Change in depressive symptoms over higher education and professional establishment - a longitudinal investigation in a national cohort of Swedish nursing students

Abstract

Background: There are indications of a high prevalence of psychological distress among students in higher education and also that distress increases over the course of study. However, not all studies on student distress controlled for sociodemographic differences and few followed development of distress over an extended period through professional establishment. We investigated if there is an independent effect of time in education and the first two years in the profession on depressive symptoms and mapped change over the period in a national cohort of students.

Methods: Data came from LANE, a nation-wide longitudinal panel survey of Swedish nursing students (N = 1700) who responded to annual questionnaires over five years from 2002 to 2007. Depressive symptoms were measured by the Major Depression Inventory and change over time analysed in a linear mixed effects model for repeated measures.

Results: There was a significant change in level of depressive symptoms over time: an increase from the first to later years in education and a decrease to levels similar to baseline after graduation and a year in the profession. The change in symptoms remained significant after adjustment for sociodemographic factors (p < 0.01). Symptom levels differed due to age, gender, household composition and prior nurse assistant training but change over time was similar in all groups. The correlation among the repeated measures, representing within individual correlation over time, varied between 0.44-0.60.

Conclusions: The findings indicate an independent but transitional effect of time in education and professional establishment on depressive symptoms. We think heightened distress over education abates as the graduate accommodates to the profession. Nevertheless, within education, the differences in depressive symptoms associated to demographic factors can help identify student groups more vulnerable to distress. Also, as individual differences in distress seem to persist over time, perhaps students highly distressed in the beginning of education can be helped by awareness among educators of the elevated levels of distress in late education.

Figure 1

Description of the cohort over time*. *Response rates compared with the defined cohort of 1700; n and (%) responders in education/graduated and registered as nurses; n and (%) with information on depressive symptoms at each time point.

Figure 2

Graph of predicted means of depressive symptoms stratified for graduation and time of graduation*. *Estimates and error bars (of +/- 1 standard error) from a bivariable model of depressive symptoms over time containing the main effect for graduation year (year 4, 5 or no graduation within the study frame) plus time and the interaction between graduation year and time (n = 1468, the number of participants with information on graduation).

Figure 3

Graphs of predicted means of depressive symptoms over education (year 1-3) and establishment in the profession (year 4-5)*. *Graph 1: Estimates and error bars (of +/- 1 standard error) from two models of change in depressive symptoms over time in a) all 1700 cohort members and b) the subset of 1306 cohort members who graduated according to the expected time schedule, before year 4. Graphs 2-8: Estimates and error bars (of +/- 1 standard error) from bivariable models of depressive symptoms containing the main effect of a factor plus time, and the interaction between that factor and time (Bivariable models in Table 2.).