Factors Affecting The Perception of Mental Health and Mental Health Services Among University Students of Kampala International University, Western Uganda

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org Open Access

EURASIAN EXPERIMENT JOURNAL OF MEDICINE AND MEDICAL SCIENCES
(EEJMMS) ISSN: 2992-4103
©EEJMMS Publications Volume 5 Issue 1 2024
Page | 31 Factors Affecting the Perception of Mental Health and

Mental Health Services among University Students of
Kampala International University, Western Uganda
Muhesi Edward
Faculty of Clinical Medicine and Dentistry Kampala International University Western Campus Uganda.
ABSTRACT
Mental illness is a maladaptive response to stressors from the internal or external environment, manifested by
thoughts, feelings, and behavioral disturbances. Consequently, people with mental illness are often seen to be
aggressive, dangerous, violent, unpredictable in their behavior, unable to handle too much responsibility, and more
likely to commit offences or crimes. To assess the perceptions, level of knowledge and socio-demographic factors
affecting the perception of mental health and mental health services among Kampala International University
students. This was an institution descriptive and analytic cross-sectional study that employed both quantitative
methods of data collection to gather data that was used to establish associations between the dependent and
independent variables. A big percentage (45.4%) strongly agreed that mental disease was treatable which was low
compared to (73.3%), and 0.3% believed that mental disease was not treatable, which was low compared to 3.3% in
a study carried out in Uganda by Wallace, some statements which describe a person with mental illness, the majority
of the participants (91.3%) ticked has been admitted, most (77.2%) ticked yes for bouts of depression, a greater
number (50.4%) ticked yes for born with an abnormality in the brain, majority (61.7%) ticked not responsible for
own actions, a greater number (72.2%) of the participants knew a health patient as a person who was incapable of
making simple decisions. The perceptions associated with factors and knowledge of mental health and mental health
services were significantly associated with age and family history of mental illness.
Keywords: Mental illness, Behavioral problems, mental health, Family history.
INTRODUCTION
Mental illness is a maladaptive response to stressors from the internal or external environment, manifested by
thoughts, feelings, and behavioral disturbances. Consequently, people with mental illness (PMI) are often seen to be
aggressive, dangerous, violent, unpredictable in their behavior, unable to handle too much responsibility, and more
likely to commit offences or crimes [1-3]. Mental health problems have become an alarming condition in the present
health scenario. World Health Organization report reflects that one in four persons fulfil the criteria of any mental
illness at least once at some point in their lifetime [4]. Mental and behavioral problems exist in all countries, in
women and men at all stages of life, among the poor and rich and among rural and urban people. As many as 450
million people worldwide are estimated to be suffering at any given time from some kind of mental or brain disorder,
including behavioral and substance-related disorders [5]. Mental health disorders constitute the major causes of
disabilities worldwide, accounting for 37% of all healthy life years lost through disease. Mental illness is a disabling,
chronic condition that poses numerous challenges in its management and as a risk factor for other health problems
[6]. World Health Organization (WHO) estimates the prevalence rate of mental illnesses to be from the lowest in
Japan at 3% to 16.9% in the United States of America, and other countries ranging from 8% to 12% [7]. It is
estimated that one out of five Americans suffer from mental illness, and during their lifetime, 50% of adult Americans
will have a current diagnosis or history of mental illness [8]. In a national study of the prevalence of psychiatric
illnesses in the United Arab Emirates among 610 elder populations, the results showed that 20.3% had depression,
and 5.6% having anxiety disorder [9]. The national prevalence rate for mental illnesses in India is found to be
73/1000 population [4]. The Indonesian Health Ministry (2013) reported the prevalence of mental illnesses, such
as schizophrenia, is approximately 1%, and emotional disorders affect approximately 6% of the total population.
©Muhesi, 2024
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provided the original work is properly cited
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Holistically, what one culture may consider as a mental disease or abnormal behavior may be seen as normal in
another culture. This dissimilarity in conception shows bias in the definition, identification and management of a
mentally ill individual. There is often disagreement and lots of debate on how to understand mental illness in
developing countries across different cultures [10, 11]. According to a survey of mentally healthy people from 21
countries, as many as 78% of respondents in developed countries and 15-16% in developing countries believe that
PMI are more violent than the average person [12]. Moreover, approximately 90% of PMI admitted to experiencing
Page | 32 stigma, and 86% of PMI had experienced discrimination [13]. That study showed that PMI experienced stigma or
suffered negative attitudes from society. A study conducted in Southeast Asian countries, including Vietnam,
suggested that suicidal ideation rates among college students were 11.7%, while similar rates for this age group in
