Journal of Mental Health

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Prevalence of mental distress and associated

factors among university students in Ethiopia: a
meta-analysis

Berihun Assefa Dachew, Brhanu Boru Bifftu, Bewket Tadesse Tiruneh,

Degefaye Zelalem Anlay & Meseret Adugna Wassie

To cite this article: Berihun Assefa Dachew, Brhanu Boru Bifftu, Bewket Tadesse Tiruneh,
Degefaye Zelalem Anlay & Meseret Adugna Wassie (2019): Prevalence of mental distress and
associated factors among university students in Ethiopia: a meta-analysis, Journal of Mental
Health, DOI: 10.1080/09638237.2019.1630717

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JOURNAL OF MENTAL HEALTH
https://doi.org/10.1080/09638237.2019.1630717

REVIEW ARTICLE

Prevalence of mental distress and associated factors among university students

in Ethiopia: a meta-analysis
Berihun Assefa Dachewa
, Brhanu Boru Bifftub, Bewket Tadesse Tirunehb, Degefaye Zelalem Anlayb and
Meseret Adugna Wassiec
a
Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar,
Gondar, Ethiopia; bSchool of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia; cDepartment of
Health Informatics, Teda Health Science College, Gondar, Ethiopia

ABSTRACT ARTICLE HISTORY

Background: Mental distress is an important public health problem and is becoming common health Received 22 November 2017
problems among university students. Revised 8 March 2019
Aims: This study aimed to provide a pooled prevalence of mental distress and associated factors Accepted 18 April 2019
among university students in Ethiopia. Published online 24 June
2019
Method: We systematically searched PubMed, EMBASE and PsycINFO databases. A further search was
performed at Google Scholar search engine for additional studies. All observational studies reporting KEYWORDS
the prevalence of mental distress and/or associated factors among university students in Ethiopia Prevalence; mental distress;
were included. Pooled prevalence with 95% confidence interval (95% CI) were calculated using ran- university students; Ethiopia
dom effects and quality effects models. Subgroup and sensitivity analyses were performed.
Heterogeneity between studies and evidence of publication bias were assessed.
Results: The pooled prevalence of mental distress was 35% (95% CI; 28%–43%). Being female, partici-
pating in religious programmes, having close friends, experiencing financial distress, alcohol use, khat
use, conflict with friends, lack of interest in their field of study and a family history of mental illness
were factors associated with mental distress among students. We found significant heterogeneity, but
no evidence of publication bias.
Conclusions: More than one third of university students in Ethiopia have suffered with mental dis-
tress. The finding provides evidence that university students are at risk population for mental health
problems and suggests the need for early intervention to prevent severe mental illness.

Background new roommates and friends, exposure to new cultures and

Mental distress also known as common mental disorders
(CDMs) is a mental health problem characterized by a range
of depressive, anxiety or somatic symptoms including head-
ache, backache and sleep problems (de Waal, Arnold,
Spinhoven, Eekhof, & van Hemert, 2005; Rocha, de
Almeida, de Araujo, & Virtuoso, 2010). A person with men-
tal distress may also present with confused emotions and
hallucinations (Giang, Dzung, Kullgren, & Allebeck, 2010;
Rocha et al., 2010). The term is used when it has not been
possible to obtain a specific diagnosis of mental disorder
(Giang et al., 2010). Mental distress affects a substantial pro-
portion of the world population and is prevalent in univer-
sities worldwide (Dachew, Azale Bisetegn, & Berhe
Gebremariam, 2015; Lima, Domingues, & Cerqueira, 2006;
Mosley et al., 1994; Patel & Kleinman, 2003; Rocha et al.,
2010; Sidik, Rampal, & Kaneson, 2003; Stallman, 2008).
Various factors could contribute to mental distress
among university students. The experience of new lifestyles,
environments, loss of or separation from traditional adult
supervisors and low social support are some of these factors
(Al-Busaidi et al., 2011; Mosley et al., 1994; Storrie, Ahern,
& Tuckett, 2010; Yussuf, Issa, Ajiboye, & Buhari, 2013). In
addition, academic stressors, peer pressure and financial dis-
tress have been recognized as risk factors for developing
mental distress amongst students (Dachew et al., 2015;
Sreeramareddy et al., 2007). However, many students do not
seek help for their problems and inability to manage these
conditions early will lead to adverse impact on their aca-
demic achievement (Kessler, Foster, Saunders, & Stang,
1995; Sijtsema, Verboom, Penninx, Verhulst, & Ormel,
2014). More importantly, mental distress is associated with
an increased risk of substance use (Kingston, Marel, &
Mills, 2017; Swendsen et al., 2010) and suicidal behaviours
(Dvorak, Lamis, & Malone, 2013; Garlow et al., 2008;
Izadinia, Amiri, Jahromi, & Hamidi, 2010).
In Ethiopia, mental and substance use disorders are com-
mon public health problems responsible for about 1897

