CHAPTER ONE

INTRODUCTION

Worldwide, mental and behavioural disorders are common, affecting more than 25% of all

people at some time during their lives.1 They are also universal, affecting people of all countries

and societies, regardless of age, gender and income.1 The point prevalence of mental illness in

the adult population at any given time is about 10%. 1 Throughout the world, there is an

increasing awareness of mental illness as a significant cause of morbidity. 2 The recognition of

mental disorder also depends on a careful evaluation of the norms, beliefs and customs within

the individual's culture environment. Furthermore, community attitude and beliefs play a role

in determining health-seeking behaviour and successful treatment of the mentally ill.

Unarguably, ignorance and stigma prevent the mentally ill from seeking appropriate help. 3 The

relationship between the culture and the stigma attached to an illness is rather complex. It is

probably even more complicated in the developing countries. It has also been suggested that,

in most of these societies some supernatural, religious, moralistic, and magical approaches to

illness and behaviour exist. This can complicate the issue further. 4 People tend to have strong

beliefs about the mentally ill, and many of these concepts are based on prevailing local systems

of belief.5

In Nigeria as elsewhere, one of the most commonly cited reasons for the under-use of available

psychiatric services by the vast populace is the notion of stigma. Stigma is frequently blamed for

the cultural incompatibility of western- based mental health programs in certain contexts and

for the continued reliance on traditional healers.6

1
Researchers have most often assessed stigma associated with mental illness by surveying the

public about attitudes toward "mental patients" or "persons with mental illness," terms that

likely evoke images of chronic psychopathology. Consequently, it is unclear whether evidence

of stigma is indicative of prejudice toward all mental illness or only its more severe forms.

Although some studies have focused on the stigma associated with specific disorders. 7

People's beliefs and level of awareness regarding mental illness should not only be known, but

the purpose of their beliefs should be understood. Such attitudes and beliefs about mental

illness can only be studied within a culture context. 8 There are marked cultural variations in the

illness behaviour of psychiatric patients. Illness behaviour -as defined by Mechanic (1962) -

describes how symptoms are perceived, evaluated and acted upon. Social factors are involved

not only in the cognitive schemas of their symptomatology but also in the choice of different

alternatives among courses of how to deal with these symptoms, thus determining the health-

seeking behaviour i.e. the meaning and seriousness of psychiatric symptoms are deeply

embedded in the patients’ cultural assumptions. 9 The most common first contact for treatment

of mental illnesses is usually the prayer house, followed by a psychiatric hospital. This higher

preference for spiritualists than psychiatrists can be confirmed in a study of treatment-seeking

behaviour of mentally ill patients.10 In Nigeria there are still strong beliefs in magico-religious

origins of human ailments, especially mental disorders.11

Research findings from several countries have confirmed the global nature of negative

attitudes towards the mentally ill.12 Poor community knowledge of causes and the presentation

of mental disorders have sometimes been advanced as reasons for stigmatizing attitudes.

Psycho-educational interventions have been used as a tool in the fight against stigma and

2
discrimination related to mental illness by the World Psychiatric Association (WPA) in more

than 20 countries.13 Although it is postulated that educational interventions may lead to a

reduction in stigmatising behaviours towards the mentally ill, 14-16 it appears that there is no

direct relationship between stigmatising opinions and lack of knowledge of mental illness, even

among medical undergraduates.17-19 The burden of mental illness with its attendant disability is

particularly severe for students from low-income backgrounds. 20-21 Negative attitudes,

discrimination, and stigma experiences of the mentally ill, coupled with poor knowledge of

causes of mental illness, inculcate a poor health-seeking behaviour thus contributing immensely

to this disease burden. A few studies have shown that negative feelings against the mentally ill

are prevalent in Nigerian communities.3 There is therefore a need for more research on

community knowledge of likely causes of mental disorders and attitudes towards the mentally

ill.

STATEMENT OF PROBLEM

In the eyes of the Nigerian public, psychiatric patients are stereotypically seen as dirty, tattered-

looking, smelly, homeless, and as unpredictable, aimless wanderers who lack good reasoning. 22

Such negative feelings harboured against the mentally sick encourage preference to spiritual

healing.6 This fact is compounded by ignorance of existing mental health services and lack of

knowledge about orthodox medical service. Consequently, alternative sources of care are still

employed.23

Disturbingly, researchers found that less than 25 percent of these undergraduates who suffer

from mental problems actually seek treatment. 24 There is a need for community health

3
education to demystify mental illnesses as well as to highlight the availability of mental health

services; this should create positive attitudes, correct misconceptions and encourage early

specialist consultation and better treatment outcomes.23

Life as an undergraduate is characterized by the pursuit of greater educational opportunities

and employment prospects, development of personal relationships, and for some, parenthood.

