Investigating Zimbabwean university students’ help-seeking behaviour and their mental health literacy of anxiety and depression.

Abstract

Background
University students often face high levels of stress, various social and academic demands that can negatively impact their mental health and academic performance. It is thus crucial to understand their knowledge about mental health problems and their sources of help when experiencing psychological distress. Less is known about the mental health literacy (MHL) and help seeking behaviour of university students in low-to-middle income countries (LMICs) like Zimbabwe, despite the reported prevalence of anxiety and depression among this population.

Methods
This sequential mixed method study initially used validated survey questionnaires (A-lit, D-lit, GHSQ and an optional AHSQ) to investigate the help seeking behaviour and MHL of anxiety and depression among purposively selected 517 undergraduate Zimbabwean university students. After data cleaning 500 questionnaires were analysed, with a sample characteristics of 256 females and 244 males. The mean age of participants in the quantitative phase of the study was 22 years old (females=21.9, males=
22.1), the age variation was not statistically significant. To further explore these participants’ perspectives on MHL and help-seeking behaviour and better understand the quantitative data results, focus group discussions (FGDs) were held afterwards with 61 students (31 females, 30 males), with a mean age of 21.9 years (SD=2.8), that took part in six FGDs comprising of between 8-12 individuals each. The FGD participarts were purposively selected from those who participated in the surveys, however 4 invited participants brought a friend to the FGDs for moral support and as these additional participants met this study’s participant inclusion criteria, they were allowed to take part.

Results
The quantitative data results indicated that participants had low levels of MHL in terms of anxiety scoring (M = 9.7 of 22, SD = 2.6) and depression (M = 10.2 of 22, SD = 2.6). The survey data suggests parents and friends were the highest sources of help previously sought and help-seeking intention. A positive but weak correlation appeared between MHL and help seeking intention among students in this study (r(500) = .193, N = 500, p > .05). While not statistically significant, the positive direction of correlation indicates that the higher MHL knowledge, the more likely help-seeking becomes. Male students had greater intention to seek assistance from their parents compared to female students if faced with mental challenging situations, with high statistical significance (p < 0.003). The qualitative data revealed several barriers to students’ help-seeking behaviour: social stigma, lack of awareness of available resources, misconceptions about mental health, fear of being judged and socially excluded, concerns about confidentiality, cultural and social stereotypes. Focus group participants agreed that MHL programmes should be available in higher education institutions and be introduced to students as early as primary school. Participants in the current study expressed the importance of students’ autonomy in choosing the setting in which they access mental health support, whether on-campus or in the community. This research also found a reliance by these Zimbabwean students on informal sources of help, with friends and parents being the most popular. Some recounted accessing help from religious leaders or communities when faced with mentally challenging situations. Additionally, aunties were revealed as a culturally prominent source of support and advice in the Zimbabwean tradition that students utilised. However, male students in the current study expressed reluctance to seek help from others due to wanting to conform to societal masculinity norms and avoid being perceived by others as ‘weak’. While, in romantic relationships, female participants disclosed being less inclined to seek help from their intimate partners due to past negative experiences, a fear of being seen as burdensome and their perception that seeking help could strain or end their relationship.

Conclusion
This study found low MHL of anxiety and depression among participants surveyed. Based on this study’s results, a five-day MHL programme is proposed, which could be introduced in different higher education institutions in Zimbabwe. Implementing MHL programmes in universities could be key in enhancing students’ understanding of common mental disorders and their help-seeking behaviours. Future research could evaluate the effectiveness of the proposed five-day MHL programme through a pre- and post-test study design to assess whether students' MHL and help-seeking intention is enhanced from its introduction, compared to a control group. This research challenges Zimbabwean higher education institutions to have provisions for supporting students’ mental health on campus, with established referral pathways for external mental health resources. Greater collaboration between universities and external organisations, such as non-profit organisations, professionals, religious groups, and substance abuse services, could be crucial in offering students supplementary support and reduce the treatment gap in LMICs. The current study findings recommend incorporating mental
health education earlier in the academic curriculum; this area warrants further research and consideration by decision-makers, as it could help equip young students to better cope with mental health challenges and seek support sooner. The students in this research primarily relied on informal help, as the majority were unaware of available free mental health resources. This study has had an initial positive impact on the participating university students by introducing MHL awareness posters distributed across campuses, directing students to available free mental health resources. Furthermore, students at one of the universities have established a faculty-facilitated mental health support group.

Date of Award	8 Oct 2025
Original language	English
Awarding Institution	University of Bath
Supervisor	Bonnie Pang (Supervisor) & Alan Buckingham (Supervisor)