Abstract
Mental distress is a common health problem facing university students worldwide. It manifests with varying levels of depression, anxiety, and somatic symptoms such as headache, backache, sleeping problems, and fatigue. University students are a high-risk group for mental distress than the general population. This study aimed to assess knowledge, the prevalence of mental distress, and its associated factors among undergraduate students. A cross-sectional study was conducted among undergraduate students at the University of Dodoma in Tanzania. Data were collected using pre-tested and self-administered questionnaires. Bivariate and multivariable logistic regression models were used to identify factors associated with mental distress. A total of 224 undergraduate students gave a complete response, of which the majority were aware of the common symptoms of mental distress. Self-reported mental distress experience was reported among 116/224 (51.8%) students. Multivariable logistic analysis showed that only alcohol consumption (aPR = 1.61, 95% CI 1.22–2.11, p = 0.001) was independently associated with mental distress among students. The findings of this study revealed that undergraduate students had adequate knowledge of the symptoms of mental distress. Our results show that the prevalence of self-reported mental distress was moderately high among undergraduate students. Furthermore, the study indicates a significant association between alcohol consumption and self-reported mental distress among these students. These results suggest that interventions aimed at reducing alcohol consumption may be beneficial in mitigating mental health issues among undergraduate students in Tanzania.
Supplementary Information
The online version contains supplementary material available at 10.1007/s44192-024-00098-x.
Keywords: Mental distress, Undergraduate students, Factors, Alcohol consumption, Tanzania
Introduction
Mental distress is an individual’s mental health problem that manifests with varying levels of depression, anxiety, and somatic symptoms such as headache, backache, sleeping problems, and fatigue [1, 2]. Mental distress is one of the significant public health concerns worldwide, affecting enormous populations of various classes [3]. Studies from developed countries indicate that the prevalence of mental distress is high among both adult men and women, with women being more likely to experience serious mental distress than men [4, 5]. Additionally, mental distress is notably prevalent among young people, with levels ranging from 14 to 40% [6]. In Sub-Saharan Africa, mental distress is progressively gaining recognition as a public health challenge. Some countries have taken a step further to include it in national health policy [7]. These efforts have resulted in imposing some interventions at different levels to minimize exacerbation of the problem [7, 8].
Although mental distress affects various classes of people in the general population, university and college students are a high-risk group [9]. This is because university and college students are constantly subjected to multiple stressors that may arise from their academic pursuits or the transition from adolescence to adulthood [10, 11]. Leaving their homes to attend university or college can further increase symptoms of anxiety, depression, and stress [12]. University students often face stressors such as academic overload, financial hardships, social and relationship issues, peer competition, and concerns about their future careers and family responsibilities [2, 9]. If these stressors are not effectively managed, they can negatively impact students’ academic and social performance. Additionally, these challenges may increase the risk of substance use, personality disorders, and other adverse outcomes that may emerge later in life [13].
There has been growing evidence showing that undergraduate students suffer from mental distress [10, 11, 14]. A WHO survey shows that more than 30% of university students from eight countries were suffering from mental distress [15]. Findings from northern Tanzania revealed that 14% of university students suffered from mental distress [2]. Low grades, residing off-campus, family history of mental illness, lack of social support, and tobacco/marijuana smoking were the substantive associated factors of mental distress [2]. Other associated factors of mental distress among university and college students have been elucidated in literature [7, 9, 16]. However, not all students are aware of mental distress, as evidenced by a Nigerian study where approximately 88% of undergraduate students could not correctly identify the symptoms of mental distress and associated factors [17]. As a result, these students are less likely to seek psychological counseling, adopt coping strategies, or mental health treatment when they face mental distress, even if the service is available within their vicinity [18, 19].
Addressing the rapidly growing mental distress among university students is fundamental, and identifying the associated factors can improve mental health outcomes [3]. Numerous studies have reported varying levels of mental distress awareness, prevalence, and associated factors [16, 20]. However, these studies are limited in developing countries of sub-Saharan Africa, such as Tanzania, where mental health resources are insufficient. Therefore, this study aimed to assess the knowledge, prevalence, and associated factors of mental distress among undergraduate students at the University of Dodoma, Tanzania.
