UNIVERSITY OF HEALTH AND ALLIED SCIENCES

SCHOOL OF PUBLIC HEALTH (HOHOE)

2019/2021 VOCATIONAL TRAINING CASE STUDY REPORT ON

DEPRESSION, ANXIETY, AND STRESS AMONG MENTAL HEALTH PATIENTS IN
AGONA SWEDRU, AGONA WEST, MUNICIPAL

COMPILED BY
MERCY AMOAH
MENTAL HEALTH - LEVEL 300
UHAS20191377

JANUARY, 2021

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 INTRODUCTION

Background

Mental health refers to cognitive, behavioral, and emotional well-being. It is all about how
people think, feel, and behave. People sometimes use the term “mental health” to mean the
absence of a mental disorder. Mental health includes our emotional, psychological, and social
well-being. It affects how we think, feel, and act. It also helps determine how we handle stress,
relate to others, and make choices. Mental health is important at every stage of life, from
childhood and adolescence through adulthood.
Psychiatric patients are at risk of experiencing stress, anxiety and depression, which cause
psychological distress and unease. Mental health disorders account for several of the top causes
of disability in established market economies, such as the U.S., worldwide, and include: major
depression (also called clinical depression), manic depression (also called bipolar disorder),
schizophrenia, and obsessive-compulsive disorder. An estimated 26% of Americans ages 18 and
older -- about 1 in 4 adults -- suffers from a diagnosable mental disorder in a given year. Many
people suffer from more than one mental disorder at a given time. In particular, depressive
illnesses tend to co-occur with substance abuse and anxiety disorders. Approximately 9.5% of
American adults ages 18 and over will suffer from a depressive illness (major depression, bipolar
disorder, or dysthymia) each year. Women are nearly twice more likely to suffer from major
depression than men. However, men and women are equally likely to develop bipolar disorder
(Ram et al., 2016).
While major depression can develop at any age, the average age at onset is the mid-20s. With
bipolar disorder, which affects approximately 2.6% of Americans age 18 and older in a given
year, the average age at onset for a first manic episode is during the early 20s. Most people who 2
commit suicide have a diagnosable mental disorder -- most commonly a depressive disorder or a
substance abuse disorder. Four times as many men than women commit suicide. However,
women attempt suicide more often than men. The highest suicide rates in the U.S. are found in
Caucasian men over age 85. However, suicide is also one of the leading causes of death in
adolescents and adults ages 15 to 24 (Basudan et al., 2017).
In most common cases, schizophrenia is a common mental health condition in most communities
and it first appears in men during their late teens or early 20s. In women, schizophrenia often
first appears during their 20s or early 30s. Approximately about 18% of people ages 18- 54 in a
given year, have an anxiety disorder in a given year. Anxiety disorders include: panic disorder,
obsessive-compulsive disorder, post-traumatic stress disorder, generalized anxiety disorder, and

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phobias (social phobia, agoraphobia, and specific phobia) (Wang et al., 2017).
Depression is a mood disorder which is characterized by short-term emotional responses to a
serious health condition associated with impaired daily functioning accompanied by symptoms,
such as sadness and frustration, feelings of guilt, insensibility, and loss of interest. Depression is
a common psychiatric disorder in the world, affecting more than 300 million people worldwide
Depression has many possible causes, such as genetics, brain chemicals and your life situation.
Chronic stressful life situations can increase the risk of developing depression if you aren't
coping with the stress well. There's also increasing evidence of links among poor
coping, stress and physical illness (Alagizy et al., 2020).
Anxiety disorders are defined as a group of mental disorders characterized by an unpleasant
feeling with uneasiness or worry about future events or the fear of responding to current events.
It may occur without an identifiable triggering stimulus. In 2013, one out of every nine people in
the world had at least one of the anxiety disorders. In stress, a person's lack of compliance with 3
environmental conditions lead to psychological and biological changes, and the person is at risk
of becoming ill (Shete & Garkal, 2015).