CONTACT Berihun Assefa Dachew berihunassefa21@gmail.com Department of Epidemiology and Biostatistics, Institute of Public Health, College of
Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia

Institute for Social Science Research, The University of Queensland, Indooroopilly, QLD, Australia
Supplemental data for this article can be accessed here.
ß 2019 Informa UK Limited, trading as Taylor & Francis Group
2 B. A. DACHEW ET AL.
disability adjusted life years (DALYs) per 100,000 popula-
tion (Institute for Health Metrics & Evaluation [IHME],
2016). Studies have shown that mental distress is prevalent
among university students in Ethiopia, ranging from 21.6%
to 63.1% (Alem, Araya, Melaku, Wendimagegn, & Abdulahi,
2005; Busi et al., 2016; Byrd et al., 2014; Dachew et al.,
2015; Dessie, Ebrahim, & Awoke, 2013; Getachew & Tekle,
2018; Haile, Alemu, & Habtewold, 2017; Kerebih, Ajaeb, &
Hailesilassie, 2017; Melese et al., 2016; Tariku, Zerihun,
Bisrat, Adissu, & Jini, 2017; Tesfaye, 2009). Although several
individual studies have reported the prevalence of mental
distress and associated factors among university students in
Ethiopia, to our knowledge, there is no published systematic
review and meta-analysis that shows pooled estimates of
mental distress and its associated factors. Having a pooled
prevalence of mental distress and identifying the associated
factors would help policy-makers and programme managers
in developing evidence-based mental health promotion and
disease prevention programmes. Therefore, the objective of
this systematic review and meta-analysis was to review the
existing literature, with the aim of quantifying the burden of
CMDs and identifying factors associated with CMDs among
university students in Ethiopia.
Methods
This meta-analysis was conducted in accordance with the
preferred reporting items for systematic review and meta-
analysis (PRISMA) (Moher et al., 2015). The study protocol
was prospectively registered in an International Prospective
Register of Systematic Reviews (PROSPER) (Registration
Number: CRD42017067223, http://www.crd.york.ac.
uk/PROSPERO.
Data sources and search strategies
We searched PubMed, EMBASE and PsycINFO electronic
databases and Google Scholar search engine with no publi-
cation year restriction. The search comprises both Medical
Subject Headings (MeSH) and free text words (title and
abstract word searches). We used the following search
terms: “Mental distress” OR “Common mental disorders”
OR “Mental illness” OR “Psychological distress” OR “Stress”
AND “University students” OR “College students” AND
“Ethiopia.” In addition, the reference lists of included stud-
ies were manually searched for additional eligible articles.
Study selection and eligibility criteria
All observational studies reporting the prevalence of mental
distress and/or factors associated with mental distress
among university students will be included. An article will
be included if it meets the following criteria: (1) conducted
solely or partly among university and/or college students,
(2) reported the prevalence of mental distress using standar-
dized instruments or questionnaires (such as the Beck’s
Depression Inventory, Patient Health Questionnaire -9, Self-
reporting Questionnaire-20 or clinical interviews) and (3)
published in English. Conference abstracts, letters to editors,
review and commentary articles were excluded. Two investi-
gators (BAD and MAW) assessed the eligibility of each
study independently and disagreements were resolved
by discussion.
Data extraction
A standardised pre-piloted form was used to extract data
from the included studies. Extracted information includes
first author’s last name, year of publication, study location,
sample size, prevalence of mental distress, estimates for risk
or protective factors examined in each study, and ascertain-
ment of outcome.
Quality assessment
Two review authors (BAD and MAW) independently
assessed the quality of all included studies using Newcastle-
Ottawa quality assessment tool adapted for cross-sectional
studies (Anon, n.d.) and any disagreements were resolved
through discussion. The tool takes into account the selection
of participants, comparability and assessment of outcome. A
study can be given a maximum of one star for each num-
bered item within the selection and exposure categories and
a maximum of two stars can be given for comparability.
Finally, the results are summarised in three categories as
good quality (3 or 4 stars in selection domain and 1 or 2
stars in comparability domain and 2 or 3 stars in outcome/
exposure domain), fair quality (2 stars in selection domain
and 1 or 2 stars in comparability domain and 2 or 3 stars in
outcome/exposure domain) and poor quality (0 or 1 star in
selection domain or 0 stars in comparability domain or 0 or
1 stars in outcome/exposure domain). Finally, the quality of
each study was categorized as good, fair or poor quality.
We have used quality scores for quantitative analysis
(Supporting Information Table 1).
Data synthesis
We conducted random-effects meta-analyses with 95% con-
fidence interval (95% CI) to obtain the pooled prevalence of
metal distress and the pooled odds ratios of identified fac-
tors associated with mental distress (Berkey, Hoaglin,
Mosteller, & Colditz, 1995). Quality-effects meta-analysis
was also performed to examine how the quality of each
study changed the pooled estimate compared with the
results from random-effects meta-analysis (Doi & Thalib,
2008). This analysis incorporates the quality score of each
study in the calculation of the study weight, which is a
robust and innovative technique to help minimize the esti-
mator variance and account for subjectivity in quality
assessment (Doi & Thalib, 2008). Heterogeneity between the
studies was assessed using both Cochran’s Q statistic and
the I2 statistics. I2 value greater than 50% were considered
as indicative of substantial heterogeneity (Higgins &
Thompson, 2002). Evidence of publication bias was assessed
using Egger’s test (p < 0.05) (Egger, Davey Smith, Schneider,
 JOURNAL OF MENTAL HEALTH 3

