Abstract
Background
Mental disorders often begin during adolescence or young adulthood, with 75% of cases developing between the ages of 17 and 24. This age range coincides with the period when many individuals pursue higher education. Assessing mental health literacy among this population is critical as it influences the utilization of evidence-based mental health care. This study assessed mental health literacy among non-medical undergraduate students of Makerere University.
Methods
A cross-sectional study was conducted on a random sample of 365 non-medical students of Makerere University using a semi-structured questionnaire adapted from mental health literacy scale. Descriptive statistics and ordinal logistic regression were used to analyze the data. Bloom’s cutoffs were used to categorize the literacy levels.
Results
The majority of the respondents, 282 (77.3%) had moderate knowledge of mental health. Only 138 (37.8%) had positive perceptions on mental health and few, 50 (13.7%) had positive attitudes towards people with mental health disorders. The overall mental health literacy was high in only 45 (12.3%) of the students and was significantly associated with being female (aOR = 0.422, P = 0.014) and having a history of a mental disorder (aOR = 2.485, P = 0.012).
Conclusion
This study revealed that most non-medical students demonstrated moderate knowledge, with relatively few achieving high levels of mental health literacy and positive perceptions and attitudes towards people with mental health disorders. There is a need to introduce mental health course units to every academic program at the university to improve mental health literacy.
Keywords: Mental health, Mental health literacy, Attitudes, Perceptions, Knowledge, Mental disorder, Students, University
Introduction
The World Health Organization (WHO) defines mental health as “a condition of mental well-being that enables people to cope with life’s challenges, realize their strengths, study effectively, work well, and contribute to their community” [1]. Mental disorders are clinically significant disturbances in one’s cognition, emotional regulation, or behavior that manifest as abnormal thoughts, feelings, behaviors, and social interactions [2]. Approximately 1 in every 8 people globally were living with a mental disorder in 2019 [3]. It is estimated that 2.2 million individuals in Uganda suffer from mental health issues, and only 9% of these individuals have access to mental health services [4].
Globally, mental health literacy among young adults remains suboptimal, particularly in low- and middle-income countries, highlighting the need for targeted interventions [5]. Mental disorders often begin during adolescence or young adulthood, with 75% of cases developing between the ages of 17 and 24 [6]. This age range coincides with the period when many individuals pursue higher education. For students, mental health challenges may be exacerbated by stress related to academic pressure, social relationships, and family expectations [6]. Non-medical university students often have limited exposure to formal mental health education, which may contribute to poor recognition of symptoms, stigma, and delayed help-seeking [7]. Mental health services have been recognized to be effective at dealing with this stress but remain underutilized [8]. The underutilization of mental health services has been attributed to poor levels of mental health literacy [9].
Mental health literacy refers to knowledge and beliefs about mental disorders which aid their recognition, management, or prevention [10]. Raising mental health literacy eases the acceptance of evidence-based mental health care [10]. While mental health literacy among medical students has been studied in Uganda [11], non-medical students, who make up the majority of the students, remain under-examined. This study evaluated the mental health literacy of non-medical undergraduates with the aim of informing targeted interventions and strategies to improve mental health literacy among non-medical students in Makerere University and other similar settings.
Methods
Study design
A cross-sectional survey was conducted among non-medical undergraduate students of Makerere University Main Campus. The main campus of Makerere University, the oldest public university in Uganda consists of nine colleges and two schools. Most of the undergraduate students are accommodated in the nine halls of residence, six male and three female halls and private hostels located near the university.
Study population
The study population included non-medical undergraduate students of Makerere University. The university has a student population of 27,092 with 21,632 being undergraduates [12].
Sample size
Using the Kish Leslie formula; n = Z²P(1 − P) / d² [13], with a P = 0.4929 prevalence of students who had positive attitudes towards people with MHD [11], Z at 95% interval corresponding to 1.96, and d=absolute error at 5%, a sample size of 385 participants was obtained. To account for potential non-response and incomplete questionnaires, an additional five participants were approached to total to 390. However, 365 complete responses were obtained and included in the final analysis, representing a response rate of 94.8%. Stratified random sampling was used to select the participants. From the nine halls of residence, a female hall and two male halls were randomly selected while a private hostel from each of the three locations around the university (Kikumi-kikumi, Katanga and Kikoni) were randomly selected using a paper picking method.
