Common mental disorders an ‘enormous’ burden on students

To what extent are common mental disorders among university students in Sub-Saharan Africa contributing to academic failure, effectively leading to skills shortages and mismatches in human resources and capacity with the labour market needs in the region?

That is one of the many questions that mental health researchers have, apparently arising from reports worldwide of mental illness among young people, especially university students. However, due to a lack of data, very little is known about the mental status of students in Sub-Saharan Africa.

But, to start filling that gap, researchers recently conducted a survey of common mental disorders among university students in a first survey of its kind in the region that collected data from undergraduate students at 17 universities in South Africa.

According to Dr Jason Bantjes, a chief specialist scientist in the alcohol, tobacco and other drug research unit at the South African Medical Research Council, an extraordinary associate professor at South Africa’s Stellenbosch University, and the lead author of the study, 70,000 students responded to the survey and 28,268 of them were assessed for 11 common mental disorders.

These disorders included generalised anxiety disorder, panic disorder, post-traumatic stress disorder, or PTSD, social disorder, major depressive episode disorder and bipolar spectrum disorder. Other disruptive mental disorders on the list included the attention deficit hyperactivity disorder or ADHD, eating disorder, intermittent explosive disorder, as well as alcohol and drug use disorders.

Mental disorders are common

Reporting the findings of the survey in an article that was published in the latest edition of the Journal of Affective Disorders, Bantjes and his joint researchers noted that common mental disorders in South Africa appeared to be more common among university students than in the general population.

The survey, initiated by Universities South Africa, an umbrella organisation representing the 26 public universities in South Africa, was funded by the South African Medical Research Council and looked into how students were being impacted by various socio-economic and political factors such as poverty, income inequality, a history of colonisation and civil wars, political instability, and gender inequality.

University students could also be mentally stressed by a wide range of other social and development challenges such as leaving home for the first time, adapting to a new social environment, academic pressure, greater opportunities for substance misuse and financial pressure, noted Bantjes and his co-researchers.

Common disorders prevalent

Focusing on the prevalence of common mental disorders in the 30 days prior to the survey, the findings suggested that, on average, 24.5% of students suffered from social anxiety disorder, 22.7% had an eating disorder while 21% suffered from post-traumatic stress disorder, or PTSD.

According to Bantjes, as many as 16.3% of students met diagnostic criteria for a mood disorder, either major depressive disorder or a bipolar mood disorder in the 30 days prior to assessment, while 10.9% experienced a generalised anxiety disorder and 7.2% had panic disorder.

Further, the results of the survey noted that 21% of students in universities in South Africa suffered from ADHD while 6.6% had drug abuse disorder in the last 30 days prior to the survey. In total, the survey established that more than half, 53.3%, of 28,268 respondents that were assessed had at least one common mental disorder.

But, whereas those findings are specific to students in South Africa, there are no reasons to believe that the situation could be radically different in other countries in Sub-Saharan Africa.

Mental health in other parts of the region

According to Sunny Cui, a researcher at Stanford University of Medicine in the USA, and her associates at Lagos State University, Nigeria, and the University of Toronto, Canada, the prevalence of depression among university students in Nigeria stands at 26% based on a random-effects model. The random-effects model is a statistical model that is used to give a summary of the magnitude of the effect in a systematic review that assumes that the studies included are a random sample of a population of studies addressing a specific question or issue.

In a study. ‘A Systematic Review and Meta-Analysis of Depression Prevalence Among Nigerian Students Pursuing Higher Education’, that used datasets from different regions of Nigeria, researchers suggested career uncertainties, distrust in academic institutions, unavailable learning materials, poverty and disrupted peer relationships were some of the causes of depression among university students in the country.

Caleb Joseph Othieno, an associate professor of psychiatry at the University of Nairobi, in another study, ‘Depression among university students in Kenya: Prevalence and sociodemographic correlates’, noted the overall prevalence of moderate depression among students at the University of Nairobi stood at 35.7%, while severe depression was at 5.6%.

Female students had moderate depressive symptoms at 39% as compared to males at 33.5%, while severe depression for males was at 5.3% and 5.1% for females.

First-years as a special case

But, while on average, depression was high among students living off campus with parents or guardians, poor family background, poor academic performance and tobacco use, Othieno noted that the highest levels of depression were recorded among first-year students.

Similar conclusions were reached by Bantjes and co-researchers in an earlier study, ‘Mental health and academic failure among first-year university students in South Africa’, that evaluated six common mental disorders among first-year university students in South Africa.

The study, which was published two years ago, appears to be the first of its kind to provide insights into a wide range of socio-demographic and mental factors associated with academic failure among first-year students in South Africa and could be stretched further to point out to the inherent consequences of common mental disorders among students in other African countries.

Reporting the prevalence of mental distress among university students in Ethiopia, Dr Berihun Assefa Dachew, a public health researcher at the University of Gondar in Ethiopia, said the prevalence of mental distress among students was found to be about 41%.

Dr James Ngocho, a lecturer at Kilimanjaro Christian Medical University College, and his associates have also found that more than 20% of the university students in the Kilimanjaro region of Tanzania might be suffering from common mental disorders related to drug abuse, financial difficulties, unhappy personal relationships and poor academic performance.

Similar incidences of the high prevalence of depression among university students have been reported in Benin, Ghana, Rwanda, Sudan and Uganda, among other African countries.

What about student support?

But, whereas depression is the most studied common mental disorder among university students in Sub-Saharan Africa, there is almost no data about the ongoing treatment of the condition, or availability of intervention programmes specifically targeting university students.

To date, the most comprehensive study of common mental disorders among university students in Sub-Saharan Africa is the one by Bantjes and his associates that has drawn wide attention to the marked prevalence of various mental disorders affecting students.

The enormity of the problem appears to be a wake-up call for governments and universities in Sub-Saharan Africa to start realising the need for effective campus-based interventions.

“Traditional models of intervention relying on one-to-one psychotherapy with a mental health professional will not be feasible, given the enormity of the problem, making it important to explore alternative modes of intervention, including group therapies, digital interventions, peer-to-peer support, and stepped-care models,” says Bantjes.

Even then, it is good to realise that most university students in Sub-Saharan Africa are academically thriving and coping with mental stress occasioned by academic, lifestyle, physiological, psychological and social factors.

Subsequently, what is disturbing is that, although researchers are suggesting that, collectively common mental disorders could impact negatively on the overall academic progress in the region, few university students are getting treatment for those disruptive disorders.