the U.S. were at 8.8% [14]. A study on psychological distress among college students in India suggests that
psychological distress, which is associated with other negative outcomes (e.g. academic failures, substance abuse,
suicidality), is common [15]. Societal attitudes and beliefs can affect the acceptance and treatment of individuals
with mental illness. The concept of mental illness may not be known by everyone and thus it may be difficult to
measure society’s perceptions in general about mental illness. Nonetheless, one could argue that many educated
people will have an idea about the concept of mental illness. University students from various segments of society
are believed to meet the condition of being educated and are seen to bear traces of the beliefs about mental illness
from their expanding environment [16].
Mental illness accounts for approximately 7.4 % of global disease burden, with depressive disorders projected to be
the leading contributor to global disease by 2030 [17]. The global burden of mental health disorders is a significant
public health issue [18]. Mental health is one of the most recent additions to the United Nations Sustainable
Development Goals, while historically the majority of the goals were for communicable diseases [19]. One
population that has a risk for mental health issues is college students [20, 21]. Uganda has a predominately young
population with ~47.3% being under 5 years. Approximately, one in five children and adolescents suffer from mental
disorders. Mental health disorders are one of the top 5 leading causes of years lost to disability among the youth and
young children with depression in particular being the largest cause of the burden of mental diseases among young
people. Many mental health problems emerge in late childhood and early adolescence. Poor mental health or
disruptive behavioral disorders negatively impacts health and development of adolescents and is associated with
several health and social outcomes e.g. alcohol and illicit substances use, risky sexual behavior, adolescent pregnancy,
school dropout, crime and unemployment [22]. Patients with mental health disorders do not only have to endure
the burden of having the condition but also the stigma that results from it, and that is classified into: public stigma,
institutional stigma, and self-stigma [23]. Higher education leaders, scholars, and administrators have given less
attention to student mental health than to other comparable factors known to affect college student retention,
including financial stress, social connectedness, sense of belonging, and academic preparedness. This paper assessed
the perceptions, knowledge and socio-demographic factors associated with the perceptions of mental health and
mental health services among university students at KIU western campus.
METHODOLOGY
Study design
This was an institution descriptive and analytic cross-sectional study that employed both quantitative methods of
data collection to gather data that was used to establish associations between the dependent variable and the
independent variables. The cross-sectional survey research design was used because the method gathers data from
a relatively large number of different categories of respondents at a particular time in a qualitative manner without
having to follow up the participants and hence it’s cheaper on addition to being time saving.
Area of Study
This study was conducted at Kampala international University which is in Ishaka Town, a main town in Bushenyi
district, and located in the north of Bushenyi district, south west of Mbarara district and around 78km from Mbarara
town which is the biggest city in Western Uganda. Bushenyi district is also located around 361km in the south west
of Kampala (capital city) by road. Ishaka town’s coordinates together with the municipality as all are believed to be
0o 32’ 40.00’’N, 30o 8’ 16.00’’E (Latitude: 0.544445, Longitude: 30.137778).
Study population
All students of Kampala international University constituted the study population.
Sampling Technique
In order to collect scientific data that can be used to draw inferences on a large body of data on and to come up with
conclusions about all the students in the entire university, the methods/techniques selected for the study were based
on probability sampling. The main method that will be employed in selecting sample from the population were
simple random sampling technique.
©Muhesi, 2024
Simple random Sampling
With this method, the researcher identified the study population, chose the sample size, the population was
listed, numbers were assigned to the units, random numbers were found and individuals were selected to take part
in the study. The aim of the simple random sample was to reduce the potential for human bias in the selection of
cases to be included in the sample. Each of the university students in the study population had equal chances of
participating in the study.
Page | 33 Sample size determination
Fisher’s formula was used to determine the Sample size [24].
𝑧 2 𝑝(1 − 𝑝)
𝑛=
𝑑2
Where,
n = Minimum sample size
Z = the table value for standard normal deviation corresponding to 95% significance level (=1.96)
P = Prevalence of characteristic being estimated
d = Margin error, set at 0.05
The sample size of this study will be calculated using the estimated prevalence of 50% based on since there was no
similar study done in the local context and the value used for P will be 50%.
𝑧 2 𝑝(1 − 𝑝)
𝑛=
𝑑2
(1.96)2 0.5(1 − 0.5)
𝑛=
(0.05)2
3.8416 𝑥 0.5 𝑥 0.5

𝑛=
0.0025
3.8416 𝑥 0.25
𝑛=
0.0025
𝑛 = 384
From above, our sample size will be 364 participants.

