PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS

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However, the variations in prevalence reported by different published studies leaves the true burden of depression among medical students in Africa unknown. Objectives This study aimed at conducting a systematic review and meta-analysis to report the true estimate of prevalence of depression among medical students in Africa between 2012 and 2022. Methods Articles that reported prevalence of depression among medical students in Africa between 2012 and 2022 study period were searched for in PubMed, Google Scholar, African Journals Online, and Embase. Two investigators independently extracted the data for full review and eligible studies were considered for analysis after a consensus, quality of articles was assessed using JBI Critical Appraisal tool [1] for prevalence studies. R version 4.3.2 [2] was used to establish the pooled prevalence using a random effects model, funnel plot and Eggers test were used to check for publication bias. Results A total of twenty-six cross-sectional studies involving 11386 (Females: 6070, 53.3%) medical students, mean age 23, were included in this study. PHQ9 (n=10), DASS21 (n=7), BDI-II (n=5) were the most used screening instruments. The overall pooled prevalence of depression was 38% (p < 0.00). Sub-group analysis by instrument used i.e. DASS21, PHQ-9, BDI-II, revealed prevalence of 50% (p < 0.01), 39% (p < 0.01) and 32% (p < 0.01) respectively. Conclusion Nearly two-fifths of medical students in Africa suffer from depression. The findings emphasize the urgent need for research into the causes, alongside early diagnosis with standardized tools and targeted interventions to manage depression effectively among this demographic. PROPERO (CRD42022372866). 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F1000Research 2024, 13 :523 ( https://doi.org/10.12688/f1000research.149103.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details Export Export Citation Sciwheel EndNote Ref. Manager Bibtex ProCite Sente EXPORT Select a format first Track Share ▬ ✚ Systematic Review PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] Ivaan Pitua 1 , Amelia Margaret Namiiro 1 , Raafidha Raizudheen 1 , Lorraine Apili 1 Ivaan Pitua 1 , Amelia Margaret Namiiro 1 , Raafidha Raizudheen 1 , Lorraine Apili 1 PUBLISHED 22 May 2024 Author details Author details 1 School of Medicine, Makerere University, Kampala, Central Region, Uganda Ivaan Pitua Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Amelia Margaret Namiiro Roles: Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Raafidha Raizudheen Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Lorraine Apili Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing OPEN PEER REVIEW DETAILS REVIEWER STATUS Abstract Background Depression is among the most common mental health disorders affecting social and academic progress of university students globally. However, the variations in prevalence reported by different published studies leaves the true burden of depression among medical students in Africa unknown. Objectives This study aimed at conducting a systematic review and meta-analysis to report the true estimate of prevalence of depression among medical students in Africa between 2012 and 2022. Methods Articles that reported prevalence of depression among medical students in Africa between 2012 and 2022 study period were searched for in PubMed, Google Scholar, African Journals Online, and Embase. Two investigators independently extracted the data for full review and eligible studies were considered for analysis after a consensus, quality of articles was assessed using JBI Critical Appraisal tool [1] for prevalence studies. R version 4.3.2 [2] was used to establish the pooled prevalence using a random effects model, funnel plot and Eggers test were used to check for publication bias. Results A total of twenty-six cross-sectional studies involving 11386 (Females: 6070, 53.3%) medical students, mean age 23, were included in this study. PHQ9 (n=10), DASS21 (n=7), BDI-II (n=5) were the most used screening instruments. The overall pooled prevalence of depression was 38% (p < 0.00). Sub-group analysis by instrument used i.e. DASS21, PHQ-9, BDI-II, revealed prevalence of 50% (p < 0.01), 39% (p < 0.01) and 32% (p < 0.01) respectively. Conclusion Nearly two-fifths of medical students in Africa suffer from depression. The findings emphasize the urgent need for research into the causes, alongside early diagnosis with standardized tools and targeted interventions to manage depression effectively among this demographic. PROPERO (CRD42022372866). READ ALL READ LESS Keywords Depression, Depressive symptoms, Medical students, Africa Corresponding Author(s) Ivaan Pitua ( [email protected] ) Close Corresponding author: Ivaan Pitua Competing interests: No competing interests were disclosed. Grant information: The author(s) declared that no grants were involved in supporting this work. Copyright: © 2024 Pitua I et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. How to cite: Pitua I, Margaret Namiiro A, Raizudheen R and Apili L. PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.12688/f1000research.149103.1 ) First published: 22 May 2024, 13 :523 ( https://doi.org/10.12688/f1000research.149103.1 ) Latest published: 22 May 2024, 13 :523 ( https://doi.org/10.12688/f1000research.149103.1 ) 1. Introduction Over the last decade, there has been an increase in interest in university students’ mental health as depressive symptoms affect between 24 and 34 percent of university students worldwide and has also been reported to be more prevalent among health professions students than in the general population. 3 In a recent study, up to 27.2% of medical students had depression globally affecting about a third of medical students worldwide. 4 Understanding the burden of psychological morbidity among these students is critical and interventions are especially beneficial in resource-constrained contexts, such as low and middle-income countries (LMICs), where the best solution may not be readily available. 5 , 6 Medical students in Africa have also been found to have a significant prevalence of depression, according to recent studies with more association with the female sex than their male counterparts (5). Olum et al noted a prevalence of 21.5% among medical students at Makerere University, which is similar to related research findings on medical students in Nigeria (17.4%) 7 and Sudan (21.5%). 8 Academic pressure, demanding workloads, concern about one’s own health, financial concerns, exposure to patients’ suffering, student abuse and mistreatment are all factors associated with psychological morbidity among medical students. 