INTRODUCTION:

Mental health is defined as the capacity to work, capacity to love and the capacity to play and for recreation. It describes either a level of cognitive or emotional well-being or an absence of a disorder. Mental health refers to a broad array of activities directly or indirectly related to the mental well-being component. According to WHO, the definition of mental health is," a being of wellbeing in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his or her community. Mental distress is a collection of mental problems that may not fall under standard diagnostic criteria and are characterized by symptoms of insomnia, fatigue, irritability, forgetfulness, difficulty in concentrating and somatic complaints (Goldberg et.al. 1992). But the self-reporting questionnaire (SRQ) is a screening instrument developed by the World Health Organization (WHO) to assess the symptoms of mental distress ( Cary et.al. 2002). Mental distress has a wider scope than the related term mental illness. Mental illness refers to a specific set of medically defined conditions. A person in mental distress may exhibit some of the symptoms described in psychiatry, such as: anxiety, confused emotions, hallucination, rage, and depression and so on without actually being ‘ill’ in a medical sense.

Mental illness was not recognized as public health problem both in developed and developing countries until the recent period of time (WHO, 1994). But there was evidence that mental illness can lead to increased mortality; in particular, the risk of death by suicide in persons with depression or substance abuse was well described ( Gelder et.al, 1989). In developing countries mental disorders were not regarded as life threatening problems, seems too insignificant, unworthy and lacking public health attention; because in these countries, morbidity and mortality due to malnutrition and infectious diseases were very common (Goldberg and Murray et.al, 1992,1996). Mental health has always been the Cinderella of health concerns in developing countries, even though health policy and international consensus defined health in its broadest context of physical, mental and social components for about last 30 years. A popular belief is that mental illnesses are of lower priority because they are not associated with disability or mortality. However, the evidence suggests quite the opposite. Although not stated as priority, mental health problem was mentioned in National Health Policy of Ethiopia; one of the important reasons was lack of data on the extent of mental disorders especially in higher learning institutions ( NHPE, 1992). Tertiary education has always been regarded as highly stressful. This stressful environment can exert a negative effect on the psychological and physical well being of the students mainly the undergraduate students. Eventually this results in poor academic performance and possibly a large number of psychological causalities. There were very few studies on mental distress among University students in Ethiopia. Mental illness is now being recognized as a major public health problem throughout the world. Prevalence studies highlight the gravity of the problem and there by challenge the policy makers to take appropriate action and there were a few prevalence studies done on isolated population group (Giang et.al, 2010). A range of evidence was presented to demonstrate that mental disorders, in particular depression and anxiety and substance (alcohol) abuse were common, profoundly disabling, run chronic courses when untreated and can contribute to increased mortality (Murrayet.al, 1996). The recent Global Burden of Disease ( Goldberg et.al, 1992) report listed the most important causes of disability as measured by Disability Adjusted Life Years, depression was the single most disabling disorder, accounting for more than one in ten years of life lived with disability. Whereas research reveals that, five of the top 10 causes of disability were mental disorders of which depression and alcohol abuse were the most important.

There was evidence that mental illness can also lead to increased mortality. In particular, the risk of death by suicide in persons with depression or substance abuse was well described (NHPE, 1992). In Ethiopia, mental disorders were reported to account for 11% of the total burden of diseases (Giang, 2012). Though limited and inconclusive, the mental distress prevalence of 21.6% to 32.6%was reported among adama and addis ababa university students in Ethiopia respectively (Yadeta et.al, 2013). Despite mental health problem was included in National Health Policy of Ethiopia, interventions against the problem were limited. The main reason is the lack of data on the extent of the problem ( NHPE, 1992). Various factors were reported to be associated with the development of mental distress among university students. Separation from pre-existing social support, frustration with academic challenges, social problems, and threats due to high expectations from parents; teachers were reported attributes of mental distress which could present variably in different contexts (Yadeta et.al, 2013). Psychologists identified some common reasons why college students experience academic problems; which includes, Motivation factors, inadequate time management, study skills social interactions learning disabilities, substance abuse and psychological Issues. A large number of students were struggling with the many demands of college life while also dealing unassisted with major emotional issues such as loss, depression, and anxiety. Undiagnosed and untreated, many of these kind of problems lead to academic difficulties or failure (Alem A, 2005)

METHODOLOGY:

Institutionalized Descriptive cross sectional study was conducted to assess the prevalence and determinants of mental distress among University students in Hawassa, Awassa, Ethiopia. Third and fourth year Students of Hawassa University were taken as study population. The sample size was determined using the single population proportion formula with the following assumptions: prevalence of mental distress = 32.6 % ( to obtain the maximum sample size), Degree of precision= 5%, Level of confidence = 95% (Z= 1.96), Non-response rate 10%, the calculated sample size was 327. And these subjects were selected by a simple random sampling method after listing the name of the students alphabetically as a sample frame. The number of subjects to be selected from each class room was proportional to the population size of the class room. The response rate was 95.4%.