Methods
Study design and settings
This institution-based cross-sectional study was conducted at the University of Dodoma, central Tanzania, from April to May 2023. Established in 2008, the University of Dodoma is one of the largest universities in Tanzania, admitting approximately 35,000 students yearly. The university offers non-degree, undergraduate, and postgraduate programs. The undergraduate programs are broadly categorized into natural sciences, engineering and technologies, health sciences, information and communication technologies, social sciences, humanities, business, and education.
Study population, sample size and sampling
The study population consisted of undergraduate students at the University of Dodoma who voluntarily gave informed consent. The sample size was estimated using the Open Epi-info calculator for prevalence studies. Based on a previous study conducted in northern Tanzania [2], a prevalence of 14%, a 95% confidence interval, and a 5% margin of error were used. The sample size was then adjusted by 10% to account for non-response, resulting in a minimum sample size of 205. A simple random sampling technique was used to select the study participants.
Data collection tools and procedures
Data were collected using pre-tested, self-administered questionnaires. The data collection tool used in this study was a modified version of the SRQ-20, designed to gather information on knowledge of mental distress, the prevalence of self-reported mental distress, and associated factors among university students. The study’s objective was explained to the participants during the data collection process. Participation in this study was voluntary, and the anonymity of each participant was assured. The students were approached for participation immediately after finishing their lecture sessions in their respective lecture/seminar rooms. The questionnaires were distributed to students to fill out by a trained research assistant. Students of the first to fourth year of study filled out closed and open-ended questionnaires. The English version of the questionnaire was used because English is a medium of teaching and learning in higher education institutions in Tanzania. A copy of the questionnaire is included as an Additional file 1.
Study variables
The main outcome variable was mental distress, which was self-reported by asking respondents, “Have you ever experienced any signs of mental distress during your university life?” Students could respond with either “a. yes” or “b. no.” Those who responded “yes” were categorized as cases, while those who responded “no” were regarded as non-cases. Another variable was awareness of mental distress, measured by asking respondents to identify signs of mental distress from a list, which included feeling anxious or worried, feeling depressed, emotional outbursts, sleep problems, weight or appetite changes, isolating or withdrawing, substance abuse, feeling guilty or worthless, changes in behavior or feelings, thoughts of ending life, and feeding disorders. Other variables included demographic characteristics (age, sex, marital status, place of residence, year of study), financial characteristics (employment status, source of study expenses, parents/guardians/family’s main source of income), and habits (alcohol consumption).
Ethical consideration
The Institutional Review Board of the University of Dodoma approved the study, and a permit with reference number MA.84/261/70/32 was obtained. Written informed consent was sought from each study participant. Anonymity was applied to assure confidentiality throughout the study. The study was conducted according to the Declaration of Helsinki [21] and its later amendments.
Data analysis
Data were analyzed using STATA version 18. We started by summarizing categorical variables using frequencies and percentages. The mean age of participants was summarized using the mean and standard deviation. Each independent variable was subjected to bivariate analysis to assess its association with mental distress. All variables with a p-value < 0.25 were entered into the multivariable model to identify the independent factors associated with mental distress. Since our outcome was common (prevalence of mental distress = 51.8% > 10%), we used a modified Poisson regression with robust standard error to model factors associated with mental distress. Crude prevalence ratios (PRs) and adjusted prevalence ratios (aPRs) with their corresponding 95% confidence intervals are presented. A p-value of less than 5% was considered statistically significant.
Results
Socio-demographic characteristics of the study participants
Out of 250 approached participants, 224 students gave a complete response, representing a response rate of 89.6%. The median age of the respondents was 23 (IQR 21–24). Of the 224 respondents, more than half were male (126, 56.2%). Most were single (195, 87.1%) and not employed (197, 87.9%). The largest proportion of respondents (200, 89.3%) reported not drinking alcohol (Table 1).
Table 1.
