Skip to main content

Prevalence of depressive symptoms and depression literacy (D-Lit) among Saudi postgraduate students



The prevalence of any disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is 34.2% in Saudi Arabia over the course of a person's lifetime. Young Saudis are more likely to develop major depressive disorder than older Saudis. Globally, postgraduate students are more vulnerable to developing depression compared to the general population. According to a national study carried out in Saudi Arabia, a small proportion of individuals experiencing psychiatric disorders over a period of 12 months receive any kind of treatment. This highlights the importance of community education aimed at enhancing mental health awareness.


A web-based Arabic cross-sectional survey was conducted among Saudi postgraduate students from October 2019 to August 2020. The survey included questions related to sociodemographic characteristics, sources of information, depression literacy (D-Lit), the Patient Health Questionnaire-9 (PHQ-9) for depression, and the participants’ attitudes toward depression.


A total of 517 participants took part in the survey, with 46% of them screened positive for depression. The mean D-Lit score was 10.65, which was lower than that reported in studies conducted among medical students and hospital staff. No significant differences were found in D-Lit scores across all sociodemographic characteristics, except for gender and specialty (p = 0.002 and <0.001, respectively). The Internet, awareness posters, a doctor (previously diagnosed with depression), and awareness activities related to depression showed significant differences in the mean score of D-Lit (p < 0.001, 0.005, < 0.001, and < 0.001, respectively).


In Saudi Arabia, this study found that postgraduate students have a notably higher occurrence of depression compared to the general population. However, despite their higher educational level, these students lacked sufficient awareness and understanding of depression to recognize it and seek help. Consequently, it is important to initiate awareness campaigns aimed at enhancing the mental well-being of postgraduate student


The prevalence of any disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) is 34.2% in Saudi Arabia over the course of a person's lifetime [1]. With a prevalence rate of 6%, major depressive disorder (MDD) stands as one of the most prevalent psychiatric disorders [1]. Young Saudi respondents are more likely to develop MDD than older Saudis. Findings from a national study in Saudi Arabia indicated that only a small proportion of individuals with 12-month psychiatric disorders receive any form of treatment [2]. Furthermore, according to systematic reviews only 20% of individuals diagnosed with major depressive disorder (MDD) receive treatment that meets the minimum adequacy criteria in affluent nations, while the percentage is even lower in impoverished countries (1 in 27) [3]. Insufficient treatment is a prevalent issue, even in severe cases, as only a minority of individuals receive limited or no treatment for their condition, regardless of whether they reside in low-income or high-income countries across the globe [4].

MDD is a chronic, recurrent, and treatable disorder [5]. It is characterized by a duration of two weeks during which individuals experience a persistent depressed mood, diminished interest or pleasure in activities, sleep disturbances, changes in appetite, fatigue, feelings of guilt, and thoughts of self-harm or suicide [6]. MDD can also impact cognitive function [7]. Therefore, MDD is expected to be the primary cause of disability in 2030 [8]. Depression is associated with increased mortality, morbidity, job loss, societal disability, increased suicidal rates, and an increased risk of Medical illnsess [9,10,11,12,13].

Depression literacy (D-Lit) is closely linked to knowledge about depression and attitudes toward it as a disorder, as well as knowledge about antidepressant medications and mental health professionals [14, 15]. Research studies have indicated that patients suffering from depression often lack knowledge about the etiologies and biological aspects of depression. Stress and negative life events are commonly suggested as etiological factors for depression [16, 17]. However, the lack of understanding of depression and its causes has been shown to negatively impact the decision to seek professional help and influence treatment choices [15, 18, 19]).

Some studies have revealed that a significant number of individuals with depression do not seek help. For instance, a study found that 55% of individuals meeting the Research Diagnostic Criteria of Major Depression did not seek help [15]. The reasons for not seeking help included not perceiving the episode as serious or identifying it as a disorder and thinking that they could manage the illness on their own. Numerous studies have examined the relationship between D-Lit and behavioral changes, such as help-seeking and adherence to antidepressants, among individuals with depression [14, 15, 18, 19]. These studies support the notion that a lack of knowledge and negative attitudes toward depression contribute to the stigmatization of individuals with depression and influence their treatment choices, particularly regarding the use of antidepressants.

