Patient satisfaction with mental health services in Ethiopia: a systematic review and meta-analysis

Abstract

Background

Satisfaction surveys in mental health services are crucial indicators of the quality of care given by the health institution and the clinical outcomes of people with mental disorders. The magnitude of patient satisfaction with mental health services was reported with various figures in different countries across the globe and in the regions of Ethiopia. The overall degree of satisfaction with mental health care in Ethiopia remained unknown. Therefore, by evaluating the degree of patient satisfaction and its determining factors with mental health services in Ethiopia, this systematic review and meta-analysis study closed the gap.

Methods

The findings of this review were reported following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guideline. Seven databases were searched. The quality of included studies was evaluated by using a modified version of the Newcastle-Ottawa Scale (NOS) for cross-sectional studies, and meta-analysis was done by STATA 17. The I² test was conducted to evaluate heterogeneity across the studies, and for the data identified as heterogeneous, a random-effects model was used during analysis. Egger’s test was also employed to assess possible publication bias.

Results

Among 531 screened studies, 10 studies with a total of 3627 patients were included in the final meta-analysis and revealed that the pooled national level of patient satisfaction with Mental health services was 65.97% [95% CI (58.57, 73.37%)]. Variables such as; living in rural are (OR = 1.92, 95%, CI: 1.40–2.44), lower educational status (OR = 2.04, 95%, CI: 1.34–2.74), living near to service providing institutions [1.93 (95% of CI;1.05,2.81)], regular availability of medications [1.61 (95% CI;1.07,2.15)] were positively and significantly associated with higher levels of patient satisfaction with mental health services in Ethiopia.

Conclusion

In Ethiopia, one-third of psychiatric patients were dissatisfied with the mental health services provided. This finding emphasizes the importance of addressing geographic, educational, and resource disparities to improve patient satisfaction and overall quality of mental health care across the country.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-025-13499-7.

Introduction

Approximately 970 million individuals worldwide suffered from a mental illness in 2019 [1]. The goals of contemporary mental health care include helping patients manage their daily lives and lead as fulfilling life as possible, in addition to assisting them in regulating their symptoms [2].

Psychiatry service users’ satisfaction is an established variable and quality indicator in mental health care. It evaluates how well services meet patients’ demands and forecasts the efficacy of treatment consequences like symptom relief and recovery. As healthcare models evolve towards a more patient-centered approach, satisfaction surveys play a pivotal role in ensuring the adaptability of mental health services to the diverse needs of patients. The World Health Organization’s (WHO) support of client-centered care as a human right is consistent with this [3].

In Ethiopia, quantifying patient satisfaction is a technique used to evaluate and enhance the quality of mental health services, which aligns with the country’s healthcare reforms [4]. Since the mental health sector does not raise enough money to sustain the system, making effective use of the resources available for service satisfaction can help bridge the gap [1]. In low-income nations, mental health services are often confronted with significant resource limitations, including a paucity of educated experts, inadequate financial resources, and inadequate facilities. Research on patient satisfaction identifies priority areas for resources, including staffing, accessibility, and drug availability [5, 6].

Because customers increasingly play a more active role in their healthcare, mental health facilities have had to ensure that their patients are happy with the care they receive and how they are treated as clients [7]. The general population is thought to be more satisfied with services than people with mental illness [8]. Patients who are satisfied with the results of interventions are more likely to adhere to their treatment programs and achieve better outcomes [4, 9, 10].

The level of patient satisfaction with mental health services was reported with different figures in several nations across the globe. It was 52.4% in Nigeria [11], 54.7% in Ghana [12], 70.6% in Oman [13], (69.3%) in Fiji [5], in India (57%) [14], in Israel (79.8%) [15], in Switzerland (93.1%) [16], in Ireland (90%) [17], and in England (85%) [18].

The prevalence of patient satisfaction with mental health services in Ethiopia varies widely, ranging from a low of 50.3% in Jimma, Oromia Region [19] to a high of 81.3% at Saint Paul’s Hospital in Addis Ababa [20]. Satisfaction with mental health care is highly correlated with patient trust, physician personal qualities, and communication, and is inversely related to lengthy waiting times [5]. The national mental health policy of Ethiopia aims to improve satisfaction by providing all Ethiopians with high-quality, culturally sensitive, evidence-based, equitable, and reasonably priced mental health care [21]. However, because mental health issues are not viewed as life-threatening, managers and medical professionals frequently neglect to pay them adequate attention [22].