ETHICAL CLEARANCE:

Ethical clearance was obtained from Institutional Review Board, Hawassa University. No materials were used during the study. Source of funding not applicable.

FINDINGS:

(a) Socio- Demographic data:

Three hundred and twelve respondents were studied with a response rate of 95.4%. Mean age of the students in was 22.6 for both male and females with a standard deviation of 2.41. Of all the respondents about 189 (73.3%) of males and 35(64.8%) females were Orthodox Christians by religion. About 19(7.4%) of males and 8(14.8%) of females were Muslims followed by 42(16.3 %) of males and 9(16.7%) of females were protestants.

(b) Distribution of Those Psychological Symptoms:

SRQ₂₄among the total respondents showed ranging between 0 and 24. In this study 52(20.2%) of male and 9(16.6%) of female respondents had no symptoms of mental distress at all ; 69(26.7 %) of males and 7(13%) of female respondents had got a score between 1and 3, fifty seven (22.1%) of males and 7(13%) of female respondents had got a positive symptom score between 4 and 6, twenty five (9.7%) of males and 3(5.6%) of females obtained score between 7and 10, nineteen (87.4%) of males and 6(11.1%) of females respondents got a positive symptoms score of 15 or more of the 20 SRQ items. The distribution of cut points and taking into account of 11 or more of the 24 SRQ₂₄ items, about 55(21.3%) males and 21(38.9%) females had mental distress in the last 4 weeks.

The study had tried to look into the socio-demographic characteristics that might influence the prevalence of mental distress among Hawassa University students. The total prevalence rate of mental distress symptoms among third and fourth year regular students was 55 (21.3%) for males and 21(38.9%) for females, the prevalence rate for both sexes was 24.4%.Among third year, 32(29.4%) males and 15(62.5%) females were exposed to mental distress. The prevalence of mental distress in third and fourth year students were 35.3% and 16.2% respectively .When it was categorized into each department; in health officers the prevalence rate was 7(23.3%) for males and 5(55.5%) for females, for both sexes 12(30.8%). In Nursing, among 38 male students 6 (15.8%) were prevalent of mental distress and from 12 females students 1(8.3%) were prevalent. In Midwifery, among 60 male students 11(18.3%) were prevalent of mental distress and from 10 females students 4(40%) were prevalent, a total of 15(21.4%) for both sexes. In Medical laboratory, no male students were prevalent for mental distress and 3 females students 3(100%) were prevalent. In Environmental health, among males 5(55.5%) were prevalent of mental distress. In Optometry, among male students 2(28.6%) were prevalent for mental distress and none of the females were found to be prevalent of mental distress. In Medicine, among male students 24(22.4%) were prevalent of mental distress and 16 females students 8(50%) were prevalent of mental distress(table-1).

Table 1: Prevalence of mental distress among male and female respondents N=327

No	Mental distress symptoms	Male						Female
		Agree		Disagree		I don’t know		Agree		Disagree		I don’t know
		No	%	No	%	No	%	No	%	No	%	No	%
1	Headache	89	34.5	151	58.5	18	6.9	30	55.6	22	40.7	2	3.7
2	Poor appetite	64	24.8	182	70.5	12	4.6	11	20.4	41	75.9	2	3.7
3	Nervousness tenses & worry	69	26.7	136	68.2	13	5	18	33.3	32	59.3	4	7.4
4	Difficulty in ADL	51	19.8	191	74	16	6.2	14	25.9	38	70.4	2	3.7
5	Loss of interest	86	33.3	161	64.4	11	4.3	25	46.3	25	46.3	4	7.4
6	Easily tired	62	24	186	72.1	10	3.9	22	40.7	21	50	5	9.3
7	Unhappy	73	28.3	174	67.4	11	4.3	17	31.5	33	61.1	4	7.4
8	Stomach discomfort	79	30.6	168	65.1	11	4.3	17	31.5	32	59.3	5	9.3
9	Unusual thinking	78	30.2	169	65.5	11	4.3	20	37	28	51.9	6	11.1
10	Increased heart rate	57	22.1	191	74.1	10	3.9	21	38.9	29	53.7	4	7.4

Table: 2 Association of socio-demographic variables with prevalence of mental distressN=327

