International Journal of Community Medicine and Public Health

Yuvaraj BY et al. Int J Community Med Public Health. 2016 Dec;3(12):3308-3312

http://www.ijcmph.com pISSN 2394-6032 | eISSN 2394-6040

DOI: http://dx.doi.org/10.18203/2394-6040.ijcmph20164026
Original Research Article

Screening for overall mental health status using mental health

inventory amongst medical students of a government
medical college in North Karnataka, India
Yuvaraj B. Y.1*, Poornima S.2, Rashmi S.3

1
Department of Community Medicine, Koppal Institute of Medical Sciences, Koppal, Karnataka, India
2
Department of Community Medicine, Mandya Institute of Medical Sciences, Mandya, Karnataka, India
3
Hospital Administration, St. Johns Medical College, Bangalore, Karnataka, India

Received: 28 October 2016

Accepted: 02 November 2016

*Correspondence:
Dr. Yuvaraj B. Y.,
E-mail: dryuvraj@gmail.com

Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under
the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial
use, distribution, and reproduction in any medium, provided the original work is properly cited.

ABSTRACT

Background: In developing countries like India, seeking mental health care is still a taboo, and a lot of stigma is
attached to consulting a psychiatric specialist or a counselor. This problem magnifies when budding doctors have a
mental health issue. Objective of the study was to assess the overall mental health status of undergraduate medical
students studying in a Government Medical College of North Karnataka by using the mental health inventory (MHI)
questionnaire.
Methods: A cross-sectional study was carried out during the period of July to September 2016 amongst 210
undergraduate medical students at Government Medical College, Koppal, Karnataka by administer a standard 18
items MHI questionnaire. The raw MHI scores (0-6) and computed MHI scores (0-100) were calculated for overall
and four subscales (i.e. anxiety, depression, behavioural control, and positive affect) were also calculated.
Results: Out of total 210 study participants, 119 (56.67%) were male and 91 (43.33%) female students. The overall
computed MHI scores (0-100) total score ranges from 58-74, mean score 63.5, median 64.43 and a standard deviation
of 4.01. However, computed MHI (0-100) scores for subgroups like anxiety ranged from 8 to 60, mean score 47.36,
depression ranged from 8 to 84, mean score 50.29, behavior control ranged from 30 to 85, mean score 67.76, and
positive affect ranged from 25 to 100, mean score 42.7.
Conclusions: Poor mental health and presence of some emotional health problems among medical students is
substantially high. Early screening, diagnosis, care and support should be made available to all the medical students.

Keywords: Mental health inventory, Mental health status, Medical students

INTRODUCTION disorders with care and support is still a long way to go in

developing countries like ours. Also the changing global
Health is a state of complete physical, mental, social demographic, political, economic, cultural, educational
wellbeing and not merely an absence of disease of scenarios have created a lot of mental stress thus making
infirmity to enable an individual live a socially and assessment of mental health status and providing care and
economically productive life. Most of the studies focused support a need of the hour for a better and healthy
on physical health as its one of the components that can society. Hence, World Health Organisation dedicated the
be easily assess. However, recognizing a mental health 2016 mental health day theme to Psychological first aid
conditions early and providing people with mental and support.1-4

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In developing countries like India, seeking mental health mental health, including emotional health of medical
care is still a taboo, and a lot of stigma is attached to students by using the mental health inventory (MHI)
consulting a psychiatric specialist or a counsellor. This questionnaire during their initial years at medical school.
problem magnifies when budding doctors have a mental
health issue. The general believe that doctors are the METHODS
cream of the society, intelligent people and healthy
people not needing any counseling service. However, as A cross-sectional study was carried out during the period
we all accept medical profession is one of the stressful of July to September 2016 amongst 210 undergraduate
professions and medical school is a very competitive and medical students at Govt. Medical College, Koppal,
demanding environment. The very reason that students in Karnataka, India. All the 1st and 2nd year medical students
their late adolescence are introduced to profession course admitted to Government Medical College, Koppal for the
like medicine with very minimal or no mental preparation year 2015 and 2016 were taken for the study. A total of
is bound to cause a lot of adjustment, personality, 300 students were admitted in two years (i.e. 150 students
behaviour, anxiety and depression among students. admission per year)
Medical students are also undergoing a lot of physical
and hormonal changes given their age as a teenager. Sample size was all the consenting students who
Social changes like being away from home, stressful and volunteer to participate in the study were enrolled. A total
demanding work schedule, excessive competition, of 210 medical students consented and volunteered to
psychological stress due to everyday exposure to patients participate in the study. For study tool a standard 18
suffering, chronic diseases, death etc.5-8 items Mental Health Inventory (MHI) developed by Veit
and Ware to assess the overall mental health status were
Ability to cope with these changes and adjust to them as used. All the 210 medical students who consented for the
an individual and as a social being is most important in study were self-administered MHI questionnaire. The
order to become a good professional. Hence, this study MHI questionnaire has 18 items all are scored on a likert
was taken up with the intension to assess the overall scale.