Gaining insight into patient satisfaction levels and the characteristics of mental health services can contribute to the improvement of care quality, thereby supporting the achievement of the third Sustainable Development Goal (SDG), which focuses on reducing the burden of noncommunicable diseases and ensuring universal health coverage (Target 3.8). Thus, the purpose of this systematic review and meta-analysis is to compile currently available empirical data on patient satisfaction with psychiatric services in Ethiopia. While the study focuses on Ethiopia, the findings have broader implications for other low- and middle-income nations confronting comparable issues in mental health services delivery. Insights from this review can add to the global efforts to design more equitable and patient-centered mental health systems.

Methods

Search strategy

The findings of this systematic review and meta-analysis were reported following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) 2009 statement [23]. The major international databases such as PubMed, Web of Science, Scopus, Embase, CINHAL, PsycINFO, and google scholar were searched for all published studies, and a manual search via Google for unpublished studies was performed. Additionally, a search of the reference lists of already identified studies was conducted to retrieve additional articles. EndNote (version X8) reference management software for Windows was used to cite articles. All studies published before March 12, 2025, and unpublished studies were retrieved to assess eligibility for inclusion in this review and for critical appraisal. The PECO (Population, Exposure, Comparison, and Outcomes) search was used in this review (Supplementary Table 1).

Records were explored with keyword searching and using the medical subject heading [MeSH] terms for each selected PECO component. A complete search was made using the subsequent search terms: “Patient satisfaction”, “satisfaction”, “determinants of patient satisfaction”, “Psychiatric service”, and “Ethiopia”. Boolean operators like “AND” and “OR” were used to combine search terms (Supplementary file 2).

Eligibility criteria

Two reviewers (HA and AG) evaluated the relevant articles using their titles and abstracts prior to the retrieval of full-text articles. The retrieved full-text articles were further screened according to pre-specified inclusion and exclusion criteria. The authors resolved disagreements by discussing with a third reviewer (YDM).

Cross-sectional and other observational studies that address patient satisfaction with psychiatric service, OR/AND factors associated with patient satisfaction with psychiatric service, or the determinants of patient satisfaction with psychiatric care in Ethiopia were included. All studies published or unpublished in the English language before March 12 /2025, regardless of their study or publication year, were included.

Studies were included irrespective of the type of satisfaction measurement instrument, the dimension of satisfaction assessed, and scoring system used to generate the overall score of satisfaction, and the patient’s demographic characteristics. Satisfaction assessment studies other than psychiatric patients, conference abstracts, and duplicated articles were excluded from the review.

Quality assessment

The quality and eligibility of the identified articles were also assessed by three and disagreements among reviewers were fixed accordingly with discussion. The quality of incorporated studies was assessed through a modified version of the Newcastle-Ottawa Scale (NOS) [24].

Data extraction

After the search was performed, data were extracted using a pre-piloted data extraction format arranged in a Microsoft Excel spreadsheet. It included the name of the author, year of publication, region/health institution, study design, sample size, number of people with outcome, and overall prevalence.

Statistical analysis

Comprehensive meta-analysis STATA™ software version 17 for meta-analysis was used, and the overall pooled level of satisfaction was estimated. Cochrane’s Q and I² tests were conducted to evaluate the heterogeneity across the studies [25]. According to Higgins et al. I² < 49%, 50–75, and > 75% denote low, moderate, and high levels of heterogeneity, respectively [26]. For the data identified as heterogeneous, a random-effects model was used during analysis, and in particular, the Hartung-Knapp method was applied for substantially heterogeneous data [27]. Visual assessment of publication bias was conducted using a funnel plot. Asymmetry of the funnel plot is an indicator of publication bias [28]. Egger’s test was also done to assess possible publication bias [29]. A P-value of less than 0.05 was applied to affirm the statistical significance of publication bias. Subgroup analyses were conducted by the sample size, year of publication, and numbers of included primary studies. To estimate the pooled prevalence and identify the determinants of satisfaction, Der Simonian-Laird random-effect model was used, and forest plots were employed to show combined estimates with 95% Confidence Interval (CI).

