c e p s Journal | V ol.11 | N o 4 | Y ear 2021 169 Personality Traits and Changes in Depression Symptoms in Female University Students Jasminka Bobić 1 , Adrijana Koscec Bjelajac* 2 , Marija Bakotić 3 and Jelena Macan 1 • The present study aimed to investigate the course of symptoms of de - pression in female university students over a four-year period, while also exploring the predictive value of four personality traits with regard to symptoms of depression. The sample comprised 74 female first-year uni - versity students. Symptoms of depression were assessed using the Zung Self-Rating Depression Scale and were collected twice over a four-year interval, while the personality traits of extraversion, neuroticism, psy - choticism and lie tendencies were assessed by the Eysenck Personality Questionnaire only at the baseline. The results revealed that after a four- year period the depression symptoms increased in intensity/frequency on 10 out of 20 items as well as in the summary score, and decreased only in diurnal variations, which was a favourable outcome. Multiple regression analysis indicated that out of the four personality traits only neuroticism was a significant predictor of the summary depression score four years later. This means that young female students with high - er scores in neuroticism, although still in the normal or average range, would very probably have a more pronounced and less well-regulated emotional response to a stressful period of their university education. Keywords: depression symptoms, Eysenck Personality Questionnaire, female students, neuroticism, Zung Self-Rating Depression Scale 1 Institute for Medical Research and Occupational Health, Croatia. 2 *Corresponding Author. Institute for Medical Research and Occupational Health, Croatia; abjelajac@imi.hr. 3 Stadtwerkeprojekt-Spectrum Arbeit Beruf Soziales, Germany. varia doi: 10.26529/cepsj.756 170 personality traits and changes in depression symptoms in female university students Osebnostne lastnosti in spremembe simptomov depresije pri študentkah Jasminka Bobić, Adrijana Koscec Bjelajac, Marija Bakotić in Jelena Macan • Cilja raziskave sta bila preučitev poteka simptomov depresije pri študent - kah v štiriletnem obdobju in določitev napovedne vrednosti simptomov depresije pri štirih osebnostnih lastnostih. V raziskavo je bilo vključe - nih 74 študentk prvega letnika. Simptome depresije smo zajeli dvakrat v štiriletnem obdobju in jih ocenjevali z Zungovo lestvico za samooceno depresije; samo na začetku raziskave smo z Eysenckovim osebnostnim vprašalnikom ocenili osebnostne lastnosti ekstraverzije, nevroticizma, psihoticizma in nagnjenosti k laganju. Rezultati so pokazali, da so po štiriletnem obdobju simptomi depresije narasli glede intenzivnosti/po - gostosti pri 10 od 20 postavk in v skupni vrednosti, zmanjšali pa so se le pri dnevnih nihanjih, kar je bil ugoden izid. Multipla regresijska analiza je pokazala, da je izmed štirih osebnostnih lastnosti samo nevroticizem pomemben napovednik skupne vrednosti depresije po štirih letih. Na - vedeno pomeni, da bi se mlade študentke z višje doseženimi vrednostmi pri nevroticizmu, čeprav še vedno v običajnem ali povprečnem razponu, zelo verjetno izraziteje in manj čustveno uravnovešeno odzivale na stre - sno študijsko obdobje. Ključne besede: simptomi depresije, Eysenckov osebnostni vprašalnik, študentke, nevroticizem, Zungova lestvica za samooceno depresije c e p s Journal | V ol.11 | N o 4 | Y ear 2021 171 Introduction Everyone experiences some unhappiness, sadness or anxiety during their lifetime, often as a result of unexpected, unwanted or just very impor - tant life changes. The transition from secondary school to university is usually a major challenge in one’s life. Many students leave home for the first time, start living on their own and face the demands of adapting to a new cultural and social context. Many engage in various paid or unpaid jobs (e.g., volun - tary work) for additional professional development and/or to meet existential needs. Furthermore, many have to cope with partnership issues, which is one of the vital tasks in this developmental period. Finally, all students have to deal with increased academic demands that require high levels of self-regulated be - haviour. These circumstances may elicit a negative emotional response to chal - lenges and stress, especially in persons with a high level of neuroticism (Fanous et al., 2002; Hutchinson & Williams, 2007). A recent study performed on a large sample of 697 high school students aged 14–19 years in Zagreb (Croatia) ana - lysed the frequency of depression and auto-aggression. The results revealed that as many as 26.5% of the participants had depressive disorders of some degree, ranging from mild to very severe (Tripković et al. , 2014). It is well known that the