In the present study there is high prevalence of mental distress and perceived need for professional mental health care among university students. The top five frequently reported barriers for not receiving professional mental health service were: thinking the problem would get better by itself, being unsure where to go to get professional care, wanting to solve the problem by oneself, denying mental health problem, and preferring to get alternative forms of care. Rural background and being in a fourth-year were significant barriers to receiving formal mental health service among the students.
The prevalence of mental distress which is reported in the present study is higher than what has been reported in the meta-analysis of the general population studies in Ethiopia [32]. Perhaps our finding may not be surprising, because university students are more likely than the general population to be exposed to mental distress [12]. The possible difference between individual studies reviewed in the meta-analysis [32] and the present study could partly attributed to the discrepancy in data collection instrument, cut-off points used, data collection time, age group, and setting.
The current prevalence of mental distress is higher than what has been reported in previous studies conducted among university students [18, 59]. One possible reason for the discrepancy is the difference in the cut-off values used to define mental illness [18, 59]. The other explanation for the difference might be resulted from not using locally validated instrument [59]. The current finding is lower than what was reported in previous studies in Ethiopian universities [45, 60]. The first possible justification for the difference might be data collection instrument being used to screen mental distress [45, 60]. The second possible reason for the difference could be data collection time in which exam was approaching [60]. The present finding is comparable with a study report conducted in Jima University [42]. This might be resulted from similarity of the data collection tool and the cut-off points used to define mental distress.
The high prevalence of perceived need for professional mental health services in the current study suggests that most students with mental distress in Wolaita Sodo University remain untreated. This may not be astonishing, because most universities in LMICs are ill-equipped to solve students’ mental health problems [46]. Previous study also reported that only a few numbers of university students receive mental health services for their mental health problems [61]. Mental health treatment gap adversely affects students’ academic result [14], health, social life and cognitive outcomes [62]. Our finding is higher than what has been reported in the general population of Ethiopia. In a meta-analysis of Ethiopian studies the pooled prevalence of the help-seeking intention of people with depression in Ethiopia is 42% [35] which is much lower than the current finding. The possible explanations for the difference could be difference in mental health literacy, study population and data collection instruments being used.
However, the present perceived need for treatment is lower than what has been reported by a study conducted among rural Chinese adults, where 80% of the participants needed to receive formal mental health service for their mental illnesses [63]. The main difference with the current study are the participants in the Chinese study [63] were rural adults, but in the present study, respondents were adolescents. As evidence shows as age increases, the need to receive mental health care also increases [64], so that adults may have more help-seeking intentions than adolescents, because of having more increased mental health literacy [65]. The other possible difference can be culture difference affects treatment preference, in the Chinese study [63] 72% of the participants preferred care from formal sources, but in Ethiopia, the majority of university students received mental health treatments from informal sources [45]. Our study supports previous web-based survey reporting that 37% to 84% of university students screened positive to mental distress did not receive any professional mental health service [26]. The similarity of the result may be, due to using similar data collection tool and similar age group of participants.
Among the top five reported barriers for receiving professional mental health service by the students who recognized a need for care, the first was thinking mental distress would get better by itself. This indicates that students perceive mental distress would get better without receiving any treatment, which may be associated with considering mental health problems as not serious so that they become reluctant to use available mental health services [62] and it may also be associated with having poor mental health literacy [66]. The current finding supports a prior study reporting that the majority of college students believed that time by itself would solve their mental health problem [56].
The present study shows that most undergraduate students with mental distress had no information about where to find professional mental health services at the university, even if WSU has two counseling offices established to help students mainly with mental health problems and a teaching referral hospital that provides physical and mental health services for the community and the students as well. The information gap is probably caused by lack of awareness creation about their services done by the university mental health service providers. Our finding supported by prior studies, where the majority of university students had no information about the availability of mental health service in their university [67, 68].
Wanting to solve mental health problem by oneself is reported as the third common barrier to receive mental health service in the present study. This suggests that most students may not want to share their mental health problems with professionals so that they need to handle the problem by themselves. This is possibly due to perceiving their problem as not serious or transit or being skeptical about the effectiveness of professional mental health service [26]. As a result, they may prefer to manage their mental health problem using a healthy coping mechanism like problem-solving [69] or using unhealthy coping strategies such as substance use and isolation [70]. The present finding supports the past studies reporting a major barrier for receiving formal mental health service among university students with mild to moderate depression and anxiety was preferring to self-medication [71, 72].
The fourth barrier identified in the present study is denying mental health problems. Students may not want to recognize their mental health problems due to lack of knowledge about mental illness [66] or they may deny their mental health problem as a coping strategy by rejecting the reality and not taking appropriate action to treat their problem [70]. Our finding supports prior study finding reporting the majority of university students deny mental health problems that hindered them to receive professional mental health care [29].
