Document Type : Review article


1 Associate Professor of Psychology, Ilam University, Ilam, Iran

2 Assistant Professor of Psychology, Department of Psychology, Faculty of Human Sciences, Islamic Azad University, Ilam Branch, Ilam, Iran

3 Department of Psychology, Faculty of Psychology and Educational Sciences, Islamic Azad University, Ilam Branch, Ilam, Iran


Background and aims: Depression is the most common psychiatric disorder, and students are more predisposed to depression than other populations. This meta-analysis was conducted to estimate the mean depression score in Iranian students based on DASS-21.
Methods: The search was carried out using keywords Depression, Student, DASS-21 and Iran in domestic databases, including SID, Medlib, IranMedex, Irandoc, and Magiran. Data were analyzed using a meta-analysis (random effects model). The heterogeneity of studies was studied using the I2 index. Data were analyzed using the Stata software version 11. DASS-21 had been used in all reviewed studies. 
Results: The sample size was 3229 people included in 17 studies. The mean depression score in Iranian students based on DASS-21 was 9.30 (95% CI: 12.57-6.03), 8.90 in female students (95% CI: 4.50-13.29) and 8.45 in male students (95% CI: 4.03-12.86). The mean scores of anxiety and stress in students were 8.58 (95% CI: 5.95-12.86) and 9.91 (95% CI: 11.28-8.54), respectively. 
Conclusion: The mean depression score is higher in female students than in male students, and the mean score of stress is slightly higher than those of anxiety and depression.