Results

Study identification

A total of 531 articles were found, 530 published and 1 unpublished among them. From those, 227 duplicated records were removed, and 274 articles were excluded through screening of the titles and abstracts. After that, a total of 30 full-text papers were evaluated for eligibility by considering the inclusion and exclusion criteria. Lastly, 10 studies were involved in the final quantitative meta-analysis (Fig. 1).

Fig. 1.

PRISMA flow chart of a systematic review and meta-analysis study on patient satisfaction and determinant factors with mental health services in Ethiopia

Characteristics of the included studies

The study was done on 3627 people with mental illness, with a maximum sample size of 589, a study done in Saint Paul hospital, Addis Abeba [20], and a minimum of 250, a study done in the University of Gondar Specialized Hospital, Gondar [30]. Among the total of 10 studies included in our analysis, four were done in Amhara [4, 30–32], three in Addis Ababa [20, 33, 34], and the other three studies were conducted in Oromia [19], Southern Ethiopia [35], and the Tigray region [36]. All studies used a cross-sectional study design, and the publication year of those studies ranged from 2016 [31] to 2023 [4] (Table 1). Regarding the instrument used, 4 studies used the Mental Health Service Satisfaction Scale (MHSSS) [4, 19, 33, 35], 2 studies used the client satisfaction questionnaire (CSQ-8) [20, 36], 2 studies used the Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS) [31, 34] and 1 study used a standardized satisfaction measurement tool developed for low-income countries [30] to assess patient satisfaction with psychiatric service in Ethiopia (Table 1).

Table 1.

Study characteristics included in a systematic review and meta-analysis study on patient satisfaction and determinant factors with mental health services in Ethiopia

S. No	Author/s [reference]	Publication year	Study area, region	Health facility name	Study design	Instrument	Sample size	Proportion of satisfied patients (%)	NOS score
1.	(Yimer et al., 2016)	2016	Dessie, Amhara	Dessie Referral Hospital	Cross-sectional	Charleston Psychiatric Outpatient Satisfaction Scale	441	61.2	8
2.	(Desta et al., 2018)	2018	Mekelle, Tigray	Ayder referral hospital and Mekelle hospital	Cross-sectional	Client satisfaction questionnaire (CSQ-8)	415	72	8
3.	(Kassaw et al., 2020)	2020	Jima, Oromia	Jimma University Medical Center	Cross-sectional	Mental Health Service Satisfaction Scale	414	50.3	9
4.	(Kassaw et al., 2022)	2022	Dilla, SNNPE	Dilla university referral hospital	Cross-sectional	mental health satisfaction scale (MHSSS)	409	55.4	9
5.	(Goben et al., 2020)	2019	Addis Ababa	Saint Paulo’s hospital	Cross-sectional	Client Satisfaction Questionnaire (CSQ-8)	589	81.3	8
6.	(Kibrom et al., 2022)	2022	Addis Ababa	Amanuel Mental Specialized Hospital	Cross-sectional	Mental health service satisfaction scale (MHSSS)	420	63.3	8
7.	(Zienawi et al., 2019)	2019	Addis Ababa	Health centers in Addis Ababa	Cross sectional	Charleston Psychiatric outpatient Satisfaction Scale (CPOSS)	287	57	7
8.	(Melkam and Kassew, 2023)	2023	Gondar, Amhara	University of Gondar Specialized Hospital	Cross sectional	Mental Healthcare Services Satisfaction Scale	402	65.46	8
9.	(Woldekidan et al., 2019)	2019	Gondar, Amhara	University of Gondar Specialized Hospital	Cross sectional	a standardized satisfaction measurement tool developed for low-income countries	250	77.6	4
10.	(Alemu et al., 2025)	2025	Gondar, Amhara	University of Gondar Specialized Hospital	Cross sectional	Client Satisfaction Questionnaire (CSQ-8)	636	75.3	8

Quality of included studies

The procedural quality of the encompassed primary studies ranged from 4 to 9. The revised NOS for cross-sectional studies ranged between 0 and 10 points, and the study is declared to have good quality if the global score fell within 7 to 9 points (≥ 4 points in selection, 1 point in comparability, ≥ 2 points in outcome/exposure) [24] (Supplementary Table 3).

