Relationship Between Cumulative Twenty Four-hour Urinary Noradrenaline and Depression Among Students Of Kampala International University Western Campus

ABSTRACT BACKGROUND: Depression is one of the major mental problems in the students' population and it is continuously increasing. The catecholamine hypothesis postulated that depression results from functional deficiency of noradrenaline in the brain. In this study, the relationship between depression and twenty four hours urinary noradrenaline was analysed among medical students ofKIU-Western Campus. METHOD: A cluster sampling approach was used to select University students in K.IU. A 21-ltem Beck Depression Inventory (BDI) was used to screen for depressive status among participants. BDI scores of 11 and above were categorized as depression while BD! scores of 10 and below were categorized as normal. At the same time, the 24-hour urine samples of participants were assayed for noradrenaline levels using colorimetric technique. RESULT: Out of 135 students who participated in the study (65 males and 70 females), 27 (22.3%) of the pm1icipants had a BDI score of 11 and above while 94(77.7%) had a BDI of I 0 and below. Noradrenaline levels of the 27 (22.3%) depressed pat1icipants were matched for age, sex along with other socio-demographic characteristics of patiicipants whose BDI scores were within the normal range. Outcome from independent !-test showed there is no significant difference (P > 0.05) in the mean 24 - hours urinary noradrenaline levels between the two groups (depressed and non-depressed) but there was a slight increase in mean 24-hours urinary noradrenaline levels among depressed than normal pat1icipants. CONCLUSION: There is a mild prevalence of depression among Kampala International University -Western Campus Students especially among the married. The slight increase in mean 24 -hours urinary noradrenaline levels in depressed participants' suggests that noradrenaline could be a biomarker for depression. RECOMMENDATION: There is need for fmiher similar study involving larger sample size to compare levels of 24-hours urinary noradrenaline. Measurement of noradrenaline could be improved with High performance liquid chromatography. Also, there is need for development of effective model for the prediction and treatment of depression among University Students.

 Table of Contents 

DECLARATION ......................................................................................................................................... ii 

CERTIFICATION ..................................................................................................................................... iii 

DEDICATION ............................................................................................................................................ iv 

ACKNOWLEDGEMENT .......................................................................................................................... v 

ABBREVIATIONS AND ACRONYMS ................................................................................................... x 

LIST OF FIGURES .................................................................................................................................. xii 

LIST OFT ABLES ................................................................................................................................... xiii 

OPERATIONAL DEFINITIONS ........................................................................................................... xiv 

ABSTRACT ............................................................................................................................................... xv 

CHAPTER ONE ......................................................................................................................................... ! 

1.0 INTRODUCTION ......................................................................................................................... I 

1.1 Background ......................................................................................................................................... I 

.. Historical Background ..................................................................................................................... I 

.1.2 Theoretical Background ................................................................................................................... 3 

1.1.2.1 Biological Theories of Depression ................................................................................................ 3 

1.1.2.2 Cognitive Theories of Depression ................................................................................................. 4 

1.1.2.3 Hopelessness Theory of Depression ........................................................................................... 4 

1.1 .3 Conceptual Background ................................................................................................................... 5 

1.1 .4 Contextual background .................................................................................................................... 6 

1.2 Problem Statement ........................................................................................................................ 6 

1.3 Study Objectives ................................................................................................................................. 7 

1.3.1 General objective/ Purpose .............................................................................................................. 7 

.3.2 Specific objectives ........................................................................................................................... 7 

1.4 Research Questions ....................................................................................................................... 7 

vi 

1.5 Importance/Significance of the Study ........................................................................................... 8 

1.6 Scope of the Study ................ , .............................................................................................................. 8 

1.9 Conceptual framework ........................................................................................................................ 9 

CHAPTER TWO ...................................................................................................................................... !! 

2.0 LITERATURE REVIEW .................................................................................................................. II 

2. I Prevalence of Depression ................................................................................................................ I I 

2.2 Possible Biomarkers of depression ................................................................................................... I 2 

2.2.1 Cm1isol Hormone ........................................................................................................................... 12 

2.2.2 Thyroid hormone ............................................................................................................................ 13 

2.2.3 Serotonin ........................................................................................................................................ I 4 

2.2.4 Adrenaline, Noradrenaline and Dopamine ..................................................................................... I 6 

2.2.4.1 The Biology ofNoradrenaline ................................................................................................. 17 

2.2.4.2 Mechanism of action of noradrenaline .................................................................................... 18 

2.2.4.3 Biosynthesis of Noradrenaline ................................................................................................ I 8 

