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Assessment of Mental Health Status and Attitude towards Promotive
Mental Health Care Practice among Nurses in Ekiti State, Nigeria
*Oluwagbenga O. Aina
1
, Joel A. Afolayan
2
, Ejemba Anyebe
2
, Abosede O. Ajiboye
3
, Bunmi A. Yusuf
3
1
Department of Nursing Science, Federal University Oye Ekiti, Ekiti State
2
Department of Nursing Science, University of Ilorin, Kwara State
3
Department of Nursing, Afe Babalola University, Ado-Ekiti, Ekiti State, Nigeria.
*Corresponding Author
DOI: https://dx.doi.org/10.47772/IJRISS.2025.903SEDU0680
Received: 14 May 2025; Accepted: 24 May 2025; Published: 21 November 2025
ABSTRACT
Self care practices remain a major concern among nurses. In particular, mental health self care awareness and
practice is an uninvestigated area of research in our environment.
Aim: The study aimed to investigate mental health status and attitude towards promotive mental health care
practice among nurses in Ekiti State southwest Nigeria.
Materials and Methods: Adopting a descriptive cross-sectional design, a multistage sampling technique was
employed involving proportionate sampling with simple random probability sampling method to select 263
Nurses whose Socio-demographic data, mental health status and attitude towards promotive mental health care
practice were determined using an adapted standardized questionnaire. Descriptive analyses and Logistic
regression was used at 0.05 level of significance through statistical package for the social science software.
SPSS version 27
Results: Results indicated that study participants had, predominantly female gender of (81.9%), (74.6%) of the
respondents had working experiences of between 1 and 5 years and with the mean age to be 27.6 years.
Majority (97.3%) reported good mental health state. The mean value of (2.74) was recorded for attitude
towards the practice of promotive mental health care with the expected mean value of (2.0). The model fitting
information (MFI) value of (0.001) with Pearson and Deviance good-of- fit value of (0.600 and 0.870)
respectively, shown significant relationship between respondents’ attitude and the practice of promotive
mental health care. The study concludes that the mental health state among the studied population is good and
that attitude towards practice of promotive mental health care is good among nurses.
Keywords: Mental Health Status, Promotive, Mental Health Care, Nurses.
BACKGROUND OF THE STUDY
The burden of mental health problems is increasing globally. In 2020, mental disorders accounted for 13 % of
the worlds burden of diseases and this figure is projected to increase to 15 % by the year 2025. Worldwide
studies have shown that as many as 450 million people suffer from mental disorder and their disabling effect.
Mental disorder, as defined according to diagnostic criteria, refers to a lack of psychological wellbeing
affecting a person’s thoughts, feelings, behavior and functioning. (Sintayehu, 2020).
According to Anyebe et al (2019), despite having the mental health units on the service delivery charts of the
primary healthcare centres, none was providing any formal mental health services and there were only few
uncoordinated services in some centres in Nigeria.
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Mental health is the level of psychological well-being or an absence of mental illness (WHO, 2019). It is the
state of someone who is "functioning at a satisfactory level of emotional and behavioral adjustment".
From the
perspectives of positive psychology or of holism, mental health may include an individual's ability to enjoy life
and to create a balance between life activities and efforts to achieve psychological resilience (Snyder, Lopez,
Shane, Pedrotti & Jennifer, 2017). In a study on interventions to increase use of services; Mental Health
prevention and promotion in Nigeria, The incident rate for initial period of intervention is five times higher
than the baseline rate (95% CI; 3.42–7.56; p < 0.001) though this diminished in the long term, leveling off
above initial baseline (Gureje et al, 2018).