personality dimension of neuroticism, i.e., emotional instability, is a good predictor of anxiety and depressive symptom - atology (Gershuny & Sher, 1998; Kotov et al., 2010; Nolan et al., 1998) as well as of wellbeing (Butković et al., 2012; Diener & Lucas, 2009). Barnhofer et al. (2011) applied the well-known Eysenck Personality Questionnaire (EPQ – Eysenck & Eysenck, 1975) on a sample of 144 individuals at the first point of measurement and the Beck Depression Inventory (BDI-II – Beck et al., 1996) six years later. They found that scores on Neuroticism assessed six years earlier were positively correlated with the severity of symptoms of depression assessed by the BDI-II. In their recent study, Shi et al. (2015) also indicated that the trait of neuroticism was positively related to depression in a large sample of 2000 Chinese undergraduate medical students. The psychological and sociocultural adjustment of first-year international students in the USA was the focus of a study performed by Hirai et al. (2015), who concluded that the most consistent predictors of the process of adjustment were per - ceived control over academic stress and neuroticism. Longitudinal studies by Hirschfeld et al. (1989) and Krueger et al. (1996) also suggest that a high premorbid level of neuroticism is positively associated with the development of depression. The same was found by Roberts and Kendler (1999), who per - formed a study on a large sample of female subjects using the EPQ. In his 172 personality traits and changes in depression symptoms in female university students paper on the relevance of neuroticism to public health, Lahey (2009) stated that neuroticism was “a robust correlate and predictor of many different men - tal and physical disorders, comorbidity among them, and the frequency of mental and general health service use” (p. 241). As such, neuroticism has long been a topic of interest to many researchers in the broad fields of psychology, psychiatry and public health (Ormel et al., 2013). Our previous research results have shown that women with a higher degree of neuroticism perceive the quality of their lives in the domain of envi - ronment as lower (Radošević-Vidaček et al., 2009), and that more emotionally stable adults perceive their life as better in quality and are in general more sat - isfied with their work environment (Bobić, 2012). In addition to devoting attention to stable personality traits that may shape students’ coping strategies in their new demanding environment, the awareness and management of subtle depression symptoms that do not exceed the boundaries of “normality” is also important. It is well known that besides difficulties in social adaptive processes depression symptoms can reduce intel - lectual performance crucial to learning abilities. Klein et al. (2011) stressed the importance of personality research in the prevention of depressive disorders, stating that “personality is at least somewhat malleable, especially in youth, but may forecast the onset of depression years in advance, which makes traits a potentially attractive means of identifying individuals at risk and informing selection of interventions” (p. 287). In order to examine the relationship between personality traits, symp - toms of depression and self-perceived health-related wellbeing among univer - sity students, we performed a study with 430 healthy students of both male and female gender in the first year of their university studies (Bobić et al., 2015). This study was a part of a larger cross-sectional study aimed at defining rela - tionships between various genetic, environmental and life-style factors in the development of the atopic diseases rhinitis, asthma and dermatitis (Babić et al., 2016; Sabolić Pipinić et al., 2013; Sabolić Pipinić, 2015). We found that the trait of neuroticism (EPQ N) predicted the summary score on the Zung Self-Rat - ing Depression Scale (SDS) and on health-related wellbeing better than any other personality trait assessed by the EPQ, and that neuroticism significant - ly contributed to increased scores on the SDS only in women. These results for the EPQ and the SDS were obtained at the same point of measurement. Approximately four years later, we approached the same participants to test the assumption that higher initial levels of neuroticism, although within the average range, would also be prospectively associated with more frequent or more pronounced depressive symptoms at follow-up. Additionally, we wanted c e p s Journal | V ol.11 | N o 4 | Y ear 2021 173 to assess the possible changes of depression symptoms over the course of uni - versity studies. Findings on differences in the mental health status of university students depending on the year of study are inconclusive, varying from more distress at the entry years to more distress before