of depression on academic achievement, this paper will enable to compile the widely spread empirical literature from multiple empirical studies into a one while providing a summarized understanding on the filed for future researchers. Therefore, this research paper has been presented under six sub parts that initially contain the overall summarized literature related to clinical depression among undergraduates and in relation to the academic achievement among undergraduates. Then the past empirical literature on factors affecting clinical depression and impact of clinical depression among academic achievement is detailed and in the next proceeding section, the summary of findings from the empirical studies related to factors affecting clinical depression and the summary of findings from the empirical studies related to impact of clinical depression among academic achievement is presented. Finally, the overall conclusion is presented looking into the overall empirical literature.

Clinical depression among undergraduates

As per Schwartz KD, et al. [28] mental health among students have been a controversial topic of discussion over the past which is not yet fully detailed or analyzed. Historical literature suggests that many factors during one’s undergraduate life can lead towards depression, yet most factors are yet unexplored [29]. Depression among undergraduates can lead towards poor academic achievement, substance abuse, risky sexual behaviors, poor relationships, mood swings and finally towards suicides [11].

Most students who suffer from depression does not gain access to right treatment on time and this reluctance is evolved due to the social stigma that abides on depression [26]. In a survey conducted in Boston University in 2020 revealed that almost 33,000 students were diagnosed of major depressive symptoms while another 83% stated that their mental health has been impacted adversely from their academic achievement within the past (Boston University, 2021). Depression among undergraduates can cause severe repercussions on their present and future lives while causing de-creasing levels of interest on studies, social interactions and on own life [29] The published literature on depression among undergraduates is limited and it is stated that individuals with depression will showcase poor psychological health, higher risks of relapses and increased tendency of self-harm and suicides and this is more severe with the young adults [11].

The current pandemic of COVID-19 has made many impacts on the behaviours of the college students across the world where they are now struggling with more and more mental health problems than the early years leading towards depression resulting in suicidal intentions [30] with the sudden closure of campuses and con-version of offline classes to online, more pressure has aroused among student communities creating a stressful situation leading to depression. In a survey conducted by the Centre for Disease Control and Prevention in 2020 on the impact of the COVID-19 pandemic on mental health have stated that the young adults between the ages of 18 to 24 were recorded to have suicidal intentions due to depression [31].

In a survey conducted by the Dartmouth College reveals that the effects of the pandemic have extended beyond the physical health and has even impacted on the future of people in isolation and with limited social interactions where students have been marked as a high-risk group in this regard [32] as per another recent survey conducted it is found that around 23% of students experience frequent depressive symptoms during the pandemic period which is relatively higher to the initial rate of 19% prior the pandemic period [33] As per the report presented by the University Commissions (2021) it is stated that the first year students at universities are more open to suffer from depression more than they were used to prior the COVID-19 pandemic as the data reveals, 40% of students have reported to be depressed during the pandemic compared to 18.1% which was prior the pandemic [34].

Academic achievement among undergraduates

Academic achievement and graduation rates have been a main concern for higher education institutions over the years [35].

As per Priyadarshana AJM and Kumari HGMD [36] at present there is a gap between the government expenditure and academic achievement which shows fallen standards of education both globally and locally. Though there are higher levels of student enrolment to be seen for undergraduate pro-grams, the students who successfully complete and graduate at the end showcases a declining trend over the past [37] whereas when there is a failure in achieving good academic achievement it can lead towards less return on government investment on education while impacting negative influence on student future and the progress of a nation [38]. that signals the importance and necessity of identifying the factors that impact on academic achievement of the undergraduates.

Better academic achievement is a better state of performance that is mostly over-looked with relation to good achievement at examinations or at tests and is mostly related with the achievement of a higher-grade point average (GPA) in studies Steinmayr R, et al. [39]. As per Islam A and Tasnim S [40] providing evidence for successfulness to the social, government and international higher educational pillars are a main challenge faced by most universities and in terms of such ensuring good academic achievement among its undergraduates will become a key consideration for action. In most parts of the world, rate of graduated students with good academic achievement is considered as an evaluation mechanism for university quality which also have impact on the societal progress at the end [41].