Perceived and self-stigmatizing responses to seeking help for depression are common in the community and can lead to hesitation in seeking help. The stigma surrounding depression negatively impacts patients’ willingness to seek help and adhere to antidepressant treatment [16]. Conversely, individuals who have a lower perception of psychiatric stigma and attribute the disorder to biological factors rather than personal characteristics tend to hold positive attitudes toward seeking professional help. Furthermore, research has shown that better adherence to antidepressants is linked to a lower perceived stigma about the disorder [20].

The occurrence of major depressive disorder (MDD) among postgraduate students appears to be elevated in comparison to the general population. A study conducted among bioscience graduate students revealed a prevalence of 43%–46% for major depression [21]. In a separate study, the prevalence of major depressive disorder (MDD) was found to be 39% among the postgraduate population, in stark contrast to the 6% prevalence observed in the general population [22]. Moreover, studies have indicated that graduate students in nursing school encounter significant levels of stress [23]. Based on the aforementioned findings, the objective of this study was to examine the prevalence of depressive symptoms and (D-Lit) among postgraduate students in Saudi Arabia. Additionally, the study aimed to investigate the attitudes of these students toward depression.


Study design

The Institutional Review Board of Imam Mohammad ibn Saud Islamic University in Riyadh, Saudi Arabia, granted approval for this study. A cross-sectional survey in Arabic was conducted online to evaluate depressive symptoms and (D-Lit) among postgraduate students in Saudi Arabia. The survey was administered to participants between October 2019 and August 2020. The target population consisted of Saudi postgraduate students, and the survey was distributed via email, Twitter, and the instant messaging service WhatsApp. The Inclusion criteria are Saudi , Arabic speaker, master and phd students and adult over 18-64. The exclusion criteria are non saudi , undergraduate student, holder of master and phd student and non Arabic speakers.

To calulcate Sample size, The sample size required = 396

The sample size was calculated by using the following formula


n = sample size

N = population (4500)

e = margin of error (5%)

The type of sample is simple random sampling. To ensure the inclusion of Saudi participants, individuals were directly asked about their country of origin and the universities or colleges they attended. Informed consent was obtained from the participants, who were required to provide their consent by checking a box, indicating their willingness to anonymously share their data for the survey.

The survey encompassed five sections. The first section collected sociodemographic data, including age, gender, educational level, specialty, and scholarship status. The second and third sections focused on the source of information and utilized the validated Arabic version of the D-Lit Scale. The fourth section employed the Arabic-validated version of the PHQ-9. Finally, the fifth section assessed participants' attitudes toward depression. The second section of the survey utilized D-Lit as a means to assess participants' knowledge and awareness regarding depression [24]. This scale consists of 22 questions, with participants selecting one of three responses: true, false, or I don’t know. Each correct answer received one point, resulting in a score range of 0–22. A higher score indicated a higher literacy toward depression. The Arabic-validated version of D-Lit demonstrated good reliability, with a Cronbach’s alpha of 0.78 and a test-retest reliability of 0.92 [25].

The PHQ-9, a screening scale used to identify MDD and assess symptom severity, was employed in this study. It combines the nine items from the DSM-IV MDD criteria with additional leading symptoms to create a brief self-report instrument. A cutoff score of 10 has been determined to possess a sensitivity of 88% and a specificity of 88% in detecting depression [26]. An Arabic-validated version of the PHQ-9 was used [27], with an internal consistency reliability of 0.857, as calculated using Cronbach’s alpha. A cutoff point of 10 was employed to identify depression, with further classification of depressed participants into depression (score 10–14), moderately severe depression (score 15–19), and severe depression (score ≥ 20).

The author designed statements of the participants’ attitudes toward depression. These statements test common misconceptions and believes of depression and its treatment in Saudi population .Before widespread distribution, the statements were tested on a small group of participants (n=20). Based on the feedback received from the pilot sample, certain questions underwent modifications in terms of wording and suggested answers. The participants’ attitudes toward depression were assessed using a 1–5 scale to measure their responses to five statements, ranging from strongly agree to strongly disagree. The statements included in this section were as follows: “Depression is a weakness, not a disease,” “Exercise can help treating depression,” “Registering my name in the psychiatric clinic as a patient may affect my career and social future,” “The presence of a counseling clinic at the university may help someone with depression,” and “Awareness lectures on mental health contribute to improving our understanding of depression and its treatment.”

Data analysis

Data were analyzed using the Statistical Package of the Social Sciences (SPSS 22; IBM Corp., New York, NY, USA). Continuous variables were expressed as means and standard deviations, while categorical variables were expressed as percentages. The Mann–Whitney and Kruskal–Wallis tests were used for comparing continuous, nonnormally distributed variables. The Shapiro–Wilk test was used to assess the normality of the distribution of variables. Linear regression was used to identify factors associated with depression. A P value of less than 0.05 was considered statistically significant.