& Minder, 1997) and visual inspection of the symmetry in
funnel plots (Liu, 2011).
Subgroup analyses were undertaken by sample size, year
of publication, study quality and screening tool as possible
sources of heterogeneity between studies. Sensitivity analyses
were performed by excluding each study one by one and
calculating a pooled estimate for the reminder of the studies.
All statistical analyses were performed using MetaXL version
5.3 and STATA14 Metaprop package (StataCorp, 2015).
Results
After duplicates removal, 246 articles were identified and of
them, 148 were excluded during initial assessment as their
titles were found to be irrelevant. We further screened the
abstracts of the remaining 98 studies and excluded 64 of
these as they did not fulfil the eligibility criteria. The
remaining (n ¼ 34) full text papers were screened for
relevance and 11 papers were found to be eligible for meta-
analysis (Figure 1).
Study characteristics
Table 1 shows the characteristics of studies included in the
meta-analysis. All of the included studies were cross-sec-
tional and published between 2005 and 2018. The partici-
pant ages ranged from 16 to 35 years. The sample sizes of
included studies ranged from 240 to 2817, with the response
rate of 80–100%. Most studies used stratified random sam-
pling techniques to recruit the study participants. Of the
included studies, eight studies used the Self-Reporting
Questionnaire (SRQ-20) to assess mental distress. SRQ-20 is
a screening tool having 20 item questions, originally devel-
oped by World Health Organization (WHO) designed to
indicate mental distress (World Health Organization, 1994).
The tool is adopted from WHO and was validated in low
and middle-income countries including Ethiopia; and found

Additional records defined

Total records identified trough cross-referencing
Idenficaon

(n=368) (n=1)

Records after duplication removed (n=246)

Records excluded (n=148)

Records screened by title for Not relevant, reviews,
relevance (n=246) conference papers, unrelated
Screening

outcome

Recodes excluded (n=64)

Not in Ethiopia (n=37)
Records screened by abstract (n=98) Different outcome (27)
Eligibility

Full text articles excluded

(n=23)
Full text articles assessed for Not in college/university
eligibility (34) students (n=6)
Not based in Ethiopia (n=11)
Different outcome (5)
Prevalence not reported (1)
Included

Studies included in the meta-

analysis (11)

Figure 1. Flow diagram of studies included in meta-analysis.

4 B. A. DACHEW ET AL.

to be highly sensitive and specific (Ali, Ryan, & De Silva,

diagnostic
Outcome

criteria

GHQ-R
2016; Lund et al., 2011; Youngmann, Zilber, Workneh, &

SRQ

SRQ
SRQ
SRQ

SRQ
SRQ
SRQ
SRQ
K10

NR
Giel, 2008). A cut-off point of eight and above was taken by
most of the studies (n ¼ 6). Seven of 11 studies were good

Prevalence
in quality studies. The average quality score of included

63.1%
35.2%
29.2%

24.4%
40.9%
26.6%
21.6%
49.1%
32.6%
38.3%
30%
Number of cases studies was 7 (Supplementray Table 1).