These aspects of life can cause a level of stress that triggers either the beginning or recurrence

of psychiatric disorders.24 It is believed that this is an indication of the age group being

particularly vulnerable to these psychiatric conditions. 24 In an age of ever-increasing stress that

accompanies mounting demands and expectations especially of the university community,

undergraduates are now more than ever struggling to maintain a healthy balance in their

everyday lives. Whether related to schoolwork, job, finances, peer pressures, or simply

surviving in a fast-paced society, life’s pressures can predispose to mental illnesses.24

JUSTIFICATION OF THE STUDY

The 1995 Nigeria National Mental Health Policy advocates the integration of mental health

promotion, treatment and rehabilitation into primary health care services (PHC). However, this

goal cannot be successfully achieved without an understanding of community attitudes towards

mental illness and mental health-seeking behaviour. 3 This study therefore sets out to ascertain

the perceptions, level of awareness, attitudes, and beliefs of undergraduates regarding the

causes, manifestations and treatment options of mental illness in a university in northern

Nigeria.

4
The role of the community in the prevention and care of the mentally handicapped has now

been widely acknowledged and is regarded as the most appropriate basis for the development

of mental health programs. Several studies have shown that knowledge of public attitude to

mental illness and its treatment is a vitally important prerequisite to the realization of

successful community-based programs.25-27 It is important to understand the choices that

people make for treating mental illnesses to ensure proper utilisation of available mental health

services, and better management and control of mental disorders.23

This study is also motivated by the insidious upsurge of suicide ideation among university

students.28 In the general population, WHO estimates that there are about 1 million suicides per

year in the world.29 Suicides are the third leading cause of death in persons below the age of 25

years29 and this constitutes a significant majority among the population of students in Ahmadu

Bello University, Zaria. Psychiatrists propose that with public awareness, these figures could be

brought down significantly and this can only be effectively carried out when the level of

awareness and psychiatric health-seeking behaviour of the populace is duly assessed. 29

AIM

To assess the awareness of psychiatric illnesses among undergraduate students of Ahmadu

Bello University Zaria and to examine their health-seeking behaviour as regards these illnesses.

OBJECTIVES

1. To determine the prevalence of psychiatric illness among undergraduates of Ahmadu

Bello University Zaria.

5
2. To assess the awareness of psychiatric illness among undergraduates of Ahmadu Bello

University Zaria.

3. To determine the health-seeking behaviour of psychiatric patients among

undergraduates of Ahmadu Bello University Zaria.

4. To identify the determinants of awareness and health-seeking behaviour of psychiatric

patients among undergraduates of Ahmadu Bello University Zaria.

CHAPTER 2
6
 LITERATURE REVIEW
PREVALENCE OF PSYCHIATRIC ILLNESSES

A significant disease burden is attributable to mental illness globally. Out of the top 10 leading

causes of disability throughout the world, 5 are psychiatric illnesses. 44 According to the World

Health Organization (WHO), mental illnesses account for 11.5% of the global burden of

disease--a figure that is projected to increase to 15% by 2020. Worldwide, 340 million people

suffer from mental illnesses, with the majority living in the developing world. 45

In Nigeria, the prevalence of mental illness is reported at 20%. 46 With a population of 140

million and less than 100 psychiatrists, the ratio of psychiatrists to population is 1:1 400 000. 47

This is a long way from the ideal; the equivalent figure for Europe is 1:1 000. 48

In Africa, a sizeable proportion of students who join University and other institutions of higher

learning have lived through a variety of difficulties, including high levels of poverty and loss of

traditional social support.30 Under these circumstances, it would be expected that, with the

added pressure of studies, university students would exhibit high levels of psychological

distress. However, the prevalence of mental health problems among University students in

