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Table of Contents
Year : 2021  |  Volume : 26  |  Issue : 3  |  Page : 183-189

A Nigerian tertiary institution students’ knowledge and attitude to mental health and services

1 Department of Community Medicine, College of Medicine, University of Nigeria, Nigeria
2 Department of Psychiatry, Enugu State University Teaching Hospital, Parklane, Enugu, Nigeria
3 Enugu State University of Science and Technology, Business School, Enugu, Nigeria

Date of Submission29-Jun-2020
Date of Decision13-Sep-2020
Date of Acceptance09-Mar-2021
Date of Web Publication20-Apr-2021

Correspondence Address:
Chinedu Arthur Idoko
Department of Community Medicine, College of Medicine, University of Nigeria.
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijmh.IJMH_43_20

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Background: Mental health and availability of its services are under-emphasized, misunderstood, and misplaced due to unfounded theories, mistaken beliefs, stigma, and fallacies, especially pronounced in the developing world. With these misconceptions come under-utilization of available services resulting in increased numbers of the mentally unhealthy in our society. This study aims at uncovering perceptions to the availability and effectiveness of mental health services as well as health-seeking behavior to such services. Materials and Methods: This study is a descriptive cross-sectional study. Respondents were picked by simple random sampling until a determined sample size was achieved. Pre-tested structured questionnaires were employed in data collection. The analysis was done with the Statistical Package for the Social Sciences (SPSS). Results: A greater percentage of respondents showed positive attitudes to mental health/services as 94.4% (321) of the respondents expressed that one had to be mentally healthy to function effectively; 66.2% (225) would seek orthodox mental health services if need be. Interestingly, a significant number (45.6%, 155) was unaware of availability of these services in Enugu even as findings revealed negative attitude toward the mentally ill, with 67.7% (230) of the view that the mentally ill should be avoided, whereas 71.7% (245) submitted that people with mental illness should not live in hostels. Conclusion: There is a need for improved/increased awareness on mental health spreading to the general populace as pronounced information gap exists even among university students.

Keywords: Attitude, knowledge, mental health, services, students

How to cite this article:
Idoko CA, Udo K, Idoko CI. A Nigerian tertiary institution students’ knowledge and attitude to mental health and services. Int J Med Health Dev 2021;26:183-9

How to cite this URL:
Idoko CA, Udo K, Idoko CI. A Nigerian tertiary institution students’ knowledge and attitude to mental health and services. Int J Med Health Dev [serial online] 2021 [cited 2022 Aug 15];26:183-9. Available from: https://www.ijmhdev.com/text.asp?2021/26/3/183/313951

  Introduction Top

The health of any individual is dependent on the inter-relationship between the physical and the mental states. The World Health Organization (WHO) defines health as a state of complete physical, mental, and social well-being of an individual and not merely the absence of disease or infirmity.[1] Many issues of mental health are under-emphasized leaving it surrounded by mistaken beliefs and fallacies, especially in a developing country like Nigeria. To society’s detriment, these misconceptions bring utilization of mental health services to a near inexistence. Approximately 20 million Nigerians live with one form of mental disorder or the other according to the WHO–AIMS Report.[1] These regardless individuals with mental health issues are stigmatized and virtually unattended to. As a result, individuals and families try to conceal illness to avoid stigma and discrimination, resulting in increase in the number of the mentally sick. Prevailing misconceptions and stigma adversely affect mental health services utilization encouraging people who are either totally unaware of existence of services or are unwilling to seek out these services. This study seeks to expose these wrong perceptions, provide indices for refuting them as well as improve awareness of mental health services.

  Materials and Methods Top

The study was done in Enugu State which hosts the University of Nigeria, a foremost Nigerian institution founded by Dr Nnamdi Azikiwe in 1955.[2],[3] University of Nigeria, Enugu Campus (UNEC), on the other hand, is a campus of the University of Nigeria located at the heart of Enugu town, behind the independence layout axis, a campus smaller than the principal Nsukka campus. This study was principally carried out in its Enugu Campus (UNEC), home to the University’s seven faculties of Medical Sciences, Dentistry and Dental Surgery, Health Sciences, Law, Business, Basic Sciences, and Environmental Sciences with about 7500 students.[3],[4]

All undergraduate students (regardless of age, gender, faculty, or place/hostel of residence) who were available/willing to participate were enrolled in the study. Those students who were unavailable and unwilling to participate were, however, excluded. Prior to this however, verbal informed consent was obtained from all the respondents, while ethical clearance was obtained from the University of Nigeria Teaching Hospital Ethics Committee. Interestingly, this study employed a descriptive cross-sectional pattern in which the sample size formula for descriptive study of population was used with application of prevalence rate of attitudes toward help-seeking from a general practitioner for mental health problems in a rural town.[5],[6] A sample size of 340 was used after accommodating for attrition and rounding to nearest 10. Going further, a simple random sampling was employed which involved meeting students of all faculties in a class and/or hostels to fill the semi-structured, close- and open-ended questionnaire which was self-administered. This continued until the desired sample size was achieved.