Inclusion criteria
All university students who were registered with the university with a valid identification card and who consented
to take part in the study were included.
Exclusion criteria
 University students who refused to consent.
 University students who were not registered with the university.
 University students who were not citizens of Uganda.
Study procedure
A total of 384 randomly selected university students from Kampala International University, western campus was
recruited to participate in the study making sure there was a fair representation of participants from each faculty
and class. After explaining the purpose of the study to the study participants, written consent was sought from the
participants. Those who did not consent to take part in the study were allowed to opt out of the study. Relevant
information from the students regarding their knowledge, perceptions towards mental health and their socio-
demographic characteristics, was filled in the self-administered questionnaires.
Data collection Instruments
A data collection instrument is a tool that is used in data collection such as a questionnaire. This provided a guide
to the researcher to collect adequate data that helped him answer the research questions to achieve the study
objectives.
©Muhesi, 2024
Questionnaires
Questionnaires were used by the researcher as the main data collection tool. This was because all the study
participants can read and write and were able to understand English. A questionnaire is a written form of questions
that are systematically arranged to enable the researcher come up with clear findings that can answer the research
questions. Research questionnaire was prepared following the available literature and was used in capturing data as
required by specific objectives. The data was collected by the principle investigation, guided by the research
Page | 34 supervisor. Questionnaires are the most generally used instrument of all according to Langford (2001) because they
are “easy to administer, inexpensive and offer anonymity. A questionnaire is the best instrument because it gives the
respondents time to fill them without being intimidated by the researcher’s presence.
Validity of instruments
Before the instruments were administered to data collectors, they were first examined by colleagues taking a similar
program as the researcher’s. They were then scrutinized by the supervisor to ensure that the terms used in the
questionnaire and interview are precisely defined and properly understood. Content Validity Index was calculated
basing on judgment by at least two knowledgeable people (Judges). When the result got was 0.7 and above, the
instrument was deemed valid for use.
Pretesting of data collection tool
The data collection tool was tested among university students from Mbarara University of science and technology
one week prior to the start of data collection. A few changes in the wordings and questions were done where needed.
Data management
The principle investigator ensured that all data collected was reviewed at two levels prior to data entry into the
research database and upon entry prior to analysis. The data collection and entry process was planned in such a way
that all data collection sheets completed in a day were reviewed and entered on the same day.
Data analysis plan
Data was checked for completeness and then entered into computer software called Microsoft excels. The entered
data was then exported into SPSS version 25 for analysis or STATA Version 14.2. The analyzed data was presented
as means of standard deviation in form of tables, charts and figures to give descriptive statistics as per the theme of
the study in one way or another. The perceptions towards mental health and mental health services among
university students was analyzed in terms of frequency and percentage with a 95% confidence interval and
information will be summarized in form of tables, pie charts and narrations. The knowledge on mental health and
mental health services among university students was analyzed in terms of frequency and percentage with a 95%
confidence interval and information was summarized in form of tables, pie charts and narrations. The socio-
demographic factors associated with the perceptions towards mental health and mental health services among
university students were assessed using Binary logistic regression. Both bivariate and multivariate logistic
regression analysis shall be carried out. Interaction and confounding were assessed using chunk test (log-likelihood
and 10% cut off) respectively. The variables in the final multivariate model will be significant when p < 0.05. The
measure of association will be reported as odds ratios (ORs) with corresponding 95% CI and p-value. To establish
the factors that are independently associated with perceptions towards mental health and mental health services
among university students, a multivariate logistic regression was run with the factors having p-values less than 0.2.
Quality assurance and quality control
The principle investigator ensured that all tools were tested for relevancy to ease the understanding and
appropriateness before data collection. This will help the researcher to ensure accuracy, validity and reliability of
the tools in order to find out the relevancy of the study objectives to the study area. These pre-test questionnaires
will not be included in the final data analysis.
Ethical considerations
It is important to note that before embarking on this research, ethical approval was obtained from the concerned
authorities.
©Muhesi, 2024
RESULTS
Social demographic data findings
Table 1: Table showing socio demographic factors of study participants
Frequency Percent
Page | 35 age
15-19 years 73 19.2
20-24 years 167 43.8
25-29 years 76 19.9
30-34 years 50 13.1
35 years and above 15 3.9
gender
male 267 70.1
female 114 29.9
Religion
catholic 148 38.8
Anglican 102 26.8
Jehovah’s witness 48 12.6
Muslim 46 12.1
others 37 9.7
marital status of mother
single 204 53.5
married 82 21.5
divorced 31 8.1
cohabiting 64 16.8
level of education of mother
none 125 32.8
primary 85 22.3
secondary 170 44.6
©Muhesi, 2024
tertiary institution 1 0.3
occupation of parents/guardian
peasant 71 18.6
business man 133 34.9