Africa is unknown.30 Unlike the rural areas with relatively lower incidence of mental illness

largely attributed to the continued existence of a tightly knit society with strong family cohesion

and social support systems, the university environment like the typical urban society is

unsupportive and fraught with an array of social stressors. 30 Among the numerous prevailing

psychosocial stressors peculiar to the university undergraduate population include

discontentment with course of study, inconsistent and arduous academic workload, overstay

etc.31

7
Substance use continues to be major risk behaviour among university students, with

consequent physical and/or mental health complications. 32 Substance use was found to be

prevalent among students in prior studies involving over-the-counter and socially acceptable

substances as well as the abuse of illicit substances.32

A relationship has been suggested to exist between mental illness and body dysmorphic

disorders thus increasing the risk of mental illness among university students. 33 This in turn

further necessitates the need to assess their awareness about mental illness with the attendant

psychiatric health-seeking behaviour.33

It is perceived that the prevalence of psychiatric illnesses is more than what is suggested by the

psychiatric hospital records due to stigma and low level of awareness. People that develop

psychiatric symptoms often ignore them and that is one of the main reasons psychiatric

disorders go unreported. This therefore confirms public awareness as an important prelude to

early detection and treatment.36

AWARENESS OF PSYCHIATRIC ILLNESSES

Awareness of mental illness as a significant cause of morbidity is increasing worldwide. 34 This

awareness has increased with the steady decline of morbidity due to nutritional disorders,

communicable diseases and other forms of physical illness; especially in countries undergoing

epidemiological transition (these are countries where epidemiological attention shifts from

declining communicable diseases, malnutrition and problems associated with pregnancy and

childbirth, to chronic non-communicable diseases which are then the dominant public health

problems).35

8
On the occasion of World Mental Health Days, medical practitioners feel that a lot needs to be

done by the government as according to them, it has failed to raise awareness among the

masses in the face of the fact that mental illnesses make for the second most common disorder.

This is supported by the growing number of Nigerian undergraduates admitted into psychiatric

hospitals and the significantly retarding effect mental illnesses have on their academic

performance.30

Mental health care users are increasingly getting involved through media and talks in a wide

range of settings. Yet very few of such activities are systematically evaluated for their

effectiveness and very few are being published in peer-review journals or in reports where

experiences and lessons can be shared and potentially applied elsewhere.37

HEALTH-SEEKING BEHAVIOUR ON PSYCHIATRIC ILLNESSES

Furthermore, community attitude and beliefs play a role in determining health-seeking

behaviour and successful treatment of the mentally ill. Unarguably, ignorance and stigma

prevent the mentally ill from seeking appropriate help. 38 The relationship between the culture

and the stigma attached to an illness is rather complex. It is probably even more complicated in

the developing countries. It has also been suggested that, in most of these societies some

supernatural, religious, moralistic, and magical approaches to illness and behaviour exist. This

can complicate the issue further.39 People tend to have strong beliefs about the mentally ill, and

many of these concepts are based on prevailing local systems of belief.40

In Nigeria as elsewhere, one of the most commonly cited reasons for the under-use of available

psychiatric services by the vast populace is the notion of stigma. Stigma is frequently blamed for

9
the cultural incompatibility of western- based mental health programs in certain contexts and

for the continued reliance on traditional healers.41

Recent studies carried out on the beliefs about mental illness among university students in

Egypt by Hani Hamed Dessoki, MD et al showed the understanding of the scientific etiological

basis of mental illness coexisting with spiritual beliefs and the influence of familial

socioeconomic status and stigma as important determinants of the varying forms of psychiatric

health-seeking behaviour.

DETERMINANTS OF AWARENESS ON AND HEALTH-SEEKING

BEHAVIOUR OF PSYCHIATRIC ILLNESS

A study of the beliefs about mental illness among university students in Egypt by Hani Hamed

Dessoki et al was carried out to detect differences in attitudes towards psychiatric illness,

regarding its nature, cause, different ways of therapy, possibility of cure and the effect on the

society in two areas from different socioeconomic classes in Egypt.

The method used was a survey study using self administered questionnaire, to detect culture

differences between students of Cairo and Beni Suef universities “Beni Suef is one of upper

Egypt governorates”. All participating students were subjected to Familial Socioeconomic status

scale, Beliefs about Psychiatric Illness in the Arab Culture Scale.

Cairo University students showed higher positive attitude regarding Beliefs about Psychiatric

Illness including the nature of psychiatric illness, psychiatric aetiology, psychiatric management,

psychiatric cure, and effect on the family than Beni Suef University students (p<.001). Females

in both groups showed lower positive attitude on Attitudes Towards Psychiatric Illness in the

10
Arab Culture Scale than males (P <.001). It was found that Beliefs about mental illness are highly

affected by low socioeconomic status, upbringing way and beliefs in Egypt. 42

CHAPTER THREE

METHODOLOGY

BACKGROUND INFORMATION ON THE STUDY AREA

11
The Ahmadu Bello University lies 16 kilometres to the North of Zaria city at the village of

Samaru. Presently the university has 12 teaching faculties, about 78 departments, 5 research

and training institutes, 6 specialized centres, a division of agricultural colleges, a postgraduate

school and 3 organized and extension and consultancy services. The total student population

pursuing various undergraduate courses number approximately 30,000.