As stated by Gopal R, et al. [42]. Understanding the factors that impact on the academic achievement of such undergraduates is a timely necessity for policy development and educational revamps. As discovered in the literature survey conducted by Islam A and Tasnim S [40] the causes behind the student academic achievement include gender, level of family income, social environment, place of living, hours of studying per day, and mental and physical health. A similar view is presented by Ebele UF and Olofu PA [43] where the environment at home, study habits, skills on learning and interaction with academic concerns are to impact on one’s academic achievement and is subjected to be changed with the neuropsychological conditions of the person [43].

The student achievement is influenced by the process of teaching and learning, influence from the family and peers, facilities and infrastructure at university, and financial capabilities of the students and is mainly impact from the health of students [35]. Better academic achievement helps undergraduates to complete their studies on time and meet the graduation without delays whereas students with poor academic achievement will gain less cumulative Grade Point Average (GPA) and result in missing graduation on time [44]. In their study Priyadarshana AJM and Kumari HGMD [36] state that internship period can also influence on the academic performance of students yet subjected to their psychological and physical wellbeing during such period and also identifies proficiency in English, lecture attendance and parent education also as factors of influence in Sri Lankan context.

Factors affecting clinical depression

When analyzing the past empirical literature related to factors affecting depression only a limited studies are available to refer. Therefore, in this section it aims to summarize these limited past studies that have examined the various factors that affect depression.

In 2020 Bhattarai D, et al. [45] have examined on what factors are associated towards the prevalence of depression among the schooling adolescents at the Pokhara Metropolitan in Nepal participating 312 high school students. In their findings it was identified that majority of the study participants were experiencing higher levels of depression. Further it was also identified that level of social support, self-esteem and help seeking behaviours had a significant association with the mental wellbeing and the state of depression among the students [45]

In another study conducted in 2020 by Islam S, et al. [15] the researchers have explored into the prevalence and the factors that have an association towards depression among the first-year undergraduates in Bangladesh. Hereby they have examined 400 first year undergraduates where it had been found that there was a higher level of depressive symptoms among the examined undergraduate sample [15]. Yet, the findings state that there was no gender-based difference in terms of the prevalence of depression. Also, the researchers have identified that poor sleep quality, lack of physical exercises and excessive internet use can lead towards higher levels of depression among undergraduates [15].

In a study conducted among the nursing students in Cameroon of Central Africa by the researchers [46] have explored the determinant factors that cause depression among the identified study sample. Hereby a total of 447 nursing students have been examined. The findings of this study have showcased that there was higher levels of depression among these nursing students and recent life changing crisis was recorded to have higher level of impact on their level of depression while it was also found that first year nursing undergraduates were relatively more depressed than students from senior years [46]

Mahees MTM [47]. Also have research into the prevalence of stress with relation to the undergraduates at the University of Colombo in Sri Lanka. Through this study, the re-searcher has aimed on examining the academic, personal, socio-cultural, and economic factors that lead towards stress among the students in Sri Lankan universities. Hereby the researcher has used qualitative study design with twenty semi structured interviews and four focus groups and as per the findings derived from this study, it is stated that higher academic workload, hardships with financials, personal relationship problems, issues with family background, ragging at universities, student politics, lack of hostel infrastructure, pressure from external social and cultural parties lead towards higher stress levels among undergraduates [47].

In 2020 in another study, Ahmed G, et al. [48] have examined on what are the factors that leads towards depression among the undergraduates at Jimma University of Ethiopia in East Africa. This study has taken a sample of 556 students while socioeconomic characteristics and the depression scores of the study participants have been taken into derive the study findings. As per the findings it had been identified that there is a high level of depression scores among the undergraduate students [48]. The researchers also found that, higher levels of depression had caused in relation to various factors that included the past violence by a sexual partner, sexual conduct after alcohol consumption, emotional abuse during childhood, having mentally ill family members in main while having more pocket money and promoted academic performance was also related with depression [48].