Study objective

The goal of this study was to find out the level of stress, depression and anxiety among the
mental health patients diagnosed in Agona Swedru and to suggest appropriate measures to
intensify screening for depression, anxiety and stress and treat appropriately.
MATERIALS AND METHODS

Study design

Descriptive cross-sectional design was used as the study design. It inspects the prevalence of a
disease or condition in a defined population at a specific point or period in time. Google form
was used to conduct the survey.
Sample & sample size

A total of 30 randomly selected patients who were receiving mental health treatment in Agona
Swedru Hospital gave their consent to participate in the study.
Study setting

The Agona West Municipal is one of the 260 Metropolitan, Municipal and District Assemblies in
Ghana and forms part of the 22 MMDAs in the Central Region. It has a total land area of 540-sq.
km. and a population of 160,000. With its capital as Swedru has a population of about 40,000. It

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lies to the north of Winneba and is about 40 km. off the main Accra-Takoradi Highway. The
municipality is divided into eleven zones.
It lies within latitudes 5 30’ and 5 50N and longitudes 0 3.5’ and 0 55W. The area is bounded to
the east and west by Effutu Municipal and Asikum/Odoben/Brakwa Districts respectively,
northeast with West Akim Municipal, to the northwest with Birim Central Municipal and to the
South, with Gomoa Central District. The population of the Municipality according to 2010
population and housing census stands at 115,358 with 54,159 males and 61,199 females. Agona
Swedru has one of the best hospitals in Central Region. The hospital has an excellent orthopedic
center. It is rated among the top three in Ghana (Ghana Statistical Service, 2014).
Data collection Instrument

The study used a structured questionnaire to collect information about participants’

sociodemographic including age; and gender. An approved instrument for assessing depression,
anxiety, and stress was used. DASS is a short screening tool that measures depression, anxiety,
and stress by a 21-item self-report questionnaire. For each disorder, seven questions are
considered, and the final score is obtained by the total score of the questions related to it. Each
question was scored using a Likert scale, ranging from 0 (did not apply to me at all/never) to
three (applied to me very much, or most of the time/almost always). Higher scores indicated a
higher level of disorder by a specific classification scoring. Individuals are classified as normal,
mild, moderate, severe, and very severe based on their responses.
Procedures

The Permission of the institution was soughed first and afterwards selected respondents were
briefed on the study. Confidentiality of the participants was maintained, before the
questionnaires were administered to the participants individually using Google Forms containing
the socio-demographic data and the DASS -21 tools. The instrument was administered by the
student and the appropriate options from the respondent were selected accordingly by ticking the
appropriate response in the questionnaire and submit the responses after each participant until the
30 respondents were completed.

Data Analysis

After completing the questionnaire with the 30 respondents, the data were transferred from

Google Forms to an Excel sheet and exported to SPSS version 20.0 for the analysis. Data was

analyzed using Statistical Package for Social Sciences (SPSS) version 20 and thereafter,

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descriptive statistics such as frequencies, percentages, tables, and charts were used to present the

data.

Ethical Approval

Ethical approval was obtained from the study area before the data collection, and consent form in

the Google Form was first completed before the survey questions precede. Those who agreed to

participate in the survey only had access to the remaining questionnaire. However, participants

who were not interested in participating in the survey were denied access to the questionnaire.

Participants who gave their consent to participate in the survey were informed that their

participation was voluntary and that they could withdraw from the study at any point or choose

not to answer any question. Participants’ confidentiality was maintained as no identifying

information was collected and findings would not convey respondent’s information.

General Information about the study

I am Amoah Mercy, a Level 300 mental health student of School of Public Health, University of

Health and Allied Sciences, Hohoe. I am conducting a case study is to find out the prevalence of

depression, anxiety and stress among patients receiving mental health services in Agona Swedru,

Agona West Municipal. In case of enquiries, you can please contact me on 0244894603.

Participant agreement

I have read or have had someone read all of the above, asked questions, received answers

regarding participation in this study, and am willing to give consent for me, my child/ward to

participate in this study.