In another study on Developing mental health services in Nigeria For the year 2013, the distribution of the
counts (new patients seen) was not statistically different from month to month between the months of January
to October 2003 (v 2 = 9.50, df = 9 and P = 0.39). How- ever, the distribution of counts for the whole year,
following the awareness campaign, was statistically signifcant (v 2 = 149.82, df = 11 and P < 0.05). Again, this
basic conclusion held when a linear model fit on this time series was carried out. The model incorporating the
first 10 months yielded an R 2 of 0.001 with a P value of 0.93. In sharp contrast was the model that
incorporated the 2 months of November and December following the awareness campaign, it yielded an R 2 of
0.33 and a P value of 0.05. Thus, the awareness campaign accounted for about a third of the increase in the
presentation of new cases to the community clinics. The result of a linear model fit for the year 2014 (when no
training was held in Imo) was instructive. There was no statistical difference for the first 10 months and that of
the whole year. The burden of illnesses from mental health disorders is by far the highest of all health
problems worldwide, accounting for 13% of the total burden of illness from all diseases. More specifically,
mental illness accounts for 32.4% of years lost due to mental illness or disability (YLDs) and 13% of
disability-adjusted life years (DALYs), which is the exact measure of disease burden (Sam & Greb, 2017).
DALYs corresponding to the burden of mental illness is the sum of YLDs along with years lost due to
premature death from mental illness (YLL). At the EU Member State level, the cost of mental disorders is
estimated at 3–4% of GDP, mainly due to the loss of productivity. Providing high-quality psychiatric care to
mental patients, especially in the context of the EU, is an obligation of the welfare state, a duty of the mental
health professionals, and the patients’ right (Vigo &Thornicroft, 2018). Health is defined as "a state of
complete physical, mental, and social well-being and not merely an absence of disease or infirmity" by World
Health Organization (WHO, 2016).
The three kinds of interventions of promotion, prevention, and treatment are interrelated and complementary;
however, they are somewhat different from one another. In this regards, psychiatrists also need to be
competent in prevention of mental illnesses and mental health promotion in various settings, therefore this
research will assess preventive and promotive mental healthcare services among nurses in selected Hospitals In
Ekiti State.
MATERIAL AND METHOD
A descriptive survey method was employed in carrying out this study. The setting was the three (3) tertiary
health institutions, the three (3) state specialist hospitals with the general hospitals in Ekiti State which were
Federal Teaching Hospital, Ido-Ekiti (FETHI), Ekiti State University Teaching Hospital, Ado-Ekiti
(EKSUTH), Afe-Babalola Multisystem Hospital, Ado-Ekiti (AMSH), State Specialist Hospital in Ikole Ekiti,
Ado Ekiti and Ijero Ekiti, General Hospital in Oye Ekiti, Ifaki Ekiti and Iyin Ekiti. The target population
comprised of 916 nurses from the health institutions. The sample size is two hundred and sixty three (263)
participants proportionate and simple random probability sampling technique
Sample Size Determination
Proportionate and simple random probability sampling technique was employed to ensure that every nurse who
met the inclusion criteria was adequately represented and had equal chance of being selected. The sample size
was determined using Taro Yamane method of sample size calculation according to the formula, n = sample
size, e= margin error = 0.05 with a sample size of 263. A standardized instrument adapted from Abaris
Questionnaire was developed. The instrument comprised of four sections. Section A consist of demographic
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
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characteristics of respondents, Section B focused on mental health state of the respondents , Section C
presented attitudes of the respondents towards promotive mental health care practice.
Ethical Approval
The study was approved by the ethical committees of the health institutions and ethical approval certificate
was obtained with reference number ERC/2021/05/30/550B, EKSUTH/A67/2021/03/07 and AB/EC/21/03/230
respectively. Having obtained the informed written consent from the eligible participants, the respondents were
informed about the purpose and benefits of the study. They were informed of their right to withdraw at any
time without any consequences. Information provided by the participants during data collection was not
divulged to others. Name or any form of identity was not required on the questionnaire to ensure confidentially
and anonymity, thus protecting the privacy of participants.