9 , 10 Depression is also associated with higher suicide rates, which may explain why medical professionals have a higher suicide rate than the general population. 10 , 11 Students who are experiencing extreme stress or depression require immediate attention; otherwise, their inability to cope successfully with the enormous stress of education may result in a cascade of personal and professional consequences. 11 – 13 Students’ psychological distress can have a negative impact on their academic performance and quality of life, as well as contribute to alcohol and substance abuse, decreased empathy, and academic dishonesty. 12 , 14 Given the risks and consequences of psychological morbidity on students, as well as the remarkable growth in medical student numbers in Sub-Saharan Africa over the last decade, there is a need to understand the pooled prevalence of depression among these students. However, previous systematic reviews evaluating the prevalence of depression among health professions’ students have been conducted on studies that were carried out in the Brazil, 13 Pakistan, 3 Canada and other European and Asian countries 14 therefore, conducting a systematic review and meta-analysis of prevalence of depression among medical students in Africa is equally essential for informed preventive and treatment measures. 2. Methods 2.1 Study design The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) guidelines 15 was used by the researchers. The study protocol was registered with PROPERO (CRD42022372866). 2.2 Eligibility criteria Studies carried out between 2012 and 2022 reporting prevalence of depression among medical students in Africa. 2.3 Exclusion criteria Review studies, case reports, case series and studies reporting disorders other than depression like anxiety, suicidal ideation and burn out were strictly excluded. Similar studies carried out in continents other than Africa were also excluded from the review. 2.4 Search strategy/data sources Relevant sources (PubMed, Google Scholar, African Journals Online and Embase) were used with help of a medical librarian, articles reporting studies conducted between 2012 and 2022 were considered. Only peer-reviewed articles in English were included, review articles, case reports and case series were excluded, cross-sectional studies were included. Authors whose articles were not free access were contacted by email, references to selected studies were searched for manually to obtain more relevant studies. Our search words included; depression, depression among medical students, depressive symptoms, African medical students, prevalence of depression, burden and incidence of depression. 2.5 Study selection process Duplicates of eligible studies were screened off using EndNote v20.5 software and articles were included for full review by NAM and RR, any disagreement was settled by IP and LA. The articles were then shared among paired reviewers (NAM and RR) and (IP and LA), and the lead investigator IP settled disagreements among individuals during the process of synthesis ( Figure 1 ). Figure 1. The PRISMA flow diagram. 2.6 Data management and extraction An excel spreadsheet document was used to capture the following information from each study; Study, Study year, Country, Sampling technique, Sample size, Prevalence, Mean Age, Females, Males, Instrument used. 2.7 Quality assessment Joanna Briggs Institute (JBI) checklist 1 was used to evaluate the risk of bias. It is a 4-point Likert scale with the following questions; 1). Was the sample frame appropriate to address the target population? 2) Were study participants sampled appropriately? 3) Was the sample size adequate? 4) Were the study subjects and settings described in details? 5) Was the data analysis conducted with sufficient coverage of the identified sample? 6) Were valid methods used for the identification of the condition? 7) Was the condition measured in a standard reliable way for all participants? 8) Was there appropriate statistical analysis? 9) Was the response rate adequate, and if not, was the low response rate managed appropriately? “No”, “Yes”, “Unclear” and “Not applicable” are the responses and 1 point is assigned for a Yes, a score less than 5 qualified an article for exclusion ( Table 1 ). Table 1. Joanna Briggs Institute (JBI) checklist scores for included studies. Study Type of study Was the sample frame appropriate to address the target population? Were study participants sampled in appropriate way? Was the sample size adequate? Were the study subjects and the settings describes in detail? Was the data analysis conducted with sufficient coverage of the identified sample? Were valid methods used for identification of the condition? Was the condition measured in a standard reliable way for all participants? Was there appropriate statistical analysis? Was the response rate adequate, and if not, was the low response rate managed appropriately? Alphonsus et al.,2022 16 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Dafaalla et al., 2016 8 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Dagnew et al., 2020 9 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Deborah et al., 2020 17 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Elsawy et al., 2020 18 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Falade et al., 2020 19 Cross-sectional study Yes No Yes Yes Yes Yes Yes Yes Yes Fawzy & Hamed, 2017 20 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Ibrahim et al., 2015 21 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Mebratu et al., 2019 22 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Melaku et al., 2021 23 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Mohamed et al., 2019 24 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Mwita et al., 2020 25 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Nelao et al., 2023 26 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Ngasa et al., 2017 27 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Njim et al., 2019 28 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Nkporbu et al., 2019 29 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Olum et al., 2020 30 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Osama et al., 2022 31 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Ossai, 2021 7 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Pillay et al., 2016 32 Cross-sectional study Yes No Yes Yes Yes Yes Yes Yes Yes Sherif et al., 2021 33 Cross-sectional study Yes No Yes Yes Yes Yes Yes Yes Yes Uzoechi et al.,2021 34 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Van et al., 2019 35 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Yousif et al., 2016 36 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Mohammed et al., 2022 37 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Worku et al., 2020 38 Cross-sectional study Yes Yes Yes Yes Yes Yes Yes Yes Yes Data analysis R version 4.3.2 2 was used to perform a random effects model meta-analysis for prevalence of depression. Overall pooled estimate of prevalence was reported as percentage at 95% CI, determined by random effects model when I 2 >50 was realized and results were shown in forest plots. Publication bias was visually assessed using corresponding funnel plot and an Eggers test was done to test asymmetry. A subgroup analysis based on screening tools used to diagnose depression was conducted, a comparison was made in relation to prevalence of depression considering p-value < 0.05 as significant. 