The university has a sick bay situated within its campus. Nurses and physicians were employed

therein to enable it serve its sole purpose of delivering healthcare to the university community.

The sick bay provided mental healthcare services through specialist psychiatrists from the

Ahmadu Bello University Teaching Hospital running psychiatric clinic for two days per week and

admitting for periods ranging from a few hours to a maximum of three days. For cases requiring

hospital admission beyond that, patients were referred to the psychiatric clinic of Ahmadu Bello

University Teaching Hospital which is adequately equipped for this purpose. Payment for

medical service by undergraduates was covered in the National Health Insurance Scheme

(NHIS) recently introduced into the university fees as against previous years when all students

pay for medical service from personal funds.

STUDY POPULATION

The study population comprised all undergraduate students of Ahmadu Bello University Zaria.

INCLUSION CRITERION

All registered undergraduates of Ahmadu Bello University Zaria.

12
EXCLUSION CRITERION

All postgraduate or diploma students

STUDY DESIGN

Study was descriptive cross-sectional in design

SAMPLE SIZE DETERMINATION

2
Z Pq 50
Sample size for the study was calculated using the formula [ N= 2 ]. This was the formula
d

for estimating minimum sample size in descriptive health studies. Where

n = Sample size

P = Proportion of the adult population with mental illness. In this case 10%
based on The World Health Report.
q = proportion of adult population without mental illness

[1-p]=0.9

Z = Value of standard normal deviate is = 1.96

d = 0.05 level of precision.

n = (1.96)2 (o.1) (0.9)

0.052

n = 138.298 ̴ 138

In consideration of non-response, irretrievable and inappropriately completed questionnaires,

10% i.e. 13.8 ̴ 14 will be added thus:

Using this, the sample size is calculated as 138 + 14 = 152.

SAMPLING TECHNIQUE

13
A multi-stage sampling technique was used. The sampling frame consisted of twelve faculties.

Stage 1: Eight faculties were randomly selected by balloting after labelling all the faculties

numerically as 1, 2, 3 . . . 8. The faculties selected were as follows: Art, Environmental design,

Pharmaceutical Sciences, Law, Sciences, Engineering, Social Sciences, and Medicine.

Stage 2: From each selected faculty, simple random selection of three departments was done

also by balloting after labelling all the departments numerically.

Stage 3: Random selection of three academic strata in each of the selected department was

done by balloting.

Stage 4: This stage involved the determination of the number of students to be interviewed per

academic stratum. This was calculated using the formula:

X = U/V × n

Where X = Number of students interviewed per academic stratum selected.

U = Total number of students in that academic stratum.

V = Total number of students in the fifteen selected units.

n = sample size

SERIAL FACULTY DEPARTMENT ACADEMIC TOTAL STUDENTS

NUMBER STRATUM NUMBER OF INTERVIEWED

STUDENTS

1. Art English and 100 185 3

Literary

14
 Studies

300 180 3

200 178 3

French 200 65 1

Literature

100 122 2

300 123 2

Archaeology 100 125 2

200 121 2

300 119 2

2. Environmental Architecture 400 180 3

Design

200 182 3

500 179 3

Quantity 400 130 2

Survey

200 180 3

300 126 2

Urban and 200 130 2

Regional

Planning

300 120 2

15
 400 120 2

3. Pharmaceutical Pharmacy 300 135 2

Sciences

200 183 3

400 182 3

4. Law Shari’ah Law 100 120 2

200 124 2

400 120 2

Civil Law 100 127 2

200 140 2

400 125 2

Public Law 100 123 2

200 130 2

300 121 2

5. Sciences Geography 200 140 2

300 125 2

400 122 2

Textile 200 185 3

Science

300 161 2

100 129 2

Disaster 100 140 2

16
 Management

200 150 2

400 140 2

6. Engineering Chemical 200 133 2

Engineering

300 125 2

400 122 2

Electrical 200 122 2

Engineering

300 126 2

400 122 2

Mechanical 100 140 2

Engineering

200 122 2

300 125 2

7. Social Sciences International 200 185 3

Studies

300 187 3

400 144 2

Economics 100 191 3

300 190 3

200 186 3

Political 100 195 3

17
 Science

300 135 2

200 181 3

8. Medicine Medicine 200 183 3

400 188 3

600 136 2

Human 200 80 1

Anatomy

300 70 1

400 80 1

Nursing 100 138 2

200 142 2

400 140 2

TOTAL 3607 147

DATA COLLECTION

This was by the use of self-administered questionnaire that contained questions on socio-

demographic data, awareness about psychiatric illness and health-seeking behaviour on

psychiatric illness.