Sampling technique
Within each residence, 65 participants were recruited by randomly selecting floors and rooms where the participants resided. A single eligible occupant in any given room was considered for participation. In cases of multiple eligible occupants in a room, multistage sampling technique was employed, incorporating stratified sampling followed by simple random sampling using the ballot method.
Data collection
Data were collected using a self-administered semi-structured questionnaire adapted from the Mental Health Literacy Scale (MHLS) developed by O’Connor and Casey (2015) [14]. The MHLS is a validated instrument designed to assess mental health literacy across domains such as knowledge, attitudes, and perceptions. The questionnaire was adapted to suit the local context and study objectives.
Knowledge of students about mental health was measured based on 18 binary yes/no questions adapted from the Mental Health Literacy Scale (MHLS) [15, 16], with a score of 1 for each correct answer and 0 for each wrong answer. Bloom’s cut-off points (Bloom, 1956) were used to grade knowledge as good for a score of 80 to 100%, moderate for a score of 60 to 79%, and poor for less than 60% score.
Attitudes of students towards people with mental disorders were measured based on four Likert scale questions adapted from the MHLS with the lowest score being 4 and the highest 20. A percentage score was calculated and the overall attitude was categorized using Bloom’s cut-off point as positive for scores 80 to 100%, neutral for scores 60 to 79%, and negative for scores less than 60%.
Perceptions of students about mental health was measured based on nine Likert scale questions adapted from the MHLS, with the lowest score as 9 and the highest 45. The percentage score was calculated and Bloom’s cut-off point was used to categorize perceptions as positive for a score of 80 to 100%, neutral for a score of 60 to 79%, and negative for scores below 60%.
Mental Health Literacy domain scores were summed to obtain an overall mental health literacy score for each participant. The total possible score ranged from a minimum [13] to a maximum value (83) determined by the number of items included. Scores were converted into percentages to facilitate interpretation. Bloom’s cut-off points was used to grade literacy as high if the score was 80 to 100%, moderate for 60 to 79% score, and low for a score less than 60%.
Data analysis
The collected questionnaires were checked for completeness and accuracy before data entry. Data were entered, edited, backed up, and stored using Microsoft Excel and SPSS version 25. Descriptive statistics were generated using SPSS version 25 and summarized as frequencies and percentages for categorical variables and as means and standard deviation for numerical variables. Continuous variables such as age were analyzed using mean and standard deviation. Although age was categorized for presentation, calculations were based on raw continuous data. The associations between socio-demographic characteristics and knowledge, attitudes, perceptions, and literacy levels of mental health were determined using ordinal logistic regression analysis. Factors with p-values < 0.2 in bivariate analysis were included in multivariate analysis. A factor was determined to be associated if it had a p-value < 0.05 at 95% confidence interval.
Results
Socio-demographic characteristics
A total of 365 students out of 385 participated in the study giving a response rate of 94.8%. The average age of the respondents was 22.26 years (22.26 ± 1.634), with the age range of 17–29 years. There were almost as many male participants 184 (50.4%) as female participants 181 (49.6%) participants. The largest proportion of the respondents were in their second year of study 138 (37.8%) and reported no history of a mental health disorder 300 (82.2%). The most reported sources of information about mental health were the internet 254 (69.6%) and friends 156 (42.7%). (Table 1)
Table 1.
