Bridging the divide: unveiling treatment gap and barriers to mental health care for medical students in Pakistan: a cross-sectional study
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20254013Keywords:
Medical student, Mental health, Mental health service, Healthcare disparities, Health seeking behavior, cross sectional studiesAbstract
Background: Depression is a common yet often underrecognized and treatable disorder among medical students. In Pakistani cohort there is limited research on barriers to accessing mental health care. This study aims to quantify the treatment gap in mental health conditions among Pakistani medical students, identify potential barriers to initiating mental health treatment, and explore demographic predictors influencing the reporting of these barriers.
Methods: A cross-sectional study was conducted between March and July 2025 involving 144 medical students. Data collection utilized the barriers to access to care evaluation (BACE v3) and the Rosenberg self-esteem scale (RSES) questionnaires. Statistical analyses were performed using SPSS version 28 to ensure rigorous examination of the data.
Results: The study examined the demographics, self-esteem levels, and barriers to seeking professional mental health care among 144 participants. The findings indicate that the majority 70.8% exhibited medium to high self-esteem, whereas approximately 29.2% reported low self-esteem. The most prominent barriers identified were attitudinal, 95.8% participants endorsing the preference to "solve the problem on my own," and stigma-related, 79.9% expressing concern about “what my family might think.
Discussion: Thematic analysis further revealed key barriers, including stigmatizing beliefs, difficulty in disclosing personal issues, a reliance on self-management, and challenges in accessing professional help.
Conclusion: Medical students face significant mental health challenges, often hindered by stigma and attitudinal barriers. Improving awareness, reducing stigma, and enhancing access to mental health services in universities are essential. Early intervention and supportive environments can help safeguard their mental well-being and academic success.
Metrics
References
Markoulakis R, Kirsh B. Difficulties for University Students with Mental Health Problems: A Critical Interpretive Synthesis. Rev High Ed. 2013;37(1):77–100. DOI: https://doi.org/10.1353/rhe.2013.0073
Patel V. Global mental health: from science to action. Harvard review of psychiatry. 2012;20(1):6-12. DOI: https://doi.org/10.3109/10673229.2012.649108
Qin X, Hsieh CR. Understanding and addressing the treatment gap in mental healthcare: economic perspectives and evidence from China. Inquiry: The J Health Care Org, Prov, Finan. 2020;57:566.. DOI: https://doi.org/10.1177/0046958020950566
WHO. Mental disorders. Available at: https://www.who.int/news-room/fact-sheets/detail/mental-disorders. Accessed on 12 July 2025.
Alangari AS, Knox SS, Kristjansson AL, Wen S, Innes KE, Bilal L, et al. Barriers to Mental Health Treatment in the Saudi National Mental Health Survey. Int J Env Res Publ Heal. 2020;17(11):859. DOI: https://doi.org/10.3390/ijerph17113877
Frank RG, McGuire TG. Economics and mental health. Handbook Heal Econom. 2000;1:893-954. DOI: https://doi.org/10.1016/S1574-0064(00)80029-3
Abdullah T, Brown TL. Mental illness stigma and ethnocultural beliefs, values, and norms: An integrative review. Clin Psychol Rev. 2011;31(6):934-48. DOI: https://doi.org/10.1016/j.cpr.2011.05.003
Ben-Zeev D, Young MA, Corrigan PW. DSM-V and the stigma of mental illness. J Ment Heal. 2010;19(4):318-27. DOI: https://doi.org/10.3109/09638237.2010.492484
Rüsch N, Angermeyer MC, Corrigan PW. Mental illness stigma: Concepts, consequences, and initiatives to reduce stigma. European Psych. 2005;20(8):529-39. DOI: https://doi.org/10.1016/j.eurpsy.2005.04.004
Thornicroft G, Chatterji S, Evans-Lacko S, Gruber M, Sampson N. Undertreatment of people with major depressive disorder in 21 countries. The British J Psych. 2017;210(2):119-24. DOI: https://doi.org/10.1192/bjp.bp.116.188078
Luitel NP, Jordans MJ, Kohrt BA, Rathod SD, Komproe IH. Treatment gap and barriers for mental health care: a cross-sectional community survey in Nepal. PloS one. 2017;12(8):183223. DOI: https://doi.org/10.1371/journal.pone.0183223
Almanasef M. Mental health literacy and help-seeking behaviours among undergraduate pharmacy students in Abha, Saudi Arabia. Risk Man Health Policy. 2021:1281-6. DOI: https://doi.org/10.2147/RMHP.S289211
Bruffaerts R, Mortier P, Kiekens G, Auerbach RP, Cuijpers P, Demyttenaere K. Mental health problems in college freshmen: Prevalence and academic functioning. Journal of affective disorders. 2018;225:97-103. DOI: https://doi.org/10.1016/j.jad.2017.07.044
Oláh B, Rádi BM, Kósa K. Barriers to seeking mental help and interventions to remove them in medical school during the COVID-19 pandemic: perspectives of students. Int J Environmen Res Publ Heal. 2022;19(13):7662. DOI: https://doi.org/10.3390/ijerph19137662
Dahlin ME, Runeson B. Burnout and psychiatric morbidity among medical students entering clinical training: a three-year prospective questionnaire and interview-based study. BMC Med Edu. 2007;7:1-8. DOI: https://doi.org/10.1186/1472-6920-7-6