DATA ANALYSIS

The data was analysed using Statistical Package for Social Science (SPSS), version 17.0. Results

was summarised and presented using tables and charts. Chi square test was used to test the

significance of association at p value of 0.05.

18
The awareness was graded accordingly as follows:

Poor Awareness− <50%

Fair Awareness− 50 – 70%

Good Awareness− >70 - 100%

The health-seeking behaviour was graded accordingly as follows:

Poor Health-seeking Behaviour- <50%

Fair Health-seeking Behaviour- 50 – 70%

Good Health-seeking Behaviour- >70 – 100%

ETHICAL CONSIDERATION

Permission was obtained from the school authority to interview the students. Informed verbal

consent will be sought from each respondent with assurance of confidentiality of information

given. No monetary compensation was given.

LIMITATION OF THE STUDY

Some respondents responded to questions based on what they think the researcher wanted

especially because of the stigma associated with mental illness.

19
 CHAPTER FOUR
RESULTS

A total 147 questionnaires were distributed and 141 were retrieved. The results were analyzed

and presented in sections in line with the study objectives as follows:

Section A: Socio-demographic characteristics.

Section B: Prevalence of psychiatric illness.

Section C: The awareness of psychiatric illness.

Section D: The health-seeking behaviour towards psychiatric illness.

20
Section E: Determinants of awareness and health-seeking behavior towards psychiatric illness.

SECTION A: SOCIO-DEMOGRAPHIC DATA

Table 1.0: the socio-demographic characteristics of the respondents (n=141)

FREQUENCY PERCENTAGE
AGE (years)
15-19 16 11.3
20-24 87 61.7
25-29 33 23.4
30-34 5 3.5
SEX
Male 109 77.3
Female 32 22.7
ETHNICITY
Hausa 57 40.4
Yoruba 25 17.7
Igbo 11 7.8
Others 48 34.0
RELIGION
Islam 80 56.7
Christianity 60 42.6

21
 Others 1 0.7
FACULTY
Pharmaceutical Sciences 8 5.7
Art 20 14.2
Medicine 16 11.3
Social Sciences 26 18.4
Law 14 9.9
Sciences 17 12.1
Engineering 18 12.8
Environmental Design 22 15.6

ACADEMIC STRATUM
100level 25 17.7
200level 49 34.8
300level 30 21.3
400level 30 21.3
500level 3 2.1
600level 4 2.8

MARITAL STATUS
Single 131 92.9
Married 10 7.1

WORKING 8 5.7
NOT WORKING 133 94.3
RECEIVING SCHOLARSHIP 34 24.1
NOT RECEIVING SCHOLARSHIP 107 75.9

Majority of the respondents (61.7%) are of ages that range between 20 and 24 years, and a sizeable

majority (77.3%) belong to the male gender. Quite a good majority (40.4%) are of the Hausa ethnic

extraction likewise a majority (34.8%) fall in the 200level academic stratum, with a majority (94.3%) not

working.

SECTION B: PREVALENCE OF PSYCHIATRIC ILLNESS

Table 2: Percent distribution of prevalence of psychiatric illness.

WHETHER RESPONDENT FREQUENCY PERCENT

HAD SYMPTOMS OF

PSYCHIATRIC ILLNESS IN

THE LAST 6 MONTHS

YES 21 14.9

NO 120 85.1

22
 TOTAL 141 100.0

The overall prevalence of psychiatric illness is 14.9%

SECTION C: AWARENESS OF PSYCHIATRIC ILLNESS

TABLE 3: Percent distribution of the awareness of symptoms of psychiatric illness.

AWARENESS OF SYMPTOMS FREQUENCY PERCENTAGE

Poor 101 71.6
Fair 12 8.5
Good 28 19.9
TOTAL 141 100.0
Comment: Majority of the respondents (71.6%) have poor awareness of symptoms.

TABLE 4: Percent distribution of the awareness of causes of psychiatric illness.

AWARENESS OF CAUSES FREQUENCY PERCENTAGE

Poor 114 80.9
Fair 18 12.8
Good 9 6.4
TOTAL 141 100.0
Comment: Majority of the respondents (80.9%) have poor awareness of causes of psychiatric illness.

TABLE 5: Percent distribution of awareness of treatment of psychiatric illness.

AWARENESS OF TREATMENT FREQUENCY PERCENTAGE

Poor 15 10.6
Fair 98 69.5
Good 28 19.9
TOTAL 141 100.0
Comment: Majority (69.5%) of the respondents had a fair awareness of the treatment of psychiatric
illness.

