Problems and Factors that may be Associated with Mental Health Problems Leading University Students to Seek Assistance at the Counseling Clinic of the Primary Care Unit of Khon Kaen University

Abstract

Introduction:

Mental health problems frequently occur in university students. This study evaluated the prevalence of problems and individual factors that may be associated with mental health problems leading university students to seek assistance at the counseling clinic of the primary care unit.

Materials and Methods:

This was a cross-sectional descriptive study. We examined the database and medical records of 142 university students over 18 years old who visited the mental health counseling clinic during 2023. Participants’ characteristics and student problems were summarized using descriptive statistics. A logistic regression analysis calculated the crude and adjusted odds ratios.

Results:

Student counseling clinic visits are most often caused by stress (97.18%). Most of the reasons for the mental health problems were academic problems (82.39%). Female and not domiciled in the Northeast region were associated with relationship problems within the family (AOR = 4.050, 95% CI: 1.590–10.313 and AOR = 6.424, 95% CI: 1.179–34.994), having a boyfriend or girlfriend was associated with problems in romantic relationships (AOR = 12.215, 95% CI: 4.652–32.071), and residing in a university dormitory was associated with financial problems (AOR = 2.598, 95% CI: 1.051–6.425).

Conclusion:

Individual factor data may be used to identify the most frequent mental health problems, improving patient care in primary care settings.

INTRODUCTION

University students are transitioning from adolescence to young adulthood. This transition changes social interactions, friendships, and study habits. Additionally, they are not yet completely mature.[1] Previous studies have indicated that mental disorders and suicidality are common among university students.[2,3,4] Mental health problems among university students are leading to decreased academic performance.[5] Mental problems result in both immediate and enduring effects, influencing physical wellbeing and interpersonal relationships.[6,7] Mental health among university students is increasingly recognized as a major public health issue. The World Health Organization supports integrating specialized health care services, highlighting the need to combine mental health services with patient care in primary care units as a fundamental public health recommendation.[8] It is crucial to offer mental health care services on university.[9] However, there is a significant unmet need for the treatment of mental disorders among university students.[10]

University students encounter numerous challenges in their academic journey that can lead to mental health issues. Challenges include relationship problems within the family, friendship problems, academic problems, physical health concerns, adjustment problems, financial problems, and problems in romantic relationships.[7,11,12] Previous studies indicated that among the university student population, the prevalence rates of depression and stress disorders ranked as the highest, with a greater incidence observed in females compared to males.[13,14,15] A greater association of stress and anxiety was identified among university students in the health sciences field compared to those in other disciplines.[7]

Students at Khon Kaen University come from various provinces, especially in Northeast Thailand, which encounters significant socioeconomic challenges. Students come from various family backgrounds and social environments, which can lead to a higher risk of mental health problems. A clinic counseling service has been established within the primary care unit at Khon Kaen University. This service is free for students, ensuring easy and convenient access for all students. Additionally, the primary care unit also coordinates initiatives to prevent and quickly recognize mental health problems among university students. So, we were focused on examining the prevalence of problems and individual factors that may be associated with mental health problems leading university students to seek assistance at the counseling clinic of the primary care unit, to implement the findings in the care of students with mental health issues and to enhance prevention and awareness of mental health concerns among university students.

MATERIALS AND METHODS

Study design and participants

This study was a cross-sectional descriptive study. The inclusion criteria were derived from the database and medical records of all undergraduate university students who utilized the mental health counseling clinic between January 1 and December 31, 2023. The exclusion criteria included missing consultation details in the database or medical records. The data were gathered exclusively from students who utilized counseling services at the clinic for the first time in 2023. The study population comprised 142 university students.

Questionnaire

This research questionnaire was developed by examining theories, concepts, and studies related to mental health issues in university students, combined with expert opinions from a counseling clinic. Data were gathered from the clinic’s medical records, documented by family doctors and nurses. Records included demographic data, reasons for seeking counseling clinic, the reason for the mental health problems, and the post-counseling status.