Socio-demographic characteristics of respondents
| Variable | Frequency (n = 365) | Percentage | Mean (SD) | |
|---|---|---|---|---|
| Age (years) | 20–24 | 343 | 94.0 | |
| 25–29 | 15 | 4.1 | ||
| Less than 20 | 7 | 1.9 | ||
| Average | 22.26 (1.634) | |||
| Sex | Male | 184 | 50.4 | |
| Female | 181 | 49.6 | ||
| Academic Year of study | Year 1 | 64 | 17.5 | |
| Year 2 | 138 | 37.8 | ||
| Year 3 | 109 | 29.9 | ||
| Year 4 | 52 | 14.2 | ||
| Year 5 | 2 | 0.5 | ||
| History of Mental disorder | Yes | 65 | 17.8 | |
| No | 300 | 82.2 | ||
| Source of mental health information | Internet | 254 | 69.6 | |
| Friends | 156 | 42.7 | ||
| Family | 91 | 24.9 | ||
| Professionals | 106 | 29.0 | ||
| Books | 99 | 27.1 |
Knowledge, perceptions and attitudes about mental health
The majority of respondents 282 (77.3%) had moderate knowledge and fewer, 26 (7.1%) had good knowledge of mental health. Most of the participants were either neutral 183 (50.1%) or had positive perceptions, 138 (37.8%) of mental health. Majority of respondents had negative attitudes towards people with mental health disorders 198 (54.2%) and only 50 (13.7%) had positive attitudes. (Table 2)
Table 2.
Knowledge, perceptions and attitudes about mental health
| Variable | Frequency (n = 365) | Percentage | Mean (SD) | |
|---|---|---|---|---|
| Knowledge | Good (≥ 80%) | 26 | 7.1 | |
| Moderate (60–79%) | 282 | 77.3 | ||
| Poor (< 60%) | 57 | 15.6 | ||
| Average | 67.8 (9.6) | |||
| Perceptions | Positive (≥ 80%) | 138 | 37.8 | |
| Neutral (60–79%) | 183 | 50.1 | ||
| Negative (< 60%) | 44 | 12.1 | ||
| Average | 74.1 (12.96) | |||
| Attitudes | Positive (≥ 80%) | 50 | 13.7 | |
| Neutral (60–79%) | 117 | 32.1 | ||
| Negative (< 60%) | 198 | 54.2 | ||
| Average | 63.8 (12.8) |
Majority (70.1%) of the respondents had good knowledge about the management and prevention of mental health conditions as well as their effects and symptoms (72.6%). However, 71.2% had poor knowledge about the causes and risk factors of mental illness. (Fig. 1)
Fig. 1.
Knowledge of Causes, Risk factors, Prevention, Management, Symptoms and Effects of mental health conditions
In response to questions on perceptions about mental health, majority of the respondents strongly disagreed with the notion of avoiding people with a mental disorder 193 (52.9%) and that seeing a mental health professional meant that one is not strong enough to manage their own difficulties 185 (50.7%). Most of them disagreed with the notion of not seeking help from a mental health professional if they had a mental health disorder 183 (50.1%) and that of ineffectiveness of treatment for mental disorders 143 (39.2%). (Table 3)
Table 3.
Participants’ responses to questions on perceptions about mental health
| Variable | Frequency (Percentage) | ||||
|---|---|---|---|---|---|
| Strongly Disagree | Disagree | Neutral | Agree | Strongly agree | |
| People with a mental disorder could snap out if they wanted | 75 (20.5) | 77 (21.1) | 52 (14.2) | 110 (30.1) | 48 (13.2) |
| A mental disorder is a sign of personal weakness | 123 (33.7) | 118 (32.3) | 38 (10.4) | 58 (15.9) | 26 (7.1) |
| A mental disorder is not a real medical illness | 130 (35.6) | 95 (26.0) | 42 (11.5) | 66 (18.1) | 29 (7.9) |
| People with mental disorders are dangerous | 40 (11.0) | 74 (20.3) | 74 (20.3) | 124 (34) | 51 (14) |
| It is best to avoid people with a mental disorder | 193 (52.9) | 106 (29) | 24 (6.6) | 25 (6.8) | 13 (3.6) |
| If I had a mental disorder, I would not tell anyone | 150 (41.1) | 98 (26.8) | 63 (17.3) | 36 (9.9) | 13 (3.6) |
| Seeing a mental health professional means you are not strong enough to manage your own difficulties | 185 (50.7) | 91 (24.9) | 26 (7.1) | 39 (10.7) | 22 (6.0) |
| If I had a mental disorder, I would not seek help from a mental health professional | 183 (50.1) | 89 (24.4) | 31 (8.5) | 34 (9.3) | 25 (6.8) |
| I believe treatment for a mental disorder provided by a mental health professional, would not be effective | 143 (39.2) | 121 (33.2) | 33 (9) | 42 (11.5) | 23 (6.3) |
Majority of the respondents were definitely unwilling to employ someone with a mental disorder 128 (35.1%) and to live with someone with a mental disorder in the same family 126 (34.5%). Only 142 (38.9%) and 104 (28.5%) were willing to make friends with someone with a mental disorder and to move next door to someone with a mental disorder respectively. (Table 4)
Table 4.