3. Results 3.1 Study characteristics 26 cross-sectional studies involving 11386 (Females: 6070, 53.3%) medical students with a mean age of 23 met the inclusion criteria, this was out of a total of 87 related studies conducted between 2012 and 2022. Most of the studies were conducted in Nigeria (n=6) and Egypt (n=5). Ethiopia had 4 studies, while Sudan had 3. Both South Africa and Cameroon had 2 studies each, and Libya, Uganda, Namibia, and Tanzania had one study each. PHQ9 (n=10), DASS21 (n=7), BDI-II (n=5) were the most used screening instruments. Table 2 provides a summary of the studies reviewed. Table 2. Characteristics of studies reporting prevalence of depression among medical students in Africa between 2012 and 2022. Study Study year Country Sampling technique Sample size Prevalence Mean age Females Males Instrument Mebratu et al., 2019 22 2017 Ethiopia Systematic sampling 273 0.51 - 108 165 HADS Ibrahim et al., 2015 21 2014 Egypt Random sampling 164 0.58 19 82 82 BDI-II Yousif et al., 2016 36 2015 Egypt Random sampling 442 0.61 20 270 172 DASS-21 Fawzy & Hamed, 2017 20 2015 Egypt Random sampling 700 0.65 21 452 248 DASS-21 Dagnew et al., 2020 9 2019 Ethiopia Random sampling 383 0.35 21 115 268 BDI-II Sherif et al., 2021 33 2018 Libya Random sampling 270 0.45 - 270 0 PHQ-9 Falade et al., 2020 19 2019 Nigeria Purposive sampling 944 0.14 21 642 302 HADS Ossai, 2021 7 2021 Nigeria Random sampling 522 0.17 23 208 314 BDI-II Pillay et al., 2016 32 2016 South Africa Convinience sampling 230 0.16 - 164 66 Zung SDS Van et al., 2020 35 2018 South Africa - 473 0.36 22 333 140 PHQ-9 Dafaalla et al., 2016 8 2016 Sudan Random sampling 487 0.21 - 162 325 DASS-21 Osama et al., 2022 31 2020 Sudan Convinience sampling 1058 0.75 21 604 454 DASS-21 Olum et al., 2020 30 2019 Uganda Random sampling 331 0.22 23 136 195 PHQ-9 Ngasa et al., 2017 27 2015 Cameroon Random sampling 618 0.31 22 286 332 PHQ-9 Njim et al., 2019 28 2018 Cameroon Random sampling 413 0.66 21 188 225 PHQ-9 Mohamed et al., 2019 24 2017 Sudan Convinience sampling 440 0.22 - 223 217 PHQ-9 Deborah et al., 2020 17 2019 Nigeria Purposive sampling 408 0.45 23 207 201 DASS-21 Elsawy et al., 2020 18 2016 Egypt Random sampling 390 0.45 - 195 195 BDI-II Melaku et al., 2021 23 2019 Ethiopia Random sampling 260 0.52 22 96 164 DASS-21 Nelao et al., 2023 26 2022 Namibia Random sampling 229 0.44 22 164 65 PHQ-9 Nkporbu et al., 2019 29 2016 Nigeria Random sampling 305 0.05 24 138 167 Zung SDS Uzoechi et al., 2021 34 2018 Nigeria Random sampling 243 0.31 - 115 128 DASS-21 Alphonsus et al., 2022 16 2020 Nigeria Random sampling 300 0.32 22 159 141 PHQ-9 Mwita et al., 2020 25 2020 Tanzania Random selection 353 0.41 - 162 191 PHQ-9 Mohammed et al., 2022 37 2019/20 Egypt Multi stage sampling 766 0.56 21 428 338 PHQ-9 Worku et al., 2020 38 2019 Ethiopia 384 0.04 - 163 221 BDI-II Prevalence of depression The overall pooled prevalence of depression was 38% (p < 0.00). Sub-group analysis by instrument used revealed prevalence of 50% (p < 0.01), 32% (p < 0.01) and 39% (p < 0.01) for DASS21, BDI-II, and PHQ-9 respectively Figure 2 and Figure 4 . Figure 2. Forest plot of prevalence of depression. PHQ = Primary Health Questionnaire, DASS = Depression Anxiety Stress Scale, BDI = Beck Depression Inventory, DASS21 = Depression, Anxiety and Stress Scale – 21, HADS = Hospital Anxiety and Depression Scale, Zung SDS = Zung Self-Rating Depression Scale. Figure 3. Funnel plot of prevalence of depression. Figure 4. Forest plot of prevalence of depression sub-grouped by screening tools used. In assessing the potential for publication bias within our meta-analysis, we conducted Egger’s regression test. The test did not reveal statistically significant evidence of publication bias (p = 0.090), with the intercept from Egger’s test being 1.697 standard errors away from the null hypothesis of no bias (Z = 1.697). These findings suggest that our meta-analytic results are not markedly influenced by publication. Funnel plot of prevalence of depression shown in Figure 3 . 4. Discussion The present study reviewed 26 articles published of studies conducted between 2012 and 2022 (over a ten year period). Included were all studies reporting the prevalence of depression or depressive symptoms among medical students in Africa. A total of 11386 medical students were amassed from different medical schools across universities and colleges in Africa inclusive of 6070 females (53.3%) and 5316 males (46.7%). The studies were mainly carried out in the countries of Egypt, Nigeria, Ethiopia and South Africa, Namibia, Tanzania, Cameroon, Sudan and Uganda which gives a good representation of all regions across the African continent. The overall pooled prevalence of depression was 38% (p < 0.00). Sub-group analysis by instrument used revealed prevalence of 50% (p < 0.01), 39% (p < 0.01) and 32% (p < 0.01) for DASS21, PHQ-9 and BDI-II respectively. A similar study conducted in India addressing the depression reviewed a total of 28 original studies published between 2014 and 2018. 39 A total of 7046 medical students (3170 females) were considered and it reported a prevalence of 42.6% which is not significantly skewed from our findings though slightly higher than the outcome our analysis of 38%. The sample sizes of the studies considered in this review was ranging from 86 to 444 medical students, compared to our study (164 to 1058). The studies included reported prevalence ranging from 08.9% to 79.2% compared to our study that included articles reporting ranges from 4% to a worrisome 75%. These findings are significantly high and thus worrying as widespread depression is allied to decreased performance and higher incidences of long standing morbidity and even suicidal tendencies especially amongst this population in study. The high prevalence of depression among medical students in Africa, as compared to the general population, raises critical questions about the unique stressors and challenges faced by these students. Academic pressures, demanding workloads, and exposure to patient suffering, previously identified as significant factors contributing to psychological morbidity among medical students. 