S .no	Variables		Total n=312		Mental distress
S .no	Variables		Frequency	%	Exposed	Not exposed	X²_cal(df=i) 95 %CI	X²_tab(df=i) 95 %CI	p-value	Remark
1	Sex	Male	258	82.7	55	203	5.95 Df=1	3.841	P<0.05	*
1	Sex	Female	54	17.3	21	33	5.95 Df=1	3.841	P<0.05	*
2	Age	19-23	237	75.9	55	182	1.369 Df=2	5.991	p>0.2	NS
		24-28	73	23.4	21	52
		>28	2	0.64	0	2
3	Study year	3rd year	133	42.6	47	86	15.57 Df=1	3.841	p<0.05	*
3	Study year	4th year	179	57.4	29	150	15.57 Df=1	3.841	p<0.05	*
4	Department	Health officer	39	12.5	12	27	7.128 Df=6	12.592	p>0.05	NS
		Nursing	50	16	7	43
		Midwifery	70	22.4	15	55
		Medical laboratory	10	3.2	3	7
		Environmental health	9	2.9	5	4
		Optometry	11	3.5	2	9
		Medicine	123	39.4	32	91
5	Religion.	Orthodox	224	71.8	58	166	3.3424 Df=5	11.070	p>0.05	NS
		Muslim	27	8.7	7	20
		Protestant	51	16.3	9	42
		Catholic	2	0.6	1	1
		I have no religion	2	0.6	0	2
		Other	6	1.9	1	5
6	Marital status	Single	290	92.9	68	222	4.089 Df	7.815	P>0.2	NS
		Married	11	3.5	4	7
		Divorced	2	0.6	0	2
		Others	9	2.9	4	5
7	Ethinicity	Oromo	72	23.1	17	55	8.404 Df=8	15.507	p>0.05	NS
		Amhara	143	45.8	37	106
		Tigre	24	7.7	4	20
		Wolaita	13	4.2	2	11
		Harari	4	1.3	0	4
		Sidama	7	2.2	1	6
		Hadiya	7	2.2	1	6
		Gurage	18	5.8	8	10
		Others	24	7.7	6	18
8	Familly condition	Live together	228	73.1	49	179	12.481 Df=4	9.488	P=0.015(>0.05)	*
		Live in different area	32	10.3	8	24
		Diorced	8	2.5	3	5
		One parent loss	34	10.9	10	24
		Both parent loss	10	3.2	6	4
9	Monthly income	No income	18	5.8	8	10	3.332 Df=4	9.488 Df =4	p>0.05	NS
		Less than100	29	9.3	8	21
		From 100 to299	116	37.2	28	88
		From 300 t0 499	87	27.9	18	69
		500 and above	62	19.9	14	48

(* indicates significance)

(d) Factors Determining Mental Distress:

In this study different factors that determine mental distress among study subjects were identified. a higher level of mental distress was reported in females than males which was statistically significant with at 95% CI (Xcal _(df=1)=5.95, P=0.015). Study year of the students were having significant association with mental distress (Xcal _(df=1)=5.95, P=0.015). Third year students were more exposed to mental distress due to high academic work load , less experience on self-management of stress and other factors as compared to fourth year students. family living conditions ( live together, live in different place, divorced ,one parent loss and both parent loss) were found to have strong association with mental distress at 95%CI (Xcal _(df=4)=12.48, P=0.015) especially those respondents whose parents (both father and mother) were lost had high prevalence 6 (60%) of mental distress due to absence of communication during problem facing, less social and economic support to cover their educational expenses. There was no association between age of study subjects and having mental distress but age greater than 28 was found to be a protective factor for mental distress due to different factors which needs further study. In addition to this, there was no statistically significant association between mental distress and department, ethnicity, religion, monthly income, and marital status (table 2).

CONCLUSION:

In this study, about one fourth (24.4 %) of the university students were found to have mental distress. Mental distress was found almost two times higher among female students (39%) as compared to male students (21%). The prevalence of mental distress in 3^rd year students (35.4%) were two times higher than that of 4^th year students (16.2%). The family living condition was found to be strongly associated with mental distress. Especially those respondents whose parents (both father and mother) lost had high prevalence (60%) of mental distress as compared to those whose parents live together (49%),%), live in different place (25%), divorced (37.5%),one parent lost (29%). In this study, there was no significant association of mental distress with age, religion, ethnicity, respondents’ marital status, monthly income, and department of the respondents. Also abuse of substances like khat, alcohol, cigarette and sedatives had no statically significant association with mental distress

ACKNOWLEDGEMENT:

Several people have indifferent and valuable ways contributed to the creation of this study. Their assistance and input is acknowledged with appreciation. Special thanks to Hawassa University, the interviewers, the interviewees, for support throughout the study.

REFERENCES

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Received on 05.10.2015 Modified on 17.10.2015

Asian J. Nur. Edu. and Research. 2016; 6(3): 356-360

DOI: 10.5958/2349-2996.2016.00067.7