Statistical analysis involved data collected in the form of questionnaires which were analyzed using Statistical Package for the Social Sciences and results presented in tables.

  Results Top

A total of 340 questionnaires were administered to 340 respondents. A total of 340 questionnaires were retrieved giving a response rate of 100%. [Table 1] reflects the sociodemographics of the respondents. Here, 50.3% of the respondents were aged 20 and below; 64.4% of the respondents were female; whereas 98.2% (334) and 93.5% (318) were Christian and Ibo by tribe, respectively. This is even as 46.5% of the respondents were business faculties. About 7.0% were medical students and of these 7.0%, 42.4% were 300 level students. There is no statistically significant difference among age (P = 0.744), gender (P = 1.00), faculty (P = 0.533), level (P = 0.747), and awareness of mental health in the respondents. The results of knowledge of respondents on mental health are captured in [Table 2]. It can be appreciated from this table that 94.7% (322) of the respondents had information on mental health; 22.9% (130) through lectures; and 22.4% (127) via television. Different perceptions of the mentally ill included 36.6% (191) that considered people walking the street naked as mad, 39.8% (230) attributing cause of mental illness to emotional disturbances; and 36% (208) believed that substance abuse caused mental illness.
Table 1: Sociodemographic variables of the respondents with age, gender, faculty, and level associated to awareness of mental health

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Table 2: Knowledge of mental health

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A total of 155 respondents (45.6%) were unaware of mental health services in Enugu as can be inferred from [Table 3], which dealt exclusively on respondents knowledge of mental health services. However, among the aware, majority picked information from friends. The existence of Psychological Medicine Department of UNTH was obvious to 40.8% (141) of the respondents. In [Table 4], 50.6% (172) of the respondents have the opinion that mental health services in Enugu were not effective just as 23.2% (79) reported that they would advise the mentally ill to seek care in a psychiatric hospital. Concluding [Table 5], which deals with attitude toward the mentally ill, the majority of respondents were actually uncertain that treatment for mental illness could be completely successful. About 127 respondents (37.4%) shared this opinion; 36.4% (124) respondents indeed felt that abnormal behavior remained after treatment. Furthermore, [Table 5] reflects that a minority of 9.4% (32) assume that the mentally ill are responsible for their condition.
Table 3: Knowledge of mental health services

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Table 4: Attitude toward mental health services

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Table 5: Attitude toward the mentally ill continued

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  Discussion Top

Three-hundred and forty respondents in all were studied. Seven percent of them were medical students comprising principally 300 level medical students (42.4% of the 7.0%). Faculty of Business Administration made up 46.5% of the total respondents. A slight majority of the respondents were, however, 20 years and below (50.3%) and 93.5% were Igbo by tribe. It is also observed that female respondents were 64.4% of total in tandem, with a 2007 study carried out in a university student population that revealed 48% of female respondent’s population.[7] Sociodemographics furthermore revealed 98.2% Christian respondents’ population, while 98.5% were single. It is interesting to note that just very few respondents were medical students. Of this few, a minute percentage (0.3%) was 600 class of medical students who would have completed lectures and clerkship in psychiatry. Most respondents, in general, therefore probably had very little prior knowledge of the subject matter which incidentally is a sharp contrast with the sociodemographics of a prospective study conducted in Bayero University specifically among 500 and 600 level medical students.[8]

A greater percentage (90%) of the respondents agreed that health is not just a state of physical well-being but also entails social and mental well-being. This obviously implies that most of the respondents acknowledged the fact that one needs to be mentally healthy in order to be wholesomely healthy. The majority of the respondents, 306 (94.7%), admit awareness of mental health. Of this, 127 (22.4%) derived information from television, 130 (22.9%) at lectures, whereas the lesser number (24) of respondents (4.2%) was informed via billboard posts. This entails that respondents essentially got mental health exposure from television and formal means. The Canadian Centre for Addiction and Mental Health in a study confirmed that programs aimed at increasing young people’s knowledge of mental health through education have shown positive results in reducing negative attitudes toward people with these disorders.[9],[10],[11] This also conforms to other studies carried out in Nigeria which affirmed the role of health education.[12],[13],[14],[15],[16] In another study done in Nigeria in 2009, media coverage (Television) proved an efficient way of information on mental health and mental health services.[17] In a particular study, a greater percentage of respondents considered only people walking naked on the streets to be mentally ill, followed by people who mumble incomprehensible words. Those people who were sad and tired, lost interest in their daily activities as well as engage in so many activities/tasks without completing any were least considered mentally ill/unhealthy.[18],[19],[20],[21],[22],[23]