RESULTS
The socio-demographic data of Ekiti Nurses that took part in the study has mean age of 27.6 years. The
majority were female with 213(81.9%) of the participants and male nurses involved were only 47(18.1%). The
marital status across board were 202(77.7%), single 52(20%), divorce 2(0.8%) and widowed 4(1.5%). Three
prominent ethnicity were focused; Yoruba 225(86.5%), Igbo 15(5.8%), Hausa 0(0%) and others 20(7.7%)
formed the ethnicity. The religion were Christianity that has the highest devotees of 246(94.6%), Islamic
religion recorded 12 (4.6%) while others has the least members 3(0.4%). Those with RN that took part in the
study was 176(67.7%), RN/RPN 40(15.4%), RPN/BSc 39(15%), RPN/MSc 3(1.2%). The Ekiti Nurses were
ranked under five cadres namely Nursing Officer (NO), Senior Nursing Officer (SNO), Principal Nurses
Officer (PNO), Chief Nursing Officer (CNO) and Assistant Director Nursing Services (ADNS) with the values
194(74.6%), 40(15.4%), 12(4.6%), 6(2,3%) and 7(2.7%) respectively. Lastly, the year of service starting from
1-5years who has the highest number194 (74.6%), followed by 6-10years with figure 40(15.4%), 11-20years
of experience recorded 14(5.4%) and above 20years has the lowest number of 12(4.6%)
Out of 260 nurses that formed the sample only 8 (3.1%) confessed that they were admitted for mental health
related issues. Also, 8(3.1%) indicated presently taking mental health medication. “Have taken medication on
mental health problem in the past”, “trouble in controlling violent behaviour” and “serious thought of suicide”
recorded values 14(5.4%), 18(6.9%) and 19(7.3%) respectively. However, trouble in concentrating was
61(23.5%), troubled understanding was 36(13.8) and trouble in remembering attracted 49(18.8%)
Behavioral patterns like cowardly attractive; feeling of worthlessness; feeling of not being loved; hostility;
inadequacy, being ugly recorded low scores: 7(2.73%), 7(2.7%), 9(3.5%), 10(3.8%), 6(2.3%) and 4(1.6%)
respectively. While feeling of guilt was 20(7.7%), aggressiveness accounted for 18(6.9%) and misunderstood
by people had 35(13.5%). Other behavioral patterns that received higher responses are anxiety, feeling of
being intelligence incompetency, attractiveness and being confident were 82(31.3%), 108(41.5%),116(41.5%)
and133(51.2%). On the attitude towards promotive mental health care practice, the mean values were 2.4808,
2.6154, 2.4615, 2.5615 and 2.7385 which were well above benchmark of 2.0. for screening, proper diagnosis,
level of predisposition, referral services and treatment respectively. The model fitting information (MFI) in
Table 4.7 is significant with value 0.000, the good-of- fit of Pearson and Deviance were 0.60 and 0.870
respectively hence the model was well fit to the data set. The value of 0.264 for pseudo R square meaning that
26.4% of the dependent variable which is PPMS would be explained by the two covariates predictors known as
attitude of Ekiti Nurses and factors influencing PPMS.
The estimate of 0.858 indicated that one unit of attitude variable would be predicted by the dependent variable.
Similarly, one unit of factor variables would be explained by estimate of 1.993 of dependent variable. In the
same vein, attitude and factor are significant.
The implication of the result is that attitudes and factors would not significantly predict PPMH despite that
fitting of the model to the dataset. Hence the hypothesis 2 is thereby rejected.
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DISCUSSION
It was found that suicidal tendency, violent behaviour and taking of mental drugs in the past recorded low
percentages 19(7.3%), 18(6.7%) and 14(5.4%). But trouble in concentration and forgetfulness were fairly on
the high side with values of 61(23.5%) and 49 (18.8%) respectively. This contradicted the result obtained by
Zing et al (2020) in a national cross – sectional survey on mental health status of Chinese healthcare providers
which revealed that anxiety, feeling unhappy & depressed, unable to concentrate and couldn’t overcome
difficulties with the values of 2970(32.18%), 4533(49.12%), 8195(88.81%) and 8442 (91.48%) respectively.
Also, only 8(3.1%) were admitted for mental health related cases but 6258(67.77%) confessed to be admitted
for mental health related issue. The findings indicated that the attitudes of nurses toward practice of promotive
mental health care were positive. These findings disagreed with all the literature on attitudes of nurses on
mental health issues reviewed within and outside the country. The studies of Al-Awadji et al (2017); Hsiao et
al (2015); Sahile et al (2019) & Coker et al (2018) submitted that nurses have negative attitude to mental
health issues in the hospital. The result revealed that the predictors that is; attitude would not significantly
predict mental health care practice. These findings agreed with the findings of Al-Awadhi et al., (2017) and the
study of Sahile et al., (2019) that nurses have negative attitude toward mental health issues in the hospital. In
the same vein, the factors identified to influence mental health care practice would not significantly predict
mental health practice as stated by Umukoro (2016).
