Psychological distress, help-seeking behavior, and barriers to mental health care among Yemeni undergraduate students: a cross-sectional multi-university study

Abstract

University students are increasingly vulnerable to psychological distress, yet many do not seek professional mental health care. This study aimed to examine the prevalence of psychological distress, patterns of help-seeking behavior, and the barriers to accessing mental health services among Yemeni undergraduate students. A cross-sectional online survey was conducted among 2,872 undergraduate students from 16 universities across Yemen. Psychological distress was screened using the General Health Questionnaire-28 (GHQ-28), and perceived barriers to care were assessed using the Barriers to Access to Care Evaluation (BACE-III) scale. Descriptive statistics, chi-square tests, logistic regression, and correlation analyses were performed to examine associations between demographic factors, psychological distress, and perceived barriers to care. Nearly half of the participants (49.7%) screened positive for psychological distress. Among those with psychological distress, 92.2% had not sought professional mental health care. The most commonly reported barriers included wanting to solve problems independently (69.2%), preference for traditional or religious healing methods (54.2%), and uncertainty about where to obtain professional care (52.2%). Additional barriers included discomfort discussing personal emotions (50.9%), lack of someone to facilitate access to care (50.2%), and concern about family perceptions (47.6%). Attitudinal and instrumental barriers were more frequently reported than stigma-related barriers. Logistic regression analysis identified female sex and a history of mental disorders as significant predictors of psychological distress. Psychological distress appears to be common among Yemeni undergraduate students, while professional mental health care utilization remains very low. Attitudinal and practical barriers, particularly self-reliance and limited awareness of available services, may play an important role in discouraging help-seeking. Efforts to improve mental health literacy, expand accessible counseling services, and develop culturally appropriate support systems may help address unmet mental health needs among university students in Yemen.