This survey was accessed by a total of 618 individuals, out of which 517 successfully completed the questionnaire, resulting in a response rate of 83.6%. Among the participants, there were 110 men and 407 women. Regarding marital status, 285 individuals reported being single, 213 were married, and 19 were divorced. In terms of educational level, 417 participants (80.66%) were Masters students, while 100 (19.34%) were Ph.D. students. Regarding specialty, the majority of participants had a basic science specialty (n = 243, 47.0%), followed by health (n = 75, 14.51%), engineering & computer (n = 65, 12.57%), and other specialties (n = 134, 25.92%). Furthermore, 417 (80.66%) students did not have a scholarship, and 100(19.34%) did. In terms of age, 293 participants (56.67%) were in the 20–29-year age group, 203 (39.26%) in the 30–39-year age group, and 21 participants (4.06%) in the ≥40-year age group (Table 1).

Table 1 Sociodemographic Characteristics of the Participants (N=517)

Out of all participants, 239 individuals (46.2%) screened positive for depression, with 72 (13.9%) having moderately severe depression and 64 (12.4%) having severe depression. The linear regression analysis revealed that depression was significantly lower in males than in females (B = −2.411, p = 0.002) and in married participants (B = −1.416, p = 0.045) than in divorced ones (B = −3.739, p = 0.024).

Table 2 presents the responses to the items of the D-Lit Questionnaire (n = 517), which revealed a mean score of 10.65 out of 22, with a standard deviation of 4.18.

Table 2 Responses of items of depression literacy questionnaire (N = 517)

Table 3 shows the mean score of D-Lit based on the sociodemographic characteristics of the participants. No significant differences were found in D-Lit scores across all sociodemographic characteristics, except for gender and specialty (p = 0.002 and < 0.001, respectively).

Table 3 Mean score of depression literacy by sociodemographic characteristics of the participants

Regarding the source of information, 84.5% of participants reported gaining information from the Internet, 15.5% from television channels and radio stations, 20.5% from mental health awareness posters and flyers, 10.3% from a doctor (previously diagnosed with depression), 11.6% from relatives or friends suffering from depression, and 13.7% from attending lectures and awareness activities related to depression (Fig. 1).

Fig. 1
figure 1

Source of information

Figure 2 shows there is a directly correlation between the mean score of depression literacy and the mean score of depression (PHQ9) (r=0.071) but non-significant (p=0.105).

Fig. 2
figure 2

Correlation between mean score of depression literacy and mean score of depression (PHQ9) (r=0.071, p= 0.105). r is Pearson correlation coefficient

Table 4 presents the mean score of D-Lit based on the source of information. The Internet, mental health awareness posters and flyers, a doctor (previously diagnosed with depression), and attending lectures and awareness activities related to depression showed significant differences in the mean score of D-Lit (p < 0.001, 0.005, < 0.001, and < 0.001, respectively). Among these sources, attending lectures and awareness activities related to depression had the highest mean score of D-Lit (13.55 ± 3.78).

Table 4 Mean score of depression literacy by source of information

Table 5 summarizes participants’ responses to the D-Lit Questionnaire, which is divided into six subscales. The mean score for knowledge about the psychological symptoms was 3.69/5, the effectiveness of available treatment methods was 1.31/5, cognitive behavioral symptoms was 2.65/6, taking antidepressants and their adverse effects was 1.54/4, and the severity of the disease was 1.46/2. The subscale with the lowest percentage of correction responses (26%) was Awareness regarding the efficacy of existing treatment modalities, followed by Awareness about taking medications and their side effects (38.6%).

Table 5 Descriptive statistics of the D-Lit questionnaire subscale scores and PHQ9 among participants

Table 6 presents attitudes toward depression. Only 19.92% of participants agreed or strongly agreed that depression is a weakness, not a disease, while 65% disagreed or strongly disagreed with this statement. The majority of participants strongly agreed or agreed that exercise can help treat depression, with 2.69% disagreeing or strongly disagreeing. In addition, 23.41% of the sample expressed concern that registering their names in the psychiatric clinic as patients may affect their career and social future, while 54.55% either disagreed or strongly disagreed with this concern. A vast majority of respondents (80.46%) believed that the presence of a counseling clinic at the university may help someone with depression, while approximately 11% did not. Most of the participants strongly agreed or agreed that awareness lectures on mental health contribute to improving their understanding of depression and its treatment, with only 1.16% disagreeing or strongly disagreeing with this statement.