The researchers Ramón-Arbués E, et al. [49] also have explored into depression and its related factors with relation to the students at San Jorge University in Spain in 2020. In this study, 1074 college students have been assessed and it had been found that there were higher rates of depression among the study participants. The research findings have revealed that depression among these undergraduates is triggered by various factors that include, excessive internet use, drinking alcohol, smoking, lack of self-esteem and insomnia being the most impacting factors [49]

In another 2020 study conducted by Olum R, et al. [24] the researchers have examined the prevalence of depression and the factors that leads towards depression among medical undergraduates in Uganda of East Africa. Hereby they have considered 331 valid responses obtained from the study participants at Maker ere University and findings have showed that most of the students were experiencing depression. The researchers have also found that the study year and the performance in academic activities have significant impact towards depression among medical undergraduates [24]

In a similar study conducted among health undergraduates at Arsi University, Ethiopia by Worku, MG, et al. [25] in 2020, the researchers have aimed on exploring the stress, depression and the related factors with relation to the health science students at Arsi University Ethiopia in East Africa [50]. The findings derived from this study found that the age, year of study in the study program, continuous pressure in securing a good grade, lack of quality dormitory facilities, attachment for practical sessions, increased expecta-tions from parents, problems with managing financials and achieving a good career path have led towards increasing the depression levels among undergraduate students of the study sample [25]

The impact of internet addiction towards depression among undergraduates at University of Peradeniya in Sri Lanka have been assessed in a study conducted by Chamika RMA and Dias SR [51]. Here the researchers have examined 175 undergraduate stu-dents at University of Peradeniya in Sri Lanka and have found that higher the level of internet addiction among the students, higher the depression levels they have recorded [51].

Islam S, et al. [15] have also conducted a study examining the factors affecting depression among the Malaysian undergraduates in 2018. In this study, 1,023 undergraduates have been taken into consideration and majority of the participants have reported to have high levels of depressive symptoms. As the results revealed, it is stated that students who live out of their residences, having difficulties with financials, experiencing poor sleeping conditions, and have affected with Post-Traumatic Stress Disorder (PTSD) have more tendency of been depressed [15]

In a 2017 study conducted by Suleiman AK, et al. [52]. The researchers have aimed on assessing the factors that determined depression using a survey conducted among the Malaysian university undergraduates. Hereby 249 students have taken part in the study and the researchers have found that there was no statistically significant relationship to be found between the faculty of study, gender, year, and the level of depression among the study participants [52].

In another study conducted in 2017 by Dawood E, et al. [14] the researchers have aimed on assessing the state of depression and the factors that lead towards depression with relation to the nursing undergraduates in Saudi Arabia. For this study, 149 nursing students have participated and the findings of the study state that depression among the nursing undergraduates are associated with previous family history of cases of depression, certain psychiatric disorders, past consultations made with a psychiatrist and in relation to certain physical illnesses [14].

Another similar study had been conducted in Sri Lanka in 2015 by Amarasuriya SD, et al. [16]. in assessing the depression and its related factors among local undergraduates at University of Colombo in Sri Lanka. For this survey-based study, 4304 undergraduates have provided their responses. The researchers have identified that students who live out of their homes to be more depressed than the ones who were living in their homes while there was no faculty-based difference in terms of depression state of students [16]. Moreover, study findings also state that students who have experienced threatening life events, death of family members, physical illnesses, and breakdown of relationships, difficulties with education, domestic violence and unemployment had more tendency of getting depressed during their studies [16]. The findings from these past empirical studies on factors affecting clinical depression can be summarized as follows.

Impact of clinical depression on academic achievement

There is a dearth of literature that examines the impact of clinical depression on academic achievement and only a limited number of studies out of them are related to the recent past while majority holds outdated findings. Therefore, in this section it aims on exploring these limited empirical studies to identify their empirical findings on the impact of clinical depression on academic achievement [50].

In a study that was conducted by Bitew and Birhan have examined the potential impact of depression on the academic outcomes of students in Northwest Ethiopia of East Africa in 2021. In this cross-sectional study, 710 pre-engineering students have taken into consideration and majority of study participants had recorded to have higher levels of depressive symptoms. As per their findings, depressive symptoms have found to be associated with difficulties in learning among the students [53].