9 , 10 Furthermore, the significant association of depression with higher suicidal ideation and rates among medical professionals 10 , 19 , 30 highlights the critical importance of early diagnosis, standardized screening, and effective management strategies. These findings advocate for the integration of mental health services and support systems within medical education, emphasizing the necessity of creating environments that not only recognize the mental health needs of students but also actively contribute to their well-being. Our review also identified the PHQ-9, DASS-21, and BDI-II as the most adopted instruments employed across the studies. Each of these instruments brings distinct strengths to the understanding of depression among medical students. The PHQ-9’s alignment with DSM-IV criteria for depression ensures that it is clinically relevant, while the DASS-21’s broader scope captures a wide range of emotional distress, offering insights beyond mere depressive symptoms. The BDI-II’s focus on cognitive aspects allows for the exploration of thought patterns associated with depression, providing depth to the assessment. However, these tools also have limitations. The PHQ-9’s brevity might overlook nuanced aspects of depression experienced by medical students, especially those related to academic stressors. The DASS-21, while comprehensive, may dilute the focus on depression by encompassing anxiety and stress. The BDI-II’s emphasis on cognition may miss other crucial aspects, such as physical symptoms associated with depression. 40 – 42 Comparatively, clinical diagnosis of depression, typically conducted through structured interviews based on DSM-5 criteria, offers a holistic assessment of the individual, considering both psychological and physical symptoms along with functional impairments. 43 – 45 While the screening instruments provide a practical and accessible means of identifying symptoms of depression, they cannot fully replicate the depth of clinical diagnosis, which considers the patient’s complete medical history, co-occurring disorders, and the intricate interplay of symptoms over time. 4.1 Limitations of the study The study focused on only published data which had reported different screening instruments and individual demographics, also the study variables inspected were not sufficient to explain heterogeneity. A study involving a larger population randomly screened by clinical diagnosis and formal expert interviews other than self-report questionnaires could achieve a more accurate estimate. 4.2 Future direction Two suggestions are noted by the researchers; one is to carry out a multicenter study covering a large population using clinical diagnosis of depression and formal diagnostic interviews in place of self-report questionnaires. Secondly, we suggest studies to be carried out on other students pursuing nonmedical disciplines as well as these have been ignored by most researchers. 5. Conclusion Nearly two-fifths of medical students in Africa suffer from depression. The findings emphasize the need for research into the causes, alongside early diagnosis with standardized tools and targeted interventions to manage depression effectively among this demographic. Author contributions Conceptualization: Ivaan Pitua (IP), Namiiro Amelia Margaret (AM) Data curation: Ivaan Pitua (IP), Namiiro Amelia Margaret (AM), Raafidha Raizudheen (RR), Lorraine Apili (LA) Data analysis: Ivaan Pitua (IP) Initial report and manuscript draft: Ivaan Pitua (IP), Namiiro Amelia Margaret (AM), Raafidha Raizudheen (RR), Lorraine Apili (LA) All authors reviewed the manuscript for intellectual content and approval of final manuscript. Data availability No data are associated with this article. All data can be accessed from Figshare: Checklist for ‘Prevalence of depression among medical students in Africa: A systematic review and meta-analysis’, doi.org/10.6084/m9.figshare.25699332.v1 . 46 Extended data Figshare: Prevalence of depression among medical students in Africa: A systematic review and meta-analysis, DOI: doi.org/10.6084/m9.figshare.25699332.v1 . 46 This project contains the following extended data: 1. Search strategy-Extended data.docx 2. Figure 1. The PRISMA Flow Diagram.jpeg 3. Figure 2. Forest plot of prevalence of depression.jpeg 4. Figure 3. Funnel plot of prevalence of depression.jpeg 5. Table 1. Joanna Briggs Institute (JBI) checklist scores for included studies.jpeg 6. Table 2 Characteristics of studies reporting prevalence of depression among medical students in Africa between 2012 and 2022.jpeg 7. PRISMA Flowchart - Extended data.docx 8. Sample Data extraction tool-Extended data.docx 9. Figure 4. Forest plot of prevalence of depression sub-grouped by screening tools used.jpeg 10. JBI_Critical_Appraisal-Checklist_for_Prevalence_Studies2017_0.pdf Reporting guidelines The authors followed the PRISMA guidelines for reporting prevalence studies. Checklist can be accessible through Figshare: Checklist for ‘Prevalence of depression among medical students in Africa: A systematic review and meta-analysis’, doi.org/10.6084/m9.figshare.25699332.v1 . 46 Data are available under the terms of the Creative Commons Attribution 4.0 International license (CC-BY 4.0). Acknowledgements Not applicable. References 1. JBI Critical Appraisal Checklist for Prevalence Studies.2017. 2. Team RC: R: A Language and Environment for Statistical Computing.2023. Reference Source 3. Khan MN, et al. : Prevalence of Depressive Symptoms Among University Students in Pakistan: A Systematic Review and Meta-Analysis. Front. Public Health. 2020; 8 : 603357. 4. Puthran R, et al. : Prevalence of depression amongst medical students: a meta-analysis. Med. Educ. 2016; 50 (4): 456–468. PubMed Abstract | Publisher Full Text 5. Rathod S, et al. : Mental Health Service Provision in Low- and Middle-Income Countries. Health Serv. Insights. 2017; 10 : 1178632917694350. 6. January J, et al. : Prevalence of depression and anxiety among undergraduate university students in low- and middle-income countries: a systematic review protocol. Syst. Rev. 2018; 7 (1): 57. PubMed Abstract | Publisher Full Text | Free Full Text 7. Ossai EN, et al. : How large is the burden of depression in a medical school? A cross-sectional study among medical students in Nigeria. Pan Afr. Med. J. 2021; 40 : 71. 8. Dafaalla M, et al. : Depression, Anxiety, and Stress in Sudanese Medical Students: A Cross Sectional Study on Role of Quality of Life and Social Support. Am. J. Educ. Res. 2016; 26 : 937–942. 