Table 6 Attitude of the participants toward depression


Education has a significant impact on health and well-being, leading to a higher life expectancy and the adoption of healthy behaviours. It is also associated with increased employment opportunities and income [28, 29]. However, stress among academics is a widespread concern [30, 31], particularly among younger researchers [32, 33]. They often face job insecurity, work-life imbalances, stressful relationships with supervisors, tight deadlines, and funding difficulties [33]. Several reports have highlighted the challenges faced by graduate students, as 85% of them spent over 41 hours per week on their postgraduate programs, 74% failed to complete their programs within the set timeframe, and 79% faced uncertainty about their job and career futures [33].

In our research, 46% of the participants exhibited positive screening results for major depressive disorder (MDD), aligning with the findings of comparable studies [21]. Nevertheless, the prevalence of major depressive disorder (MDD) observed in our study surpassed the rates reported in another study that specifically examined postgraduate students [21]. In a comprehensive meta-analysis and systematic review encompassing 36 studies, the prevalence of depressive symptoms among postgraduate students was found to vary significantly. The reported prevalence ranged from 6.2% to 85.4%, with a pooled prevalence estimate of 34% based on a total of 26,579 participants. However, it is worth noting that there was substantial heterogeneity among the studies, as indicated by statistical measures (Q = 2,683.40, p < 0.01; τ2 = 0.67, I2 = 98.6%) [34].

The mean D-Lit score in our study was 10.65, that is higher than that found in studies among high school and university students in various countries, including Jordan [35], Saudi Arabia [25], India [36, 37], Malaysia [38], and Bangladesh [39, 40]. Previous research has shown that as the educational level increases, the Depression literacy level increases. Studies have demonstrated that individuals with higher levels of education are more commonly diagnosed with depression compared to those with lower educational attainment [41]. Furthermore, it is worth noting that higher education has been linked to enhanced well-being in both psychological and physical aspects of individuals' lives [42]. Education has been identified as a significant predictor of depression diagnosis and higher knowledge of depression [43]. However, despite the higher mean D-Lit score in our study, the results indicate that the sample had low levels of D-Lit compared to previous studies conducted among hospital staff, medical students, professionals, and nurses [5, 44,45,46]. Furthermore, knowledge about the effectiveness of available treatments and awareness about taking antidepressants and their adverse effects had the lowest percentage of correct responses compared to other subscales of D-Lit.

According to the findings of this study, a noteworthy correlation was observed between D-Lit and gender, revealing that females exhibited considerably higher levels of D-Lit compared to males. Furthermore, multiple studies have consistently demonstrated that women tend to have higher D-Lit scores [47], possess greater abilities in diagnosing psychiatric disorders [48], and are more inclined than men to seek occupational psychiatric health services [49]. Additionally, women tend to actively engage in learning about mental health and interact with individuals who have mental disorders [50].

The gender disparity observed in D-Lit levels could be attributed to the lower prevalence of Major Depressive Disorder (MDD) in males and their limited exposure to the illness. However, this lack of recognition may also contribute to fewer males seeking help for depression. Additionally, males often associate depression with a weak personality and may turn to alcohol as a means of relaxation [51]. Targeted interventions may be necessary to enhance mental health literacy and increase support specifically for men.

Furthermore, the study’s findings indicated that there was no significant relationship between age groups and D-Lit levels. However, the younger age group exhibited higher rates of D-Lit compared to the older age groups [14].

In this study, compared to other sources of information, the highest mean scores of D-Lit were observed among participants who had previously been diagnosed with depression by doctors, those who attended lectures and awareness activities related to depression, and those who were exposed to awareness posters and flyers, with mean scores of 13.55, 13.45, and 11.74, respectively. To put it differently, individuals who indicated seeking assistance from a psychologist for their psychological concerns exhibited significantly higher levels of D-Lit compared to those who did not seek such help. However, participants who reported a family history of mental illness or having family members referred to a psychologist for psychological issues did not demonstrate significantly higher D-Lit levels compared to others.