Prevalence of mental distress

The prevalence of mental distress ranged from 21.6% to
245
102
90
72
80
342
716
93
588
89
232
63.1%. The pooled prevalence of mental distress was 35%
(95% CI; 28%–43%) (Figure 2).
The quality effects model provides consistent finding
(pooled prevalence ¼ 35%; 95% CI, 25%–45%)
Response rate
91.9%

97.2%

95.4%
95.9%
93.9%
97.3%
95.4%

(Supplementary Figure 1). We found significant between

100%

100%
95%

80%

study heterogeneity (Q ¼ 381, p < 0.001 and I2 ¼ 97%).

Tests for publication bias demonstrated no asymmetry based
on funnel plot (Supplementary Figure 2). Egger’s test also
Sample size

confirmed non-significant bias coefficients (p ¼ 0.38) sug-

422
305
317
240
327
872
2817
442
1198
350
605

gesting absence of publication bias.

Subgroup analyses showed consistent prevalence estimate
among good quality studies (pooled prevalence ¼ 34%,
Stratified multistage sampling

95%CI, 26%–42%), studies using SRQ as a screening tool

Stratified random sampling
Stratified random sampling
Stratified random sampling
Stratified random sampling

(pooled prevalence ¼ 34%, 95%CI, 27%–41%), and studies

Entire student population

GHQ-R: General Health Questionnaire; K10: Kessler psychological distress; NR: Not reported; SRQ: Self-Reporting questionnaire (SRQ).
Simple random sampling

Simple random sampling

Simple random sampling

Simple random sampling

Sampling technique

published after 2010 (pooled prevalence ¼ 34%, 95%CI,

Multistage sampling

27%–42%) (Table 2 and Supplementary Figure 3–6)

Sensitivity analysis produced a pooled estimate ranging
from 33% (95% CI, 27%–39%) to 37% (95% CI; 30%–44%)
(Supplementary Table 2).

Factors associated with mental distress

Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Cross-sectional
Study design

In this study, we identified factors associated with

mental distress among students. Only those factors that
were assessed by at least two studies were considered for
meta-analysis. Being female, participating in religious pro-
Mizan Aman Health Science college, Southwest Ethiopia

grammes, having close friends, experiencing financial dis-

tress, alcohol use, khat use, conflict with friends, lack of
interest in their field of study and a family history of mental
Madda Walabu University, Southeast Ethiopia
Table 1. Characteristics of studies included in the meta-analysis (n ¼ 11).

illness were factors associated with mental distress among

Gondar and Haramaya University, Ethiopia
Debre Berhan University, Central Ethiopia

University of Gondar, Northwest Ethiopia

Addis Ababa University, Central Ethiopia

students (Table 3).

Hawassa University, Southern Ethiopia
Hawassa University, Southern Ethiopia

Hawassa University, Southern Ethiopia

Jimma University, Southwest Ethiopia
Study location

Adama University, Eastern Ethiopia

Discussion
This is the first meta-analysis that determined the pooled
prevalence of mental distress and associated factors among
university students in Ethiopia. Our finding suggests that
more than one third of university students have experienced
mental distress. The prevalence of mental distress found in
this study is much higher than that found in the general
population of Ethiopia (11.7%–17.7%) (Alem, Kebede,
Woldesemiat, Jacobsson, & Kullgren, 1999; Gelaye et al.,
Getachew & Tekle, 2018

2012; Kebede, Alem, & Rashid, 1999). The finding provides

Dachew et al., 2015
Kerebih et al., 2017

Melese et al., 2016

Dessie et al., 2013

Tariku et al., 2017

evidence that university students are at risk population for

Alem et al., 2005
Haile et al., 2017

Byrd et al., 2014

Busi et al., 2016

Tesfaye, 2009

mental health problems. This higher level of distress may

Author, year

have short and long-term influence on students’ achieve-

ment. Students are less likely to perform well at university
when suffering from mental illness (Kessler et al., 1995;
 JOURNAL OF MENTAL HEALTH 5