leaving the relative security of student life (Liu et al., 2019). In order to gain a more comprehensive insight into the areas of functioning in which vulnerabilities are most likely to develop, we wanted to examine the changes in each of the 20 symptoms that comprise the SDS separately. Therefore, the aims of the present study were to explore how symptoms of depression fluctuate over time from the beginning to the end of university studies, and to estimate the tentative predictive value of four EPQ personality variables measured at the beginning of studies for the level of summary depres - sion score after a period of approximately four years. Method Participants and procedure We initially assessed 430 healthy first-year university students (males and females) from seven different public faculties of the University of Zagreb, with the goal of determining how personality traits may predict symptoms of depression and wellbeing assessed at the same time point. These results of the baseline study were published elsewhere (Bobić et al. , 2015). The second part of the study was performed approximately four years (47 months) after the first assessment, when we called all of the students from the first pool once again. All of the procedures were carried out in our insti - tution. A total of 93 participants of both genders responded and we were able to assess their mood in relation to depression symptoms as measured by the SDS for a second time. Due to the very small number of male students who responded to our second invitation, we limited our analyses to female students. A detailed description of the number of students at each stage of the study and the reasons for their exclusion from the analyses is presented in Figure 1. The mean age of the 74 female students who participated in the retest was 18.9 years, with a range of 18–29 years at the first point of measurement. At the second point of measurement, their mean age was 22.9 years with a range of 22–33 years. Each participant was fully informed about the aims of the study and the study protocol, and a consent form was signed during the first phase of the study. The study was conducted in accordance with the Declaration of Helsinki 174 personality traits and changes in depression symptoms in female university students of 1997 (revised in Edinburgh in 2000) and was approved by the Ethics Com - mittee of the Institute for Medical Research and Occupational Health. Instruments Zung Self-Rating Depression Scale (SDS) The Zung Depression Scale (Zung, 1965) is a self-rating scale that com - prises 20 questions on different depressive symptoms (affective, psychological and somatic). Each answer is scored on a Likert-type scale from 1 to 4, indicat - ing the level of agreement to the respective statement, from minimal “None or a little of the time” , to severe “Most or all of the time” . Positively phrased items are reverse scored. The total score represents the sum of scores on all twenty items. It can range from 20 to 80, with higher scores indicating an increased number of depressive symptoms or more intensive symptoms. In the present study, raw scores were used for the statistical analysis. In addition to a number of studies including different patients groups, the SDS has proven itself as a use - ful instrument in young healthy adults (Gotestam et al., 2008; Kitamura et al., 2004), primary healthcare patients without any psychiatric disorder (Milanović et al., 2015) and healthy workers (Ikenouchi-Sugita et al., 2013). Furthermore, Shumway et al. (2004) found it to be one of the least complex measures of de - pression, being very easy to comprehend. The reliability ( α = .81) and validity of the SDS have been reported to be adequate to excellent (Overholser et al., 1993; Tate et al. , 1993). Eysenck Personality Questionnaire (EPQ) The Eysenck Personality Questionnaire is one of the most often used questionnaires for assessment of personality traits. The questionnaire was de - veloped by Hans and Sybil Eysenck in 1975 (Lojk, 1984) and has demonstrated its validity and reliability as a standardised instrument in many countries. Lojk et al. (1979) reported a comparison between results obtained from ex-Yugo - slavian subjects and English subjects and concluded that the organisation of personality was sufficiently similar to make national comparisons feasible. Its internal consistency ranges from 0.68 to 0.91 depending on scale and gender (Lojk, 1984). The EPQ was originally conceived to measure stable personality traits. It consists of 90 items to which participants respond in “yes” or “no” form. The scores are calculated separately for each of the four scales: Psychot - icism (EPQ-P), which denotes aggressiveness, assertiveness, egocentrism, unhelpfulness, tough-mindedness and inclination toward manipulation com - prises 