According to the findings of this study, individuals who obtained information about mental disorders from the Internet displayed significantly higher levels of D-Lit compared to those who did not rely on online sources. However, it is crucial to acknowledge that information found on the Internet may not always be reliable or accurate. Therefore, it is of utmost importance to emphasize that psychiatrists, psychologists, and healthcare professionals are the most trustworthy and credible sources of mental health information [52]. Seeking professional help from these sources is vital for the prevention, early detection, diagnosis, treatment, and complete recovery of psychiatric disorders, and timely referral to these professionals is essential [53]. Reluctance to seek help from a psychiatrist or psychologist may indicate a lack of knowledge regarding psychiatric services or a misunderstanding of the effective treatments offered by these specialists.

Regarding to Arabic studies, the results of a study of a total of 650 students aged 16 to 24 years in jordan indicate that the participants demonstrated low levels of literacy. These findings align with previous research conducted on the stigma surroundingy depression among students in Jordan [54]. However, the elevated levels of stigma surrounding depression observed in our sample could be attributed to Arab culture. In Arab communities, individuals tend to be reserved and prefer not to discuss personal matters, such as mental health issues, even with healthcare providers [55, 56]


Although cross-sectional studies have some advantages, such as being relatively cheaper and less time-consuming, they also have several disadvantages. Firstly, the findings may not be generalizable to the entire population as the sample might not accurately represent the broader population. Secondly, these studies are unable to track changes in population behavior over time, providing only a snapshot of information at a specific moment. Thirdly, they do not establish a causal relationship between variables, only revealing associations or correlations. Lastly, there is a possibility of recall bias, whereby participants may inaccurately remember or report information, potentially affecting the validity of the results. Moreover, self-administered questionnaires have their own drawbacks, including low response rates, lack of control over the environment, no opportunity for clarification, potential misconceptions of questions, language barriers, and difficulty in verifying responses. Given that this study was conducted online and distributed through email and various social media platforms, there is a possibility of excluding individuals who lack access to social media or who choose not to participate due to social stigmas associated with mental health. Consequently, future research should strive to involve participants who are more receptive to discussions about mental health and illness. Furthermore, this recruitment method carries the risk of overestimating the prevalence of Major Depressive Disorder (MDD).


In this study, it was observed that postgraduate students in Saudi Arabia had a higher incidence of depression compared to the general population. Specifically, female Saudi postgraduate students were found to be more susceptible to developing depression compared to their male counterparts. Additionally, these female students exhibited higher levels of D-Lit scores. However, despite their higher educational level, these students lacked sufficient awareness and understanding of mental health to recognize their own depressive symptoms and seek help. The lack of knowledge about depression plays an important role in stigmatizing individuals with depression and influences the choice of treatment options and their willingness to seek help. Based on the implications of these findings, it is recommended to initiate awareness campaigns focused on depression and implement wellness programs aimed at promoting and safeguarding the mental health of postgraduate students.

Availability of data and materials

The data and material used during the current study are available from the corresponding author on reasonable request.



Depression Literacy


Diagnostic and Statistical Manual of Mental Disorders—Fourth Edition


Diagnostic and Statistical Manual of Mental Disorders—Fifth Edition


  1. Altwaijri YA, Al-Subaie AS, Al-Habeeb A, Bilal L, Al-Desouki M, Aradati M, King AJ, Sampson NA, Kessler RC (2020) Lifetime prevalence and age-of-onset distributions of mental disorders in the Saudi national mental health survey. Int J Methods Psychiatr Res 29:e1836.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Al-Habeeb A, Altwaijri YA, Al-Subaie AS, Bilal L, Almeharish A, Sampson NA, Liu H, Kessler RC, Kessler RC (2020) Twelve-month treatment of mental disorders in the Saudi national mental health survey. Int J Methods Psychiatr Res 29:e1832.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N, Aguilar-Gaxiola S, Al-Hamzawi A, Alonso J, Andrade L, Borges G, Bruffaerts R, Bunting B, de Almeida JM, Florescu S, de Girolamo G, Gureje O, Haro JM, He Y, Hinkov H, Karam E, Kawakami N, Lee S, Navarro-Mateu F, Piazza M, Posada-Villa J, de Galvis YT, Kessler RC (2017) Undertreatment of people with major depressive disorder in 21 countries. Br J Psychiatry 210:119–124.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Wang PS, Aguilar-Gaxiola S, Alonso J, Angermeyer MC, Borges G, Bromet EJ, Bruffaerts R, de Girolamo G, de Graaf R, Gureje O, Haro JM, Karam EG, Kessler RC, Kovess V, Lane MC, Lee S, Levinson D, Ono Y, Petukhova M, Posada-Villa J, Seedat S, Wells JE (2007) Use of mental health services for anxiety, mood, and substance disorders in 17 countries in the WHO world mental health surveys. Lancet 370:841–850.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Arafat S, Ahmed S, Uddin M (2018a) Depression literacy status in Bangladesh: a cross sectional comparative observation. J Behav Health 7(2):91–97