Socio-demographic characteristics of the study participants (N = 224)
| Characteristic | Number | Percentage |
|---|---|---|
| Age (years) | ||
| Mean ± SD | 23 ± 2.3 | |
| Sex | ||
| Male | 126 | 56.2 |
| Female | 98 | 43.8 |
| Marital status | ||
| Single | 195 | 87.1 |
| Married | 29 | 12.9 |
| Home zone | ||
| Lake zone | 67 | 29.9 |
| Central zone | 37 | 16.5 |
| Western zone | 13 | 5.8 |
| Northern zone | 42 | 18.8 |
| Coastal zone and Zanzibar | 34 | 15.2 |
| Southern highlands zone | 31 | 13.8 |
| Field of study | ||
| Science/engineering/health | 130 | 58.0 |
| Social/humanities/education | 94 | 42.0 |
| Study year | ||
| 1 | 64 | 28.6 |
| 2 | 86 | 38.4 |
| 3 | 66 | 29.5 |
| 4 | 8 | 3.6 |
| Employment status | ||
| Not employed | 197 | 87.9 |
| Employed | 27 | 12.1 |
| Alcohol consumption | ||
| No | 200 | 89.3 |
| Yes | 24 | 10.7 |
| Financial source | ||
| Family/personal | 19 | 8.5 |
| Sponsor | 30 | 13.4 |
| Loan board/government | 175 | 78.1 |
| Family economic activity | ||
| Agriculture | 128 | 57.1 |
| Business | 69 | 30.8 |
| Formal employment | 27 | 12.1 |
Awareness of mental distress symptoms
Participants were asked if they knew the common symptoms of mental distress. The majority of participants were aware of the common symptoms of mental distress. About three-quarters, 167 (74.6%) were aware of feeling depressed/unhappy; 154 (68.8%) of feeling anxious/worried; and 152 (67.9%) were aware of the thought of ending life/suicide as among symptoms of mental distress. Also, awareness of emotional outbursts, 151 (67.4%); changes in behavior or feelings, 143 (63.8%); substance abuse, 141 (62.9%); and sleep problems, 138 (61.6%) were reported among the participants (Table 2).
Table 2.
Students’ awareness of mental distress symptoms (N = 224)
| Mental distress symptom | Number | Percentage |
|---|---|---|
| Feeling anxious or worried | 154 | 68.8 |
| Feeling depressed or unhappy | 167 | 74.6 |
| Emotional outbursts | 151 | 67.4 |
| Sleep problems | 138 | 61.6 |
| Weight or appetite changes | 117 | 52.2 |
| Isolating/quiet or withdrawn | 130 | 58.0 |
| Substance abuse e.g. drugs or alcohol | 141 | 62.9 |
| Feeling guilty or worthless | 127 | 56.7 |
| Changes in behavior or feelings | 143 | 63.8 |
| Thought of ending life (suicide) | 152 | 67.9 |
| Feeding disorder (overeating or undereating) | 116 | 51.8 |
Participants’ reported perceived factors contributing to mental distress
Participants of this study were inquired about their feelings about factors contributing to mental distress among students. About 117 (52.2%) and 118 (52.7%) strongly agreed that financial difficulties and sexual relationships contribute to mental distress, respectively. About 96 (42.9%), 71 (31.7%), 81 (36.2%), 81 (36.2%), 68 (30.4%), and 76 (33.9%) agreed that low exam grades, bullying, substance abuse, prolonged health conditions, childbearing, and uncertainty about finding a job after graduation are the factors contributing to mental distress among students, respectively (Table 3).
Table 3.
Students’ perceived factors contributing to mental distress (N = 224)
| Factor | Number | Percentage |
|---|---|---|
| Financial difficulties | 193 | 86.2 |
| Low grades | 139 | 62.1 |
| Learning environment | 85 | 37.9 |
| Sexual relationship | 177 | 79.0 |
| Bullying | 111 | 49.6 |
| Substance abuse (alcohol and drugs) | 146 | 65.2 |
| High class workload | 76 | 33.9 |
| Prolonged health conditions | 119 | 53.1 |
| Child bearing | 104 | 46.4 |
| Uncertainty about finding job after graduation | 122 | 54.5 |
Self-reported mental distress
Students were asked if they had experienced mental distress at any point during their study at the university. Students who reported having ever experienced mental distress were 116 (51.8%). Students who ever experienced mental distress mentioned financial problems, 34 (29.6%); sexual relationships, 31 (27.0%); childbearing, 17 (14.8%); low grades, 12 (10.4%); health issues, 17 (14.8%); and family issues, 4 (3.5%) as contributing factors to their mental distress (Fig. 1).