The fifth commonly reported barrier for using professional mental health service is preferring to get mental health service from informal sources. This suggests that majority of students receive mental health help from friends, family, relatives, religious leaders, and traditional healers [45], which is also common practice in the general population of Ethiopia [73]. The present finding also supported by previous studies, where informal sources of mental health care reported by college students as a reason for not to receive mental health services in their university [66, 74].
Interestingly, the current study found that fourth-year students with mental distress are more likely than other level of study years to report attitudinal, instrumental, and stigma related treatment barriers. The reason can be the majority of fourth-year students in the present study were from engineering department. Students from this department are more likely to be exposed to mental distress, due to heavy course loads both in theories and application [75]. Hence, they may encounter more barriers to receiving professional mental health services compared to other fields of study [76]. However, our finding contradicts with a study finding reporting that first-year students are more likely than their junior and senior students to perceive a greater number of barriers to receive professional mental health care [29]. The result difference with the present study could be due to difference in data collection tool, study setting, and sample size in each level of the study year. Caution in the present study, the number of fourth-year students is small.
Our study also found that students from rural backgrounds are more likely than students from urban areas to face instrumental-related barriers to seeking professional mental health care. This might be because of adolescents from rural areas may not have increased knowledge of mental illnesses so that they may not have sufficient information about the availability of free mental health services in the university and they may not be psychologically open toward professional mental health services [77]. Our finding confirms with the past study conducted in Australia reporting that adolescents from rural areas have more instrumental-related challenges for receiving formal mental health care than adolescents from urban areas [78]. Our study also shows that second-year students reported more instrumental-related barriers like fourth-year students. This is probably due to the interaction effects of other controlled variables in the adjusted model. This may need further study in the future.
The present study implies that mental distress is prevalent among undergraduate students. Likewise, the need to receive professional mental health services is increasing, even though the students could not be able to receive the service provided in the university due to attitudinal, instrumental and stigma-related barriers particularly fourth-year engineering students and students who came from rural areas. This needs designing practical mental health interventions to treat their mental distress, otherwise, it affects their health, social life, and academic results [23].
Therefore, the present findings provide useful information and directions for university mental health service providers to create awareness about mental health problems and their service, benefits of receiving professional mental health care, and when and where to seek professional mental health support by distributing flyers, preparing training, and mental health day. All these together enhance to develop active university-based mental health intervention to reduce the prevalence of mental distress and to satisfy the need for receiving professional mental health service by minimizing the reported major barriers. The present study investigated some demographic predictors of barriers to receiving professional mental health care, but further study is necessary to examine the associations of other variables such as mental health literacy and academic results with barriers to receiving professional mental health services. Furthermore, future research is needed to study predictors of perceived need for professional mental health care among undergraduate students.
Any research has its own limitations; similarly, the present study is not limitations free. First, data were collected using self-reported questionnaires so that recalling bias may occur to remember mental distress symptoms that happened in the past one month and rating the degree of barriers to receive professional mental health care may be difficult to remember. Second, barriers to receiving mental health care measuring instrument was not locally adapted, although it is properly translated and piloted for the present research. Third, a screening tool was used to identify participants positive to mental distress; it would have been better to use a diagnosis tool. Fourth, the study was a cross-sectional design that cannot show causality among variables. Fifth, data collectors were classroom representatives so that they might be in a position to know the participants’ response to each item while checking missing data during they return the questionnaire. Six, since the participants were recruited from a single public university, it is difficult to generalize the result to all public universities and private colleges that are found in Ethiopia.
Despite the limitations mentioned above, the present study has some strengths. First, a large number of students were participated in the prevalence study. Second, the study used a locally adapted instrument, SRQ–20. Third, the research contains findings of the prevalence of mental distress, perceived needs, and barriers to receiving professional mental health services together, so that this information all together can serve as input for the future feasibility study of mental health interventions for mental distress among university students.
Conclusion and recommendation: the present study shows that the prevalence of mental distress and perceived need for professional mental health service was high among regular undergraduate students at Wolaita Sodo University. The top five perceived barriers for not to receive professional mental health service in this university were: thinking the problem would get better by itself, being unsure where to go to get professional care, wanting to solve the problem by oneself, denying mental health problem, and preferring to get alternative forms of care. So, to alleviate these problems, students need to receive professional mental health interventions in the university. Hence, mental health providers in the university should make their services accessible to the students, because the majority of the students did not know where to get mental health services at the university.
Besides the interventions, developing preventive mental health education strategy is essential to minimize the prevalence of mental distress by creating conducive environments that promote and sustain positive mental health for every student. Moreover, preparing mental health celebration day in the university can play a great role in changing the attitude of students toward receiving mental health care and improving mental health literacy, because out of the five major barriers, four of them were attitudinal-related. In this celebration day, creating awareness about the treatability of mental distress like any other physical illness, benefits of receiving mental health care from professionals, recognizing mental distress to search solution in the early stage, and educating students to receive mental health care from professional parallel withreceiving treatment from alternative sources are very important. Therefore, this is an alarm call for action from university administrations, university mental health care providers, and the Ministry of Science and Higher Education for helping undergraduate students with mental distress and preventing this problem.