DATA COLLECTION TOOL

Dear Respondent,

I am Amoah Mercy, a Level 300 mental health student of School of Public Health, University of

Health and Allied Sciences, Hohoe. I am conducting a case study is to find out the prevalence of

depression, anxiety and stress among patients receiving mental health services in Agona Swedru,

Agona West Municipal. In case of enquiries, you can please contact me on 0244894603. This is
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 for academic purpose and therefore every piece of information will be treated with

confidentiality. Thank you.

SECTION A

SOCIO-DEMOGRAPHIC INFORMATION OF RESPONDENTS

Instruction: Please provide the appropriate option by ticking in the space provided
PERSONAL DATA RESPONSE
Age of respondent 18 – 25 years [ ]

1 26 -33 years [ ]
34 years and above [ ]
2 Sex of respondent Male [ ]
Female [ ]

SECTION B

DEPRESSION, ANXIETY AND STRESS SCALE - DASS 21

INSTRUCTION: Please read each statement and circle a number 0, 1, 2, or 3 which indicates

how much the statement applied to you over the past week. There are no right or wrong answers.

Do not spend too much time on any statement.

The rating scale is as follows:

1 - Did not apply to me at all

2 - Applied to me to so degree, or some of the time

3 - Applied to me to a considerable degree or a good part of the time

4 - Applied to me very much or most of the time

SN DEPRESSION, ANXIETY AND STRESS SCALE RESPONSES
(Choose only one option)
1 I found it hard to wind down 0 1 2 3
2 I was aware of dryness of my mouth 0 1 2 3
3 I couldn’t seem to experience any positive feeling at all 0 1 2 3

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4 I experienced breathing difficulty (e.g. excessively rapid 0 1 2 3
breathing, breathlessness in the absence of physical exertion)

5 I found it difficult to work up the initiative to do things 0 1 2 3

6 I tended to over-react to situations 0 1 2 3
7 I experienced trembling (e.g. in the hands) 0 1 2 3
8 I felt that I was using a lot of nervous energy 0 1 2 3
9 I was worried about situations in which I might panic and make a 0 1 2 3
fool of myself

10 I felt that I had nothing to look forward to 0 1 2 3

11 I found myself getting agitated 0 1 2 3

12 I found it difficult to relax 0 1 2 3

13 I felt down-hearted and blue 0 1 2 3
14 I was intolerant of anything that kept me from getting on with 0 1 2 3
what I was doing
15 I felt I was close to panic 0 1 2 3
16 I was unable to become enthusiastic about anything 0 1 2 3
17 I felt I wasn’t worth much as a person 0 1 2 3
18 I felt that I was rather touchy 0 1 2 3
19 I was aware of the action of my heart in the absence of physical 0 1 2 3
exertion (e.g. sense of heart rate increase, heart missing a beat)

20 I felt scared without any good reason 0 1 2 3

21 I felt that life was meaningless 0 1 2 3

RESULTS AND DISCUSSIONS

This present respondent socio-demographic information such as age and sex and the DASS-21

questionnaire. Tables, pie charts and bar charts are used in representing the findings.

Some Demographic Characteristics of Respondents

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The age of the respondents and the results of the analysis are shown in Figure 1.

Figure 1; Age Distribution of Respondents

Personal Data Response Percentage (%)

18-25 10 33.33
26-33 11 36.67
Age of respondents
34 years and 9 30
above
Total 30 100

male 20 66.67
Sex of respondents
female 10 33.33
Total 30 100

36.67%
33.33%
30%

The data in Figure 1 showed that 10 respondents (33.33%) were aged between 18 – 25 years, 11

respondents (36.67%) were aged between 26 – 33 years, and 9 respondents (30%) were aged

between 34 years and above.

The Sex distribution of respondents was analyzed using pie chart and the outcome of this

analysis is presented in Figure 2.

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 Figure 2: Sex distribution of Respondents

The data in Figure 2 indicated that, 20 respondents (66.67%) were males and 10 respondents

(33.33%) were females.