Pertaining to the cause of mental illness, 36% were of the opinion that mental illness results from substance abuse, whereas the greater percentage 39.8% think that it is caused by emotional disturbances with the least percentage of respondents (2.8%) stating that sin/immoral living is a cause of mental health. Hence, there is awareness among most of the respondents of the causative factors of mental illness. This corresponds to the findings of a research also done in Nigeria in 2005, in which most of respondents agreed substance abuse to be the most common cause of mental illness.[22],[24],[25],[26] The percentage of respondents that affirmed awareness of existence of mental health services in Enugu was more than ones that did not (54.4% affirmed, while 45.6% did not). It is however a concern that as much as 45.6% actually claimed ignorance of same. This emphasizes need for populace education on mental health services in Enugu. Information on services by respondents appeared through friends, followed by the media (television) obviously signifying the importance of friends and peer groups in spreading mental health and mental health services information/knowledge. In this study, most respondents agreed to awareness of existence of Psychological Medicine Unit UNTH, despite the fact the majority think that mental health services in Enugu are not exactly effective. It is interesting to note that 90.6% of the respondents posited that they would advise a mentally ill respondent to seek help, with a high percentage (66.2%) actually acknowledging that they would themselves seek help from available mental health services if need be. This corresponds with a research done in 2008 in which it was found that positive attitude toward mental health services is associated with service utilization.[27],[28] In a study done in Russia in 2009 however, the intention to seek help was associated with attitudes of tolerance.[29] Also in a study done in Echuca, a rural community in Australia, it was discovered that higher perceived stigma was associated with more negative attitude toward seeking help.[12] The respondents in our study had a positive attitude toward help-seeking, even though the majority was unsure of exactly where to seek help.

The majority of the respondents disagreed that mentally ill people should be avoided. Interestingly, however, a further majority (67.6%) cumulatively think that mentally ill people are dangerous and another 71.7% do not think that mentally ill students should live in hostels. These results are pointers to the fact that respondents might be unwilling to change the innate orientation of avoiding mentally ill people, despite their expressed opinion of not having them ostracized. This consistent increasing unwillingness to be closely associated with the mentally ill is reflected in results of a 2005 Nigerian study which observed that the closer the intimacy required for the interaction, the stronger the community’s desire to keep a distance.[24],[30] Increased numbers of respondents were uncertain that treatment for the mentally ill could be completely successful as about 36.4% agreed that abnormal behaviors remained after treatment. These notions probably form the foundation of unwillingness to associate with mentally ill or people identified to have been previously mentally ill.[9],[17],[25],[26] Only 9.4% think that the mentally ill are responsible for their condition. This is a welcome observation if it does not paradoxically contribute to discrimination in the sense that since mentally ill people may be thought to be non-liable for their actions they hence may constitute a greater danger. This sort of ideation was seen in a study conducted in Germany in the 1990s; as respondents endorsed biological factors (beyond the control of the mentally ill), the more lacking in self-control they believed the mentally ill to be, the more they distanced selves.[31]

A major limitation was a few of the respondents returned incompletely filled out questionnaires, which was, however, effectively taken care by provision made for attrition.

  Conclusion Top

This study found that the majority of the university students had good knowledge of the importance of mental health in the life of an individual. The majority, though lacked knowledge of mental illnesses, assume that schizophrenia is the only mental illness. A greater percentage, however, showed positive attitude to mental health services even as a significant number were unaware of available mental health services Enugu had to offer. This is attributable to poor awareness efforts as available information to the priviledge informed was only limited to UNTH Psychiatric Unit. Furthermore, findings revealed high level of negative attitude toward the mentally ill among students. The need for mental health enlightenment and awareness campaigns is recommended; these are organized and delivered to educate people on the risk factors, behavior, and features as well as when and where to seek care. Social and psychological rehabilitation should be extended to every patient following treatment, while the need for increased mental health research cannot be overemphasized, especially considering the limited published work in our environment.


We wish to appreciate the Head, Department of Community Medicine, College of Medicine, University of Nigeria for enabling the collaborative environment created in the Department that promotes collaborative work. The authors also thank Ugorji Wisdom, Ugwuanyi Kenneth, Ugwuanyi N., and Ugwuanyi Ozioma for the logistic support and running around for data collection.

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.

  References Top

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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