Fig. 1.
Reported mental distress factors among students who ever experienced mental distress during their study at the university
Factors associated with mental distress
Different factors associated with self-reported mental distress were identified among students. In bivariate regression analysis, the factors significantly associated with students’ mental distress were age (PR = 1.06, 95% CI 1.01–1.12, p = 0.03), being married (PR = 1.57, 95% CI 1.22–2.03, p ≤ 0.001), being in third or fourth year of study (PR = 1.47, 95% CI 1.10–1.96, p = 0.010), employed (PR = 1.52, 95% CI 1.17–1.98, p = 0.002), and consuming alcohol (PR = 1.74, 95% CI 1.38–2.19, p ≤ 0.001). In the multivariable regression model, only alcohol consumption was statistically significantly associated with mental distress (aPR = 1.61, 95% CI 1.22–2.11, p = 0.001). Mental distress was higher among married participants but only marginally significant (aPR = 1.35, 95% CI 0.96–1.90, p = 0.081) (Table 4).
Table 4.
Bivariate and multivariate regression analysis of factors associated with mental distress among undergraduate students (N = 224)
| Characteristic | Ever experienced mental distress (%) | Crude PR (95% CI) | p-value | aPR (95% CI) | p-value |
|---|---|---|---|---|---|
| Age (years) | N/A | 1.06 (1.01–1.12) | 0.03 | 1.00 (0.93–1.07) | 0.914 |
| Sex | |||||
| Male | 64 (50.79) | 1 | |||
| Female | 52 (53.06) | 1.04 (0.81–1.35) | 0.736 | – | – |
| Marital status | |||||
| Single | 94 (48.21) | 1 | 1 | ||
| Married | 22 (75.86) | 1.57 (1.22–2.03) | < 0.001 | 1.35 (0.96–1.90) | 0.081 |
| Field of study | |||||
| Social/humanities/education | 48 (51.06) | 1 | |||
| Science/engineering/health | 68 (52.31) | 1.02 (0.79–1.33) | 0.855 | – | – |
| Study year | |||||
| 1 | 30 (46.88) | 1.06 (0.74–1.51) | 0.743 | – | – |
| 2 | 38 (44.19) | 1 | |||
| 3 and 4 | 48 (64.86) | 1.47 (1.10–1.96) | 0.010 | – | – |
| Employment status | |||||
| Not employed | 96 (48.73) | 1 | 1 | ||
| Employed | 20 (74.07) | 1.52 (1.17–1.98) | 0.002 | 0.13 (0.75–1.71) | 0.543 |
| Alcohol consumption | |||||
| No | 96 (48.00) | 1 | 1 | ||
| Yes | 20 (83.33) | 1.74 (1.38–2.19) | < 0.001 | 1.61 (1.22–2.11) | 0.001 |
| Financial source | |||||
| Family/personal | 12 (63.16) | 1.29 (0.88–1.87) | 0.191 | 1.18 (0.77–1.79) | 0.451 |
| Loan board/government | 86 (49.14) | 1 | 1 | ||
| Sponsor | 18 (60.00) | 1.22 (0.88–1.70) | 0.235 | 0.92 (0.64–1.32) | 0.638 |
| Family economic activity | |||||
| Agriculture | 63 (49.22) | 0.89 (0.61–1.30) | 0.534 | – | – |
| Formal employment | 15 (55.56) | 1 | |||
| Business | 38 (55.07) | 0.99 (0.66–1.48) | 0.966 | – | – |
Discussion
The present study assessed knowledge, self-reported mental distress, and its associated factors among undergraduate students in Tanzania. Our findings showed that the undergraduate students who participated in the current study had relatively sufficient knowledge of mental distress. We revealed that the majority of our participants were aware and capable of pointing out the common symptoms of mental distress among students. The majority of participants pointed out that they agree or strongly agree that financial difficulties, sexual relationships, low exam grades, bullying, substance abuse, prolonged health conditions, childbearing, and uncertainty about finding a job after graduation are perceived factors of mental distress among students. This finding corroborates a previous study in Australia among higher education students that found over 70% of participants could correctly identify the symptoms of mental distress [22]. However, it should be noted that the relatively high level of knowledge about mental distress and it’s associated factors in our study population might not reflect the general mental distress knowledge of the Tanzanian population. After all, undergraduate students are considered among a few classes of elite groups in Tanzania and, therefore, expected to have heightened awareness regarding mental distress than the general population. Our findings contrast the studies from college students of the University of Nigeria [17], Turkiye [23], and Caribbean universities [24] in which a low level of knowledge about mental health issues was reported.