In another study conducted among the final year MBBS students at Rawalpindi Medical University in Pakistan in 2020 the researchers [8]. have examined the association between depression and academic achievement with relation to final year MBBS undergraduates at Rawalpindi Medical University in Pakistan. The responses from 307 students have taken into analysis and the study findings have recorded that there is a high level of depression among the final year MBBS students and the rates to be higher with female students compared to male medical students [8]. Further the findings suggest that depression is negatively associated with academic achievement where higher the depression, lower the academic achievement [8].

In her study in 2020, Goodwin has explored into how depression impact the academic success and help seeking attitude among the engineering students at Midwestern University in Illinois in United States of America. A total of 582 male engineering students have been the respondents to this survey while majority of them have reported to have depressive symptoms as per the findings [54]. As the main findings state, depression and academic achievement are to be negatively related and higher levels of depression have adversely impacted to the academic success of students [54].

In another longitudinal cohort study conducted by Awadalla S, et al. [55] in 2020, the re-searchers have investigated the relationship between academic achievement and depression and anxiety among the undergraduates at Emirati university, United Arab Emirates. A total of 404 students have taken into data collection and their responses for the survey have revealed that most of them were suffering from depression [55] The researchers have found that depression and anxiety are related to academic achievement among the students in a negative manner that was shown with poor GPA scores when having higher depression and anxiety levels [55].

In a qualitative study conducted among Kwame Nkrumah University of Science and Technology in, West Africa in 2019, the researchers Dapaah & Amoako have examined the causes for depression among the university students and how depression can affect their academic life. The findings of the study have stated that most of students have encountered depression and the prevalence of depression have created a negative impact on the academic success among these students [56].

The relationship between academic achievement and depression have also been explored by Wahab in 2019 where he has considered the high school students in Kerala, India for the study sample. As the findings of the study reveal, majority of students are affected with depression and as a result they have experienced various difficulties in conducting their academic activities in a successful manner [57]. This is since depression adversely impacts the level of motivation of the students creating difficulties to concentrate well that results in poor success in academic involvement [57].

Muhammad K, et al. [58] also have examined the relationship that exists between depression and academic achievement with relation to the undergraduates at Benue State University in Nigeria in West Africa in 2018. A total of 153 participants have been examined herewith in this study and the findings have recorded that the students had higher depression levels. The researchers have identified that female students are more likely to be depressed compared to male students and higher depression levels will impose more difficulty in achieving better academic success [58].

In a 2016 study by Sindhu, the researcher has examined the impact of depression on the academic achievement among Indian engineering students. The study has considered 20 undergraduate engineering students from Visvesvaraya Technological University in India and have qualitatively assessed how depression have impacted their academic success. The findings from this study shows that higher levels of depression had resulted in poor academic achievement [59]. Another study conducted by Khalid FM, et al. [60], have also examined on how depression and academic achievement are related. Hereby the researchers have considered students from two universities in Malaysia and have found that depression and age level have significant impact on the academic achievement of the students while there was no significance to be found in terms of gender and financial background on academic achievement [60]. The findings from these past empirical studies on impact of clinical depression on academic achievement can be summarized as follows.

Summary of findings on factors affecting clinical depression

As it was reviewed in the earlier sections, there is an absence of direct empirical studies conducted in examining both the factors affecting clinical depression and its impact on academic achievement. Moreover, there is a dearth of empirical studies conducted on examining the factors affecting clinical depression and impact of clinical depression on academic achievement among Sri Lankan undergraduates. The limited international and local studies conducted have either explored this re-search phenomenon either in isolation to depression and its causes or else in terms of the impact of depression on academic achievement in a more generic level. As a result of this, finding a direct or contextually specific findings on the overall research phenomenon is difficult completely in referring the published sources specially in terms of the Sri Lankan context. The available empirical studies on factors affecting clinical depression though it does not explore the study phenomenon in a singular manner have revealed the following findings.

Summary of findings on effects of clinical depression on academic achievement

The past empirical studies on impact of clinical depression on academic achievement have revealed the following findings.