Operational definitions

The symptoms causing students to visit the counseling clinic include stress, anxiety, feelings of depression, regret, insomnia, self-harm, low self-esteem, and palpitation.

The reason for the mental health problems includes academic problems, relationship problems within the family, friendship problems, problems in romantic relationships, financial problems, and physical health concerns.

Data collection

The researcher composed a letter to the director of Srinagarind Hospital and the head of the primary care unit at Khon Kaen University, requesting data collection from medical records of students using counseling clinic services at the primary care unit in 2023. The researcher recorded details from the patient’s medical records using a researcher-generated record form and verified the accuracy and completeness of the information upon finishing each medical record review.

Statistical analysis

Descriptive analysis

The participants’ characteristics and problems of students receiving services at the counseling clinic of the primary care unit were summarized through descriptive statistics. Continuous variables were analyzed using mean and standard deviations, while categorical variables were assessed through frequency and percentages. The Pearson Chi-square test is utilized to determine the relationship between variables.

Crude and multivariable analysis

To determine the association between the individual factors and the reason for the mental health problems, the crude odds ratios and 95% confidence intervals (95% CI) were computed by bivariate logistic regression. Multivariate logistic regression was conducted to calculate an adjusted odds ratio with the 95% CI. The effects of confounding variables were controlled for in multivariate analysis by selecting variables that were found to have a P value less than 0.2 in crude analysis and variables that were shown in previous reports to have an effect on mental health problems in university students.

All analyses used SPSS 28.0 software for Windows. All tests were two-sided, with a P value under 0.05 considered statistically significant.

RESULTS

1. Demographic Data

   This study gathered data from the database and medical records of 142 university students aged 18 to 25 years. Among these, 79.6% were female. The mean age was 20.82 years (SD 1.426). The majority of the participants (75.4%) did not have a boyfriend or girlfriend, were not in the health sciences faculty (81.7%), were from the northeastern region (90.1%), did not have chronic diseases (94.4%), and did not reside in a university dormitory (73.9%) [Table 1].

2. The mental health problems of the student

   Stress is the most common symptom causing students to visit the counseling clinic (n = 138; 97.18%), followed by anxiety (n = 116; 81.69%) and insomnia (n = 99; 69.72%) [Table 2]. Most of the reasons for the mental health problems were academic problems (n = 117; 82.39%), followed by relationship problems within the family (n = 90; 63.38%) and friendship problems (n = 69; 48.59%) [Table 3].

3. The association between individual factors and the reason for mental health problems

Table 1.

Demographic information of the participants

Demographic information	Amount n (%)
Gender
Male	29 (20.4)
Female	119 (79.6)
Have a boyfriend or girlfriend
No	107 (75.4)
Yes	35 (24.6)
Faculty: Health science
No	116 (81.7)
Yes	26 (18.3)
Domicile: Northeast region
No	13 (9.2)
Yes	129 (20.8)
Underlying disease
No	134 (94.4)
Yes	8 (5.6)
Reside in a university dormitory
No	105 (73.9)
Yes	37 (26.1)

Table 2.

Symptoms that caused students to visit the counseling clinic

The symptoms that caused students to visit the counseling clinic	Total (n=142) n (%)
Stress	138 (97.18)
Anxiety	116 (81.69)
Feelings of depression	88 (61.97)
Regret	70 (49.30)
Insomnia	99 (69.72)
Self-harm	19 (13.38)
Low self-esteem	35 (24.65)
Palpitation	10 (7.04)

Table 3.