Table 1: Subdivision of questionnaire according to the standard 18 items.

Sub scale Item number on MHI Total no. of items in MHI Cronbachs alfa value
Anxiety 4,6,11, 18 & m10* 5 0.80
Depression 2, 9,12,14 & m3* 5 0.87
Behaviour control 16,17, m5*, m8* 4 0.78
Positive affect m1*, m7*, m13*, m15* 4 0.83
*modified raw scored used reverse coded; Reverse code includes assigning the each item responses scores as below- All of the time =
6, Most of the time = 5, A good bit of the time = 4, Some of the time = 3, A little of the time = 2, None of the time = 1; The cronbachs
alfa scores as calculated for the sub group are as follows- for 5 items anxiety 0.80, for 5 items depression scale was 0.87, for 4 items
behavioral and emotional control is 0.78 and 4 item positive affect is 0.83.

For each item there are six responses scored as follows - hence ranges from 1-6. The mean, median and standard
all of the time = 1, most of the time = 2, a good bit of the deviation of the raw scores is also presented to help
time = 3, some of the time = 4, a little of the time = 5, understand the distribution. However, over all MHI is
none of the time = 6. The overall reliability of the 18 item computed by the formula (Raw MHI -1*100) / 5, which
MHI scale is 0.93. The MHI has 18 items and can assess ranges from 0 - 100. Higher the score better is the mental
4 subscales of emotional status like Anxiety, Depression, health status.
Behavioral control, and Positive affect. MHI generates
one total score. The subscale and total scores range from For our study purpose, after consultation with the experts
0 - 100, with higher scores indicate better mental health. like psychiatrists and counselors, it was decided that
participants with an overall computed MHI score of less
Data analysis than or equal to 61 will be considered to be in poor
mental health requiring immediate counseling and
The data was entered in Microsoft excel and results were assistance by psychiatrist for care and support. However,
analysed using excel and epi info softwares as per the those with an overall computed MHI score of 62, 63,64,
Multiple Sclerosis Quality of Life Inventory: A User's 65, and 66 were considered to be in better mental health
Manual, which is developed by The Consortium of but with some mental health problems and could benefit
Multiple Sclerosis Centers Health Services Research. In from counseling services, participants with a score of 67
present study we have calculated the Raw MHI scores or more were considered to be in good mental health. The
which sum of all the scores of 18 items divided by 18 raw and computed MHI scores were calculated for the

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 Yuvaraj BY et al. Int J Community Med Public Health. 2016 Dec;3(12):3308-3312

subgroups of anxiety, depression, behaviour control, and reported was 22 years. 132 (62.85%) were from rural
positive affect using the same method. areas and 78 (37.15%) were from urban areas. Majority
participants were Hindu by religion 180 (85.71%)
RESULTS followed by 20 (9.52%) were Muslims, 6 (2.85%)
Christians and 4 (1.92%) reported to belong to other
The socio-demographic characteristics of the study religion. Most of the participants hailed from nuclear
population were depicted in Table 2. family 137 (65.24%) followed 54 (25.71%) reported to be
hailing from joint families and only 19 (9.05%) were
Table 2: Socio-demographic profile of the from three generation families.
study population.
Raw MHI scores of the study population with mean,
Socio-demographic No. of Percentage median and standard deviation with various subgroups
profile participants like anxiety, depression, behaviour control, positive
(n=210) affect were shown in Table 3. The mean MHI raw scores
Age (in years) (1-6) in this study for overall mental health ranged from
17-18 99 47.14 3.22 to 4.11, mean was 3.58, median 3.56 and standard
19-20 103 49.05 deviation 0.22.
21-22 8 3.81
However, computed MHI scores of the study population
Gender
with mean, median and standard deviation with various
Male 119 56.67
subgroups like anxiety, depression, behaviour control,
Female 91 43.33 positive affect were shown in Table 4.
Type of family
Nuclear 137 65.24 The computed MHI (0-100) total score ranges from 58-
Joint 54 25.71 74, mean score 51.56, median 51.2 and a standard
Three generation 19 9.05 deviation of 4.48. About 53 (25.24%) participants had an
Religion overall computed MHI score of 67 or more and hence
Hindu 180 85.71 were classified as having good mental health. 99
Muslim 20 9.52 (47.14%) participants with scores 62 - 66 were with
Christian 6 2.85 some mental health problem and were referred for
Other 4 1.92 counseling services. However, 58 (27.62%) were
classified to be having poor mental health requiring
further referral and detailed evaluation.
Of the 210 study participants, 119 (56.67%) were males
and 91 (43.33%) female students. Mean age of the study
participants was 18.55 years and standard deviation of The mean and computed MHI score of Sub-scale was
0.89. Minimum age was 17 years and maximum age shown in Table 3 and 4.