Conclusion

This research paper has been conducted in the form of a literature review and it has explored into the empirical literature pertaining to factors affecting clinical depression and its effects on academic performance among the undergraduates.

As per the empirical review conducted, it identified that there is currently a dearth of empirical literature in this filed and the available limited literature over the recent past have been detailed and summarized in the earlier sections. As per the findings from these limited empirical literature state, help seeking behavior, level of social support, self-esteem, poor sleep quality, lack of physical exercises, excessive internet use, recent life changing crisis, domestic violence, substance abuse, family and personal history of depression, study year, academic demands, living conditions, parental expectations, financial difficulties and unemployment are related to depression and can act as factors that affect towards depression.

Furthermore, past literature highlighted the substantial negative impact of clinical depression on academic performance. As per the findings from the past empirical studies related to impact of depression on academic performance, it is identified that depression can lead towards difficulties in learning while negatively affecting the academic success. Moreover, depression and age have been identified to have an impact on one’s academic achievement as well. Students with depression often faced difficulties in concentration, memory retention, and overall cognitive functioning, leading to decreased productivity and lower grades. The study also demonstrated a higher likelihood of absenteeism, reduced motivation, and impaired decision-making abilities among depressed individuals. These academic challenges not only affected the students' current educational journey but also had potential long-term implications for their career prospects and overall well-being.

Considering these findings, educational institutions can recognize and address the factors affecting clinical depression among undergraduate students. Efforts should be directed towards implementing comprehensive mental health support systems that encompass prevention, early intervention, and ongoing treatment options. This could involve increased access to counseling services, awareness campaigns to reduce stigma, and the provision of academic accommodations for students with mental health conditions. Collaborative efforts between faculty, staff, and mental health professionals are crucial to creating a supportive environment that promotes mental wellbeing and academic success.

Additionally, further research in this area can explore into the specific mechanisms through which clinical depression influences academic performance. Exploring potential mediators and moderators, such as coping strategies, social support, and resilience factors, could provide valuable insights into developing targeted interventions for students experiencing depression.

Ultimately, by recognizing the factors contributing to clinical depression and ac-know edging its detrimental effects on academic performance, educational institutions can take proactive steps to foster a healthier and more conducive learning environment for undergraduate students. By prioritizing mental health support, we can empower students to overcome the challenges posed by depression and achieve their full academic potential while promoting their overall well-being.

Acknowledgement

None.

Conflict of Interest

There are no conflict of interest by author.

References

1. Ahmed, Helal Uddin, Mohammad Didar Hossain, Afzal Aftab and Tanjir Rashid Soron, et al. "Suicide and depression in the World Health Organization South-East Asia region: A systematic review." WHO South-East Asia J Public Health 6 (2017): 60-66.

Google Scholar, Crossref, Indexed at

2. https://www.who.int/news-room/fact-sheets/detail/depression
3. https://www.ncbi.nlm.nih.gov/books/NBK559078/
4. https://www.verywellmind.com/depression-statistics-everyone-should-know-4159056
5. Greenberg, Paul E., Andree-Anne Fournier, Tammy Sisitsky and  Crystal T. Pike, et al. "The economic burden of adults with major depressive disorder in the United States (2005 and 2010)." J Clin Psychiatry 76 (2015): 5356.

Google Scholar, Crossref, Indexed at

6. https://educationdata.org/college-enrollment-statistics
7. Zada, Shagufta, Yuefen Wang, Muhammad Zada and Fatima Gul. "Effect of mental health problems on academic performance among university students in Pakistan." Int J Ment Health Promot 23 (2021): 395-408.

Google Scholar, Crossref, Indexed at

8. Khan, Tayyab Mumtaz, Somia Bibi, Eisha Shoaib and Hafiz Abu Sufian, et al. "Association of depression with academic performance among final year MBBS students of Rawalpindi Medical University, Pakistan." Eur J Med Sci 2 (2020).

Google Scholar, Crossref, Indexed at

9. Mofatteh, Mohammad. "Risk factors associated with stress, anxiety, and depression among university undergraduate students." AIMS Public Health 8 (2021): 36.