SECTION D: HEALTH-SEEKING BEHAVIOUR TOWARDS PSYCHIATRIC ILLNESS.

TABLE 6: Percent distribution of health-seeking behaviour towards psychiatric illness.

HEALTH-SEEKING BEHAVIOUR FREQUENCY PERCENTAGE

23
 Poor 62 44.0
Fair 74 52.5
Good 5 3.5
TOTAL 141 100.0
Comment: Majority (52.5%) of the respondents had a fair health-seeking behaviour. Only 3.5% had good
health-seeking behaviour.

SECTION D: DETERMINANTS OF AWARENESS AND HEALTH-SEEKING BEHAVIOUR

DETERMINANTS OF AWARENESS

TABLE 7: Distribution of awareness of cause of psychiatric illness by whether respondents have mentally
ill members in their families.

WHETHER ANY AWARENESS OF CAUSES

MEMBER OF
FAMILY IS
MENTALLY ILL
POOR FAIR GOOD
Yes 16 2 2
No 98 16 7
TOTAL 114 18 9
Total Statistical Significance: X2 = 0.619 df = 2 P = 0.734

TABLE 8: Distribution of awareness of symptoms of psychiatric illness by whether respondents have

mentally ill members in their families.

WHETHER ANY AWARENESS OF SYMPTOMS

MEMBER OF
FAMILY IS
MENTALLY ILL
POOR FAIR GOOD
Yes 16 0 4
No 85 12 24
TOTAL 101 12 28
Total Statistical Significance: X2 = 2.212 df = 2 P = 0.331

TABLE 9: Distribution of awareness of treatment of psychiatric illness by whether respondents have

mentally ill members in their families.

WHETHER ANY AWARENESS OF TREATMENT

MEMBER OF

24
 FAMILY IS
MENTALLY ILL
POOR FAIR GOOD
Yes 1 15 4
No 14 83 24
TOTAL 15 98 28
Total Statistical Significance: X2 = 0.798 df = 2 P = 0.671

DETERMINANTS OF HEALTH-SEEKING BEHAVIOUR

TABLE 10: Distribution of health-seeking behaviour towards psychiatric illness by proximity to mental
health facility.

ONE-WAY HEALTH-SEEKING BEHAVIOUR

WALKING TIME TO
MENTAL HEALTH
FACILITY FROM
RESIDENCE
POOR FAIR GOOD
LESS THAN 30 10 41 4
MINUTES
MORE THAN 30 44 33 1
MINUTES
NON-APPLICABLE 8 0 0
TOTAL 62 74 5
Total Statistical Significance: X2 = 31.179 df = 4 P = 0.001

TABLE 11: Distribution of health-seeking behaviour by fear of affordability of service of health facility.

WHETHER HEALTH-SEEKING BEHAVIOUR

RESPONDENT
FEARS HE/SHE
CAN PAY FOR
SERVICE OF
MENTAL HEALTH
FACILITY
POOR FAIR GOOD
Yes 15 57 4
No 39 17 1
Non-applicable 8 0 0
TOTAL 62 74 5
Total Statistical Significance: X2 = 42.160 df = 4 P = 0.001

25
TABLE 12: Distribution of health-seeking behaviour by stigma associated with visiting a psychiatrist.

WHETHER PATIENT WOULD NOT HEALTH- SEEKING BEHAVIOUR

VISIT A MENTAL HEALTH
FACILITY BECAUSE OF STIGMA
POOR FAIR GOOD
Yes 6 1 0
No 14 0 0
Non-applicable 42 73 5
TOTAL 62 74 5
2
Total Statistical Significance: X = 26.728 df = 4 P = 0.001

TABLE 13: Distribution of health-seeking behaviour by lack of confidentiality in visiting psychiatrist (n =

141).

WHETHER HEALTH-SEEKING BEHAVIOUR

PATIENT WOULD
NOT VISIT A
MENTAL HEALTH
FACILITY BECAUSE
OF LACK OF
CONFIDENTIALITY
POOR FAIR GOOD
Yes 4 0 0
No 16 1 0
Non-applicable 42 73 5
TOTAL 62 74 5
X2 = 26.377 df = 4 P = 0.001

CHAPTER 5
DISCUSSION

Overall prevalence of psychiatric illness was low (14.9%). Good awareness of the symptoms,

causes and treatment were 19.9%, 6.4%, 69.55% respectively. Only 3.5% had good health-

seeking behaviour and the major determinants of good health-seeking behaviour were distance

to facility, fear of ability to pay for service, stigma and lack of confidentiality.