    Google Scholar 

  6. Torres F (2020) What is depression? Accessed

  7. McIntyre RS, Lee Y, Carmona NE, Subramaniapillai M, Cha DS, Lee J, Lee JH, Alageel A, Rodrigues NB, Park C, Ragguett RM, Rosenblat JE, Almatham F, Pan Z, Rong C, Mansur RB (2018) Characterizing, assessing, and treating cognitive dysfunction in major depressive disorder. Harv Rev Psychiatry 26:241–249.

    Article  PubMed  Google Scholar 

  8. United Nations Department of Economic and Social Affairs (2021) Issue: mental health and development. Accessed

  9. Bifftu BB, Takele WW, Guracho YD, Yehualashet FA (2018) Depression and its help seeking behaviors: a systematic review and meta-analysis of community survey in Ethiopia. Depress Res Treat 2018.

  10. Kohrt BA, Asher L, Bhardwaj A, Fazel M, Jordans MJD, Mutamba BB, Nadkarni A, Pedersen GA, Singla DR, Patel V (2018) The role of communities in mental health care in low- and middle-income countries: a meta-review of components and competencies. Int J Environ Res Public Health 15:1279.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Lee HY, Hwang J, Ball JG, Lee J, Albright DL (2020) Is health literacy associated with mental health literacy? Findings from mental health literacy scale. Perspect Psychiatr Care 56:393–400.

    Article  PubMed  Google Scholar 

  12. Reddy MS (2010) Depression: the disorder and the burden. Indian J Psychol Med 32:1–2.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  13. Goli B, Jaafari-Pooyan E, Moradi A, Safi-Arian R, Moradi M, Darabi F (2021) Prevalence of anxiety, depression and stress in CABG candidate patients and factors affecting it at Farshchian cardiovascular hospital in Hamadan. Iran J Health Educ Health Promot 9:212–225.

    Article  Google Scholar 

  14. Fisher LJ, Goldney RD (2003) Differences in community mental health literacy in older and younger Australians. Int J Geriatr Psychiatry 18:33–40.

    Article  PubMed  Google Scholar 

  15. Blumenthal R, Endicott J (1996) Barriers to seeking treatment for major depression. Depress Anxiety 4:273–278.<273::AID-DA3>3.0.CO;2-D

    Article  PubMed  Google Scholar 

  16. Sirey JA, Bruce ML, Alexopoulos GS, Perlick DA, Friedman SJ, Meyers BS (2001) Stigma as a barrier to recovery: perceived stigma and patient-rated severity of illness as predictors of antidepressant drug adherence. Psychiatr Serv 52:1615–1620.

    Article  CAS  PubMed  Google Scholar 

  17. Srinivasan J, Cohen NL, Parikh SV (2003) Patient attitudes regarding causes of depression: implications for psychoeducation. Can J Psychiatr 48:493–495.

    Article  Google Scholar 

  18. Goldney RD, Fisher LJ, Wilson DH (2001) Mental health literacy: an impediment to the optimum treatment of major depression in the community. J Affect Disord 64:277–284.

    Article  CAS  PubMed  Google Scholar 

  19. Thompson A, Hunt C, Issakidis C (2004) Why wait? Reasons for delay and prompts to seek help for mental health problems in an Australian clinical sample. Soc Psychiatry Psychiatr Epidemiol 39:810–817.

    Article  PubMed  Google Scholar 

  20. Gabriel A, Claudio V (2010) Depression literacy among patients and the public: a literature review. Prim Psychiatry 17:1

    Google Scholar 

  21. University of California (2014). Graduate assembly graduate student happiness and well-being report. Berkeley.

  22. Evans TM, Bira L, Gastelum JB, Weiss LT, Vanderford NL (2018) Evidence for a mental health crisis in graduate education. Nat Biotechnol 36:282–284.

    Article  CAS  PubMed  Google Scholar 

  23. Brown K, Anderson-Johnson P, McPherson AN (2016) Academic-related stress among graduate students in nursing in a Jamaican school of nursing. Nurse Educ Pract 20:117–124.