Google Scholar, Crossref, Indexed at

10. Johansson, Fred, Pierre Côté, Sheilah Hogg-Johnson and Ann Rudman, et al. "Depression, anxiety and stress among Swedish university students before and during six months of the COVID-19 pandemic: A cohort study." Scand J Public Health 49 (2021): 741-749. 

Google Scholar, Crossref, Indexed at

11. Pedrelli, Paola, Maren Nyer, Albert Yeung and Courtney Zulauf, et al. "College students: Mental health problems and treatment considerations." Acad Psychiatry 39 (2015): 503-511.

Google Scholar, Crossref, Indexed at

12. https://www.healthdata.org/news-events/insights-blog/acting-data/new-global-burden-disease-analyses-show-depression-and
13. Collaborators, C.-1. M. “Estimating the global prevalence and burden of depressive and anxiety disorders induce to the COVID-19 pandemic.” Lancet
14. Dawood, Eman, Rufa Mitsu, H. Ghadeer and Fatimah Alrabodh. "Assessment of depression and its contributing factors among undergraduate nursing students." Int J Nurs Stud 4 (2017): 69-79.

Google Scholar, Indexed at

15. Islam, Saiful, Rejina Akter, Tajuddin Sikder and Mark D. Griffiths. "Prevalence and factors associated with depression and anxiety among first-year university students in Bangladesh: A cross-sectional study." Int  J Ment Health Addict (2020): 1-14.  

Google Scholar, Crossref, Indexed at

16. Amarasuriya, Santushi D., Anthony F. Jorm and Nicola J. Reavley. "Depression literacy of undergraduates in a non-western developing context: The case of Sri Lanka." BMC Res Notes 8 (2015): 1-14.

Google Scholar, Crossref, Indexed at

17. Perera, Bilesha, Mohammad R. Torabi, Gamini Jayawardana and Nayana Pallethanna. "Depressive symptoms among adolescents in Sri Lanka: Prevalence and behavioral correlates." J Adolesc Health 39 (2006): 144-146.

Google Scholar, Crossref, Indexed at

18. Torabi, Mohammad R and Bilesha Perera. "A study of depressive symptomatology, its behavioral correlates and anxiety among undergraduates in Sri Lanka." (2006).

Google Scholar

19. https://www.ft.lk/article/608382/Breaking-the-silence-on-depression--Challenging-task-for-Sri-Lanka
20. https://www.colombotelegraph.com/index.php/depression-lets-talk/`
21. Fernando, Neil, Thirupathy Suveendran and Chithramalee de Silva. "Decentralizing provision of mental health care in Sri Lanka." WHO South East Asia J Public Health 6 (2017): 18-21.

Google Scholar, Crossref, Indexed at

22. https://www.forbes.com/sites/davidebanis/2019/01/24/mental-illness-is-the-most-neglected-health-problem-in-the-developing-world/?sh=1ae709c21db4
23. Kodagoda, A. S. K and M. K. D. L. Meegoda. "The prevalence of depression among undergraduates of a selected medical faculty in Sri Lanka." (2020).  

Google Scholar, Crossref, Indexed at

24. Olum, Ronald, Frederick Nelson Nakwagala and Raymond Odokonyero. "Prevalence and factors associated with depression among medical students at Makerere university, Uganda." Adv Medical Educ Pract (2020): 853-860.

Google Scholar, Crossref, Indexed at

25. Worku, Misganaw Gebrie, Zemenu Tadesse Tessema, Achamyeleh Birhanu Teshale and Getayeneh Antehunegn Tesema, et al. "Prevalence and associated factors of adolescent pregnancy (15–19 years) in East Africa: A multilevel analysis." BMC Pregnancy and Childbirth 21 (2021): 1-8.

Google Scholar

26. Amarasuriya, Santushi D., Anthony F. Jorm and Nicola J. Reavley. "Predicting intentions to seek help for depression among undergraduates in Sri Lanka." BMC Psychiatry 18 (2018): 1-12.

