Availability, accessibility, and utilization of mental health services or support among university students in Africa: a mixed methods systematic review with meta-analysis and meta-synthesis

Abstract

Background: The literature is replete with studies documenting the magnitude of mental illness among university students in Africa. However, it is unclear what mental health services or support (MHSS) are available to students and the extent to which they access and utilize them. We determined the availability, accessibility, and utilization of MHSS among university students in Africa and explored factors associated with the accessibility and utilization of MHSS.

Methods: We obtained data through a systematic search of five databases and included studies that reported on the availability, accessibility, or utilization of MHSS among university students in Africa. We extracted data on sociodemographic characteristics, MHSS focus (availability, accessibility, or utilization), mental health outcomes, and factors associated with MHSS accessibility and utilization. Quantitative data were meta-analyzed, and qualitative data were meta-synthesized.

Results and conclusion: We included 18 studies. More informal than formal sources of MHSS are available, accessible, and utilized by African university students. While parents and lecturers are often seen as the available informal sources of MHSS for university students in Africa, access to these services is hampered by instrumental-related barriers such as inadequate mental health literacy and financial constraints. These findings underscore the need for targeted, low-cost interventions, such as faculty training and peer counseling, that improve mental health literacy and access to services. Providing psychoeducation to parents can help them guide students toward appropriate help without being an obstructive force. Rather than adopting a one-size-fits-all approach, universities and policymakers can consider developing segmented mental health promotion campaigns that target specific student subpopulations (i.e., those with different religious, cultural, or ethnic backgrounds) with messages that resonate with their preferred help-seeking pathways. There is a need to prioritize policies that expand access to mental health insurance and services.

Keywords: Anxiety; Counseling; Help-seeking behavior; Mental health services; Psychosocial distress; Public health; University students; Young adults.

Fig. 1

PRISMA flow diagram depicting literature search and selection process

Fig. 2

Authors’ judgments about each risk of bias item presented as percentages across all included (a) cross-sectional studies and (b) qualitative or mixed methods studies

Fig. 3

Forest plot of pooled proportion of students accessing informal sources of mental health services or support (based on random effect models with 95% confidence interval)

Fig. 4

Forest plot of pooled proportion of students accessing formal sources of mental health services or support (based on random effect models with 95% confidence interval)

Fig. 5

Forest plot of pooled proportion of students citing instrumental-related barriers to access of mental health services or support (based on random effect models with 95% confidence interval)

Fig. 6

Forest plot of pooled proportion of students citing attitudinal-related barriers to access of mental health services or support (based on random effect models with 95% confidence interval)

Fig. 7

Forest plot of pooled proportion of students citing stigma-related barriers to access of mental health services or support (based on random effect models with 95% confidence interval)

Fig. 8

Forest plot of pooled proportion of students utilizing formal (upper panel) and informal (lower panel) sources of mental health services or support (based on random effect models with 95% confidence interval)