Table 1: Respondents levels of symptoms of depression, anxiety and stress by their Sex
Distribution
levels of Symptoms of Depression Symptoms of Anxiety Symptoms of Stress
symptoms
Male n Female Male Female Male Female n
(%) n (%) n (%) n (%) n (%) (%)
Normal
17 (56.7%) 8(26.7%) 15(50%) 5 (16.7%) 19(63.3%) 7(23.3%)
Mild
2(6.7%) 1(3.3%) 2(6.7%) 4(13.3%) 0 3(10%)
Moderate
1(3.3%) 1(3.3%) 3(10%) 1(3.3%) 1(3.3%) 0

Severe
0 0 0 0 0 0
Extremely severe
0 0 0 0 0 0

The data in Table 1 shows that 2 male participants (6.7%) presented mild symptoms of

depression, 1 female participant (3.3%) presented mild symptoms of depression, 1 male

participants (3.3%) presented moderate symptoms of depression and 1 female participants (3.3%)

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 presented moderate symptoms of depression. 2 male participants (6.7%) presented with mild

symptoms of Anxiety, 4 female participants (13.3%) presented mild symptoms of Anxiety, 3

male participants (10%) presented moderate symptoms of Anxiety and 1 female participant

(3.3%) presented moderate symptoms of Anxiety. Also, 1 male participant (3.3%) presented

moderate symptoms of Stress and 3 female participants (10%) presented mild symptoms of

Stress (see Table 1).

Table 2: Respondents levels of symptoms of depression, anxiety and stress by their Age Groups
AGE GROUP DEPRESSION

Normal Mild Moderate Extremely Severe

18 – 25 years 7(23.3%) 1(3.3%) 1(3.3%) 0

26 -33 years 11(36.7%) 1(3.3%) 0 0

34 years and above 7(23.3%) 1(3.3%) 1(3.3%) 0

ANXIETY

18 – 25 years 5(20%) 0 0 0

26 -33 years 8(26.7%) 2(6.7%) 3(10%) 0

34 years and above 7(23.3%) 4(13.3%) 1(3.3%) 0

STRESS

18 – 25 years 6(20%) 0 0 0

26 -33 years 9(30%) 3(10%) 0 0

34 years and above 11(36.7%) 0 1(3.3%) 0

The data in Table 2 showed that 1 participant (3.3%) aged between 18 – 25 years presented mild

symptoms of depression, 1 participant (3.3%) aged between 26 – 33 years presented mild

symptoms of depression, 1 participant (3.3%) aged between 34 years and above presented mild

symptoms of depression. However, 1 participant (3.3%) aged between 18 – 25 years presented

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moderate symptoms of depression and 1 participant (3.3%) aged between 34 years and above

presented with moderate symptoms of depression. For anxiety, 2 participants (6.7%) aged

between 26-33 years presented with mild symptoms of anxiety and 4 participants (13.3%) aged

between 34 years and above presented with mild symptoms of anxiety. However, 3 participants

(10%) aged between 26-33 years presented with moderate symptoms of anxiety and 1 participant

(3.3%) aged between 34 years and above presented with moderate symptoms of anxiety. 3

participants (10%) were aged between 26-33 years presented symptoms of moderate stress and 1

participant (3.3%) were aged between 34 years and above, presented symptoms of moderate

stress (See Table 2).

SHORTFALLS OF DASS-21 TOOL

1. The DASS-21 is reliable and suitable for use to assess symptoms of common mental health

problems, especially depression and anxiety among adolescents. However, its ability in

detecting stress among these adolescents may be limited.

2. Understanding and interpretation of some questions during administration of the tool is

difficult.

RECOMMENDATION

1. Considering the increasing use of the DASS-21, it is necessary to revise some items,

especially those belonging to the stress construct, to minimize misinterpretation or lack of

comprehension of some items.

2. The DASS-21 tool should be design to clearly and independently identify the signs of the

three psychological states that compose it, in a population.

3. There should be a short training on how to use the DASS21 tool to ensure proper and

accuracy of findings.

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students. 179–186. https://doi.org/10.5116/ijme.5910.b961

Ghana Statistical Service. (2014). Agona West District.

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