Berliant M, Rahman N, Mattice C, Bhatt C, Haykal KA. Barriers faced by medical students in seeking mental healthcare: a scoping review. Med Ed Publish. 2022;12:75. DOI: https://doi.org/10.12688/mep.19115.1
Hankir AK, Northall A, Zaman R. Stigma and mental health challenges in medical students. Case Reports. 2014;2:5226. DOI: https://doi.org/10.1136/bcr-2014-205226
Rodriguez ML, Corse AK, Rosen LD. Mental health services use among medical students: perceived stigma and barriers to care. Med Sci Educator. 2017;27:267-72. DOI: https://doi.org/10.1007/s40670-017-0392-6
Alshahrani SS, Alrajhi MM, Alshehri MA, Alotaibi FM, Altwerqe MS. Challenges and barriers in primary mental health services in Saudi Arabia: a narrative review. Adv Human Biol. 2023;13(4):309-12. DOI: https://doi.org/10.4103/aihb.aihb_54_23
Noorwali R, Almotairy S, Akhder R, Mahmoud G, Sharif L, Alasmee N. Barriers and facilitators to mental health help-seeking among young adults in Saudi Arabia: a qualitative study. Int J Env Res Publ Heal. 2022;19(5):2848. DOI: https://doi.org/10.3390/ijerph19052848
Givens JL, Tjia J. Depressed medical students' use of mental health services and barriers to use. Academic Med. 2002;77(9):918-21. DOI: https://doi.org/10.1097/00001888-200209000-00024
Alaqeel M, Alkhudairy FA, Basuliman AS, Alsubaie AM, Alqahtani FN, Almkainzi HA. The barriers to seeking mental health Services at King Saud bin Abdulaziz University for health sciences. Cureus. 2023;15(9):47. DOI: https://doi.org/10.7759/cureus.45321
Billingsley M. More than 80% of medical students with mental health issues feel under-supported, says Student BMJ survey. BMJ. 2015;3:5187. DOI: https://doi.org/10.1136/sbmj.h4521
Taylor A. Overstretched NHS services are sending suicidal students back to universities for help. BMJ. 2020;36:3958. DOI: https://doi.org/10.1136/bmj.m814
Broglia E, Millings A, Barkham M. Student mental health profiles and barriers to help seeking: When and why students seek help for a mental health concern. Counsel Psyc Res. 2021;21(4):816-26. DOI: https://doi.org/10.1002/capr.12462
Hong V, Busby DR, O’Chel S, King CA. University students presenting for psychiatric emergency services: Socio-demographic and clinical factors related to service utilization and suicide risk. J American Coll Heal. 2022;70(3):773-82. DOI: https://doi.org/10.1080/07448481.2020.1764004
Husain W. Barriers in seeking psychological help: public perception in Pakistan. Comm Ment Health J. 2020;56(1):75-8. DOI: https://doi.org/10.1007/s10597-019-00464-y
Siddiqui F. Barriers and challenges to mental health care in Pakistan. Pakistan J Neurol Sci. 2021;16(3):1-2.
Alsalman Z, Shafey MM, Al-Khofi A, Alessa J, Bukhamsin R, Bokhuwah M, et al. Barriers to mental health service utilisation among medical students in Saudi Arabia. Front Publ Heal. 2024;12:1371628. DOI: https://doi.org/10.3389/fpubh.2024.1371628
Das A. Treatment gap or service deficit: What is meant by the treatment gap in mental illness. Indian J Psychiat. 2023;65(9):982-3. DOI: https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_435_23
Salaheddin K, Mason B. Identifying barriers to mental health help-seeking among young adults in the UK: a cross-sectional survey. British J Gen Pract. 2016;66(651):686-92. DOI: https://doi.org/10.3399/bjgp16X687313
Rotenstein LS, Ramos MA, Torre M, Segal JB, Peluso MJ, Guille C. Prevalence of depression, depressive symptoms, and suicidal ideation among medical students: a systematic review and meta-analysis. JAMA. 2016;316(21):2214-36. DOI: https://doi.org/10.1001/jama.2016.17324
Wijeratne C, Johnco C, Draper B, Earl J. Doctors’ reporting of mental health stigma and barriers to help-seeking. Occupationa Med. 2021;71(8):366-74. DOI: https://doi.org/10.1093/occmed/kqab119
Abdel-Hady D, Baklola M, Terra M, El-Gilany AH. Patterns and barriers of mental health service utilization among medical students: a cross-sectional study. Middle East Current Psychiatry. 2022;29(1):98. DOI: https://doi.org/10.1186/s43045-022-00267-0
Negash A, Khan MA, Medhin G, Wondimagegn D, Araya M. Mental distress, perceived need, and barriers to receive professional mental health care among university students in Ethiopia. BMC Psych. 2020;20:1-5. DOI: https://doi.org/10.1186/s12888-020-02602-3
Freire T, Tavares D. Influência da autoestima, da regulação emocional e do gênero no bem-estar subjetivo e psicológico de adolescentes. Arch Clin Psych. 2011;38:184-8. DOI: https://doi.org/10.1590/S0101-60832011000500003
Bleidorn W, Buyukcan-Tetik A, Schwaba T, Van Scheppingen MA, Denissen JJ, Finkenauer C. Stability and change in self-esteem during the transition to parenthood. Soc Psychol Personal Sci. 2016;7(6):560-9. DOI: https://doi.org/10.1177/1948550616646428
Donnellan MB, Trzesniewski KH, Robins RW. Measures of self-esteem. Meas Personal Soc Psychol Constr. 2015;2:131-57. DOI: https://doi.org/10.1016/B978-0-12-386915-9.00006-1
Hinz A, Michalski D, Schwarz R, Herzberg PY. The acquiescence effect in responding to a questionnaire. GMS Psycho-Social Medicine. 2007;4:857.
Nieto MD, Garrido LE, Martínez-Molina A, Abad FJ. Modeling wording effects does not help in recovering uncontaminated person scores: a systematic evaluation with random intercept item factor analysis. Front Psychol. 2021;12:685326. DOI: https://doi.org/10.3389/fpsyg.2021.685326
Downloads
Published
How to Cite
Issue
Section