CONCLUSION
In accordance with the results of this study, it could be concluded that the nurses working in the three tertiary
health facilities have good mental assessments. The attitudes toward PMHC and its practice are commendable
in Ekiti State. Irrespective of gender and years of experience of nurses in Ekiti State to practice preventive and
promotive of mental health care services do not statistically related. Consequently, attitudes of nurses would
not significantly predict the practice of Preventive Mental Health Care.
RECOMMENDATIONS
Based on the findings from this study, the following are recommended:
Paucity of funding and unfavourable government policy about mental health and its practice inhibiting the
development of mental health nursing in Nigeria, the government at all levels are hereby encourage to fund
and enact laws that would assist mental health delivery in Nigeria.
Awareness about preventive and promotive mental health service through available mass media channels
should be embarked upon so that superstitious beliefs and stigmatization about mental illnesses could be
addressed among populace.
Government at all levels should make policy that will enhance Promotive Mental Health Care Services
Government at all levels should allocate more resources to finance Mental Health Care system
Suggestions for further studies
There are always rooms for further study on MHSPMHC, the topic can encompasses many categorical,
dependent and independent variables. The study was delimited to health institution in Ekiti State, it could
therefore be extended to southwest, Nigeria. A mixed method research or qualitative research could be carried
out, this would give a good evidence on triangulation of results. Other research design could be employed for
instance longitudinal method, quasi experimental design among others. Therefore the following research topics
are hereby suggested:
Effect of preventive and promotive mental health care service on mental health clients’ prognosis in specified
location.
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Perceptions and knowledge of non- psychiatry nurses toward preventive and promotive mental health service
in selected specialists hospitals in a specified location
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Table 1: Socio- Demographic Characteristics of Nurses in Tertiary Health Facilities in Ekiti State
Variables
Frequency
Percent
Valid Percent
Gender
male
47
18.1
18.1
female
213
81.9
81.9
Total
260
100.0
100.0
Marital Status
Single
202
77.7
77.7
Married
52
20.0
20.0
Divorce
2
.8
.8
Widowed
4
1.5
1.5
Total
260
100.0
100.0
Ethnicity
Yoruba
225
86.5
86.5
Igbo
15
5.8
5.8
others
20
7.7
7.7
Total
260
100.0
100.0
Religion
Christianity
246
94.6
95.0
Islam
12
4.6
4.6
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Others
1
.4
.4
Total
259
99.6
100.0
Professional Qualification
RN
176
67.7
68.2
RN/RPN
40
15.4
15.5
RPN/BSc
39
15.0
15.1
RPN/MSc
3
1.2
1.2
Total
258
99.2
100.0
Ranks
NO
194
74.6
74.9
SNO
40
15.4
15.4
PNO
12
4.6
4.6
CNO
6
2.3
2.3
ADNS
7
2.7
2.7
Total
259
99.6
100.0
Years of Experience
1-5years
194
74.6
74.6
6-10years
40
15.4
15.4
11-20
14
5.4
5.4
>20years
12
4.6
4.6
Total
260
100.0
100.0
Age
Mean = 27.6
Median=26.0
Mode=24.0
Table 2: Mental Health Assessment of Nurses in Ekiti State
Mental health assessment
Frequency
Percent
Valid Percent
Cumulative Percent
Number of patients hospitalized
8
3.1
3.1
3.1
Trouble in understanding
No
224
86.2
86.2
86.2
Yes
36
13.8
13.8
13.8
Total
260
100.0
100.0
100.0
Trouble in concentrating
No
199
76.5
76.5
76.5
Yes
61
23.5
23.5
23.5
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Total
260
100.0
100.0
100.0
Trouble in remembering
No
211
81.2
81.2
81.2
Yes
49
18.8
18.8
18.8
Total
260
100.0
100.0
100.0
Trouble in controlling violent
behavior
No
242
93.1
93.1
93.1
Yes
18
6.9
6.9
6.9
Total
260
100.0
100.0
100.0
Serious thought of suicide
No
239
92.7
92.7
92.7
Yes
19
7.3
7.3
7.3
Total
260
100.0
100.0
100.0
Presently taking mental health
medication?