25 items; Extraversion (EPQ-E), which denotes social dimensions of c e p s Journal | V ol.11 | N o 4 | Y ear 2021 175 personality: sociability, liveliness, domination, impulsiveness, irresponsibility, risk-taking, outgoing and talkative characteristics, comprises 21 items; Neurot - icism (EPQ-N), which denotes emotional instability and anxiousness, irritabil - ity, feelings of guilt, depressed mood and low self-esteem, comprises 23 items; and Lie scale (EPQ-L), which denotes dissimulation, social naïveté, social con - formity or social desirability, comprises 21 items. Before running the statistical analyses, we tested whether there were any significant differences in the arithmetic means of the four EPQ personality var - iables and the sum result on the SDS at the first point of measurement (EPQ P , EPQ E, EPQ N, EPQ L, SDS 1) between those who later came to retest and those who did not. The means of those who did not come to retest were: SDS 1 n=233 = 25.72; EPQ P n=222 = 4.33; EPQ E n=222 = 15.14; EPQ N n=222 = 10.94; EPQ L n=222 = 8.34. The means of those who did come to retest were: SDS 1 n=74 = 25.85; EPQ P n=69 = 3.62; EPQ E n=69 = 14.14; EPQ N n=69 = 10.65; EPQ L n=69 = 8.38. We employed the t-test for independent samples and found only that those who came to retest had lower EPQ P values at the first point of measurement than those who did not retest, at a level of significance of p = .046. 176 personality traits and changes in depression symptoms in female university students Figure 1 Number of participants at each stage of the study Note. ZDS1 = Zung Self-Rating Depression Scale at measurement point 1; ZDS2 = Zung Self-Rating Depression Scale at measurement point 2; EPQ1 = Eysenck Personality Questionnaire at measurement point 1. Students of both gender assessed at the first point of measurement (n = 430) SDS Retest Excluded because males (n = 118) Excluded because did not complete SDS1 (n = 5) Excluded from analyses because did not complete EPQ (n = 21) Excluded because did not have EPQ results from the first measurement (n = 5) Female students available for the assessment of depression and personality (n = 312) Completed SDS1 (n = 307) • Available for factor analysis of SDS Completed SDS2 (n = 74) • Available for SDS test-retest comparison Completed both SDS1 and EPQ (n = 286) • Available for descriptive statistics of SDS and EPQ, as well as for multiple regression at the first point of measurement Completed both SDS2 and EPQ1 (n = 69) • Available for multiple regression at the second point of measurement c e p s Journal | V ol.11 | N o 4 | Y ear 2021 177 Results and discussion Changes in depression symptoms The first aim of our study was to evaluate the course of 20 SDS items/ symptoms after a four-year period. The mean values of all 20 SDS items for baseline and repeated measurements for the 74 female students who came for retest approximately four years later are presented in Table 1. The nonparamet - ric statistical method Wilcoxon Matched Pairs Test was used for dependent groups in order to test differences between the mean raw scores on each item and the summary SDS raw score. Statistically significant differences were found for 11 out of 20 items, as well as for the summary SDS score. The results show that the female students reported less diurnal variations of mood (item 2) on the retest, which may also be an indicator of the adaptation process to the academic schedule and of an age-related phase shift towards more pronounced morningness (Roenneberg et al., 2004), since it is the only symptom that showed improvement over time. At the second point of measurement, the students reported more sleeping dis - turbances (item 4); changed appetite – eating more or less than they used to eat (item 5); decreased sexual interest/libido (item 6); weight loss (item 7); more troubles with constipation (item 8); increased confusion/clouded reasoning (item 11); more frequent task difficulties (item 12); more emphasised person - al devaluation/diminished self-esteem (item 17); more pronounced feeling of emptiness (item 18); and a more frequent feeling of dissatisfaction/anhedonia (item 20). Overall, our results are in accordance with the findings of Bostanci et al. (2005), who found an increase in the prevalence of depressive symptoms among older students (using Beck Depression Inventory) ranging from 25% to as much as 32%, i.e., a positive association between being a senior in school and the level of depressive symptoms. This somewhat unexpected result may be explained by the strain that emerges at the end of the schooling period, ac - centuated by expectations associated with the problem of finding proper em - ployment. Students are aware of the high unemployment rate of young people in our society and are therefore put in a position of high uncertainty. Galanaki and Leontopoulou (2017) investigated the transition to adulthood on a large sample of university students in Greece and reported that more than two-thirds (71.4%) of young people exhibited ambivalence with regard to their perceived adult status. 