Background
Mental health is a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and able to contribute to her or his community [
1]. Mental disorder is a syndrome characterized by a clinically significant disturbances in cognition, emotion regulation, or behavior accompanied by psychological, biological, or developmental processes dysfunction [
2]. Mental disorders account for 14% of the global burden of disease; 75% of affected people are living in low-income countries [
3]. In Ethiopia, mental disorder is the leading non-communicable disorder which made up 11% of the total burden of disease [
4].
The social environment, academic norms, and psychosomatic reactions to diverse situation potentially affect the mental health of university students [
5]. Research conducted by the National Alliance on Mental Illness in the US have shown that 25% college students had a diagnosable illness, 40% did not seek help, 80% felt overwhelmed by their responsibilities, and 50% had anxiety [
6]. The American College Health Association survey report in 2010 also revealed that 45.6% of the students feeling hopeless and 30.7% feeling depressed [
7].
The prevalence of mental distress, a non-specific form of altered mental health, in Ethiopian university students was found to be 21.6–49.1% [
8‐
11]. The most consistent associated factors were a family history of mental illness, frequent conflicts with fellows, Khat chewing, worshiping, batch of students, field of study, level of training, and age [
8‐
11]. In addition, another study reported that mental distress has been associated with the difficulty in making friends and dating, active sexual practice, income and stationary materials inadequacy, lack of adequate access to academic reference materials, lack of adequate access to sanitary and recreational facility, overcrowding, and worrying about personal safety [
11].
Common mental disorder (CMD), also known as a minor psychiatric disorder, is characterized by insomnia, fatigue, irritability, forgetfulness, difficulty in concentration, and somatic complaints [
12]. Globally, the prevalence of CMD was ranging from 7 to 50% [
13‐
22]. Similarly, a meta-analysis of 174 studies concluded that the 1-year prevalence of CMD was 17.6% and the lifetime prevalence was 29.2%; both estimates were low in Asia and Sub-Saharan African countries [
23]. Moreover, a cross-sectional survey in England, Wales and Scotland revealed that the prevalence of CMD was 17–31% [
24,
25].
The prevalence of CMD was 28.8–44.7% among university students [
26‐
30], 43.3% among community-based health agents [
31], 50.1% among socio-educational agents [
32], 22–42.6% among primary healthcare workers [
33,
34], 22.3–34.5% among university employees [
35], 30.2–50% among patients [
36‐
39], 41.4% among pregnant women [
40], 29.7–32.1% among elders [
41,
42], 24% among physicians [
43], and 6.7% among civil aviation pilots [
44].
CMD has been associated with several factors. A systematic review of 115 studies in low and middle-income countries reported that CMD was strongly associated with poverty, education, food insecurity, housing, social class, socio-economic status, and financial stress [
45]. Similarly, cross-sectional studies conducted in South America identified poverty, schooling, social inequality, low income, sex, age, employment status, inadequate body weight perception, tobacco smoking, violence, poor social support, sedentary behavior and body image dissatisfaction were risk factors of CMD [
16,
17,
19,
20,
35,
36,
46,
47]. Moreover, Harpham et al. [
18] found out gender, educational status, and violence were the risk factors of CMD. Weich et al. [
24,
25] also concluded that high-income individuals to be more prone to CMD and vice versa.
Even though CMD is common in the general population, young people particularly university students are more susceptible [
18,
46,
48]. A cross-sectional study with university students uncovered that the prevalence of CMD was 28.8–44.7% [
26‐
30]. The risk factors were difficulty in making friends, poor self-evaluation of academic performance, thoughts of dropping out, sleep disorder, not owning a car, feeling overloaded, discrimination, limited physical activity, and perceived lack of emotional support [
26‐
30]. A large cross-sectional web-based study conducted at the University of Newcastle found that nearly one-third of students reported at least one CMD [
49]. The risk factors were financial stress, living alone, and low socioeconomic background [
50,
51]. In addition, the prevalence of CMD among Dutch university medical students was 48–54% [
52]. Another cross-sectional study conducted at the public university in Northeast Brazil reported that the prevalence of CMD was 33.7%; the risk factors were gender, lack of good expectations regarding the future, course as not a source of pleasure, and feeling emotionally tense [
53].
The high public health burden of CMD has an impact on students interpersonal relationships and quality of life perhaps that affects their academic performance [
27]. In addition, comparative data from the US have shown a significant link between high levels of psychological distress and low academic performance among college students [
54]. Moreover, another earlier study discovered the association of mental illness and termination of university education, difficulty with time and resource management, and a decreased likelihood to seek academic assistance [
55]. However, little is known about CMD in Sub-Saharan African countries particularly in Ethiopia. This gap pointed out the need to conduct further studies to measure the magnitude of mental health problem among university students and initiate culturally tailored evidence-based interventions [
56]. Thus, the aim of this study was to assess the prevalence and risk factors of CMD. In addition, the association between CMD and academic performance was tested.