    Article  PubMed  Google Scholar 

  24. Griffiths KM, Christensen H, Jorm AF, Evans K, Groves C (2004) Effect of web-based depression literacy and cognitive-behavioural therapy interventions on stigmatising attitudes to depression: randomised controlled trial. Br J Psychiatry 185:342–349.

    Article  PubMed  Google Scholar 

  25. Darraj HA, Mahfouz MS, Al Sanosi RM, Badedi M, Sabai A, Al Refaei A, Mutawm H (2016) Arabic translation and psychometric evaluation of the depression literacy questionnaire among adolescents. Psychiatry J 2016:8045262.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Kroenke K, Spitzer RL, Williams JB (2001) The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 16:606–613.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Al-Hadi AN, Al-Ateeq DA, Al-Sharif E, Bawazeer HM, Alanazi H, AlShomrani AT, Shuqdar RM, AlOwaybil R (2017) An Arabic translation, reliability, and validation of patient health questionnaire in a Saudi sample. Ann General Psychiatry 16:32.

    Article  Google Scholar 

  28. Organization for Economic Co-operation and Development (2019) Education at a glance 2019: OECD indicators. OECD Publishing.

    Book  Google Scholar 

  29. Shankar J, Ip E, Khalema E, Couture J, Tan S, Zulla RT, Lam G (2013) Education as a social determinant of health: issues facing indigenous and visible minority students in postsecondary education in western Canada. Int J Environ Res Public Health 10:3908–3929.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Bozeman B, Gaughan M (2011) Job satisfaction among University faculty: individual, work, and institutional determinants. J High Educ 82:154–186.

    Article  Google Scholar 

  31. Reevy GM, Deason G (2014) Predictors of depression, stress, and anxiety among non-tenure track faculty. Front Psychol 5:701.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Cvetkovski S, Jorm AF, Mackinnon AJ (2019) An analysis of the mental health trajectories of university students compared to their community peers using a national longitudinal survey. Stud High Educ 44:185–200.

    Article  Google Scholar 

  33. Woolston C (2019) PhDs: the tortuous truth. Nature 575:403–406.

    Article  CAS  PubMed  Google Scholar 

  34. Guo L, Fan H, Xu Z, Li J, Chen T, Zhang Z, Yang K (2021) Prevalence and changes in depressive symptoms among postgraduate students: a systematic review and meta-analysis from 1980 to 2020. Stress Health 37:835–847.

    Article  PubMed  Google Scholar 

  35. Al-Shannaq Y, Darwish S, Mohammad AA, Jaradat D (2023) Depression and depression literacy among adolescent school students. Jordan J Nurs Res 2:55–68.

    Article  Google Scholar 

  36. Nigam T, Pole R, Vankar GK (2013) Depression literacy among high school adolescents. Arch Indian Psychiatry 15:37–41

    Google Scholar 

  37. Ram D, Chandran S, Basavana GH (2017) Suicide and depression literacy among healthcare profession students in tertiary care center in South India. Psychiatry Behav Sci 7:149.

    Article  Google Scholar 

  38. Ibrahim N, Amit N, Shahar S, Wee LH, Ismail R, Khairuddin R, Siau CS, Safien AM, Safien AM (2019) Do depression literacy, mental illness beliefs and stigma influence mental health help-seeking attitude? A cross-sectional study of secondary school and university students from B40 households in Malaysia. BMC Public Health 19:544.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Arafat SMY, Al Mamun MAA, Uddin MS (2019) Depression literacy among first-year university students: A cross-sectional study in Bangladesh. Glob Psychiatry 2:31–36.

    Article  Google Scholar 

  40. Mamun MA, Naher S, Moonajilin MS, Jobayar AM, Rayhan I, Kircaburun K, Griffiths MD (2020) Depression literacy and awareness programs among Bangladeshi students: an online survey. Heliyon 6:e04901.

    Article  PubMed  PubMed Central  Google Scholar 

  41. Nguyen TT, Tchetgen Tchetgen EJ, Kawachi I, Gilman SE, Walter S, Glymour MM (2017) The role of literacy in the association between educational attainment and depressive symptoms. SSM Popul Health 3:586–593.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Hu Z, Qin L, Xu H (2019) Association between diabetes-specific health literacy and health-related quality of life among elderly individuals with pre-diabetes in rural Hunan Province, China: a cross-sectional study. BMJ Open 9:e028648.