No
250
96.2
96.9
96.9
Yes
8
3.1
3.1
3.1
Total
260
100.0
100.0
100.0
Have taken medication on mental
health problem in the past
No
244
93.8
94.6
94.6
Yes
14
5.4
5.4
5.4
Total
260
100.0
100.0
100.0
Table 3: A closer look on mental health assessment
Mental Health Assessment
Frequency
Percent
Valid Percent
Cumulative Percent
Worthlessness
No
253
97.3
97.3
97.3
Yes
7
2.7
2.7
100.0
Total
260
100.0
100.0
Inadequate
No
254
97.7
97.7
97.7
Yes
6
2.3
2.3
100.0
Total
260
100.0
100.0
Guilt
No
240
92.3
92.3
92.3
Yes
20
7.7
7.7
100.0
Total
260
100.0
100.0
Anxious
No
178
68.5
68.5
68.5
Yes
82
31.5
31.5
100.0
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Total
260
100.0
100.0
Aggressive
No
242
93.1
93.1
93.1
Yes
18
6.9
6.9
100.0
Total
260
100.0
100.0
Lonely
No
221
85.0
85.3
85.3
Yes
38
14.6
14.7
100.0
Total
259
99.6
100.0
Confused
agitated
No
245
94.2
94.2
94.2
Yes
15
5.8
5.8
100.0
Total
260
100.0
100.0
Ugly
No
254
98.4
98.4
98.4
Yes
4
1.6
1.6
100.0
Total
258
99.2
100.0
Unloved
No
251
96.5
96.5
96.5
Yes
9
3.5
3.5
100,0
Total
260
100.0
100.0
Unconfident
No
235
90.4
90.4
90.4
Yes
25
9.6
9.6
100.0
Total
260
100.0
100.0
Intelligence
incompetent
No
152
58.5
58.5
58.5
Yes
108
41.5
41.5
100.0
Total
260
100.0
100.0
Hostility
No
250
96.2
96.2
96.2
Yes
10
3.8
3.8
100.0
Total
260
100.0
100.0
Cowardy
unattractive
No
253
97.3
97.3
97.3
Yes
7
2.7
2.7
100.0
Total
260
100.0
100.0
Misunderstoo
d by people
No
225
86.5
86.5
86.5
Yes
35
13.5
13.5
100.0
INTERNATIONAL JOURNAL OF RESEARCH AND INNOVATION IN SOCIAL SCIENCE (IJRISS)
ISSN No. 2454-6186 | DOI: 10.47772/IJRISS | Volume IX Issue XXVI October 2025 | Special Issue on Education
www.rsisinternational.org
Page 8976
Total
260
100.0
100.0
Attractive
No
144
55.4
55.4
55.4
Yes
116
44.6
44.6
100.0
Total
260
100.0
100.0
Confident
No
127
48.8
48.8
48.8
Yes
133
51.2
51.2
100.0
Total
260
100.0
100.0
Panicky
No
237
91.2
91.2
91.2
Yes
23
8.8
8.8
100.0
Total
260
100.0
100.0
Table 4: Attitude of Ekiti Nurses toward Promotive Mental Health Care Practice.
Attitude towards preventive and promotive mental
health care services
N
Mean
Expected
mean
Std.
Deviation
Remark
It is necessary to go for screening on mental well-
being
260
2.4808
2.0
1.45579
G.A
Appropriate diagnose is necessary to know my mental
status
260
2.6154
2.0
0.66790
G.A
I must verify whether I am predisposing to a mental
problem
260
2.4615
2.0
0.79723
G.A
Prompt referral for mental problems when indicated is
necessary
260
2.5615
2.0
0.71933
G.A
Prompt treatment is necessary for mental problems
260
2.7385
2.0
0.62204
G.A
Table 5: Ordinal regression of Practice of Mental Health Care against attitude of nurses and factors influencing
PPMHC
PREDICTORS
Estimate
Std.
Error
Wald
df
Pseudo
R
square
Good-of-fit
MFI
Sig.
95% Confidence
Interval
Pearson
Deviance
Lower
Bound
Upper
Bound
ATTITUDE
0.858
.214
16.033
1
26.4%
0.600
0.870
0.000
0.000
0.438
1.278
FACTOR
1.993
.343
33.838
1
0.000
1.322
2.665