Google Scholar, Crossref, Indexed at

27. Khurshid, Shumaila, Qaisara Parveen, M. Imran Yousuf and Abid Ghafoor Chaudhry. "Effects of depression on students’academic performance." Psychiatry 903 (2007): 912.

Google Scholar

28. Schwartz, Kelly Dean, Deinera Exner-Cortens, Carly A. McMorris and Erica Makarenko, et al. "COVID-19 and student well-being: Stress and mental health during return-to-school." Can J Sch Psychol 36 (2021): 166-185.

Google Scholar, Crossref, Indexed at

29. Mofatteh, Mohammad. "Risk factors associated with stress, anxiety and depression among university undergraduate students." AIMS Public Health 8 (2021): 36.

Google Scholar, Crossref, Indexed at

30. Rodríguez-Hidalgo, Antonio J., Yisela Pantaleón, Irene Dios and Daniel Falla. "Fear of COVID-19, stress, and anxiety in university undergraduate students: A predictive model for depression." Front Psychol 11 (2020): 591797.  

Google Scholar, Crossref, Indexed at

31. Panchal, Nirmita, Rabah Kamal, Kendal Orgera and Cynthia Cox, et al. "The implications of COVID-19 for mental health and substance use." Kaiser Family Foundation 21 (2020): 1-16.

Google Scholar

32. https://www.washingtonpost.com/education/2021/06/10/dartmouth-mental-health-study/
33. https://theconversation.com/covid-has-increased-anxiety-and-depression-rates-among-university-students-and-they-were-already-higher-than-average-167787
34. https://research.unc.edu/2021/03/04/pandemic-worsens-depression-anxiety-among-first-year-college-students/
35. Ab Razak, W. Maziah Wan, S. Alia Syed Baharom and Zalinawati Abdullah, et al. "Academic performance of University students: A case in a higher learning institution." KnE Soc Sci (2019): 1294-1304.

Google Scholar, Crossref, Indexed at

36. Priyadarshana, A. J. M and H. G. M. D. Kumari. "Determinants of undergraduate students’ academic performance: The case of University of Sri Jayewardenepura, Sri Lanka." Int J Sci Res 10 (2020): 171-177.  

Google Scholar, Crossref, Indexed at

37. Chan, Roy Y. "Understanding the purpose of higher education: An analysis of the economic and social benefits for completing a college degree." J Educ Policy 6 (2016): 1-40.

Google Scholar, Indexed at

38. Hanushek, Eric A and Ludger Woessmann. "The economic impacts of learning losses." (2020).

Google Scholar

39. Steinmayr, Ricarda, Anja Meiner, Anne F. Weideinger and Linda Wirthwein. “Academic achievement.” Oxford, UK: Oxford University Press (2014).

Google Scholar

40. Islam, Ariful and Sanzida Tasnim. "An analysis of factors influencing academic performance of undergraduate students: A case study of Rabindra University, Bangladesh (RUB)." Shanlax int  j educ 9 (2021): 127-135.

Google Scholar, Crossref, Indexed at

41. Almerino, Porferio M., Lanndon A. Ocampo, Dharyll Prince M. Abellana and Jana Gloria F. Almerino, et al. "Evaluating the academic performance of K-12 students in the philippines: A standardized evaluation approach." Educ Res Int 2020 (2020): 1-8.

Google Scholar, Crossref, Indexed at

42. Gopal, Ram, Varsha Singh and Arun Aggarwal. "Impact of online classes on the satisfaction and performance of students during the pandemic period of COVID 19." Educ Inf Technol 26 (2021): 6923-6947.

Google Scholar, Crossref, Indexed at

43. Ebele, Uju F and Paul A. Olofu. "Study Habit and Its Impact on Secondary School Students' Academic Performance in Biology in the Federal Capital Territory, Abuja."Edu Res Rev 12 (2017): 583-588.

Google Scholar

44. Tatar, Ahmet Emin and Dilek Duştegor. "Prediction of academic performance at undergraduate graduation: Course grades or grade point average?" Appl Sci 10 (2020): 4967.