26
The finding that the overall prevalence of psychiatric illness among the undergraduate

population of Ahmadu Bello University is 14.9% is lower than that estimated by Gurege O. et al

(20%).46 This can be attributed to the fact that strong negative feelings and stigma are more

widely held against the mentally ill in such a typical African society coupled with the fact that it

is an academic environment where fitness for promotion and employment prospects and

opportunities are highly coveted and aspired to, thus increasing the reluctance to admitting

having symptoms of psychiatric illness. A poor knowledge of psychiatric illness is clearly

portrayed by 71.6% of the undergraduate population having poor awareness of symptoms of

psychiatric illness with a whopping 80.9% having poor awareness of causes and 69.5% having

only a fair awareness of treatment of psychiatric illness. This explains to a large extent the

finding that 52.5% have fair health-seeking behaviour with almost half of the undergraduate

student population i.e. 44.0% having poor health-seeking behaviour towards psychiatric illness

in conformity with Nguyen and Degotardi (2003) which claimed that awareness and beliefs

about mental illness influence care-seeking behaviour.

Contrary to the findings of Hani M. D. et al 42 that showed that students with a positive family

history show higher awareness about psychiatric illness corroborated by a study on community

attitudes towards the mentally ill in New Zealand51 that reported that those who had previous

contact with the mentally ill held informed and enlightened views, the results obtained in this

study showed no significant statistical relationship between family history and awareness.

Interestingly, a recent Hong Kong study reported a generally poor health-seeking behaviour

despite a fairly good knowledge of mental illness among the respondent supported by Wolff G

27
et al on Community knowledge of mental illness and reaction to mentally ill people. 52 This

implies that contrary to general belief, awareness is not always proportional to health-seeking

behaviour as evidenced by the results obtained in this study.

The level of health-seeking behaviour may have been affected by the fact that a majority of the

respondents (34.8%) are in their second year of study and thus not acquainted with the

available mental health services of the university.

The low good health-seeking behaviour and the relationship between health-seeking behaviour

and stigma (P = 0.001) among the respondents clearly demonstrates that the fair health-seeking

behaviour is attributable to the fact that the concept of the mentally sick has an unfavourable

public image. It has been shown that people may evaluate mental illness negatively, reject and

discriminate against mental patients, and base their views on traditional stereotypes. 25, 53 and 54

Although despite the fact that the awareness of symptoms and causes was poor, the awareness

of treatment was fair (69.5%) thus very likely responsible for the health-seeking behaviour

remaining fair. This is consistent with findings reported by Madianos et al. in Greece55, and by

Alem et al56 in Ethiopia that showed that literacy was found to be significantly associated with

positive care-seeking behaviour and a positive attitude towards the mentally sick. Furthermore

it is in agreement with Greenley et al, (1987) who found that psychiatric patients used the

available mental health services more in higher social environment. Also, Judd et al, (2006)

reported that psychiatric patients in rural culture used health services less because of their

lower availability and accessibility in such culture.

Hani MD et al also found that urban residents showed higher positive attitude regarding cure

from psychiatric illness.42 There was significant statistical relationship between health-seeking

28
behaviour with proximity to mental health facility. There was also significant statistical

relationship between health-seeking behaviour with perceived cost of mental health services.

This was consistent with Melissa et al., (2004) which found that majority of participants from

higher socioeconomic areas stated that psychiatric patient could be cured and would personally

seek orthodox medical care if mentally sick.

Hani D. et al also found a relationship between socioeconomic status and health-seeking

behaviour. It also confirms Dietrich et al (2005) conclusion that respondents in countries with

less developed mental health care systems showed less positive attitude, and more frequently

relied on helping sources outside the mental health sector and on traditional “alternative”

treatment methods. In this regard, the fact that only 24.1% of the students receive scholarship

and only 5.7% were workers may have influenced the health-seeking behaviour negatively with

almost half (44.0%) of the undergraduate population having poor health-seeking behaviour.

There was a statistically significant relationship between health-seeking behaviour with stigma

and lack of confidentiality. This corroborates Kabir M. et al3, Faberga H. J4 and Asuni T. et al5

that found ignorance and stigma preventing the mentally ill from seeking appropriate help on a

background of some supernatural, religious, moralistic, and magical approaches to illness and

behaviour occurring with strong negative beliefs about the mentally ill being based on

prevailing local systems of belief. It also supports Al-Krenawi A et al6 on mental health

utilization which claimed that the most commonly cited reasons for the under-use of available

psychiatric services by the vast populace is the notion of stigma. Stigma is frequently blamed for

the cultural incompatibility of western- based mental health programs in certain contexts and

for the continued reliance on traditional healers.