Page | 36
civil servant 75 19.7
private employee 20 5.2
self employed 82 21.5
region of origin
central 116 30.4
eastern 36 9.4
western 223 58.5
northern 6 1.6
area of residence
urban 228 59.8
rural 153 40.2
history of mental illness
yes 123 32.3
no 258 67.7
know anyone with a mental illness
yes 194 50.9
no 187 49.1
awareness on mental illnesses
yes 248 65.1
no 133 34.9
class
1st year 84 22
2nd year 162 42.5
3rd year 52 13.6
©Muhesi, 2024
4th year 42 11
5th year 41 10.8
A greater number of the participants were males (70.1%) most were aged between 20-24 years (43.8%) by religion,
most (38.8%) were Catholics, the marital status of mothers of most participants (53.5%) were single, most (34.9%)
guardians were business men, urban is where a greater number (59.8%)of the participants lived, and most came from
Page | 37 western Uganda.
Table 2: shows the Perception about mental health and mental health services
Frequency Percent
Due to substance abuse
strongly agree 258 67.7
agree 123 32.3
due to genetic inheritance
agree 124 32.5
un decided 41 10.8
disagree 39 10.2
strongly disagree 16 4.2
Due to head injury
strongly agree 183 48
agree 150 39.4
un decided 13 3.4
disagree 21 5.5
due to physical illness
agree 130 34.1
un decided 71 18.6
disagree 49 12.9
strongly disagree 19 5
Is mental illness treatable
agree 172 45.1
un decided 31 8.1
disagree 1 0.3
strongly disagree 4 1
contagious
agree 49 12.9
un decided 48 12.6
disagree 38 10
evil spirits
©Muhesi, 2024
agree 64 16.8
un decided 143 37.5
disagree 5 1.3
Page | 38
responsibility to care for patients
agree 77 20.2
un decided 28 7.3
disagree 11 2.9
stress
agree 161 42.3
un decided 42 11
disagree 33 8.7

Is mental disease a punishment
agree 44 11.5
un decided 82 21.5
disagree 85 22.3
Bivariate analysis of socio-demographic factors associated with perception towards mental health and mental health
services among university students
Table 3: Bivariate analysis of socio-demographic factors associated with the perceptions towards mental
health and mental health services among university students.
Frequency Percent p- values odd ratios

age
15-19 years 73 19.2 0.091 0.784
20-24 years 167 43.8
25-29 years 76 19.9
30-34 years 50 13.1
35 years and above 15 3.9
gender 0.252 1.417
male 267 70.1
female 114 29.9
religion
catholic 148 38.8 0 1.874
Anglican 102 26.8
©Muhesi, 2024
Jehovah’s witness 48 12.6
Muslim 46 12.1
others 37 9.7
marital status of mother
single 204 53.5 0.131 0.824
Page | 39
married 82 21.5
divorced 31 8.1
cohabiting 64 16.8
level of education of mother
none 125 32.8 0 2.182
primary 85 22.3
secondary 170 44.6
tertiary institution 1 0.3
occupation of parents/guardian
peasant 71 18.6 0.019 0.792
business man 133 34.9
civil servant 75 19.7
private employee 20 5.2
self employed 82 21.5
region of origin
central 116 30.4
eastern 36 9.4
western 223 58.5
northern 6 1.6
area of residence
urban 228 59.8 0 0.157
rural 153 40.2
history of mental illness
yes 123 32.3 0.021 0.519
no 258 67.7
know anyone with a mental illness
yes 194 50.9
no 187 49.1
awareness on mental illnesses
yes 248 65.1
no 133 34.9
class
1st year 84 22 0.499 1.081
©Muhesi, 2024
2nd year 162 42.5
3rd year 52 13.6
4th year 42 11
5th year 41 10.8
Page | 40
Knowledge on mental health and mental health services.

Table 4: shows the knowledge on mental health and mental health services among university students
Frequency Percent
has to be admitted
yes 348 91.3
no 33 8.7
has had serious depression
yes 294 77.2
no 87 22.8
born with brain abnormality
yes 192 50.4
no 189 49.6
person not responsible for own actions
yes 235 61.7
no 146 38.3
incapable of making simple decisions
yes 275 72.2
no 106 27.8
prone to violence
yes 290 76.1
no 91 23.9
know advice for professional help
yes 255 66.9
no 126 33.1
know treatment is effective
yes 268 70.3
no 113 29.7
psychotherapy effective treatment
yes 223 58.5
no 158 41.5
know it can recover
yes 261 68.5
no 120 31.5
©Muhesi, 2024
Figure 1
Page | 41
Figure 1: shows some statements which describe a person with mental illness; majority of the participants (91.3%)
ticked has been admitted, most (77.2%) ticked yes for bouts of depression, a greater number (50.4%) ticked yes for
born with an abnormality in the brain, majority (61.7%)ticked not responsible for own actions, a greater
number(72.2%) of the participants knew a health patient as a person who is incapable of making simple decisions,
and statements which assess stigma related to mental health knowledge; majority of the participants (66.9%) said
yes, they know advice to give for professional help, most of the participants (70.3%) know treatment is effective in
treating mental illness, a greater number of the participants (58.5%) know that psychotherapy is effective in treating
mental illness and 68.5% know that mental illness can recover.
DISCUSSION
Socio demographic factors of study participants
A greater number of the participants were males (70.1%) most were aged between 20-24 years (43.8%) by religion,
most (38.8%) were Catholics, the marital status of mothers of most participants (53.5%) were single, most (34.9%)
guardians were business men, urban is where a greater number (59.8%)of the participants lived, and most came from
western Uganda.
Perception about mental health and mental health services
Table 2: Majority of the participants (67.7%) strongly agreed that mental illness can be caused by substance abuse,
a greater number strongly agreed that mental illness is caused by genetic inheritance (42.3%), majority
(42.3%)agreed that stress can cause mental disease, most (48%) strongly agreed that head injury can cause mental
©Muhesi, 2024
illness, a big percentage (45.4%) strongly agreed that mental disease is treatable, most (39.4%) strongly disagreed
that mental illness is not contagious, majority (37.5%) were un decided about mental disease being caused by evil
spirits, majority (66.1%) strongly agreed that they have responsibility to care for patients with mental disease and
most(28.9%) strongly disagreed that mental disease is a punishment. A big percentage (45.4%) strongly agreed that
mental disease is treatable which is low compared to (73.3%), and 0.3% believed that mental is not treatable, which
is low compared to 3.3% in a study carried out in Uganda by Wallace et al. [25].
Page | 42 Knowledge on mental health and mental health services
Table 4: shows some statements which describe a person with mental illness; majority of the participants (91.3%)
ticked has been admitted, most (77.2%) ticked yes for bouts of depression, a greater number (50.4%) ticked yes for
born with an abnormality in the brain, majority (61.7%)ticked not responsible for own actions, a greater
number(72.2%) of the participants knew a health patient as a person who is incapable of making simple decisions,
and statements which assess stigma related to mental health knowledge; majority of the participants (66.9%) know
the advice to give for professional help, most of the participants (70.3%) know treatment is effective in treating
mental illness, a greater number of the participants (58.5%) know that psychotherapy is effective in treating mental
illness and 68.5% know that mental illness can recover.
CONCLUSION
The perceptions associated with factors and knowledge on mental health and mental health services were
significantly associated with age and family history of mental illness.
Recommendations
People with a positive family of mental diseases should avoid situations, like stress and drugs of abuse which would
trigger the mental illnesses. The government and potential health workers should consider availing programs to
avail knowledge and awareness on mental diseases. Academicians, researchers and organization should carry out
more studies related to perception and factors associated with mental health and mental health services.
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CITE AS: Muhesi Edward (2024). Factors Affecting the Perception of

Mental Health and Mental Health Services among University
Students of Kampala International University, Western Uganda.
EURASIAN EXPERIMENT JOURNAL OF MEDICINE AND
MEDICAL SCIENCES, 5(1):31-43.
©Muhesi, 2024

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Page | 31 Factors Affecting the Perception of Mental Health and

3.8416 𝑥 0.5 𝑥 0.5

From above, our sample size will be 364 participants.

15-19 years 73 19.2

20-24 years 167 43.8

25-29 years 76 19.9

30-34 years 50 13.1

35 years and above 15 3.9

male 267 70.1

female 114 29.9

catholic 148 38.8

Anglican 102 26.8

Jehovah’s witness 48 12.6

marital status of mother

single 204 53.5

level of education of mother

none 125 32.8

secondary 170 44.6

business man 133 34.9

private employee 20 5.2

self employed 82 21.5

central 116 30.4

western 223 58.5

urban 228 59.8

rural 153 40.2

history of mental illness

yes 123 32.3

know anyone with a mental illness

yes 194 50.9

awareness on mental illnesses

yes 248 65.1

2nd year 162 42.5

3rd year 52 13.6

5th year 41 10.8

strongly disagree 28 7.3

Frequency Percent p- values odd ratios

Knowledge on mental health and mental health services.

CITE AS: Muhesi Edward (2024). Factors Affecting the Perception of

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