178 personality traits and changes in depression symptoms in female university students Table 1 Differences between test and retest results for Zung Self-Rating Depression Scale raw scores SDS Item (Content) M1 M2 p 1. Depressed mood/affect 1.46 1.46 - 2. Diurnal variation 2.81 2.42 .012 3. Crying 1.27 1.34 .402 4. Sleep disturbance/insomnia 1.26 1.49 .014 5. Appetite 1.12 1.39 .004 6. Decreased libido/sexual interest 1.01 1.64 .001 7. Weight loss 1.03 1.22 .001 8. Constipation 1.12 1.24 .038 9. Palpitation 1.11 1.12 .798 10. Fatigue 1.31 1.24 .470 11. Confusion/clouded reasoning 1.04 1.16 .012 12. Task difficulties 1.04 1.16 .012 13. Restlessness 1.34 1.47 .167 14. Hopelessness/lack of hope 1.18 1.27 .196 15. Irritability 1.37 1.38 .874 16. Indecisiveness 1.95 1.93 .913 17. Diminished self-esteem/personal devaluation 1.19 1.42 .012 18. Emptiness 1.15 1.37 .004 19. Suicidal ideation 1.08 1.04 .181 20. Dissatisfaction/anhedonia 1.03 1.22 .002 Σ SDS 25.85 27.97 .001 Note. N = 74 female students; SDS = Zung Self-Rating Depression Scale; Σ SDS – Sum SDS result; M1 = means at the first measurement point; M2 = means at the retest. We also explored the structure of the SDS scores obtained on female participants at the first measurement point ( N = 308) in order to determine whether the items of the SDS would group around theoretical categories and consequently whether we could expect changes across time in a specific cate - gory. The internal consistency coefficient for this subsample of female students was α = 0.71. Item 2 ( Morning is when I feel the best ) was excluded from the analysis, as this was the only item that significantly decreased in mean value on the second time point, as mentioned above. W e assumed that for the majority of participants in this age group the answer on this item would be related more to the concept of morningness-eveningness and sleep quality than to depression c e p s Journal | V ol.11 | N o 4 | Y ear 2021 179 (Bakotić et al., 2017). Furthermore, the participants often stated that they were forced by circumstances to get up earlier than they would otherwise like, as they tended to go to sleep later. It seems that later in the study period they adjusted to the requirements of the university regime and simply acquired new habits and went to bed earlier. Removing this item from the scale yielded a better internal consistency of the scale ( α = 0.77), which was not the case with other items. We performed a principal-component analysis on 19 items. The Kaiser- Meyer-Olkin measure of sampling adequacy was 0.778, which is above the usual acceptable level of 0.5, and Bartlett’s test of sphericity was significant (Chi-square = 1258.23; d. f. = 171; p < 0.001). Based on the Kaiser’s criterion only (eigenvalues above 1), the initial unrotated solution yielded six components. The eigenvalues of the first two components were 4.36 and 1.78, explaining 23% and 9.3% of the variance, respectively. The following four components had ei - genvalues of 1.3, 1.2, 1.2 and 1.1., and explained 6.6%, 6.3%, 6.2% and 5.9% of the variance, respectively. As the average communality for this solution was under the recommended 0.6 and a solution with so many components was difficult to interpret, we decided to use the scree test in conjunction with the eigenvalues to determine the number of components to be retained. The curve on the scree plot clearly began to tail off after three components, which together explained 39% of the variance. We performed both varimax and promax rotations with three extracted components, which yielded similar solutions. We kept the so - lution obtained by the promax rotation because it was somewhat simpler for interpretation (Table 2). An item was selected in the final solution if its primary component loading was at least .40 and it had no cross-loading of .40 or above (presented in Table 2 in bold script). Three items (7, 9 and 16) did not load at least .40 on any component and were therefore eliminated from the final solu - tion. In the end, three components were identified: Component 1: cognitive symptoms (items: 8, 14, 17, 18, 19, 20); Component 2: affective symptoms (items: 1, 3, 4, 6, 10, 13, 15); and Component 3: somatic symptoms (items: 5, 11, 12). 