9. Dagnew B, Dagne H, Andualem Z: Depression and Its Determinant Factors Among University of Gondar Medical and Health Science Students, Northwest Ethiopia: Institution-Based Cross-Sectional Study. Neuropsychiatr. Dis. Treat. 2020; 16 : 839–845. PubMed Abstract | Publisher Full Text | Free Full Text 10. Desalegn GT, et al. : Suicide ideation, attempt, and determinants among medical students Northwest Ethiopia: an institution-based cross-sectional study. Ann. General Psychiatry. 2020; 19 : 44. PubMed Abstract | Publisher Full Text | Free Full Text 11. Pedrelli P, et al. : College Students: Mental Health Problems and Treatment Considerations. Acad. Psychiatry. 2015; 39 (5): 503–511. PubMed Abstract | Publisher Full Text | Free Full Text 12. Tembo C, Burns S, Kalembo F: The association between levels of alcohol consumption and mental health problems and academic performance among young university students. PLoS One. 2017; 12 (6): e0178142. PubMed Abstract | Publisher Full Text | Free Full Text 13. Pacheco JP, et al. : Mental health problems among medical students in Brazil: a systematic review and meta-analysis. Braz. J. Psychiatry. 2017; 39 (4): 369–378. PubMed Abstract | Publisher Full Text | Free Full Text 14. Rotenstein LS, et al. : Prevalence of Depression, Depressive Symptoms, and Suicidal Ideation Among Medical Students: A Systematic Review and Meta-Analysis. JAMA. 2016; 316 (21): 2214–2236. PubMed Abstract | Publisher Full Text | Free Full Text 15. Page MJ, et al. : The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. PLoS Med. 2021; 18 (3): e1003583. PubMed Abstract | Publisher Full Text | Free Full Text 16. Isara AR, Nwokoye OI, Odaman AO: Prevalence and risk factors of depression among undergraduate medical students in a Nigerian university. Ghana Med. J. 2022; 56 (4): 303–310. PubMed Abstract | Publisher Full Text | Free Full Text 17. Aluh DO, Abba A, Afosi AB: Prevalence and correlates of depression, anxiety and stress among undergraduate pharmacy students in Nigeria. Pharm. Educ. 2020; 20 : 236–248. Publisher Full Text 18. Elsawy WIH, et al. : Depression among medical students in Alexandria, Egypt. Afr. Health Sci. 2020; 20 (3): 1416–1425. PubMed Abstract | Publisher Full Text | Free Full Text 19. Falade J, et al. : Prevalence and correlates of psychiatric morbidity, comorbid anxiety and depression among medical students in public and private tertiary institutions in a Nigerian state: a cross-sectional analytical study. Pan Afr. Med. J. 2020; 37 : 53. 20. Fawzy M, Hamed SA: Prevalence of psychological stress, depression and anxiety among medical students in Egypt. Psychiatry Res. 2017; 255 : 186–194. PubMed Abstract | Publisher Full Text 21. Ibrahim MB, Abdelreheem MH: Prevalence of anxiety and depression among medical and pharmaceutical students in Alexandria University. Alexandria J. Med. 2015; 51 (2): 167–173. Publisher Full Text 22. Kebede MA, Anbessie B, Ayano G: Prevalence and predictors of depression and anxiety among medical students in Addis Ababa, Ethiopia. Int. J. Ment. Health Syst. 2019; 13 : 30. PubMed Abstract | Publisher Full Text | Free Full Text 23. Melaku L, Bulcha G, Worku D: Stress, Anxiety, and Depression among Medical Undergraduate Students and Their Coping Strategies. Educ. Res. Int. 2021; 2021 : 9880309. 24. Mohamed E, et al. : Prevalence of Depression Among Medical Students in Sudan International University in May 2017 – August 2017.2019. 25. Mwita, et al. : prevalence-of-depression-and-suicidality-among-medical-students-in-mwanza-tanzania-a-crosssectional-study.2020. 26. Mhata NT, et al. : Prevalence of depression, anxiety and burnout in medical students at the University of Namibia. S. Afr. J. Psychiatry. 2023; 29 : 2044. 27. Ngasa SN, et al. : Prevalence and factors associated with depression among medical students in Cameroon: a cross-sectional study. BMC Psychiatry. 2017; 17 (1): 216. PubMed Abstract | Publisher Full Text | Free Full Text 28. Tsi N, et al. : Burnout as a correlate of depression among medical students in Cameroon: a cross-sectional study. BMJ Open. 2019; 9 (5): e027709. Publisher Full Text 29. Asuquo E, et al. : Socio-demographic characteristics and other factors associated with depressive illness among medical students at the University of Port Harcourt. Insights Depress. Anxiety. 2020; 4 : 040–048. Publisher Full Text 30. Olum R, Nakwagala FN, Odokonyero R: Prevalence and Factors Associated with Depression among Medical Students at Makerere University, Uganda. Adv. Med. Educ. Pract. 2020; 11 : 853–860. PubMed Abstract | Publisher Full Text | Free Full Text 31. Nubi OG, et al. : Depression, Anxiety, and Stress among Sudanese Medical Students during the COVID-19 Lockdown Period. Open Access Maced. J. Med. Sci. 2022; 10 : 1365–1371. 32. Pillay N, Ramlall S, Burns JK: Spirituality, depression and quality of life in medical students in KwaZulu-Natal. S. Afr. J. Psychiatry. 2016; 22 (1): 6. Publisher Full Text 33. Sherif R, et al. : Prevalence of depression among Libyan medical students. Iberoamerican. J. Med. 2021; 3 : 196–203. Publisher Full Text 34. Chikezie U, Okoro T: Prevalence of Depression and Associated Factors among Medical Students in a Southern Nigerian University. Global J. Health Sci. 2021; 13 : 12. Publisher Full Text 35. Van der Walt S, et al. : The burden of depression and anxiety among medical students in South Africa: A cross-sectional survey at the University of Cape Town. S. Afr. Med. J. 2019; 110 (1): 69–76. PubMed Abstract | Publisher Full Text 36. Abdel Wahed W, Hassan S: Prevalence and associated factors of stress, anxiety and depression among medical Fayoum University students. Alexandria J. Med. 2016; 53 : 77–84. Publisher Full Text 37. Mohammed HM, et al. : Depressive symptoms and its correlates among medical students in Upper Egypt. Middle East Curr. Psychiatr. 2022; 29 (1). Publisher Full Text 38. Worku D, et al. : Perceived Stress, Depression, and Associated Factors among Undergraduate Health Science Students at Arsi University in 2019 in Oromia, Ethiopia. Psychiatry J. 2020; 2020 : 4956234. 39. Dwivedi N, Sachdeva S, Taneja N: Depression among Medical Students of India: Meta-Analysis of Published Research Studies using Screening Instruments. Indian J. Soc. Psychiatry. 2021; 37 (2): 183. Publisher Full Text 40. García-Batista ZE, et al. : Validity and reliability of the Beck Depression Inventory (BDI-II) in general and hospital population of Dominican Republic. PLoS One. 2018; 13 (6): e0199750. PubMed Abstract | Publisher Full Text | Free Full Text 41. Choi SW, et al. : Establishing a common metric for depressive symptoms: linking the BDI-II, CES-D, and PHQ-9 to PROMIS depression. Psychol. Assess. 