    Article  PubMed  PubMed Central  Google Scholar 

  43. Loo P-W, Furnham A (2013) Knowledge and beliefs about depression among urban and rural Indian Malaysians. Ment Health Relig Cult 16:1009–1029.

    Article  Google Scholar 

  44. Bhuiyan MAH, Griffiths MD, Mamun MA (2020) Depression literacy among Bangladeshi pre-university students: differences based on gender, educational attainment, depression, and anxiety. Asian J Psychiatr 50:101944.

    Article  PubMed  Google Scholar 

  45. Mali B, Akter H, Arafat SY (2018) Depression literacy among nurses: a cross-sectional observation in a tertiary care hospital of Bangladesh. Malays J Psychiatry 27:14–19

    Google Scholar 

  46. Kheirabadi D, Kheirabadi GR, Tarrahi MJ (2021) Depression literacy and the related factors among a group of hospitals’ staff in Iran. Int J Soc Psychiatry 67:369–375.

    Article  PubMed  Google Scholar 

  47. Dias P, Campos L, Almeida H, Palha F (2018) Mental health literacy in young adults: adaptation and psychometric properties of the mental health literacy questionnaire. Int J Environ Res Public Health 15:1318.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Ghadirian L, Sayarifard A (2019) Depression literacy in urban and suburban residents of Tehran, the capital of Iran; recognition, help seeking and stigmatizing attitude and the predicting factors. Int J Prev Med 10:134.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Yu Y, Liu ZW, Hu M, Liu HM, Yang JP, Zhou L, Xiao SY (2015) Mental health help-seeking intentions and preferences of rural Chinese adults. PLoS One 10:e0141889.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  50. Rong Y, Glozier N, Luscombe GM, Davenport TA, Huang Y, Hickie IB (2011) Improving knowledge and attitudes towards depression: a controlled trial among Chinese medical students. BMC Psychiatry 11:36.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Bendik I, Friedel A, Roos FF, Weber P, Eggersdorfer M (2014) Vitamin D: a critical and essential micronutrient for human health. Front Physiol 5:248.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Reavley NJ, Mackinnon AJ, Morgan AJ, Alvarez-Jimenez M, Hetrick SE, Killackey E, Nelson B, Purcell R, Yap MBH, Jorm AF (2012) Quality of information sources about mental disorders: a comparison of Wikipedia with centrally controlled web and printed sources. Psychol Med 42:1753–1762.

    Article  CAS  PubMed  Google Scholar 

  53. Picco L, Abdin E, Chong SA, Pang S, Vaingankar JA, Sagayadevan V, Kwok KW, Subramaniam M (2016) Beliefs about help seeking for mental disorders: findings from a mental health literacy study in Singapore. Psychiatr Serv 67:1246–1253.

    Article  PubMed  Google Scholar 

  54. Dardas LA, Silva SG, Smoski MJ, Noonan D, Simmons LA (2017) Personal and perceived depression stigma among Arab adolescents: Associations with depression severity and personal characteristics. Arch Psychiatr Nurs 31(5):499–506.

    Article  PubMed  Google Scholar 

  55. Ismayilova L, Hmoud O, Alkhasawneh E, Shaw S, El-Bassel N (2013) Depressive symptoms among Jordanian youth: Results of a national survey. Community Ment Health J 49(1):133–140.

    Article  PubMed  Google Scholar 

  56. Zolezzi M, Bensmail N, Zahrah F, Khaled SM, El-Gaili T (2017) Stigma associated with mental illness: Perspectives of university students in Qatar. Neuropsychiatr Dis Treat 13:1221–1233.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


I would like to sincerely thank the Deanship of Academic Research, Imam Mohammad Ibn Saud Islamic University (IMSIU) and the SABIC Psychological Health Research & Applications Chair.


This research was supported by the Deanship of Scientific Research, Imam Mohammad Ibn Saud Islamic University (IMSIU), Saudi Arabia, [grant number 18-11-13-004].

Author information

Authors and Affiliations



The author participating in the research have contributed to the manuscript and approved the last version of the manuscript

Corresponding author

Correspondence to Asem Abdualziz S. Alageel.

Ethics declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

A written informed consent was obtained from the participants, ensuring the confidentiality of the participants in all respects, before publishing the data.

Competing interests

The author declares no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Alageel, A.A.S. Prevalence of depressive symptoms and depression literacy (D-Lit) among Saudi postgraduate students. Middle East Curr Psychiatry 31, 5 (2024).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: