Mental Health Help-Seeking Behavior in Young Adults in Tshabalala, Bulawayo, Zimbabwe

Mental Health Help-Seeking Behavior in Young Adults in Tshabalala, Bulawayo, Zimbabwe

Honest Tshuma & Cathrine Tariro Macherera

Great Zimbabwe University

DOI:

Received: 30 January 2025; Accepted: 08 February 2025; Published: 12 March 2025

ABSTRACT

This study used the quantitative approach to examine the mental help-seeking behaviors of young adults in Tshabalala, a location in Bulawayo Zimbabwe. It sought to explore mental health literacy, availability of mental services, and perceived need for help. The study population was 1341 young adults in the 18-29 age group. The sample consisted of 107 participants. The findings of the Chi-square test were statistically significant (X2(7, N=107) =28,428, p, <.001), thus indicating a strong association between Gender differences and Help-seeking behavior and (X2(9, N=107) =73,742 p, <.001). The study also shows a strong association between Gender differences and Perceived need for help. Further computations showed that 92% of the participants did not know the mental illness onset. The researcher came up with a School-Based Mental Health Literacy model that integrates mental health literacy into the extracurricular activities. The researcher recommended the inclusion of mental health education in the curriculum and the promotion of campaigns.

Keyterms:  Mental, Health, Gender, Seeking behavior, Stress, Anxiety, Depression

INTRODUCTION

Young people between 18-24 are estimated to be about 1.2 billion, thus 16 % of the global population. Brits (2021) [2] states that research has shown that there are high incidence rates of mental disorders in 16 sub-Saharan African countries. Across 37 studies from 2008 to 2020 with 97,616 participants the researchers found that 26.9% had depression, anxiety disorders 29.8%, emotional behavioral problems 40,8%, PTSD 21.5%, and suicidal thoughts 20.8%. These mental conditions have been more prevalent in high-income countries. Still, now a new trend is being seen in Africa especially sub-Saharan Africa with impoverished living conditions, HIV and AIDS, and other problems that Africa faces as a continent like unemployment. Africa only holds about 454.5 million of this population, 22% of the world’s population (Rocca & Schultes, n.d.) [10] Jurewicz (2015) [5]. A study by the Zimbabwe Civil Liberties And Drug Network showed that 60% of admissions to mental health institutions were due to substance abuse and 80% of these were students from tertiary institutions (Gora, 2022) [4]. According to WHO (2020) , Zimbabwe has shortages in services and human resources to cater to mental health issues in the country. Wong et.al (2020) [13] suggest that studies have shown that mental health help-seeking behavior is influenced by stigma, lack of symptom awareness, and lack of knowledge about treatment services. Most studies on mental health-seeking behavior have been done in Western society hence the researcher focused on Tshabalala Bulawayo, to cater to Africans, particularly in Zimbabwe. This quantitative research has specifically focused on young adults’ mental health-seeking behavior. This research attempts to fill the knowledge gap.

Objectives

The specific objectives of the study were

1. To determine whether mental health services are available for young adults in Tshabalala
2. To assess the knowledge of young adults on mental health.
3. To analyse the perceived need for seeking mental help among young adults in  Tshabalala
4. To determine gender differences in help-seeking practices of young adults in Tshabalala.

The hypotheses tests used was as follows:

1. There are no mental health services for young adults in Tshabalala.
2. There is inadequate knowledge of mental health in young adults in Tshabalala.
3. Young adults in Tshabalala do not see the need to seek mental help.
4. There are gender differences in mental help-seeking practices among young adults in Tshabalala.

METHOD

Population

The population of this study consisted of young adults in the Tshabalala suburb between the ages of 18-29. According to Zimstats (2022), there are currently 217 829 youths that range from the ages of 15-29 in Bulawayo. Tshabalala suburb is made up of two locations, Old Tshabalala and Tshabalala Extension. The number of young adults in the Tshabalala Suburb as published by the Bulawayo City Council is 4023, While Tshabalala Extension consists of a third of the population which is 1341 young adults. The study focused on the young adults in Tshabalala Extension.

Sample and sampling techniques

The calculated sample size was 299, but the researcher conducted the study with only 107 participants because of limited time and resources such as internet to answer the survey.  The suburb was selected using simple random sampling of all high-density suburbs because they have high numbers of young adults. Simple random sampling was used to select participants for the survey, mostly because of its simplicity and lack of bias. The method of sampling was chosen because every participant in the study got an equal opportunity to be chosen, not forgetting that randomization was the best method to eliminate the issue of confounding variables.

The simple random sample size was calculated using :

n = (Z^2 * p * q) / (e^2)

where:

n is the sample size

Z is the z-score for the desired confidence level

p is the estimated proportion of the population with the characteristic of interest

q is the estimated proportion of the population without the characteristic of interest

e is the desired margin of error

299 = (±1.96*.50*.50)/(±5)

Data gathering instrument

Primary For the first objective, a desktop study was conducted, and online articles were used to assess existing mental health services for young adults in Tshabalala.

The researcher adopted the General Help-Seeking Questionnaire Vignette Version (GHSQ-V) which was developed to assess help-seeking intentions. The GHSQ-V was adapted by the researcher for the population under study. The GHSQ-V is a valid and reliable measure of help-seeking intentions with validity scores ranging from .50 to 80, while the instrument showed a good internal consistency reliability, with Cronbach alpha values ranging from .70 to 89. The instrument also showed good test-retest reliability,

 Wilson, Deane, Ciarrochi, & Rickwood (2005) [12] . The researcher also adapted the Mental Health literacy scale by O’Conor & Casey (2015) which contained questions on Mental health literacy and was also adjusted to fit the population under study. The reliability of the MHLS showed good internal consistency with the Cronbach alpha ranging from .80 to .90, it also showed to have good test-retest reliability with scores ranging from .70 to .80. The instrument also showed that it had good validity with the measures ranging from .50 to .80.

The researcher designed a closed-ended questionnaire with sections that linked to the objectives. Section A contained questions that addressed the biographical data of the participants, thus age, gender and level of education. This was important as the research sought to compare help-seeking behavior and gender. Section B contained questions on Mental Health knowledge, Section C had questions on the perceived need for help and Section E contained questions on Help-seeking intentions.

The instrument was administered online via Google Forms, as it was an easier way to disseminate the questionnaire. The platform allowed all the data to be stored there after collection for analysis.

Procedure

Permission A quantitative approach was used. Mason (2013) [7] suggests a quantitative approach seeks to quantify the observations making them numeric. This approach enabled the researcher to get responses from many participants thus getting a wider perception of the issue being studied. The researcher used this approach as a way to get a broader perspective of the mental help-seeking behaviors of young adults in Tshabalala.

Design

The research design that was used for this study is descriptive as it seeks to describe the mental health-seeking behaviors of young adults. This design is appropriate for this study as it sought to describe the trends in the help-seeking behavior of young adults and explain the phenomena. It described the knowledge of young adults on mental health and showed the frequencies and even for mental help-seeking behavior.

Data analysis

The data was analyzed using the Social Science Statistical Packages (SPSS V23) and Excel. Descriptive statistics such as age, gender and level of education were analyzed to see the variations of the participants in the study. The Pearson Chi-square test was used to examine the relationship between gender and perceived need for help in young adults and A Chi-square test that was used by the researcher to test the association of gender differences and help-seeking behavior. The researcher also analyzed the mental health literacy levels to test the hypothesis.

Ethical Considerations

The In research ethics are principles that serve as a guide to the practices and research designs, every research must adhere to a code of conduct when the data being collected involves people (Bhandari, 2018) [1].  Ethics matter as they adhere to human rights, dignity, and integrity, the participation should be voluntary, informed, and safe for participants. The researcher sought a letter from the school that allowed her to get permission to carry out the research. Informed consent was sought from the participants before they participated in the study. The participants were informed at first about the purpose of the study and they gave their consent to the participant. Confidentiality and anonymity were assured by the researcher to the respondents.

FINDINGS OF THE STUDY

Gender Distribution and education level of the respondents

The study comprised 56% (60) females and 44% (47) males. The average age of the participants was 23 years (SD= 4 years). The median age of the participants was 24 years and mode 19 years. Of these 11% indicated their highest level of education was A-level, 35% were either pursuing a degree or had obtained one, 25% had diplomas, 12% said O-level, 19% had a National Certificate, and 6% had primary education. This shows that all participants had some level of literacy.

Mental Health Services

A desktop study investigated the availability of mental health services for young adults in Tshabalala. There were none. The few offered by the City of Bulawayo outside Tshabalala are too expensive for young adults to afford. The only free counseling services available in Bulawayo town are at Ingutsheni Psychiatric Hospital but the problem is with the stigma attached to visiting the psychiatric unit, hence the hypothesis stating there are no mental health services for young adults in Tshabalala was accepted.

Mental health literacy of young adults in Tshabalala

There was a question on the mental health onset and the responses show that 39% of the participants indicated 10 years old, 8% mentioned 14 years and 53% mentioned 18 years old. It can be noted that only a total of 8% of the participants correctly mentioned the early onset of mental illnesses. 92% of the respondents don’t know the mental illness onset, which is very important information that influences help-seeking behavior. Furthermore, on the question where participants were supposed to identify mental illnesses, 23% of the participants could not, 23% got it correctly, while the rest, 54% got it wrong. This shows that the participant’s knowledge of mental illnesses is minimal.

Help seeking behavior

Table 1 Chi-Square Test, Effective Size

1. 7 cells (43.8%) have expected count less than 5. The minimum expected count is 1.27.

A Chi-square is a non-parametric test that was used by the researcher to test the association of gender differences and help seeking behavior. A Pearson Chi-square test was conducted to examine the relationship between gender and help seeking behavior in young adults. The Chi-square test was statistically significant X2(7,N=107)=28,428, p,<.001. Thus indicating a strong association between Gender differences and Help seeking behavior. The likelihood ratio Chi-square X2 LR(7,N=107)= 32.748, p<.001. The effect size as measured by Cramer V is .830 which entails that the difference between males and females in help seeking is high.

Perceived need for Help

Table 2 Chi-Square Tests

1. 11 cells (55.0%) have expected count less than 5. The minimum expected count is .16.

A Pearson Chi-square test was conducted to examine the relationship between gender and Perceived need for help in young adults. The Chi-square test was statistically significant X2(9,N=107)=73,742 p,<.001. Thus indicating a strong association between Gender differences and Perceived need for help. The likelihood ratio Chi-square X2 LR(9,N=107)= 68,980, p<.001. The effect size as measured by Cramer V is .515 which entails a moderate association between gender and perceived need for help. There are various factors that affect perceived need for help like access to mental health facility, as shown before that in Tshabalala there are no mental health facilities, which explains the moderate association between gender and perceived need for help.

Limitations of the study

The limitations of the study included the following;

1. The sample was limited to a single center, Gwanda Hospital, however, results may be applicable to other centers as well with similar characteristics.

2. The sample size with missing data might not give conclusive results, however, the missing data was catered for in the analysis.

DISCUSSION, RECOMMENDATIONS & CONCLUSION

Discussion

UNICEF (2022) suggests that there has been a high rise in mental illnesses among young adults which was noted by the high number of suicides, substance abuse, and other behaviors that are predispositions to mental illness. The researcher focused on mental health services available in Tshabalala, Mental health literacy, the perceived need for help, and the help-seeking behavior of young adults. Gora (2022) [4] states that a study by the Zimbabwe Civil Liberties and Drug Network indicated that 80% of those admitted to mental institutions were tertiary students, that’s the population that falls under young adults, thus showing the need for mental health services for young adults. WHO (2022) confirms that Zimbabwe has a shortage of mental health services and human resources that cater to mental health interventions. This is due to a lack of resources. The scarcely available resources may end up having to be shared among other pressing problems such as HIV/AIDS and food security. However, some studies show that some neighboring African countries are doing well in this regard with South Africa and Kenya having well-established mental health facilities that offer a wide range of mental health services for young adults in clinics and community-based hospitals. Rocca, & Schultes (2022) [10].

Urie Bronfenbrenner’s theory of Ecological Systems provides an understanding of the factors that contribute to the unavailability of mental services, Bronfenbrenner describes the exosystem where there are formal and informal structures that do not contain the individual directly but influence the individual (Evans,2023). The ecosystem contains the local government, and mass media etc., this theory suggests that the government might lack funding to fund mental health services in the communities, which we can attribute to the economic hardships that the country has been facing.

Mental Health Literacy: Conduct Mental health literacy was also another measure that was assessed in the study, where the researcher wanted to know if the young adults had any knowledge of mental health disorders and general knowledge of mental illnesses. The knowledge of mental illness onset is very important as mental illness can impact one’s life if there is no early intervention and can make the illness difficult to treat when severe. According to a study published in the Journal of the American Medical Association (Villatoro, et.al, 2017) [11], only 50% of young adults were aware of the onset of mental illnesses, while 50% of the young adults were not aware of the symptoms and signs of mental illness, this delays diagnosis and treatment. A study in 2017 by the National Alliance on Mental Illnesses (NAMI) found that only 44% of young adults could identify the earliest signs of mental illness and were more likely to report that they did not know the onset of the illness. This study shows that worldwide most young adults have little knowledge when it comes to onset and the symptoms of mental illness. Brits (2021) [2] states that the lack of knowledge about mental illnesses might be because mental health is not discussed in schools and at home. This could be attested by Zimbabwean curricula that do not contain information on mental health. Wong et al, (2020) [13] state that most young adults are misinformed about mental illnesses because of the high exposure to online platforms and media that circulate untruthful information. This misinformation can lead to confusion and misunderstanding about mental illnesses.

Help-seeking practices: Wilson (2005) [12] mentions that traditional gender roles often dictate that men should be independent and strong while women should be more vulnerable and dependent. This makes it difficult for men to accept that they need help, as seeking help is seen as a weakness. A study in 2021 by Wolfschlag, Grudet & and Håkansson, found that women in Ghana were more likely than men to seek help for mental health problems from both traditional healers and mental health professionals. The study also found that women who sought help from traditional healers were more likely to report that their mental health had improved, compared to men who sought help from traditional healers.  Also, cultural beliefs play a pivotal role when it comes to mental help-seeking behavior as in most African societies mental health illness is associated with some form of spirituality that then affects the help-seeking practices. Similarly, with the young adults in Tshabalala, their seeking help practices are affected by spirituality and culture. Wubetu, Habte & and Dagne’s (2019) study found that women in sub-Saharan Africa were more likely than men to seek professional help for mental health problems. Perceiving seeking help as a weakness creates a stigma associated with mental health problems in men (Wilson,2005) [12]. This stigma might prevent men from seeking help and fear of being judged.   Matar, Laletas & and Lubman(2023) [8] state that stigma can negatively impact help-seeking behavior, in the sense that one might see the need for help but might be afraid to look for help as the community, the family might not be supportive and that might affect treatment and recovery. McLeod (2023) [9] states that the social development theory by Lev Vygotsky views human development as socially meditated in which when people are young, they acquire cultural beliefs and problem-solving skills through dialogues with knowledgeable members of society. This theory shows that the knowledge that the young adults of Tshabalala have on mental health and their practices are culturally influenced and it’s the knowledge that has been passed down from the most knowledgeable of the members of the society.

Perceived need for help: The unavailability of mental health facilities is also another factor that can affect the perceived need for help. Kelly (2023) [6] states that if people do not know where or how to access the services, they are less likely to perceive the need for help even if they have mental problems. The unavailability of services usually leads to a lack of awareness of mental health problems. If people do not know about mental health problems, they are less likely to recognize the signs and symptoms in themselves or others. This can lead to delays in seeking help, which can make it more difficult to treat mental health problems treatment and recovery.  Lack of adequate knowledge about mental health can also affect the perceived need for help. Personal beliefs are the individual beliefs and values that people hold and can also influence how people perceive their mental health and whether they seek help for mental health problems. Evans (2023) [3] states that the Bronfenbrenner Ecological Systems theory can help explain one’s perceived need for help. The theory shows multiple levels of environment that affect the individual from immediate family to the law that governs a country. The microsystem that is close to the individual which is the school, family, and friends can easily affect the individual’s perceived need for help. The way that this system defines mental health and how they view it can have a huge impact on the individual and how they perceive their need for help. If the system influences the individual not to seek help, they won’t, these systems are important when it comes to an individual‘s decisions towards mental help-seeking.

Recommendation

1. Injection of funding directly to mental health systems in the country so as to allow service provision that meets international, standards of good practice and quality care. And also there is a need for a review of the Mental Health Act of 1996, as a lot may have evolved over time.
2. The inclusion of mental health information in the education sector, so that children can be taught in schools from a young age about mental health so that they can know the signs and symptoms and where to get help if the need arises.
3. To accelerate public education and campaigns that challenge traditional gender roles and encourage men to be more open about their emotions and to seek help when they need it.
4. To make mental health services more accessible and affordable for young adults.
5. To educate community leaders and religious leaders about mental health so they can play a role in reducing the stigma associated with mental illness, especially in men.

Conclusion

Mental health issues have become a top priority in this era, the country is slowly moving from demonizing mental illnesses to making them a cause of concern. A lot of issues have arisen, that is increased numbers of suicides and the high numbers of substance abuse cases, and all this being attributed to poor management of mental health problems. The issues of mental help-seeking behavior among young adults are of most concern as they are the population that is mostly affected by the negative consequences of not seeking help. The lack of knowledge about mental health is affecting the mental help-seeking behavior of young adults. Without knowledge, it is difficult to know the signs and symptoms of mental illness or to perceive help. From the tested hypothesis it can be concluded that gender differences played a role in both mental help-seeking behavior and perceived need for help. It was noted that females showed that they were more likely to seek help or to show the perceived need for help. This was mostly attributed to socialization, where it was noted that females are more socialized to be vulnerable and dependent which makes them likely to open up and share their problems as compared to their male counterparts. With the high numbers of males committing suicide, this showed the need for mental health awareness campaigns to remove the stigma associated with mental illness. None Governmental Organizations should come up with programs that include men in mental health awareness campaigns, or a hospital that offers free or affordable counseling services, to the general population.

From the tested hypothesis it can be concluded that gender differences played a role in both mental help-seeking behavior and perceived need for help. It was noted that females showed that they were more likely to seek help or to show the perceived need for help. This was mostly attributed to socialization, where it was noted that females are more socialized to be vulnerable and dependent which makes them likely to open up and share their problems as compared to their male counterparts. With the high numbers of males committing suicide, this showed the need for mental health awareness campaigns to remove the stigma associated with mental illness. Non-Governmental Organisations should come up with programs that include men in mental health awareness campaigns.

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