Patient satisfaction with psychiatric services

The pooled odds ratio of patient satisfaction with psychiatric service through the fixed effect model revealed substantial heterogeneity across the studies. Therefore, we performed the analysis with a random effects model with 95% CI to adjust for the observed variability. Accordingly, the pooled national level of patient satisfaction with psychiatric service was 65.97% (95% CI (58.57, 73.37%) with significant heterogeneity between studies (I2 = 95.69, P = 0.001) (Fig. 2).

Fig. 2.

Forest plot showing the pooled level of patient satisfaction with Mental health services in Ethiopia

Subgroup analysis of the level of psychiatric services satisfaction

For our subgroup analysis based on the region where the studies were conducted, representative data were identified for Amhara and Addis Ababa. Insufficient data were available for subgroup analysis for the Tigray, Oromia, and South Ethiopia Regional State (SERS) of the studies that were included. Patient satisfaction with psychiatric services was estimated to be 67.33%; 95% CI [51.95,82.71], I² = 97.28%, P-value = 0.001 in Addis Ababa and 69.90%; 95% CI [62.39,77.42], I² = 91.60%, P-value = 0.001 in Amhara (Fig. 3).

Fig. 3.

Forest plot showing the pooled patient satisfaction with Mental health services with subgroup analysis by region in Ethiopia

Based on years of publication, five studies were published from 2016 to 2020 [20, 30, 31, 34, 36] and the pooled magnitude of patient satisfaction was 69.93%; 95% CI [56.99,82.88], I2 = 95.33%, P-value = 0.001 whereas the other five studies were published after 2020 [4, 19, 32, 33, 35] and the pooled prevalence of patient satisfaction was 62.03%; 95% CI [50.04,74.03], I2 = 95.42%, P-value = 0.001 (Fig. 4).

Fig. 4.

Forest plot showing of the pooled patient satisfaction with Mental health services with subgroup analysis by years of publication in Ethiopia

Based on the numbers of sample size, four studies included less than 410 participants [4, 30, 34, 35] and the pooled magnitude of patient satisfaction was 63.88%; 95% CI [47.72,80.04], I² = 93.33%, P-value = 0.001 whereas six studies included more than 410 participants [19, 20]31– [33, 36] and the pooled prevalence of patient satisfaction was 67.33%; 95% CI [55.61, 79.06], I² = 96.59%, P-value = 0.001 (Fig. 5).

Fig. 5.

Forest plot showing the pooled patient satisfaction with Mental health services with subgroup analysis by sample size in Ethiopia

Based on instruments used to assess psychiatric patients’ satisfaction, four studies used Mental Health Service Satisfaction Scale (MHSSS) resulted with a satisfaction prevalence of 58.64 [95% CI;47.46,69.83, I² = 88.20%] [4, 19, 33, 35], two studies used Charleston Psychiatric Outpatient Satisfaction Scale (CPOSS) [31, 34] and the other three used client satisfaction questionnaire (CSQ-8) [20, 32, 36] reported that the prevalence of psychiatric patient satisfaction was 59.48 [95% CI;33.22,85.73, I² = 21.06%, P = 026] and 76.35% [95% CI: 64.65,88.04, I² = 84.96%, P = 001] respectively (Fig. 6).

Fig. 6.

Forest plot showing the pooled patient satisfaction with Mental health services with subgroup analysis by type of measuring instruments in Ethiopia

Publication bias

Egger’s test was used to objectively analyze publication bias, while the funnel plot was used to visualize it. The funnel plot appeared asymmetrical, but Egger’s regression tests (B= -16.51, SE = 7.17, P = 0.050) found no indication of substantial publication bias (Fig. 7).

Fig. 7.

Funnel plot showing publication bias

Sensitivity analyses

The sensitivity analysis was performed using the Galbraith plot (Fig. 8). Sensitivity tests using a random effects model revealed that no single study had a significant impact on Ethiopia’s overall prevalence estimate of patient satisfaction with psychiatric care (Fig. 9).