2.2.4.4 Vesicular transport ofnoradrenaline ....................................................................................... l8 

2.2.4.5 Release of noradrenaline ............................................................................................................. 18 

2.2.4. 7 Termination ofnoradrenaline ...................................................................................................... 9 

2.2.4.8 Degradation of noradrenaline ..................................................................................................... 19 

2.3 Relationship between Noradrenaline and Depression ....................................................................... 20 

2.4 General Integrative PhysioiO&'Y of Depression .................................................................................. 21 

CHAPTER THREE .................................................................................................................................. 22 

3.0 METHODOLOGY ............................................................................................................................ 22 

3.1 Study Design ..................................................................................................................................... 22 

3.2 Study site ........................................................................................................................................... 22 

3.3 Study population ............................................................................................................................... 22 

3.4 Sample size ....................................................................................................................................... 22 

3.5 Sampling Technique .......................................................................................................................... 23 

3.5.1 Inclusion Criteria ............................................................................................................................ 23 

3 .5.2 Exclusion Criteria .............. : ............................................................................................................ 23 

vii 

3.6 Data Collection Instrument ......................................................................................................... 24 

3.6.1 Beck Depression Inventory ..................................................................................................... 24 

3 .6.2 Socio-demographic (Self-administered Questionnaire) ................................................................. 24 

3.6.3 Materials for Urinary noradrenaline ............................................................................................... 24 

3.7 Data collection methods . .' ............................................................................................................ 25 

3. 7.1 Distribution of Beck depression Inventory, questionnaire and Urine Collection Containers. 25 

3. 7.2 Measurement of 24-hour urinary Noradrenaline Levels ......................................................... 25 

3.8 Data quality control ........................................................................................................................... 26 

3.9 Data Analysis .................................................................................................................................... 27 

3.10 Validity of the data collecting Instrument... ................................................................................ 27 

3.11 Ethical considerations ..................................................................................................................... 27 

3 .I I .I Description of Benefit ............................................................................................................. 28 

3 .11.2 Description of Risk ................................................................................................................. 28 

3 .I 1.3 Balancing of Risk with' Benefit ............................................................................................... 28 

3.12 Study Limitation and Delimitation .................................................................................................. 28 

CHAPTER FOUR ..................................................................................................................................... 30 

DATA PRESENTATION, ANALYSIS AND INTERPRETATIONS .................................................. 30 

4.0 Result ................................................................................................................................................ 30 

4.1: Prevalence of Depression among Kampala International University-Western Campus Students ... 30 

4.1.1 Socio-Demographic Characteristics of Respondents ............................................................ 31 

4.2 Noradrenaline levels among Kampala International Unive1·sity-Western Campus Students with 

respect to levels of depression ................................................................................................................. 33 

4.3 Relationship between Depression and Twenty four hours Urina1y Noradrenaline Level. ................ 36 

CHAPTER FIVE ....................................................................................................................................... 38 

DISCUSSION. CONCLUSION AND RECOMMENDATION ............................................................. 38 

5.0 Int1·oduction ....................................................................................................................................... 38 

5.1 Discussion ......................................................................................................................................... 38 

5.1.1 Prevalence of Depression among KTU Western Campus Students ................................................ 38 

5.1.2 Levels of24-hours Urinary Noradrenaline among Respondents ................................................... 39  

5.1.3 Relationship between Depression and 24hours Urinary Noradrenaline Level .............................. 40 

5.2 Conclusion ........................................................................................................................................ 40 

5.2.1 Prevalence of depression among KIU Western Campus Students ................................................. 40 

5.2.2 Levels of Urinary noradrenaline among respondents ..................................................................... 40 

5.2.3 Relationship between depression and 24hours urinary noradrenaline level ................................. .41 

5.3 Recommendation ......................................................................................................................... 41 

5.3.1 Prevalence of depression among KIU Western Campus Students ................................................. 41 

5.3.2 Levels of Twenty four hours Urinary noradrenaline among respondents ...................................... 41 

5.3.3 Relationship between depression and 24-hours urinary noradrenaline leve1 ................................ .41 

REFERENCES ........................................................................................................................................ 42 

APPENDIX I: INFORMED CONSENT FORM ..................... ,. ............................................................ 54 

APPENDIX 2: BECK DEPRESSION INVENTORY ............................................................................ 56 

APPENDIX 3: SOCIO-DEMOGRAPHIC QUESTIONNAIRE FOR BIOMEDICAL STUDENTS .... 61