Attitudes towards people with mental disorders
| Variable | Frequency (Percentage) | ||||
|---|---|---|---|---|---|
| Definitely unwilling | Probably unwilling | Neutral | Probably willing | Definitely willing | |
| Willingness to; | |||||
| Move next door to someone with a mental disorder | 45 (12.3) | 102 (27.9) | 59 (16.2) | 104 (28.5) | 54 (14.8) |
| Make friends with someone with a mental disorder | 30 (8.2) | 63 (17.3) | 61 (16.7) | 142 (38.9) | 67 (18.4) |
| Have someone with a mental disorder marry into your family | 126 (34.5) | 109 (29.9) | 75 (20.5) | 43 (11.8) | 11 (3) |
| Employ someone if they had a mental disorder | 128 (35.1) | 94 (25.8) | 58 (15.9) | 67 (18.4) | 17 (4.7) |
Overall mental health literacy of respondents
Composite scores were calculated and converted into percentages prior to categorization. The average mental health literacy score was 68.09% (SD 9.4), the minimum was 24.1% and the maximum was 90.4%. Majority of the respondents had a moderate mental health literacy 264 (72.3%) and only 45 (12.3%) had high mental health literacy. (Fig. 2)
Fig. 2.
Mental health literacy of respondents
Factors associated with knowledge, perceptions and attitudes on mental health
There was no factor found to be associated with knowledge of mental health. Perceptions of mental health were significantly associated with sex of the respondents (aOR = 1.485, P = 0.044). The odds of positive perceptions of mental health were 1.485 times higher in females than in males. Respondents with a history of a mental disorder were 3 times more likely to have positive attitudes towards people with mental disorders (aOR = 2.882, P-Value 0.002). (Table 5)
Table 5.
Factors associated with perceptions of mental health and attitudes towards people with mental disorders
| Variable | aOR | 95% CI | P-Value | |
|---|---|---|---|---|
| Perceptions of mental health | ||||
| Age (years) | 20–25 years | 2.01 | 0.546–7.403 | 0.294 |
| > 25 years | 1.00(reference) | |||
| Sex | Female | 1.485 | 1.038–2.347 | 0.044 |
| Male | 1.00(reference) | |||
| Source of mental health information | ||||
| Internet | Yes | 1.351 | 0.841–2.171 | 0.213 |
| No | 1.00(reference) | |||
| Attitudes towards mental health | ||||
| History of Mental disorder | Yes | 2.882 | 1.484–5.597 | 0.002 |
| No | 1.00(reference) | |||
| Friends | Yes | 1.557 | 0.848–2.858 | 0.153 |
| No | 1.00(reference) | |||
Factors associated with mental health literacy among respondents
The odds ratio for high Mental health literacy among respondents was lower in males than females (aOR = 0.422, P = 0.014) and was two [2] times higher in respondents with history of a Mental disorder (aOR = 2.485, P = 0.012). (Table 6)
Table 6.