Association between individual factors and the reason for mental health problems

Individual Factors	Adjusted odds ratio (95% CI)/P
	Academic problems	Relationship problems within the family	Friendship problems	Problems in romantic relationships	Financial problems	Physical health concerns
Gender: Female	1.560 (0.521–4.677)/0.427	4.050 (1.590–10.313)/0.003*	1.156 (0.486–2.753)/0.743	0.409 (0.154–1.086)/0.073	0.959 (0.338–2.727)/0.938	0.493 (0.113–2.147)/0.346
Have a boyfriend or girlfriend	0.654 (0.244–1.751)/0.398	2.513 (1.000–6.314)/0.050	0.685 (0.306–1.533)/0.358	12.215 (4.652–32.071)/<0.001*	1.248 (0.474–3.289)/0.654	0.833 (0.157–4.431)/0.830
Faculty: Health science	1.100 (0.316–3.822)/0.881	0.427 (0.159–1.151)/0.093	1.676 (0.675–4.162)/0.266	1.121 (0.390–3.219)/0.832	1.107 (0.375–3.270)/0.854	0.564 (0.063–5.078)/0.610
Not domiciled in the Northeast region	3.259 (0.377–28.156)/0.283	6.424 (1.179–34.994)/0.032*	1.496 (0.439–5.100)/0.520	1.050 (0.251–4.383)/0.947	1.453 (0.335–6.305)/0.618	2.198 (0.341–14.188)/0.408
Underlying disease	0.684 (0.118–3.945)/0.671	0.958 (0.181–5.062)/0.096	1.107 (0.251–4.882)/0.893	1.614 (0.304–8.566)/0.574	1.446 (0.242–8.649)/0.686	3.379 (0.474–24.079)/0.224
Reside in a university dormitory	2.326 (0.712–7.598)/0.162	1.175 (0.053–2.746)/0.710	0.772 (0.351–1.697)/0.519	0.963 (0.382–2.431)/0.937	2.598 (1.051–6.425)/0.039*	1.263 (0.277–5.761)/0.763
Total n (%)	117 (82.39)	90 (63.38)	69 (48.59)	52 (36.61)	29 (20.42)	10 (7.04)

*Results were considered significant at P<0.05. ^†After adjustment for gender, status, faculty, domicile, underlying dosease, and reside in dormitory of the students

Individual factors that may be associated with mental health problems include female and not domiciled in the Northeast region, which were associated with relationship problems within the family (AOR = 4.050, 95% CI: 1.590–10.313, P = 0.003 and AOR = 6.424, 95% CI: 1.179–34.994, P = 0.032), having a a boyfriend or girlfriend was associated with problems in romantic relationships (AOR = 12.215, 95% CI: 4.652–32.071, P ≤ 0.001), and residing in a university dormitory was associated with financial problems (AOR = 2.598, 95% CI: 1.051–6.425, P = 0.039) [Table 3].

DISCUSSION

This study collected data from the medical records of university students at Khon Kaen University who visited the counseling clinic at the Primary Care Unit in 2023. This period follows the end of the COVID-19 outbreak. This group of students has been significantly affected by the COVID-19 pandemic in their studies, family dynamics, and social interactions, especially during their final years of high school or early university years.

This study found that stress, anxiety, and insomnia are the primary reasons causing students to visit the counseling. This is consistent with other studies indicating that similar symptoms are common among university students.[14,15,16,17] University students are transitioning from adolescence to young adulthood. This transition involves significant changes in various aspects of their lives, including social interactions, friendships, and study habits. Furthermore, they have not reached full maturity yet.[1] University students face heightened stress and anxiety when adapting to change, which may result in insomnia linked to these emotional challenges.[17,18]

Most of the reasons for the mental health problems were academic problems, followed by relationship problems within the family and friendship problems. The trends in prevalence sequences are consistent with prior research conducted before the COVID-19 outbreak.[11] This study found a higher prevalence of reasons for mental health problems compared to previous studies, especially regarding academic problems. Challenges from the previous COVID-19 outbreak have created significant academic pressure for various reasons, especially due to online learning, which has affected academic performance and learning outcomes,[19] possibly influencing current educational difficulties. This study gathered data on university students for whom studying is the primary focus at this stage of their lives. Studying can lead to issues such as concerns about learning outcomes, exam-related stress, declining academic performance, and a lack of interest in the field, potentially resulting in mental health problems. Additionally, students with other mental health issues face a higher risk of poor academic performance.[5,20] This resulted in students in the age group who prioritize learning when academic difficulties occurred, which in turn caused even more mental health issues.[21] Family and friends significantly influence a university student’s life. Problems arising from family or friends can significantly impact mental health.[21,22]

Individual factors that may be associated with mental health problems include:

1. Female and not domiciled in the Northeast region were associated with relationship problems within the family: Previous studies have indicated that the prevalence rates of depression and stress disorders are notably higher among females than males.[13,14,15] This may be because females are generally more emotionally and mentally sensitive than males. Family relationship issues are a fundamental aspect of a student’s life. Mental health issues may be more prevalent among female students than male students. Not living in the Northeast has been linked to family relationship issues. Students may view their families as troubled, leading them to seek institutions away from home to escape familial issues, showing that communication failures in families can create issues similar to those stemming from unfamiliarity with parents.[23,24]

2. Having a boyfriend or girlfriend was associated with problems in romantic relationships. The previous study indicated that committed relationships may protect the mental health of university students.[25] However, depressive symptoms were associated with relationship conflict,[26] and romantic relationship breakup serves as a viable experimental model for examining symptoms of depression.[27] This study found that students seeking mental health counseling reported discussing relationship issues with their partners. Students with boyfriends or girlfriends face more challenges in romantic relationships than those without.

3. Residing in a university dormitory was associated with financial problems. This corresponds to prior research showing that financial difficulties significantly influence students’ choices to live in university accommodations as dormitory living is more cost-effective.[28] This study’s demographic data show that most students live in off-campus dormitories, which are pricier but provide more comfort. Students in university dormitories often face financial challenges, prompting them to seek ways to reduce living expenses.

Strengths and limitations of this study

This study collected data in a mental health counseling clinic at the largest university in Northeast Thailand. No expenses were incurred for any students attending the clinic, which provides primary care and convenient access, making this data representative of the general student population. We found that individual factors may be used as predictors of the most reason for mental health problems. However, this study had several limitations, including its retrospective design, which involved data collection from medical records. This approach may introduce bias and the presence of incomplete medical records, resulting in their exclusion from the study. Moreover, the absence of data on acute illness status may limit the generalizability of our findings. Since we gathered data and conducted sample recruitment to descriptively determine only the prevalence of problems and individual factors that may be associated with mental health problems leading university students to seek assistance at the counseling clinic of the primary care unit, the association derived from this study warrants careful interpretation due to the limited sample size. Future research should investigate the relationship between acute illness and psychiatric symptoms in this population, and a more prospective study focusing on each issue should be conducted for confirmation.

CONCLUSION

Stress is the most common symptom causing students to visit the counseling clinic. Most of the reasons for the mental health problems were academic problems. Individual factors that may be associated with mental health problems include female and not domiciled in the Northeast region, which were associated with relationship problems within the family, having a boyfriend or girlfriend, which was associated with problems in romantic relationships, and residing in a university dormitory, which was associated with financial problems. Data on individual factors may be utilized as indicator for the most common causes of mental health issues, facilitating improved patient care in primary care settings. By incorporating the information gathered from this study, it can serve as a guide for the promotion, prevention, and care of mental health in university students.

Ethical considerations

The Khon Kaen University Ethics Committee for Human Research granted approval for this research in accordance with the Declaration of Helsinki and the ICH Good Clinical Practice Guidelines (No. HE671109). This study used only retrospective data collecting from medical records, with no prospective data collection or contact for additional volunteer information. Consequently, the consent form for volunteers are exempted as this research utilizes pre-existing data. No additional data collection or direct engagement with volunteers occurred. A formal request for permission to utilize medical records was submitted by the director of Srinagarind Hospital.

Data availability statement

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Author contributions

TN and VL designed the research. The data was obtained by TN. TN, VL and PN conducted data analysis and interpretation. The manuscript was drafted by both TN and VL. All the authors have read and approved the final manuscript.

Conflicts of interest

There are no conflicts of interest to declare.

Funding Statement

Nil.