Study Prev (95% CI) % Weight

Haile et al., 2017 0.63 ( 0.58, 0.68) 9.1
Kerebih et al., 2017 0.35 ( 0.30, 0.41) 8.9
Tariku eta1., 2017 0.29 ( 0.24, 0.34) 9.0
Melese et al., 2016 0.30 ( 0.24, 0.36) 8.8
Busi etal., 2016 0.24 ( 0.20, 0.29) 9.0
Dachew et al., 2015 0.41 ( 0.38, 0.44) 9.3
Byrd et al., 2014 0.27 ( 0.25, 0.29) 9.4
Dessie et al., 2013 0.22 ( 0.18, 0.26) 9.1
Tesfaye, 2009 0.49 ( 0.46, 0.52) 9.3
Alem et al., 2005 0.33 ( 0.27, 0.38) 8.9
Getachew et al.,2018 0.38 ( 0.35, 0.42) 9.2

Overall 0.35 ( 0.28, 0.43) 100.0

Q=380.89, p=0.00, I2=97%

0 0.2 0.4 0.6 0.8

Prevalence
Figure 2. Forest plot of studies assessing the prevalence of mental distress among university students in Ethiopia using random effects model (Pooled prevalence,
with 95% CI).

Table 2. Subgroup analysis.

Subgroups Number of studies Pooled prevalence
Publication year
2010þ 9 34%
Before 2010 2 41%
Screening tool
SRQ 8 34%
Other 3 39%
Study quality
Good 7 34%
Fair 4 38%
Sample size
<500 7 33%
500þ 4 39%
Sijtsema et al., 2014). Studies revealed that up to 5% of col-
lege dropout has been associated with mental illness
(Kessler et al., 1995). Moreover, mental illness has been
shown to be associated with higher risk of substance use
(Swendsen et al., 2010) and suicidality (Dvorak et al., 2013;
Garlow et al., 2008; Izadinia et al., 2010).
This finding is also higher compared to similar studies
conducted in East African countries, where a prevalence of
16.2%–19.8% of mental distress was reported (Hersi et al.,
2017; Ovuga, Boardman, & Wasserman, 2006). In Ethiopia,
mental disorders are not considered as life-threatening prob-
lems, and mental health services are not given due priority
and the needs of people for mental health care are not met
(Ayano et al., 2017). Although it is only partially imple-
mented, a National Mental Health Strategy has been avail-
able in Ethiopia since 2012 (World Health Organization,
2014). However, neither the National Mental Health
Strategy nor the Health Sector Transformation Plan men-
tioned students as vulnerable groups for mental illness
(Federal Democratic Republic of Ethiopia Ministry of
Health, 2012, 2015). Our finding, therefore, highlights that
university students are a vulnerable group who require spe-
cial consideration when developing mental health services.
Our findings showed that students who participated in
religious practice, regardless of which religion, had a lower
Table 3. Factors associated with mental mistress among university students
95% CI in Ethiopia (Pooled OR with 95% CI).
Factors Number of studies Pooled OR (95% CI)
27%–42%
25%–58% Being female 7 1.70 (1.20–2.40)
Relationship status (in relation) 4 1.03 (0.76–1.40)
27%–41% Year of study (first year) 4 1.31 (0.68–2.50)
18%–62% Religious practice (yes) 5 0.41 (0.31–0.67)
Not interested in their filed 2 2.20 (1.48–3.26)
26%–42% Family history of mental illness 4 2.20 (1.50–3.10)
35%–42% Financial stress 3 1.6 (1.23–2.10)
Alcohol drinking 6 1.6 (1.10–2.40)
23%–45% Cigarette smoking 4 2.20 (0.98–1.84)
28%–50% Khat chewing 4 1.7 (1.10–2.70)
Conflict with friends 3 2.0 (1.60–2.70)
Having close friends 2 0.43 (0.31–0.59)
Note. Only those factors that were assessed by at least two studies were con-
sidered for meta-analysis.
risk of mental distress compared with those who were not.
Different studies have highlighted the protective role of spir-
ituality in preventing depression, anxiety and substance use
disorders and promoting well-being and quality of life
(Medlock et al., 2017; Tusa & Burgholzer, 2013;
Unterrainer, Lewis, & Fink, 2014). It is also important to
note the possibility of reverse causation, as depressed stu-
dents may stop going to worship. Similarly, students who
had close friends were less likely to have mental distress
than those who had not. As college life can be stressful,
experiencing strong, intimate friendships with a high degree
of attachment and support may help in promoting mental
health during this period. A recent longitudinal study con-
ducted in the United States of America found that close
friendships increase self-worth and decrease anxiety and
depressive symptoms (Narr, Allen, Tan, & Loeb, 2019). On
the other hand, our finding suggests that conflict with
friends were found to increase the risk of mental distress by
two folds (Pooled OR ¼ 2.0, 95%CI: 1.6–2.7).
We found that females reported higher levels of mental
distress than male students, which is consistent with the
existing evidence that a greater proportion of females report
common mental health problems than males (Tedstone
6 B. A. DACHEW ET AL.
Doherty & Kartalova-O’Doherty, 2010). This could be due
