Inequality and mental healthcare utilisation among first-year university students in South Africa

Abstract

Background: Addressing inequalities in mental healthcare utilisation among university students is important for socio-political transformation, particularly in countries with a history of educational exclusion. Methods: As part of the WHO World Mental Health International College Student Initiative, we investigated inequalities in mental healthcare utilisation among first-year students at two historically "White" universities in South Africa. Data were collected via a web-based survey from first-year university students (n = 1402) to assess 12-month mental healthcare utilisation, common mental disorders, and suicidality. Multivariate logistic regression models were used to estimate associations between sociodemographic variables and mental healthcare utilisation, controlling for common mental disorders and suicidality. Results: A total of 18.1% of students utilised mental healthcare in the past 12 months, with only 28.9% of students with mental disorders receiving treatment (ranging from 28.1% for ADHD to 64.3% for bipolar spectrum disorder). Of those receiving treatment, 52.0% used psychotropic medication, 47.3% received psychotherapy, and 5.4% consulted a traditional healer. Treatment rates for suicidal ideation, plan and attempt were 25.4%, 41.6% and 52.9%, respectively. In multivariate regression models that control for the main effects of mental health variables and all possible joint effects of sociodemographic variables, the likelihood of treatment was lower among males (aOR = 0.57) and Black students (aOR = 0.52). An interaction was observed between sexual orientation and first generation status; among second-generation students, the odds of treatment were higher for students reporting an atypical sexual orientation (aOR = 1.55), while among students with atypical sexual orientations, the likelihood of mental healthcare utilisation was lower for first-generation students (aOR = 0.29). Odds of treatment were significantly elevated among students with major depressive disorder (aOR = 1.88), generalised anxiety disorder (aOR = 2.34), bipolar spectrum disorder (aOR = 4.07), drug use disorder (aOR = 3.45), suicidal ideation (without plan or attempt) (aOR = 2.00), suicide plan (without attempt) (aOR = 3.64) and suicide attempt (aOR = 4.57). Likelihood of treatment increased with level of suicidality, but not number of mental disorders. Conclusion: We found very low mental healthcare treatment utilisation among first-year university students in South Africa, with enduring disparities among historically marginalised groups. Campus-based interventions are needed to

Maltreatment during childhood and risk for common mental disorders among first year university students in South Africa

“…Studies have illustrated how emotional abuse (but not other forms of maltreatment) contribute to the development of negative self-schemas and difficulties with emotional regulation, with negative self-cognitions mediating the relationship between emotional abuse and symptoms of depression and anxiety [ 58 , 59 ]. Emotional dysregulation has also been implicated in the development of DUD [ 60 , 61 ].…”

A Web-Based Group Cognitive Behavioral Therapy Intervention for Symptoms of Anxiety and Depression Among University Students: Open-Label, Pragmatic Trial

“…Two key challenges faced by university student counseling centers are how to respond to the large number of students with common mental disorders and how to engage and retain students in effective treatments once they reach out for professional help [13]. Many student counseling centers are underresourced and have difficulty in reaching students in need even when they are operating at full capacity [18], with the situation being more dire in low-and middle-income countries where student counseling services are often nonexistent [19]. Self-guided and guided digital interventions are potentially scalable and cost-effective ways to close the mental health treatment gap and have been shown to be effective in treating university students with anxiety and depression [20][21][22], although many of these interventions have high rates of attrition and low rates of engagement [20].…”

Reducing nonfatal suicidal behaviour among university students: actuarial analysis of potential effects of treating common mental disorders

“…These findings reiterate the importance of promoting access to mental health care services as an integral component of campus-based suicide prevention (King et al, 2015). However, this may be difficult to achieve given the significant mental health treatment gap on SA university campuses and previous findings that only 28.9% of students with CMDs receive treatment (Bantjes et al, 2020). It will be challenging to provide mental health care services particularly in resource-constrained institutions, given that the 12-month prevalence of CMDs among SA students is as high as 31.5% (Bantjes, Lochner, et al, 2019).…”