Main Subjects

1. Bahadori Khosroshahi J, Khanjani Z. Relationship of humor and negative life events with depression among students. Zahedan Journal of Research in Medical Sciences. 2012;14(2):96-100. 
2. Rezaei Aderyani M, Azadi A, Ahmadi F, Vahedian Azimi A. Comparison of depression, anxiety, stress and quality of life in dormitories students of Tarbiat Modares University. Iranian Journal of Nursing Research. 2007;2(4-5):31-8. 
3. Levine RE, Bryant SG. The depressed physician: a different kind of impairment. Hosp Physician. 2000;36(2):67-73. 
4. Yahaya N, Abolfathi Momtaz Y, Othman M, Sulaiman N, Mat Arisah F. Spiritual well-being and mental health among Malaysian adolescents. Life Sci J. 2012;9(1):440-8. 
5. Sadeghian E, Heidarianpour A. Stressors and mental health status among students of Hamadan University of Medical Sciences. Hayat. 2009;15(1):71-80. 
6. Buchanan JL. Prevention of depression in the college student population: a review of the literature. Arch Psychiatr Nurs. 2012;26(1):21-42. doi: 10.1016/j.apnu.2011.03.003. 
7. Eller T, Aluoja A, Vasar V, Veldi M. Symptoms of anxiety and depression in Estonian medical students with sleep problems. Depress Anxiety. 2006;23(4):250-6. doi: 10.1002/da.20166. 
8. Mendis N. Importance of general hospital in the development of mental health care. World Psychiatry. 2003;2(2):100-2. 
9. Dehghan Nayeri N, Adib-Hajbaghery M. Effects of relaxation techniques on stress and the quality of life of dormitory students. Feyz. 2006;10(2):50-7. 
10. Pulido-Martos M, Augusto-Landa JM, Lopez-Zafra E. Sources of stress in nursing students: a systematic review of quantitative studies. Int Nurs Rev. 2012;59(1):15-25. doi: 10.1111/j.1466- 7657.2011.00939.x. 
11. Salehi T, Dehghan Nayeri N. Relationship between anxiety and quality of life in students living in dormitories of Tehran University of Medical Sciences. Payesh. 2011;10(2):175-81.
12.Zamanian Z, Dehghani M, Hashemi H. Outline of changes in cortisol and melatonin circadian rhythms in the security guards of Shiraz University of Medical Sciences. Int J Prev Med. 2013;4(7):825-30. 
13.Stordal E, Bjartveit Kruger M, Dahl NH, Kruger O, Mykletun A, Dahl AA. Depression in relation to age and gender in the general population: the Nord-Trondelag Health Study (HUNT). Acta Psychiatr Scand. 2001;104(3):210-6. 
14.Stuart MJ, Baune BT. Depression and type 2 diabetes: inflammatory mechanisms of a psychoneuroendocrine comorbidity. Neurosci Biobehav Rev. 2012;36(1):658-76. doi: 10.1016/j.neubiorev.2011.10.001. 
15.Kaplan H, Sadock B. Kaplan & Sadock’s Comprehensive Textbook of Psychiatry. Baltimore: Lippincott Williams & Wilkins; 2000. 
16.Ibrahim MB, Abdelreheem MH. Prevalence of anxiety and depression among medical and pharmaceutical students in Alexandria University. Alex J Med. 2015;51(2):167-73. doi: 10.1016/j.ajme.2014.06.002. 
17.Eisenberg D, Gollust SE, Golberstein E, Hefner JL. Prevalence and correlates of depression, anxiety, and suicidality among university students. Am J Orthopsychiatry. 2007;77(4):534-42. doi: 10.1037/0002-9432.77.4.534.
18.Kim YH. Correlation of mental health problems with psychological constructs in adolescence: final results from a 2-year study. Int J Nurs Stud. 2003;40(2):115-24. 
19.Jones MC, Johnston DW. Reducing distress in first level and student nurses: a review of the applied stress management literature. J Adv Nurs. 2000;32(1):66-74. 
20.Hancock D. Effects of test anxiety and evaluative threat on students’ achievement and motivation. J Educ Res. 2001;94(5):284-90.
21.Sherina MS, Rampal L, Kaneson N. Psychological stress among undergraduate medical students. Med J Malaysia. 2004;59(2):207-11. 
22.Peden AR, Hall LA, Rayens MK, Beebe L. Negative thinking mediates the effect of self-esteem on depressive symptoms in college women. Nurs Res. 2000;49(4):201-7. 
23.Bostanci M, Ozdel O, Oguzhanoglu NK, Ozdel L, Ergin A, Ergin N, et al. Depressive symptomatology among university students in Denizli, Turkey: prevalence and sociodemographic correlates. Croat Med J. 2005;46(1):96-100. 
24.Zahedi Asel M. Effective factors on academic achievement students Shahed University. Journal of Thought & Behavior in Clinical Psychology. 1998;3(9):41-53. 
25.Antoni MH, Wimberly SR, Lechner SC, Kazi A, Sifre T, Urcuyo KR, et al. Reduction of cancer-specific thought intrusions and anxiety symptoms with a stress management intervention among women undergoing treatment for breast cancer. Am J Psychiatry. 2006;163(10):1791-7. doi: 10.1176/ ajp.2006.163.10.1791. 
26.Amini P, Karimi-Afshar M, Torabi-Parizi M, Jafaree B. The Stress Level and Related Factors in Students of School of Dentistry, Kerman University of Medical Sciences, Iran. Stride Dev Med Educ. 2014;10(4):467-72.
27.von Elm E, Altman DG, Egger M, Pocock SJ, Gotzsche PC, Vandenbroucke JP. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. Bmj. 2007;335(7624):806-8. doi: 10.1136/bmj.39335.541782.AD. 
28.Mohammadian Y, Shahidi S, Zadeh Mohammadi A, Mahaki B. Evaluating the use of poetry to reduce signs of depression in students. Journal of Ilam University of Medical Sciences. 2010;18(2):9-16. 