2014; 26 (2): 513–527. PubMed Abstract | Publisher Full Text | Free Full Text 42. Medvedev ON: Depression Anxiety Stress Scales (DASS-21) in International Contexts. International Handbook of Behavioral Health Assessment. Krägeloh CU, Alyami M, Medvedev ON, editors. Cham: Springer International Publishing; 2023; pp. 1–15. Publisher Full Text 43. Bredström A: Culture and Context in Mental Health Diagnosing: Scrutinizing the DSM-5 Revision. J. Med. Humanit. 2019; 40 (3): 347–363. PubMed Abstract | Publisher Full Text | Free Full Text 44. Shabani A, et al. : Psychometric properties of Structured Clinical Interview for DSM-5 Disorders-Clinician Version (SCID-5-CV). Brain Behav. 2021; 11 (5): e01894. PubMed Abstract | Publisher Full Text | Free Full Text 45. Bernaras E, Jaureguizar J, Garaigordobil M: Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments. Front. Psychol. 2019; 10 : 543. PubMed Abstract | Publisher Full Text | Free Full Text 46. Ivaan P: Prevalence of depression among medical students in Africa: A systematic review and meta-analysis. figshare. 2024. Publisher Full Text Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 22 May 2024 ADD YOUR COMMENT Comment Author details Author details 1 School of Medicine, Makerere University, Kampala, Central Region, Uganda Ivaan Pitua Roles: Conceptualization, Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Amelia Margaret Namiiro Roles: Data Curation, Formal Analysis, Methodology, Writing – Original Draft Preparation, Writing – Review & Editing Raafidha Raizudheen Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Lorraine Apili Roles: Data Curation, Writing – Original Draft Preparation, Writing – Review & Editing Competing interests No competing interests were disclosed. Grant information The author(s) declared that no grants were involved in supporting this work. Article Versions (1) version 1 Published: 22 May 2024, 13:523 https://doi.org/10.12688/f1000research.149103.1 Copyright © 2024 Pitua I et al . This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Download Export To Sciwheel Bibtex EndNote ProCite Ref. Manager (RIS) Sente metrics Views Downloads F1000Research - - PubMed Central info_outline Data from PMC are received and updated monthly. - - Citations open_in_new 0 open_in_new 0 open_in_new SEE MORE DETAILS CITE how to cite this article Pitua I, Margaret Namiiro A, Raizudheen R and Apili L. PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.12688/f1000research.149103.1 ) NOTE: If applicable, it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS track receive updates on this article Track an article to receive email alerts on any updates to this article. TRACK THIS ARTICLE Share Open Peer Review Current Reviewer Status: ? Key to Reviewer Statuses VIEW HIDE Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Version 1 VERSION 1 PUBLISHED 22 May 2024 Views 0 Cite How to cite this report: Javaid ZK. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r398127 ) The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-398127 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 21 Aug 2025 Zartashia Kynat Javaid , Government College University Faisalabad, Faisalabad, Punjab, Pakistan Not Approved VIEWS 0 https://doi.org/10.5256/f1000research.163515.r398127 I appreciate the efforts to carry out this research. There are amendments to improve. Justify the time duration. Why not recent years included as they are of significant importance. Introduction is missing in many aspects. Terms not clearly defined. Literature review ... Continue reading READ ALL I appreciate the efforts to carry out this research. There are amendments to improve. Justify the time duration. Why not recent years included as they are of significant importance. Introduction is missing in many aspects. Terms not clearly defined. Literature review is missing. I cannot see any objectives, research questions and hypothesis to be addressed. Give qualitative analysis in findings. Discussions will be based on above mentioned illustrations. Are the rationale for, and objectives of, the Systematic Review clearly stated? No Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? No If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) No Competing Interests: No competing interests were disclosed. Reviewer Expertise: Psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Javaid ZK. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r398127 ) The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-398127 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Yandri H. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r398124 ) The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-398124 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 19 Aug 2025 Hengki Yandri , Institut Agama Islam Negeri Kerinci,, Jambi, Indonesia Approved with Reservations VIEWS 0 https://doi.org/10.5256/f1000research.163515.r398124 Sampling Method Limitations In the Methods section, even though the JBI checklist is used, if any studies were rated "No" on sampling criteria, the authors should briefly discuss the potential impact of this limitation on the pooled prevalence. ... Continue reading READ ALL Sampling Method Limitations In the Methods section, even though the JBI checklist is used, if any studies were rated "No" on sampling criteria, the authors should briefly discuss the potential impact of this limitation on the pooled prevalence. This would demonstrate a deeper understanding of the strengths and weaknesses of the underlying data. Comprehensive Heterogeneity Discussion Given I 2 =99%, heterogeneity is extremely high. The discussion needs to explain further why this heterogeneity occurs, beyond just instrument differences. Consideration of cultural differences, socio-economic contexts, medical education curricula, and healthcare systems in various African countries could provide crucial insights. Eggers' Test P-value Including the specific p-value from Eggers' test for publication bias in the Results section would enhance transparency and allow readers to assess the significance of the detected bias. Discussion of Strengths and Limitations The Discussion section should explicitly include sub-sections on the strengths of this review (e.g., focused geographical scope, use of robust meta-analysis methods, PROSPERO registration) and its limitations (e.g., high heterogeneity, English-only studies, potential bias from inappropriately sampled studies, full-text access limitations). More Detailed Policy/Practice Implications The conclusion could be further expanded to provide more specific recommendations for policymakers, medical education institutions, and healthcare professionals in Africa. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Spiritual Counseling, Counseling, Educational Psychology, Mental Health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Yandri H. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r398124 ) The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-398124 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Views 0 Cite How to cite this report: Konstantinou GN. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r281807 ) The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-281807 NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Close Copy Citation Details Reviewer Report 13 Jun 2024 Gerasimos N. Konstantinou , Centre of Addiction and Mental Health, Toronto, Canada Approved VIEWS 0 https://doi.org/10.5256/f1000research.163515.r281807 The rationale and objectives of the study are well-defined and presented clearly in the manuscript. The authors effectively set the stage by discussing the significance of understanding depression among medical students and highlighting gaps in existing literature. To further enhance ... Continue reading READ ALL The rationale and objectives of the study are well-defined and presented clearly in the manuscript. The authors effectively set the stage by discussing the significance of understanding depression among medical students and highlighting gaps in existing literature. To further enhance the introduction, the authors might consider expanding on the implications of their findings for future research and policy. The methodological rigor of the study is commendable. The methods section provides a thorough description of the inclusion and exclusion criteria, data sources, search strategy, study selection process, data extraction, and quality assessment, allowing replication by others. The use of PRISMA guidelines and registration with PROPERO enhances transparency and replicability. However, the manuscript would benefit from additional details on the process for resolving disagreements during study selection and data extraction. Specifically, clarifying how discrepancies were resolved, whether through discussion or third-party adjudication, would improve clarity. The statistical analysis is robust and appropriate for the data. The use of a random-effects model for meta-analysis is suitable given the heterogeneity of the studies. The subgroup analyses based on screening tools and the assessment of indexed bias using funnel plots and Egger’s test are well-executed. Including a sensitivity analysis to test the robustness of the pooled prevalence estimate, especially considering the variability in study settings and instruments used, would further strengthen the statistical approach. The conclusions drawn are justified based on the results. The conclusion that nearly two-fifths of medical students in Africa suffer from depression is supported by the pooled prevalence estimate of 38%. The discussion contextualizes these findings within the broader literature and highlights the need for targeted interventions. To strengthen the discussion further, the authors could explore potential reasons for the high prevalence rates observed and suggest specific strategies for addressing mental health issues among medical students in Africa. In summary, this systematic review and meta-analysis provide valuable insights into the prevalence of depression among medical students in Africa. The study is methodologically sound and offers important implications for future research and interventions. Addressing the points mentioned above will further strengthen the manuscript and ensure its scientific rigor. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests: No competing interests were disclosed. Reviewer Expertise: Clinical Psychiatry, Brain Stimulation, Psychoimmunology, Mood and Anxiety Disorders I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. Close READ LESS CITE CITE HOW TO CITE THIS REPORT Konstantinou GN. Reviewer Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r281807 ) The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-281807 NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. COPY CITATION DETAILS Report a concern Respond or Comment COMMENT ON THIS REPORT Comments on this article Comments (0) Version 1 VERSION 1 PUBLISHED 22 May 2024 ADD YOUR COMMENT Comment keyboard_arrow_left keyboard_arrow_right Open Peer Review Reviewer Status info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Reviewer Reports Invited Reviewers 1 2 3 Version 1 22 May 24 read read read Gerasimos N. Konstantinou , Centre of Addiction and Mental Health, Toronto, Canada Hengki Yandri , Institut Agama Islam Negeri Kerinci,, Jambi, Indonesia Zartashia Kynat Javaid , Government College University Faisalabad, Faisalabad, Pakistan Comments on this article All Comments (0) Add a comment Sign up for content alerts Sign Up You are now signed up to receive this alert Browse by related subjects keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Javaid Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 21 Aug 2025 | for Version 1 Zartashia Kynat Javaid , Government College University Faisalabad, Faisalabad, Punjab, Pakistan 0 Views copyright © 2025 Javaid Z. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Not Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions I appreciate the efforts to carry out this research. There are amendments to improve. Justify the time duration. Why not recent years included as they are of significant importance. Introduction is missing in many aspects. Terms not clearly defined. Literature review is missing. I cannot see any objectives, research questions and hypothesis to be addressed. Give qualitative analysis in findings. Discussions will be based on above mentioned illustrations. Are the rationale for, and objectives of, the Systematic Review clearly stated? No Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? No If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) No Competing Interests No competing interests were disclosed. Reviewer Expertise Psychology I confirm that I have read this submission and believe that I have an appropriate level of expertise to state that I do not consider it to be of an acceptable scientific standard, for reasons outlined above. reply Respond to this report Responses (0) Javaid ZK. Peer Review Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r398127) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-398127 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2025 Yandri H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 19 Aug 2025 | for Version 1 Hengki Yandri , Institut Agama Islam Negeri Kerinci,, Jambi, Indonesia 0 Views copyright © 2025 Yandri H. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved With Reservations info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions Sampling Method Limitations In the Methods section, even though the JBI checklist is used, if any studies were rated "No" on sampling criteria, the authors should briefly discuss the potential impact of this limitation on the pooled prevalence. This would demonstrate a deeper understanding of the strengths and weaknesses of the underlying data. Comprehensive Heterogeneity Discussion Given I 2 =99%, heterogeneity is extremely high. The discussion needs to explain further why this heterogeneity occurs, beyond just instrument differences. Consideration of cultural differences, socio-economic contexts, medical education curricula, and healthcare systems in various African countries could provide crucial insights. Eggers' Test P-value Including the specific p-value from Eggers' test for publication bias in the Results section would enhance transparency and allow readers to assess the significance of the detected bias. Discussion of Strengths and Limitations The Discussion section should explicitly include sub-sections on the strengths of this review (e.g., focused geographical scope, use of robust meta-analysis methods, PROSPERO registration) and its limitations (e.g., high heterogeneity, English-only studies, potential bias from inappropriately sampled studies, full-text access limitations). More Detailed Policy/Practice Implications The conclusion could be further expanded to provide more specific recommendations for policymakers, medical education institutions, and healthcare professionals in Africa. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Spiritual Counseling, Counseling, Educational Psychology, Mental Health I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above. reply Respond to this report Responses (0) Yandri H. Peer Review Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r398124) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-398124 keyboard_arrow_left Back to all reports Reviewer Report 0 Views copyright © 2024 Konstantinou G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. 13 Jun 2024 | for Version 1 Gerasimos N. Konstantinou , Centre of Addiction and Mental Health, Toronto, Canada 0 Views copyright © 2024 Konstantinou G. This is an open access peer review report distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. format_quote Cite this report speaker_notes Responses (0) Approved info_outline Alongside their report, reviewers assign a status to the article: Approved The paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions The rationale and objectives of the study are well-defined and presented clearly in the manuscript. The authors effectively set the stage by discussing the significance of understanding depression among medical students and highlighting gaps in existing literature. To further enhance the introduction, the authors might consider expanding on the implications of their findings for future research and policy. The methodological rigor of the study is commendable. The methods section provides a thorough description of the inclusion and exclusion criteria, data sources, search strategy, study selection process, data extraction, and quality assessment, allowing replication by others. The use of PRISMA guidelines and registration with PROPERO enhances transparency and replicability. However, the manuscript would benefit from additional details on the process for resolving disagreements during study selection and data extraction. Specifically, clarifying how discrepancies were resolved, whether through discussion or third-party adjudication, would improve clarity. The statistical analysis is robust and appropriate for the data. The use of a random-effects model for meta-analysis is suitable given the heterogeneity of the studies. The subgroup analyses based on screening tools and the assessment of indexed bias using funnel plots and Egger’s test are well-executed. Including a sensitivity analysis to test the robustness of the pooled prevalence estimate, especially considering the variability in study settings and instruments used, would further strengthen the statistical approach. The conclusions drawn are justified based on the results. The conclusion that nearly two-fifths of medical students in Africa suffer from depression is supported by the pooled prevalence estimate of 38%. The discussion contextualizes these findings within the broader literature and highlights the need for targeted interventions. To strengthen the discussion further, the authors could explore potential reasons for the high prevalence rates observed and suggest specific strategies for addressing mental health issues among medical students in Africa. In summary, this systematic review and meta-analysis provide valuable insights into the prevalence of depression among medical students in Africa. The study is methodologically sound and offers important implications for future research and interventions. Addressing the points mentioned above will further strengthen the manuscript and ensure its scientific rigor. Are the rationale for, and objectives of, the Systematic Review clearly stated? Yes Are sufficient details of the methods and analysis provided to allow replication by others? Yes Is the statistical analysis and its interpretation appropriate? Yes Are the conclusions drawn adequately supported by the results presented in the review? Yes If this is a Living Systematic Review, is the ‘living’ method appropriate and is the search schedule clearly defined and justified? (‘Living Systematic Review’ or a variation of this term should be included in the title.) Not applicable Competing Interests No competing interests were disclosed. Reviewer Expertise Clinical Psychiatry, Brain Stimulation, Psychoimmunology, Mood and Anxiety Disorders I confirm that I have read this submission and believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard. reply Respond to this report Responses (0) Konstantinou GN. Peer Review Report For: PREVALENCE OF DEPRESSION AMONG MEDICAL STUDENTS IN AFRICA: A SYSTEMATIC REVIEW AND META-ANALYSIS [version 1; peer review: 1 approved, 1 approved with reservations, 1 not approved] . F1000Research 2024, 13 :523 ( https://doi.org/10.5256/f1000research.163515.r281807) NOTE: it is important to ensure the information in square brackets after the title is included in this citation. The direct URL for this report is: https://f1000research.com/articles/13-523/v1#referee-response-281807 Alongside their report, reviewers assign a status to the article: Approved - the paper is scientifically sound in its current form and only minor, if any, improvements are suggested Approved with reservations - A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit. 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