Discussion
In this study, the prevalence of CMD was 63.1%. This finding was in line with the previous study report in the Netherland university students [
52]. On the other hand, it was approximately two to three times the prevalence of CMD in Ethiopian university students [
60], Chilean university students [
61], and Peruvian college students [
62]. Moreover, the current study finding was higher than the study report by Silva et al. [
63], Volcan et al. [
64], and Haregu et al. [
65].
In the present study, field of study was one of the risk factors for CMD; Law and Health Science and Medicine students had less odds of CMD compared to Natural and Computational Science students. The possible explanation was that Natural and Computational Science students study a hard science, such as mathematics, physics which is usually stressful and academically demanding to students. In the contrary, recent studies with university students concluded that the risk of CMD was high among Health Science and Medicine students [
26‐
29]. The present study also uncovered that CMD was significantly associated with worshipping; students who worshiped less frequently were 1.8 times more likely develop CMD compared to those students who worshiped daily. The possible explanation was that worshipping helps to relieve stress and become optimistic about any negative life circumstances. This finding was in congruence with the study report in Brazil college students where low and moderate spiritual wellbeing showed a doubled risk of CMD [
64].
Another important significantly associated risk factor was insomnia; insomniac students were 3.8 times more likely develop CMD compared to non-insomniacs. This finding was consistent with other previous studies report by Hidalgo et al. [
66] among Brazilian medical students, Byrd et al. [
60] among Ethiopian undergraduate students, Concepcion et al. [
61] among Chilean university students, Rose et al. [
62] among Peruvian college students, and Haregu et al. [
65] among Thai college students. Furthermore, this study showed that alcohol drinking significantly increased the risk of CMD; students who drink alcohol less than once per month were 2.7 times more likely develop CMD compared to students never drink alcohol. This finding was similar to the study report by Byrd et al. [
60] among Ethiopian undergraduate students, but on the other hand, the study conducted among Chilean [
61], Peruvian [
62], and Thai [
65] university students did not confirm this significant association.
Finally, the current study sought the association between CMD and academic performance; the mean CGPA of students with CMD was lower by 0.02 compared to those without CMD though insignificant. This does not imply CMD has no relevant effect on students' academic performance. Therefore, this non-significant result might be due to two reasons. Primarily, this study had used CGPA which might be distorted by previous semester or year grade. This justification was supported by the finding that more than 75% of the students in this study were the second year and above. Secondly, the data was collected from students who actively attending their education perhaps their coping mechanism is good and academically competent. Nevertheless, the previous studies reported that CMD determine academic performance [
67,
68].
Generally, heterogeneities have seen on the prevalence and risk factors of CMD and the association between CMD and academic performance as well. This might be due to the following reasons. First, Kessler psychological distress (K10) scale was used in the present study whereas all previously reviewed studies were used General Health Questionnaire (GHQ-12) and Self-Report Questionnaire (SRQ-20) to assess mental health status. Second, the current data was collected during examination week perhaps anticipated stress increased K10 scale score. Third, most of the previous studies were conducted only with medical students; however, this study recruited students from nine disciplines. Fourth, the current study assessed only the 30 days mental health status.
In one hand, by 2030 World Health Organization (WHO) targeted to reduce non-communicable diseases related premature mortality by one-third through prevention, treatment, and promotion of mental health [
69]. On the other hand, contemporary epidemiological studies in high and low-income countries found a significant association between mental disorders and educational achievement during tertiary education [
67,
68]. Therefore, developing (inter)national mental health strategy has a pivotal role to achieve WHO health goal and improve students’ academic accomplishment. For the successful realization of the strategy, academic institutions and researchers should provide updated evidence-based information for delivering the most cost effective culturally tailored care.
This study has several implications to develop a universal culturally appropriate screening tool for the students who are at risk of CMD, serve as a baseline for future studies, and provide important evidence to plan need-based interventions for students with CMD. Meanwhile, the universal screening activity is not time-consuming, as a result, it can be integrated into a student clinic at the university. Furthermore, this study will be used as a baseline evidence for future mental heal care planning and intervention.
K10 scale, a standardized validated tool, was used to assess CMD. To the best of our knowledge, this study was the first that assessed CMD using K10 scale in university students. Moreover, a large number of students were recruited from nine disciplines. However, this study had several limitations. First, self-administered data were used that might added recall bias and socially desirability bias. Second, the cross-sectional nature of the study does not allow attribution of causality. Hence, the prevalence of CMD that was reported may not be exclusive to the situation on university alone. Finally, since our study was conducted only in one institution it might limit the external validity of results. However, this limitation was perhaps compensated by the inclusion of students from different ethnicity and socioeconomic group.
Authors’ contributions
YG conceived and designed the study. YG and TD analyzed and interpreted the data. YG, SM, and TD wrote the article. All authors read and approved the final manuscript.