Fig. 8.

Galbraith plot showing the effect of individual studies on the pooled patient satisfaction rate

Fig. 9.

Sensitivity analysis test showing the effect of individual studies on the pooled patient satisfaction rate

Factors associated with patient satisfaction with psychiatric services

Association between sex and patient satisfaction with psychiatric services

To identify the association between sex and patient satisfaction with psychiatric services, four studies were included [20, 31, 33, 34]. The remaining six studies didn’t address this association [4, 19, 30, 32, 35, 36]. The included studies showed that sex was significantly associated with patient satisfaction. However, the pooled estimate of meta-analysis showed that sex was not significantly associated with patient satisfaction with psychiatric services in Ethiopia. There was high heterogeneity among the included studies, so that the random effect model was computed (I² = 80.01%, p = 0.03) (Fig. 10).

Fig. 10.

A forest plot showing an association between sex and patient satisfaction with psychiatric services

Association between residency and patient satisfaction

The association between residency and patient satisfaction was examined through the inclusion of four studies. The remaining six studies didn’t address this association [4, 19, 20, 30, 35, 36]. The included studies showed that living in rural areas was significantly associated with patient satisfaction with psychiatric services [20, 32, 33, 36].

Patients who came from rural areas were 2,37 times more likely to be satisfied with psychiatric services as compared to Urban dwellers (OR = 1.92, 95% CI: 1.40–2.44). Fixed effect model was computed, hence there is no heterogeneity among included studies (I² = 00.0%, p = 0.67) (Fig. 11).

Fig. 11.

A forest plot showing an association between residency and patient satisfaction with psychiatric services

Association between educational status and patient satisfaction

To examine the association between educational status and patient satisfaction, three studies were included [31, 33, 34] and they reported that it was significantly associated with the outcome. The remaining seven studies didn’t address this association [4, 19, 20, 30, 32, 35, 36]. The pooled result showed that patients with lower educational status were 2.04 times more likely to be satisfied compared to participants with higher educational status (OR = 2.04, 95% CI: 1.34–3.74). Fixed effect model was computed, hence there is no heterogeneity among included studies (I² = 00.0%, p = 0.000) (Fig. 12).

Fig. 12.

A forest plot showing an association between educational status and patient satisfaction with psychiatric services

Variables such as: type of diagnosis [31, 36], social support [4, 31], medication availability [4, 20], and distance from the health institutions [33, 34] were reported as significant determinants of patient satisfaction with psychiatric services. Patients who came from nearby places had 1.93 times higher satisfaction compared with those who were far from the health institutions [1.93 (95% CI;1.05,2.81)], and compared to their counterparts, patients who had access to medication were 1.61 times more likely to be satisfied. [1.61 (95% CI;1.07,2.15)]. Social support and type of psychiatric disorder were significantly associated with psychiatric patient satisfaction in the included primary studies; however, the pooled odds ratio showed that they were not statistically significant (Fig. 13).

Fig. 13.

A forest plot showing an association between different independent variables and patient satisfaction with psychiatric services

Discussion

The purpose of this meta-analysis was to estimate the national level of patient satisfaction with psychiatric services and find characteristics associated with it using published and unpublished studies. According to the findings of this meta-analysis, the pooled level of patient satisfaction with psychiatric services in Ethiopia was 65.97% (95% CI:58.57, 73.37%). This finding was consistent with a study conducted in Oman (70.6%) [13] and in Fiji (69.3%) [5]. Whereas it was higher than the studies done in Nigeria (52.4%) [11] and India (57%) [14]. The possible reasons could be differences in study settings, measurements, and study population.

On the other hand, the pooled prevalence of this meta-analysis was lower than the studies conducted in Nigeria (90.5%) [37], Israel (79.8%) [15], Switzerland (93.1%) [16], Ireland (90%) [17], and England (85%) [18]. The possible justification might be that, in Ethiopia, mental health services may not be adequately integrated into the overall healthcare system, resulting in fragmented care. This can lead to individuals believing that their mental health requirements are not being met. Furthermore, in low-income countries such as Ethiopia, the availability of important pharmaceuticals might be irregular, causing patients’ treatment to be interrupted. In addition to medicine, patients may lack access to a variety of psychotherapy choices that are accessible in higher-income countries, reducing comprehensiveness and satisfaction with care [38].