to the affective nature of their response to stressors, as
women have lower self-esteem and sense of control than
men, as well as gender-based violence and other biological
factors (Eaton et al., 2012; Tedstone Doherty & Kartalova-
O’Doherty, 2010). Our study also found that financial hard-
ship was another factor associated with mental distress in
students. Students who reported financial stress had a
greater risk of mental distress than those who did not. The
finding is consistent with the existing evidence where poor
mental health has been consistently linked with the experi-
ence of financial hardship (Cvetkovski, Reavley, & Jorm,
2012; Kiely, Leach, Olesen, & Butterworth, 2015).
Our review found that the risk of mental distress was
70% higher in students who chewed khat as compared to
those did not. Khat is a flowering plant which is used as a
stimulant in many parts of Africa and the Arabian
Peninsula (Warfa et al., 2007). It is a commonly used psy-
choactive substance among students in Ethiopia, especially
during examination periods (Gebrehanna, Berhane, &
Worku, 2014). Many studies in Ethiopia and abroad
reported a significant association between khat use and vari-
ous mental disorders (Damena, Mossie, & Tesfaye, 2011;
Gebrehanna et al., 2014; Odenwald et al., 2005; Warfa et al.,
2007). In line with other studies, alcohol use, lack of interest
in their field of study and a family history of mental
illness were also other factors associated with mental
distress in students (Rohrer, Rohland, Denison, Pierce, &
Rasmussen, 2007).
The strengths of this meta-analysis are that we included
all studies without time restrictions. Furthermore, we used
standardized quality assessment tool with most (n ¼ 7) stud-
ies rated good in quality. In addition, almost all studies
(n ¼ 10) include in in the analyses used standardized screen-
ing questionnaires to assess the prevalence of mental distress
and eight of eleven studies used SRQ-20, the tool that has
been validated in Ethiopia (Youngmann et al., 2008).
However, this meta-analysis study had some important limi-
tations. First, we found a high level of between study het-
erogeneity, but to address this we used a random effects
model as is recommended in situations with high level of
between study heterogeneity (Ades, Lu, & Higgins, 2005). In
addition, we applied a quality effects model, which allowed
us to overcome some problems with a traditional random
effects model (Doi & Thalib, 2008). Second, although the
quality of all included studies was assessed using the
Newcastle-Ottawa quality assessment tool, methodological
appraisal remains a subjective exercise. For this reason, to
minimize bias in the review process, two reviewers assessed
the quality of all included studies independently any dis-
agreements were resolved through discussion. Third, unlike
a fixed effects model which produce unbiased estimates, the
random effects model introduce bias in the pooled estimates
(Kinney & Dunson, 2007). Fourth, although the funnel plot
did not show asymmetry on visual inspection and Egger’s
test also showed no evidence of publication bias, we may
not fully exclude the possibility of publication bias as this
meta-analysis considers only published studies. Fifth, there
is a possibility of reporting and response set bias as all
data were self-reported. Finally, the cross-sectional nature of
the study does not confirm definitive cause and effect
relationships.
Conclusion
The prevalence of mental distress among university students
in Ethiopia was found to be high. Being female, participat-
ing in religious programmes, having close friends, experi-
encing financial distress, alcohol use, khat use, conflict with
friends, lack of interest in their field of study and a family
history of mental illness were factors associated with mental
distress among students. Prospective cohort studies would
be useful to confirm the observed associations. Qualitative
studies are needed to further assess the contributory factors
leading to mental distress among university students. Our
findings suggest the need for early intervention to prevent
severe mental illness in students. We encouraged students to
seek formal as well as informal help, usually from friends,
family and religious leaders, and to implement self-care
strategies to take care and control of their own wellbeing.
Acknowledgements
The authors would like to acknowledge Ms Madonna Boman for edit-
ing the manuscript.
Disclosure statement
No potential conflict of interest was reported by the authors.
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