29.Rahiminejad A, Borjali S, Yazdani-Varzaneh M, Farahani H, Amani H. The effect of identity styles on undergraduates’ depression, anxiety and stress: Mediating role of identity commitment. Journal of Psychological Models and Methods. 2012;2(9):1-15. 
30.Zare H, Solgi Z. Investigation of the relationship between cognitive emotion regulation strategies and depression, anxiety and stress in students. Journal of Research in Psychological Health. 2012;6(3):19-29. 
31.Vafaie M, Safavi M, Salehi S. Studying correlation between anxiety, stress, and depression with body mass index (BMI) among nursing students. Medical Sciences Journal of Islamic Azad University Tehran Medical Branch. 2013;23(2):154-9. 
32.Prov D, Mohammadkhni P, Dolatshahi B, Moshtagh N. Effectiveness of a Two-Minute Session of Written Emotional Disclosure in Depression, Anxiety and Stress among the Students Suffering from Trauma. Thought & Behavior in Clinical Psychology. 2012;7(26):7-16. 
33.Safari Y, Yar Mohamadi H, Sharghi K, Naseredin Poor A, Fallahi B. Assessing of student’s cognitive emotional self-regulation and relationship with cognitive emotional self-regulation in Kermanshah University of medical sciences. Journal of Clinical Research in Medical Sciences. 2013;2(2):99-108. [Persian]. 
34.Najafi Kalyani M, Pourjam E, Jamshidi N, Karimi S, Najafi Kalyani V. Survey of stress, anxiety, depression and selfconcept of students of Fasa University of medical sciences, 2010. Journal of Fasa University of Medical Sciences. 2013;3(3):235-40. [Persian]. 
35.Kheirabadi GR, Babaeian L, Sadri S, Mahaki B, Masaeli N. Depression, Anxiety, Stress and Quality of life in Iranian and non-Iranian students of medicine, dentistry and pharmacy schools of the Isfahan University of medical Sciences. Journal of Research in Behavioural Sciences. 2014;12(4):611-20. 
36.Saberipour B, Hemmatipour A, Mousavi SA, Ziagham S, Madmoli Y. Study the Factors Affecting Depression, Stress and Anxiety of Students of the Medical Sciences Faculty of Shushtar City in 2015. Quarterly Journal of Khorramabad University of Medical Sciences. 2017;10(34-35):14-25. [Persian]. 
37.Alizadehesar A, Tohidi A, Hoseyni Soltannasir M. [The prediction of academic burnout dimensions based on alexithymia, negative emotions and self esteem]. J Educ Psychol Stud. 2016;13(24):69-88. 
38.Nasirzadeh R, Rasoulzadeh Tabatabayee K. Relationship between psychological constructs of DASS scale and coping strategies. Journal of Behavioral Sciences. 2009;3(4):317-24. 
39.Heidari S, Elahiari A, Azad Fallah P. A study of the effect of empathic short-term psychotherapy on decreasing anxiety and depression of students according to their attachment style. Clinical Psychology Research. 2012;2(1):125-42. [Persian]. 
40.Hasani J, Shahmoradi Far T. The Effectiveness of Teaching Strategies for Streamlining the Process of Excitement in Psychological Distress. Journal of Personality & Individual Differences. 2015;4(10):65-80. [Persian]. 
41.Shokri O, Shahidi S, Mazaheri M, Fath Abadi J, Rahimi Nezhad S, Khanjani M. The Effectiveness of the Student’s Mental Immunization Program against Negative Emotional Experiences Based on the Pennsylvania Prevention Model. Journal of Educational Measurement & Evaluation Studies. 2014 4(7):165-90. [Persian]. 
42.Hemmati Sabet V, Yousefi F, Hemmati Sabet A. The effect of group cognitive training on depression, anxiety and perceived stress in Hamadan’s Farhangian University students. Shenakht Journal of Psychology and Psychiatry. 2016;3(3):49-59. 
43.Samani S, Joukar B. A study on the reliability and validity of the short form of the depression anxiety stress scale (DASS21). Journal of Social Sciences and Humanities of Shiraz University. 2007;26(3):65-76. 44. Watanabe N. A survey of mental health of university students in Japan. International Medical Journal. 1995;6(3):175- 9. 
45.Grant A. Identifying student’s concern: taking a whole institutionalapproach in student mental health needs: problems and responses. London: Jessica Kingsley Publishers; 2002. 
46.Shamsuddin K, Fadzil F, Ismail WS, Shah SA, Omar K, Muhammad NA, et al. Correlates of depression, anxiety and stress among Malaysian university students. Asian J Psychiatr. 2013;6(4):318-23. doi: 10.1016/j.ajp.2013.01.014. 
47.Day V, McGrath PJ, Wojtowicz M. Internet-based guided self-help for university students with anxiety, depression and stress: a randomized controlled clinical trial. Behav Res Ther. 2013;51(7):344-51. doi: 10.1016/j.brat.2013.03.003. 
48.Bados A, Solanas A, Andres R. Psychometric properties of the Spanish version of depression, anxiety and stress scales (DASS). Psicothema. 2005;17(4):679-83 
49.Kulsoom B, Afsar NA. Stress, anxiety, and depression among medical students in a multiethnic setting. Neuropsychiatr Dis Treat. 2015;11:1713-22. doi: 10.2147/ndt.s83577. 
50.Van Gordon W, Shonin E, Sumich A, Sundin EC, Griffiths MD. Meditation awareness training (MAT) for psychological well-being in a sub-clinical sample of university students: a controlled pilot study. Mindfulness. 2014;5(4):381-91. doi: 10.1007/s12671-012-0191-5. 
51.Lovell GP, Nash K, Sharman R, Lane BR. A cross-sectional investigation of depressive, anxiety, and stress symptoms and health-behavior participation in Australian university students. Nurs Health Sci. 2015;17(1):134-42. doi: 10.1111/nhs.12147.