UNIVERSITY OF HEALTH AND ALLIED SCIENCES

SCHOOL OF PUBLIC HEALTH

2019/2021 VOCATIONAL TRAINING CASE STUDY REPORT ON

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

COMPILED BY
JOYCE BABANGNIDONG
MENTAL HEALTH – LEVEL 300
UHAS20203459

JANUARY, 2021

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 INTRODUCTION

Background

Mental health patients are at risk of experiencing stress, anxiety and depression, which cause

psychological distress. However, health care providers may fail to recognize symptoms and follow

the best practice recommendations because they may not have the time or resources to provide

evidence-based treatment in primary care settings. Psychiatric symptoms are often disguised by

somatic symptoms. In primary care, somatic symptoms play an important role in the manifestation

of depressive disorders. Because this has been under-evaluated, clinical case review is not an

adequate methodology to establish prevalence rates of mental disorders in these settings (Khan &

Khan, 2017).

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

obsessivecompulsive 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 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
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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 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

environmental conditions leads to psychological and biological changes, and the person is at risk

of becoming ill (Shete & Garkal, 2015). This vocational training case study seeks to find out the

prevalence of depression, anxiety and stress among patients receiving mental health services in

Duayaw Nkwanta, Tano North Municipal.

Study objective

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The main aim of this study was to find out the prevalence of depression, anxiety and stress among

patients receiving mental health services in Duayaw Nkwanta and to suggest appropriate measures

to intensify screening for depression, anxiety and stress and treat appropriately.

MATERIALS AND METHODS

Study design

The study design was a descriptive cross-sectional design using the Google Forms to carry out this

study. The strength of descriptive cross-sectional survey is that it can be carried out on small or

large scale.

Sample & sample size

The study population included patients receiving mental health services in Duayaw Nkwanta

between December, 2020 and January, 2021. A total of 30 randomly selected patients who consent

to participate in the study.

Study setting

The Tano North Municipal is one of the 260 Metropolitan, Municipal and District Assemblies

(MMDAs) in Ghana, and forms part of the 6 of Municipalities and Districts in the Ahafo Region.

It was carved out of the Tano District in 2004 with Duayaw-Nkwanta as its Administrative Capital.

The Municipality lies between Latitudes 70 00' N and 70 25'N and Longitudes 20 03' W and 20

15' W. It has a total land area of 837.4 square kilometers and constitutes about 1.8 percent of the

total land area of the Ahafo Region. It shares boundaries with Offinso North District to the

north-east and Ahafo Ano North Municipal to the south, all in the Ashanti Region. In the east,

it shares boundary with Tano South Municipal and Asutifi South District in the Ahafo Region and

on the west with Sunyani Municipality in the Bono Region. Duayaw Nkwanta has one of the best

hospitals in Brong-Ahafo. It is known as the Saint John of God of Hospital. The hospital has an

excellent orthopaedic centre. It is rated among the top three in Ghana (Ghana

Statistical Service, 2014).

Data collection Instrument

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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

GoogleForms 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,

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
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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 Joyce Babanidong, a Level 300 mental health student of School of Public Health, University

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

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

Nkwanta, Tano North Municipal. In case of enquiries, you can please contact me on

0541102511.
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 Joyce Babanidong, a Level 300 mental health student of School of Public Health, University

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

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

Nkwanta, Tano North Municipal. In case of enquiries, you can please contact me on 0541102511.

This is for academic purpose and therefore every piece of information will be treated with

confidentiality. Thank you.

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 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 is no right or wrong answers.

Do not spend too much time on any statement.

The rating scale is as follows:

0 - Did not apply to me at all

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

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

3 - 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
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

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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

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

Figure 1; Age Distribution of Respondents

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 FREQUENCY (N) PERCENTAGE (%)
100

50
23.3
30

26.7 7
8 15

18 -25 YEARS 26 - 33 YEARS 34 YEARS AND ABOVE TOTAL

The data in Figure 1 showed that 8 respondents (26.7%) were aged between 18 – 25 years, 15

respondents (50%) were aged between 26 – 33 years, and 7 respondents (23.3%) 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.

Figure 2: Sex distribution of Respondents

Male Female Total

Male
15
Total (50%)
30 (100%)
Female
15(50%)

The data in Figure 2 indicated that, 15 respondents (50%) were males and 15 respondents (50%)

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

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 Male Female Male Female Male Female
n (%) n (%) n (%) n (%) n (%) n (%)
Normal
13 (43.3%) 12(40%) 14(46.7%) 14 (46.7%) 13(43.3%) 14(46.7%)

Mild
2(6.7%) 1(3.3%) 1(3.3%) 1(3.3%) 2(6.7%) 1(3.3%)
Moderate
0 2(6.7%) 0 0 0 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 and 2 female participants

(6.7%) presented moderate symptoms of depression. 1 male participant (3.3%) presented with mild

symptoms of Anxiety and 1 female participants (3.3%) presented mild symptoms of Anxiety. Also,

2 male participants (6.7%) presented mild symptoms of Stress and 1 female participant (3.3%)

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 8(26.7%) 0 0 0

26 -33 years 13(43.3%) 2(6.7%) 0 0

34 years and above 4(13.3%) 1(3.3%) 2(6.7%) 0

ANXIETY

18 – 25 years 6(20%) 2(6.7%) 0 0

26 -33 years 15(50%) 0 0 0

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

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 STRESS

18 – 25 years 8(26.7%) 0 0 0

26 -33 years 15(50%) 0 0 0

34 years and above 4(13.3%) 3(10%) 0 0

The data in Table 2 showed that 2 participants (6.7%) aged between 26 – 33 years presented mild

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

moderate symptoms of depression. However, 2 participants (6.7%) aged between 34 years and

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

between 18-25 years and presented with mild symptoms of anxiety. 3 participants (10%) were

aged between 34 years and above, presented symptoms of mild 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.

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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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Basudan, S., Binanzan, N., & Alhassan, A. (2017). Depression , anxiety and stress in dental

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

Ghana Statistical Service. (2014). Tano north district.

Khan, S., & Khan, R. A. (2017). Chronic Stress Leads to Anxiety and Depression. 5, 14–17.

Ram, E., Gea-caballero, V., & Granada-l, M. (2016). The Prevalence of Depression , Anxiety and

Stress and Their Associated Factors in College Students.

Shete, A. N., & Garkal, K. D. (2015). O R IGIN A L A R TICLE A study of stress , anxiety , and

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3334.153255

Wang, J., Wu, X., Lai, W., Long, E., Zhang, X., Li, W., Zhu, Y., Chen, C., Zhong, X., Liu, Z.,

Wang, D., & Lin, H. (2017). Prevalence of depression and depressive symptoms among

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https://doi.org/10.1136/bmjopen2017-017173

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