Factors associated with good mental health literacy among respondents
| Variable | cOR | 95% CI | P-Value | |
|---|---|---|---|---|
| Sex | Male | 0.422 | 0.213–0.837 | 0.014 |
| Female | 1.00(reference) | |||
| Academic Year of study | Year 1,2 | 0.562 | 0.29–1.087 | 0.087 |
| Year 3, 4 &5 | 1.00(reference) | |||
| History of Mental disorder | Yes | 2.485 | 1.225–5.044 | 0.012 |
| No | 1.00(reference) | |||
| Source of mental health information | ||||
| Friends | Yes | 1.46 | 0.765–2.786 | 0.252 |
| No | 1.00(reference) |
Discussion
The findings of the current study provide insight into the levels of mental health literacy among non-medical undergraduate university students. Although most students demonstrated moderate mental health literacy, this does not necessarily indicate adequacy, as gaps remain in attitudes and perceptions, indicating the need for targeted mental health education interventions. Studies among medical students have reported higher levels of mental health literacy compared to non-medical students [17], likely due to formal training and exposure to health-related information [18]. This contrast further highlights the gap observed among non-medical students in the present study. Mental health literacy is widely recognized as a significant contributing factor to alleviating mental health problems and improving individual mental well-being [19]. Among young adults, adequate mental health literacy is particularly important for the early identification of psychological problems and timely intervention [20]. Previous studies have demonstrated that increased mental health literacy is associated with reduced stigma toward individuals with mental illness, greater willingness to disclose mental health problems, clearer recognition of symptoms, more positive attitudes toward seeking professional help, and increased utilization of mental health services [21, 22].
However, the findings of the present study indicate that most non-medical students demonstrated only moderate knowledge, and a substantial proportion held negative attitudes and perceptions toward mental health. Similar findings have been reported in other university settings. At Jazan University, although the majority of undergraduates demonstrated moderate mental health literacy, attitudes toward mental illness were mixed, prompting recommendations for targeted health education programs to improve literacy and foster positive attitudes [23].
In the United Kingdom, university students were found to have lower levels of mental health literacy than previously reported, although literacy levels were positively correlated with help-seeking behavior. The authors emphasized the importance of anonymous online resources in improving mental health knowledge and support-seeking [24]. Similarly, a study among Turkish university students reported high levels of psychological distress alongside low mental health literacy, with female students and those with a personal history of mental illness demonstrating higher literacy levels. The authors highlighted early identification as a critical factor in enabling effective intervention [25]. Collectively, these findings suggest that poor mental health literacy may contribute to increased stigma [23], reduced intentions to seek help [24], poor symptom recognition, delayed or absent treatment, increased psychological distress, and persistent negative attitudes toward mental health services [26].
The findings further highlight the need for culturally sensitive mental health education and intervention strategies to improve mental health literacy among university students [27, 28]. Evidence suggests that digital interventions, including web-based platforms and mobile applications, are effective in enhancing mental health knowledge and increasing intentions to seek help [29]. Additionally, workshops facilitated by mental health professionals and contact-based interventions involving individuals with lived experience of mental illness have been shown to produce positive improvements in both mental health literacy and attitudes toward mental illness [30, 31]. Peer-led initiatives and mass media interventions have also demonstrated effectiveness in engaging students, normalizing conversations around mental health, and promoting early intervention [32, 33].
In the present study, female sex and a history of mental health conditions were significant predictors of higher mental health literacy. Consistent with previous research, female students tend to demonstrate greater mental health knowledge and more positive attitudes toward mental health issues compared to male students [34]. The association between a personal history of mental illness and higher mental health literacy suggests that lived experience may enhance awareness, understanding, and recognition of mental health conditions. Gender differences in emotional awareness, socialization, and help-seeking behavior may also contribute to observed disparities in mental health literacy, with women generally being more open to discussing mental health concerns and accessing information. These findings underscore the need for targeted interventions that address gender-specific barriers, particularly among male students who may be less likely to engage with mental health resources.
Attitudes toward individuals with mental disorders were notably poor in this study, with more than half of the respondents demonstrating negative attitudes. This suggests reluctance to offer support and a potential tendency toward discrimination against individuals with mental health conditions. Evidence indicates that individuals with personal experience of mental illness tend to exhibit more positive attitudes, reduced stigma, and better understanding of mental health issues [24]. Similarly, indirect personal exposure, such as knowing someone with a mental illness, has been associated with higher mental health literacy, supporting the role of personal connections in enhancing awareness and understanding [35]. These findings align with those of the current study and emphasize the importance of interventions aimed at challenging and reversing stigmatizing beliefs.