180 personality traits and changes in depression symptoms in female university students Table 2 Component loadings based on principal component analysis with promax rotation for 19 Zung Self-Rating Depression Scale items Content Full item Component 1 Cognitive Component 2 Affective Component 3 Somatic 18. Emptiness My life is pretty full .80 -.05 -.12 14. Hopelessness I feel hopeful about the future .76 -.01 -.17 17. Self-esteem I feel that I am useful and needed .66 .11 -.07 8. Constipation I have trouble with constipation .62 -.02 -.12 19. Suicidality I feel that others would be better off if I were dead .59 .17 .08 20. Dissatisfaction I still enjoy the things I used to do .54 -.07 .39 9. Palpitation My heart beats faster than usual .38 .19 -.01 6. Sexual interest I enjoy looking at, talking to and being with attractive women/men -.37 .73 -.19 13. Restlessness I am restless and can’t keep still .29 .58 -.02 1. Depressed mood I feel downhearted and blue .20 .52 .10 4. Sleep disturbance I have trouble sleeping at night .07 .51 -.03 3. Crying I have crying spells or feel like it .03 .48 -.01 10. Fatigue I get tired for no reason .06 .45 .07 15. Irritability I am more irritable than usual .03 .44 .26 16. Indecisiveness I find it easy to make decisions .16 .19 .06 12. Task difficulties I find it easy to do the things I used to -.12 .06 .74 11. Confusion My mind is as clear as it used to be -.08 .09 .72 5. Appetite I eat as much as I used to -.16 -.06 .64 7. Weight loss I notice that I am losing weight .25 -.13 .27 Note. N = 308 female students. Kitamura et al. (2004) performed a factor analysis on SDS results on a large sample of first-year university students of male and female gender and also found three factors: affective (7 items: 1, 3, 9, 10, 13, 15, and 19), cognitive (4 items: 14, 16, 17, 18) and somatic (3 items: 5, 6, 12). There are both similarities and differences between the particular items constituting each SDS factor in first-year students in Japan and Croatia. However, the huge difference in sample size and composition does not allow for detailed comparisons between the two studies. What is interesting to note is that some of the factors that constituted the affective factor in both studies, namely Depressed mood (1), Crying (3), c e p s Journal | V ol.11 | N o 4 | Y ear 2021 181 Fatigue (10), Restlessness (13) and Irritability (15), did not show a significant change during the four-year period and progression through the educational stages in our study. A recent study by Romera et al. (2008) revealed that items 11 (confusion/ clouded reasoning) and 12 (task difficulties) were the most frequent symptoms and the symptoms with the highest mean scores ( M 11 = 3.28; M 12 = 3.29) observed in a sample of patients with major depression. Both of these items/symptoms showed a statistically significant increase in frequency over the four-year peri - od in our sample. It seems that our students experience and express more cog - nitive and somatic disturbances over the course of time, spending more time studying and coping with different stressors and less time socialising, which makes them vulnerable to the development of depressive symptoms. Personality traits as predictors of depression symptoms In order to examine the predictive value of the EPQ personality vari - ables (P, E, N and L) measured at the beginning of university studies for the total depression score after a four-year period (SDS2), we conducted multiple regression analyses. Descriptive statistics and the main results of the regression analyses are shown in Table 3. Table 3 Correlation matrix, descriptive statistics (mean and standard deviation) and main results of multiple regression analysis with SDS2 as criterion variable Variables Zero-order correlations Multiple regression weights EPQ E EPQ N EPQ P EPQ L SDS2 b ß EPQ E - -.224 .043 -.331** -.118 -.055 -.048 EPQ N - .387** -.188 .463** .402** .441** EPQ P - -.353** .186 -.031 -.015 EPQ L - -.153 -.110 -.091 M 14.14 10.65 3.62 8.38 28.01 SD 4.32 5.37 2.35 4.06 4.89 Note. N = 69; ** p < .001; * p < .005; SDS2 = Zung Self-Rating Depression Scale at the second point of measurement; EPQ = Eysenck Personality Questionnaire at the first point of measurement; E = extraversion; N = neuroticism; P = psychoticism; L = lie scale. Neuroticism was the only dimension that was significantly correlated 182 personality traits and changes in depression symptoms in female university students to the SDS summary score (SDS 2) in the subsample that came for retesting after a four-year period. Four personality variables together explained (only) 22.1% of the variance in the SDS 2 score ( F(4.64) = 4.546; p = .003; R = .470; R square = .221; adjusted R square = .173), and in this model only the N scale was a significant predictor of the summary depression symptoms score ( ß = .441, p = .001). In other words, female students with a higher degree of neuroticism would very probably report more depression symptoms as a reaction to specific circumstances and challenges and an overall stressful period of study at uni - versity, even if the symptoms do not exceed the boundaries of “normality” or