Table 3: Raw MHI scores of the study population with mean, median and standard deviation.

Overall MHI Range Mean Median Standard Deviation

1-6 3.22 - 4.11 3.58 3.56 0.22
Sub-scale
Anxiety 1.4 - 5.0 3.37 3.4 1.02
Depression 1.2 - 5.2 3.51 3.4 0.93
Behaviour control 2.5 - 5.2 4.37 4.5 0.45
Positive affect 1.75 - 6.0 3.13 3.5 0.96

Table 4: Computed MHI scores of the study population with mean, median and standard deviation.

Overall MHI Range Mean Median Standard Deviation

0-100 58 - 74 63.5 64.43 4.01
Sub-scale
Anxiety 8 - 60 47.36 48 20.27
Depression 8 - 84 50.29 48 18.69
Behaviour control 30 - 85 67.76 70 8.84
Positive affect 25 - 100 42.7 40 19.18

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Anxiety Mysore study and Iran study respectively. Another study

by Nojomi M et al also found that 19.4% of medical
The mean MHI Raw scores (1-6) in present study was students were having poor mental health status.4 In a
ranged from 1.4 to 5.0. The mean for raw scores was study done by Shaheena P et al among the youth of
3.37, median 3.4 and standard deviation 01.02. However, Kashmir majority by 38 item MHI questionnaire, 71% of
computed MHI (0-100) total score ranges from 8 to 60, the participants were found to be having some mental
mean score 47.36, median 48 and a standard deviation of health problem, 7% had poor mental health and only 22%
20.27. were in good mental health.5

Depression A study by Ganesh K et al reported the prevalence of

depression using Beck depression inventory among
The mean MHI Raw scores (1-6) in present study was medical students in Southern India, to be as high as
ranged from 1.2 to 5.2. The mean for raw scores was 71.25%.6 Various international studies conducted in
3.51, median 3.4 and standard deviation 0.93. However, different parts of world like Pakistan and United States of
computed MHI (0-100) total score ranges from 8 to 84, America reported the prevalence of depression to be 15-
Sub group analysis for behavior control mean score 65% among medical students.7-9 A study done by Sherina
50.29, median 48 and a standard deviation of 18.69. MS et al from Malaysia, the prevalence of depression was
33.6% using the CES-D scale.10 A study done by Rael D
Behavioral control Strous et al using DSM-IV criteria found 55.5% of
students had reported poor mental health status.11 In a
The mean MHI Raw scores (1-6) in present study was study conducted by Shah Navas P and Dahlin M et al
ranged from 2.5-5.2. The mean for raw scores was 4.37, among the medical students revealed that the prevalence
median 4.5 and standard deviation 0.45. However, was as low as 23% and 12% respectively.12,13
computed MHI (0-100) total score ranges from 30 to 85,
mean score 67.76, median 70 and a standard deviation of This wide range in the magnitude of prevalence of
8.84. depression can be attributed to variations in the types of
scales used in the screening and different ethnic, socio-
Positive affect demographic, socio-environmental, cultural, academic
and geographic backgrounds of students under study.
The mean MHI Raw scores (0-6) in present study was
ranged from 1.75 to 6.0. The mean for raw scores was CONCLUSION
3.13, median 3.5 and standard deviation 0.96. However,
computed MHI (0-100) total score ranges from 25 to 100, Presence of poor mental health and emotional health
mean score 42.7, median 40 and a standard deviation of problems among medical students was substantially high.
19.18. Early screening and diagnosis should be made available
to all the medical students. Accesses to a care and support
DISCUSSION should be provided to all medical students round the
clock through trained counsellors. Increasing awareness
Medicine is a demanding, competitive profession and the on various mental health issues, providing supportive
process of medical education is recognized as a stressful. mentoring and encouraging the medical students to seek
Given the factors that medical students shift to medical health when needed is crucial in promoting better mental
schools, with a different environment, away from the and emotional health of medical students.
comfort of the homely environment, vast syllabus, hectic
schedule, pressure of tests, exams, difference in food, ACKNOWLEDGEMENTS
culture, less time for relaxation and entertainment, often
exerts a negative effect on the academic performance, Authors would like to acknowledge the help and support
physical health, mental, psychological and emotional of the Director, Medical Superintendent and all the
health and wellbeing of the student. These external along Faculty of Department of Community Medicine,
with the internal motivation present as a wide spectrum Government Medical College, Koppal, Karnataka, India.
of psychological disorders like depression, anxiety, in
appropriate behaviour and negative frame of mind. 1,2 Funding: No funding sources
Conflict of interest: None declared
The findings of the present study about poor mental Ethical approval: The study was approved by the
health status of the participants was similar to that found Institutional Ethics Committee
by Manjunath R et al using Goldberg’s General Health
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