Introducing mental health course units across academic programs, implementing university-wide awareness campaigns, and conducting further evaluations of anti-stigma educational interventions may help improve mental health literacy and attitudes among students. Evidence from curriculum-based interventions demonstrates that integrated mental health education can lead to sustained improvements in attitudes and reductions in stigma over time [36].
Perceptions of mental health were also suboptimal in the present study, with only 37.8% of participants demonstrating positive perceptions. Perception influences how individuals interpret mental health information and respond to symptoms, stigma, and help-seeking opportunities. Negative or inaccurate perceptions may therefore hinder timely recognition and appropriate responses to mental health problems. These findings are consistent with existing literature indicating that low mental health literacy is often associated with unfavorable perceptions, reinforcing barriers to disclosure and treatment [31, 37]. Improving perceptions through targeted, culturally appropriate educational interventions is essential for fostering a supportive and informed environment around mental health within university settings.
Study strengths and limitations
By focusing on non-medical students at Makerere University, the study fills a gap in the literature, specifically addressing a group that has received less attention in previous research on mental health literacy. The study employs clear definitions and standardized measurement tools, such as Bloom’s cut-off points for categorizing knowledge and attitudes, which enhances the consistency and validity of the results.
The use of a self-administered questionnaire may have introduced social desirability and reporting bias. The study was conducted at Makerere University in Uganda, and findings may not be generalizable to non-medical students in other regions or countries with different cultural or educational contexts. Cultural factors can influence mental health perceptions and literacy. However, the findings may be generalized to other students since Makerere University is a national public university that admits students from all parts of the country with different socio-economic and cultural backgrounds.
Conclusion and recommendations
This study revealed a critical gap in mental health literacy among non-medical students at Makerere University. To address this, there is an urgent need for interventions such as the inclusion of mental health courses in non-medical curricula. Raising mental health literacy could improve help-seeking behavior and reduce the stigma surrounding mental health disorders.
Future research
Future research should focus on assessing the effectiveness of mental health literacy interventions among non-medical students. Longitudinal studies could also help to determine changes in attitudes and knowledge over time, especially after targeted interventions are implemented.
Acknowledgements
We would like to acknowledge the support from Makerere University’s Department of Pharmacy, as well as the participants who took part in the survey.
Abbreviations
- MakSHSREC
Makerere School of Health Sciences Research and Ethics Committee
- MHLS
Mental Health Literacy Scale
- SHSIRB
School of Health Sciences Institutional Review Board
- SD
Standard deviation
- WHO
World Health Organization
Authors' contributions
Conceptualization, G.M, D.N.N, H.K, R.K and B.K; Data curation, G.M and D.N.N; Formal analysis, G.M, H.K and R.K; Investigation, G.M, D.N.N and B.K; Methodology, G.M, D.N.N and R.K ; Project administration, G.M, H.K and R.K; Resources, G.M, B.K and D.N.N; Supervision, H.K and R.K; Validation, G.M, R.K and H.K; Writing – original draft, G.M, D.N.N and B.K; Writing – review and editing, G.M, H.K and R.K.
Funding
This study was self-funded for academic purposes.
Data availability
The data supporting the findings of this study are available from the corresponding author upon reasonable request.
Declarations
Conflict of interest
The authors declare no conflicts of interest.
Consent for publication
Not applicable.
Ethics approval and consent to participate
Ethical approval for this study was obtained from the Makerere University School of Health Sciences Institutional Review Board (MakSHSIRB REC APPROVAL NUMBER: MAKSHSREC-2023-469). All participants provided informed consent before completing the survey, and confidentiality of the responses was ensured. All procedures performed in this study were conducted in accordance with the ethical standards of the responsible institutional review board and the Declaration of Helsinki.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data supporting the findings of this study are available from the corresponding author upon reasonable request.