Compared to those who lived in cities, patients from rural areas expressed greater satisfaction with mental health services. The possible justification could be that patients in remote areas may have fewer healthcare options, leading to lower expectations. As a result, any form of mental health support, no matter how limited, could be considered useful.

In Ethiopia, those with lower educational levels were more satisfied than those with higher education levels. Individuals with less education may not be as knowledgeable about mental health issues and therapies, and as a result, they may not know what constitutes high-quality mental health care. Because individuals might not see any holes or flaws in the services they receive, this ignorance may result in greater satisfaction. Higher educated people, on the other hand, might be more aware of the possible shortcomings of the mental health services that are offered, which could result in higher levels of dissatisfaction. This finding was supported by different studies conducted in China [39] and another cross-country study [40].

The satisfaction rate was greater for people with mental illness who lived close to mental health service providers’ facilities than for those who lived far away. This could be due to the reason that easy access to care without the hassle of lengthy travel could greatly lower stress and boost satisfaction for patients with mental illness, particularly those with severe symptoms. Long trips to care facilities could be emotionally and physically exhausting, which could cause dissatisfaction.

According to our research, this is the first meta-analysis study to assess patient satisfaction and its determining factors with mental health services in Ethiopia. Thus, it will have a variety of clinical implications, such as identifying the elements that have the greatest impact on patient satisfaction, which will assist mental health professionals in better understanding patient requirements and preferences. The findings can also help policymakers understand the precise gaps or impediments that impact mental health care in Ethiopia. Understanding these characteristics may result in changes to healthcare policy, budget allocation, and training programs, ensuring that services are more responsive to patient requirements and improving overall mental health service quality.

Limitations of the study

This meta-analysis study provides a pooled estimate of patient satisfaction, which was assessed using a variety of screening instruments and may not properly reflect the genuine rate of satisfaction with mental health care. The limitations of the included primary studies may have an impact on our assessment, and we encourage readers to analyze and apply the findings, considering these limitations.

Conclusions and recommendations

This systematic review and meta-analysis highlight that approximately one in three patients in Ethiopia is dissatisfied with mental health services. Key determinants of satisfaction include place of residence, level of education, proximity to mental health facilities, and the consistent availability of psychotropic medications. These findings suggest that improving geographic accessibility and ensuring a reliable supply of essential medications are critical steps toward increasing patient satisfaction and improving the overall quality of mental health care in Ethiopia. The Ministry of Health and regional health bureaus should monitor the availability of psychotropic drugs. Researchers should also perform qualitative studies to investigate the barriers to patient satisfaction with mental health services, as well as standardize measurement tools for assessing satisfaction with mental health services. To give psychiatric patients comprehensive care, mental health services should be integrated with other types of care. This could improve outcomes and raise patient satisfaction.

Supplementary Information

Below is the link to the electronic supplementary material.

Abbreviations

CI

Confidence Interval

CPOSS

Charleston Psychiatric Outpatient Satisfaction Scale

CSQ

Client satisfaction questionnaires

MHSSS

Mental Health Service Satisfaction Scale

NOS

Newcastle-Ottawa Scale

OR

Odds Ratio

PRISMA

Preferred Reporting Items for Systematic Reviews and Meta-Analyses

SERS

South Ethiopia Regional State

SD

Sustainable Development Goal

WHO

World Health Organization

Author contributions

Haile Amha, Yilkal Dagnaw Melesse, Getnet Gedif, Aysheshim Asnake Abneh, Atsede Alle Ewunetie, Abebaw Abeje Muluneh, Anteneh Lamesgen, Asmamaw Getnet involved in Conceptualization, searching databases, analysis, writing the original draft and revision. All authors approved the final manuscript.

Funding

This research didn’t get funds from any governmental or non-governmental organizations.

Data availability

All the data are available from the corresponding author via email (haileleul19@gmail.com) on reasonable request.

Declarations

Ethics approval and consent to participate

In this study, ethical consent or ethical ascent was not taken since it incorporates the reports of primary studies.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.