Participants of this study reported experiencing mental distress at some point during their academic pursuits at the university. About 52% reported to have experienced mental distress, and the associated factors were highlighted. It was unsurprising to find that more than half of the undergraduate students had experienced mental distress because they are continually exposed to multiple stressors arising from their academic pursuits and transition to adulthood [12]. Despite variations in mental distress study protocols, a comparable higher prevalence of mental distress was reported in Australia [25], Turkiye [23], and Syria [26]. Several other studies have reported a relatively lower prevalence of mental distress among undergraduate students. A study involving undergraduate students pursuing medicine and other health-related programs reported a prevalence of 14% in northern Tanzania [2]. Studies in Ethiopia show that mental distress among undergraduate students varies appreciably between universities. A higher prevalence was reported to be 63.1%, while a lower reported 21.6% [1]. The mental distress prevalence inconsistency between studies lies in the differences in the study design, socio-cultural factors, and learning environment infrastructures between universities/colleges, thus, warrant further investigations.
Alcohol consumption was determined to strongly predict mental distress among undergraduate students in this study. Students who drink alcohol are more likely to experience mental distress than those who do not. This finding is in line with other studies that reported substance abuse, such as alcohol and drugs, are associated factors of mental distress among students [7, 27]. Alcohol is legal in Tanzania and is usually used as a relaxant by university/college students and the general public. Students who drink alcohol are more likely to abscond from classes, have poor academic performance, and regularly fall in quarrels with their fellow students, which may result in mental distress. Thus, students should find an alternative way of relaxing, such as being involved in games and sports rather than drinking.
Our study is among a few mental distress studies among undergraduate students from Tanzania. However, it comes with a few limitations. The sample size was not large enough, hence, low statistical power. We used a self-reported to measure mental distress, which must be subjective to desirability and recall bias. Also, the study’s cross-sectional nature cannot establish the actual cause-and-effect relationship.
Conclusion
The current study has shown that undergraduate students at the University of Dodoma had adequate knowledge of mental distress symptoms and its associated factors. The findings reveal that a significant proportion of these students have experienced mental distress, indicating that undergraduate students are an at-risk population. Additionally, our study found that alcohol consumption is an independent factor for mental distress among these students. This suggests that interventions aimed at reducing alcohol consumption may help mitigate mental health issues within this population. Therefore, this study emphasizes the importance of conducting mental health awareness campaigns and screenings at Tanzanian universities and colleges to prevent mental health issues at an early stage and to guide those diagnosed with mental distress toward appropriate treatment.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements
This work was carried out as part of final year special project for undergraduate students. The authors are extremely grateful to Ndushi L. Machembe who assisted in data collection. A special appreciation to all undergraduate students who consented and filled out our questionnaire.
Abbreviations
- aPR
Adjusted prevalence ratio
- CI
Confidence interval
- IQR
Interquartile rage
- N/A
Not applicable
- PR
Prevalence ratio
- WHO
World health organization
Author contributions
RPM and JIM designed the study. JIM and RPM participated in data collection. LPR, CHM and JIM analyzed and interpreted the data. LPR, CHM, JIM and RPM drafted and reviewed the manuscript. All authors approved the final draft of the manuscript.
Funding
The authors received no specific funding for this study.
Data availability
The data generated and/or analyzed during the current study are available from the corresponding author on reasonable request.
Declarations
Ethics approval and consent to participate
The study protocol was approved by institution review board of the University of Dodoma. Informed consent was obtained from each study’s participant.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Supplementary Materials
Data Availability Statement
The data generated and/or analyzed during the current study are available from the corresponding author on reasonable request.