Google Scholar, Crossref, Indexed at

45. Bhattarai, Deepa, Nisha Shrestha and Shishir Paudel. "Prevalence and factors associated with depression among higher secondary school adolescents of Pokhara Metropolitan, Nepal: A cross-sectional study." BMJ open 10 (2020): e044042.

Google Scholar, Crossref, Indexed at

46. Njim, Tsi, Clarence Mbanga, Dave Mouemba and Haman Makebe, et al. "Determinants of depression among nursing students in Cameroon: A cross-sectional analysis." BMC Nurs 19 (2020): 1-6.  

Google Scholar, Crossref, Indexed at

47. Mahees, M. T. M. "Stress Among Undergraduates: A case study of University of Colombo, Sri Lanka." (2020).

Google Scholar, Crossref, Indexed at

48. Ahmed, Gutema, Alemayehu Negash, Habtamu Kerebih and Daniel Alemu, et al. "Prevalence and associated factors of depression among Jimma University students. A cross-sectional study." Int J Ment Health Syst 14 (2020): 1-10.

Google Scholar, Crossref, Indexed at

49. Ramón-Arbués, Enrique, Vicente Gea-Caballero, José Manuel Granada-López and Raúl Juárez-Vela, et al. "The prevalence of depression, anxiety and stress and their associated factors in college students." Int J Environ Res Public Health 17 (2020): 7001.

Google Scholar, Crossref, Indexed at

50. Islam, Ariful and Sanzida Tasnim. "An Analysis of Factors Influencing Academic Performance of Undergraduate Students: A Case Study of Rabindra University, Bangladesh (RUB)." Shanlax Int J Educ 9 (2021): 127-135.

Google Scholar, Crossref, Indexed at

51. Chamika, R. M. A and Shavindra R. Dias. "Relationship of internet addiction with depression, loneliness and health related lifestyle among university students." J Health Sci 6 (2018): 310-315.

Google Scholar, Crossref, Indexed at

52. Suleiman, Amal K., Nur Farhan Izzaty Ismadi, Fahad Riaz Choudhry and Khadeeja Munawaret al. "Determinant factors of depression: A survey among university students." Malays J Public Health Med 17 (2017): 97-103. 

Google Scholar

53. Bitew, Tesera and Wohabie Birhan. "The potential effect of depression on academic outcomes of students in higher educational institutions of Northwest Ethiopia: A cross-sectional study." Educ Res Rev 16 (2021): 9-15.

Google Scholar, Crossref, Indexed at

54. Goodwin, Mary E. "The impact of depression on academic success and academic help-seeking attitudes." ASEE Annu Conf Proc (2020).

Google Scholar, Crossref, Indexed at

55. Awadalla, Suheir, E. Bethan Davies and Cris Glazebrook. "A longitudinal cohort study to explore the relationship between depression, anxiety and academic performance among Emirati university students." BMC Psychiatry 20 (2020): 1-10.

Google Scholar, Crossref, Indexed at

56. Dapaah, J. M and H. A. F. Amoako. "The causes of depression among university students and its effects on their academic life in the Kwame Nkrumah University of Science and Technology, Kumasi, Ghana." Int J Innov Stud Educ Res 7 (2019): 154-167.

Google Scholar, Crossref, Indexed at

57. Wahab, Abdul. "The relationship between depression and academic achievement among high school students in Kerala." Int J Psychol Res (2019)4-7.

Indexed at

58. Muhammed, Khadija, Ikume Gerald Terna and Daniel Benjamin Saanyol. "The relationship between depression and academic performance among undergraduate students of Benue State University Makurdi, Nigeria." Int J Educ Eval 4 (2018): 77-85.

Google Scholar

59. Sindhu, P. "Impact of stress on academic achievement among engineering students." Int J Indian Psychol 4 (2016).

Google Scholar, Crossref, Indexed at

60. Khalid, F. M., N. A. A. Suman, N. A. Rasid and N. A. Mohamad, et al. "Depression & Academic Performance: A Case Study." In International Symposium & Exhibition on Business and Accounting (2016): 1-7.

Google Scholar, Crossref, Indexed at