average scores on any of the observed trait variables. This is why it is important to ensure the availability of adequate professional support and counselling in the institutional education system. Conclusion Our results showed that the mean result for the SDS summary score re - mained within expected boundaries. The course of depression symptoms after a four-year period measured by the SDS showed an increase in intensity/fre - quency on 10 items (sleep disturbance, appetite changes, weight loss, constipa - tion, insomnia, decreased libido, confusion, task difficulties, personal devalu - ation, emptiness and dissatisfaction) as well as in the summary score, with the only decrease being in diurnal variations, which is a more favourable option. We also confirmed the three-factor structure of the SDS items. Multiple regression analysis indicated that out of the four personality variables measured by the EPQ (Psychoticism, Extraversion, Neuroticism and Lie tendencies) only Neuroticism was a significant predictor of the summary depression score at the second time point (SDS2). This means that young fe - male students with higher neuroticism scores, although in normal or average range, would very probably have a more pronounced and less well-regulated emotional response to a stressful study period. We can speculate that this pro - longed response mechanism would most likely reflect itself in a lower overall quality of life. As many reports show that the number of students seeking advice in relation to depression symptoms is rising, it would be helpful to take into ac - count the personality characteristics of these students when designing and de - veloping the best intervention procedures to be included in public health strat - egies. Y oung students navigate between being a freshmen and being a finalist a few years later and are inevitably faced with different stressors, which in turn may elicit a depressed mood. It might be beneficial for individuals with lower c e p s Journal | V ol.11 | N o 4 | Y ear 2021 183 emotional stability who are faced with stress to learn how to effectively man - age stress and subsequently reduce the quantity and/or intensity of depressive symptoms. The limitations of the present study are primarily in the small number of subjects who came to retest, which resulted in limiting the sample to females only. W e can speculate that the differences between the test and retest results on the SDS, as well as the SDS factor profile, may have been different in the male student population. Another limitation is that we disregard socioeconomic sta - tus as an important factor, although our same-gender sample is homogenous in terms of age and education. 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Her main areas of research are: clinical psychology, neuropsychology, occu - pational health psychology and social psychiatry. She is member of Croatian Psychological Chamber. Adrijana Košćec Bjelajac, psychologist and psychotherapist, PhD, scientific associate at the Institute for Medical Research and Occupational Health, Zagreb, assistant professor at the University of Zagreb, and psycho - therapist in private practice. Her main research focus are issues in sleep, mental health and quality of life in adolescents, university students, working popula - tion and older adults. She is member of Croatian Psychological Chamber, Croa - tian Chamber of Psychotherapists, Croatian Psychological Society, Society of Gestalt and Integrative Psychotherapists of Croatia, Society of Imago Therapists of Croatia, European Association for Gestalt Therapy, European Association for Psychotherapy and European Sleep Research Society. Marija Bakotić, licenced psychologist, PhD, scientific associate, now employed at Stadtwerkeprojekt-Spectrum Arbeit Beruf Soziales, München, Germany, formerly working at the Institute for Medical Research and Occu - pational Health in Zagreb, Croatia. She is experienced in sleep research and issues in mental health and quality of life in adolescents, university students and adults. Jelena Macan, MD, PhD, scientific advisor, specialist in occupational &sport medicine, with experience in environmental and occupational epide - miology, particularly epidemiology of allergic diseases, occupational toxicol - ogy and risk assessment. Beside research, she is an active medical professional working in an outpatient clinic specialized on environmental and occupational medicine. She is a full member of Croatian Academy of Medical Sciences- Collegium of Public Health, Croatian Medical Association, Croatian Medical Chamber, and a president of the Ethical Committee at the Institute for Medi - cal Research and Occupational Health. She is a Croatian delegate at the Occu - pational Medicine Section of the European Association of Medical Specialists (UEMS).