29
CONCLUSION

The findings show that prevalence of symptoms of psychiatric illness was low among the

respondents, and awareness regarding psychiatric illness generally poor especially about the

causes. The health-seeking behaviour was also poor with its major determinants of poor health-

seeking behaviour being long distance to health facility, fear of inability to pay for service,

stigma and fear of lack of confidentiality.

RECOMMENDATIONS

1- Public education about psychiatric illnesses is highly needed as psycho-educational

interventions have been used as a tool in the fight against stigma and discrimination related to

mental illness. A better understanding of mental disorders among the public would allay fear

and mistrust about mentally ill persons in the community as well as lessen stigmatization

towards such persons.

2- The NHIS and its coverage of medical expenses of undergraduates should be given adequate

publicity among the undergraduate population.

3- Mental healthcare centres should be compelled to strictly ensure adequate confidentiality to

their patients, and if they do, they should deem it necessary to assure their patients of such

confidentiality.

4- Mental healthcare facilities should be established in areas strategically close to at least a vast

majority of the population they are meant to serve.

30
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APPENDIX
QUESTIONNAIRE ON AWARENESS AND HEALTH-SEEKING BEHAVIOUR
TOWARDS PSYCHIATRIC ILLNESS AMONG UNDERGRADUATES OF AHMADU
BELLO UNIVERSITY ZARIA.
SERIAL NO…………………
Introduction/Instructions:
Please read and answer the following questions. The obtained information will be used strictly
for academic purpose only and total confidentiality will be ensured.
Thank you for your participation.

SECTION A: PERSONAL INFORMATION

1. Age [yrs]……………………………………….

36
 2. Sex: (a) Male [ ] (b) Female [ ]
3. Ethnicity (a) Hausa [ ] (b) Yoruba [ ] (c) Igbo [ ] (d) Others specify_______
4. Religion (a) Islam [ ] (b) Christianity [ ] (c) Others (specify)__________________
5. Faculty_________________________ Course of Study__________________________
Level (a) 100 [ ] (b) 200 [ ] (c) 300 [ ] (d) 400 [ ] (e) 500 [ ] (f) 600 [ ]
6. Marital status (a) single [ ] (b) married [ ] (c) divorced [ ] (d) Others
(specify)________________________________
7. Working (Yes / No) If Yes specify___________________________________________
8. Are you receiving scholarship? (a) Yes [ ] (b) No [ ]

SECTION B: AWARENESS OF PSYCHIATRIC ILLNESS

9. What are the symptoms of mental illness?

(a) Aggressiveness [ ] (b) Talkativeness [ ] (c) Weird behaviour [ ] (d) Wandering [ ]
(e) Lack of sleep [ ] (f) Others (specify) _______________________
10. In the last six months, did you experience any of the abovementioned symptoms?
(a) Yes [ ] (b) No [ ]
11. What causes the above symptoms?
(a) Evil spirits [ ] (b) Divine wrath [ ] (c) Substance abuse [ ] (d) Social stress [ ] (e)
Hereditary [ ] (f) Others (specify) ___________________________________________
12. Can a patient suffering from the above symptoms be cured? (a) Yes [ ] (b) No [ ]
13. What is the treatment for mental illness?
(a) Prayers [ ] (b) Visit a spiritualist [ ] (c) Visit a psychiatrist [ ] (d) Others
(specify)_____________________________________
14. Is there any member of your family that has any of the above symptoms?
(a) Yes [ ] (b) No [ ]

SECTION C: HEALTH-SEEKING BEHAVIOUR AS REGARDS PSYCHIATRIC ILLNESS

15. Is there any health facility near you that treats all of the above symptoms?
(a) Yes [ ] (b) No [ ]
16. What is the one-way walking time to the health facility from your residence?
37
 (a) Less than 30 minutes [ ] (b) More than 30 minutes [ ]
17. Can you pay for its services? (a) Yes [ ] (b) No [ ]
18. Would you see a psychiatrist or visit a mental health facility if you had among the above
symptoms? (a) Yes [ ] (b) No [ ]
19. If no, why?
(a) Ineffective (b) Not curative (c) No confidentiality (d) Restricts movement (e) Stigma (f)
Others (specify)__________________________________________________________
20. What would be your preferred choice of treatment?
(a) Prayer house [ ] (b) Spiritualist (c) Psychiatrist (d) Others (specify)______________

38