ESP-3936

Published

2025-09-26

Issue

Vol. 10 No. 9 (2025): Published

Section

Review Articles

License

Copyright (c) 2025 Kus Hanna Rahmi, Zakiyah Jamaluddin, Mahathir Yahaya, Azlini Binti Chik, Meiti Subardhini, Enung Huripah, Adi Fahrudin

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

The journal adopts the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0), which means that anyone can reuse and redistribute the materials for non-commercial purposes as long as you follow the license terms and the original source is properly cited.

Author(s) shall retain the copyright of their work and grant the Journal/Publisher rights for the first publication with the work concurrently licensed since 2023 Vol.8 No.2.

Under this license, author(s) will allow third parties to download, reuse, reprint, modify, distribute and/or copy the content under the condition that the authors are given credit. No permission is required from the authors or the publisher.

This broad license intends to facilitate free access, as well as the unrestricted use of original works of all types. This ensures that the published work is freely and openly available in perpetuity.

By providing open access, the following benefits are brought about:

  • Higher Visibility, Availability and Citations-free and unlimited accessibility of the publication over the internet without any restrictions increases citation of the article.
  • Ease of search-publications are easily searchable in search engines and indexing databases.
  • Rapid Publication – accepted papers are immediately published online.
  • Available for free download immediately after publication at https://esp.as-pub.com/index.php/ESP

 

Copyright Statement

1.The authors certify that the submitted manuscripts are original works, do not infringe the rights of others, are free from academic misconduct and confidentiality issues, and that there are no disputes over the authorship scheme of the collaborative articles. In case of infringement, academic misconduct and confidentiality issues, as well as disputes over the authorship scheme, all responsibilities will be borne by the authors.

2. The author agrees to grant the Editorial Office of Environment and Social Psychology a licence to use the reproduction right, distribution right, information network dissemination right, performance right, translation right, and compilation right of the submitted manuscript, including the work as a whole, as well as the diagrams, tables, abstracts, and any other parts that can be extracted from the work and used in accordance with the characteristics of the journal. The Editorial Board of Environment and Social Psychology has the right to use and sub-licence the above mentioned works for wide dissemination in print, electronic and online versions, and, in accordance with the characteristics of the periodical, for the period of legal protection of the property right of the copyright in the work, and for the territorial scope of the work throughout the world.

3. The authors are entitled to the copyright of their works under the relevant laws of Singapore, provided that they do not exercise their rights in a manner prejudicial to the interests of the Journal.

About Licence

Environment and Social Psychology is an open access journal and all published work is available under the Creative Commons Licence, Authors shall retain copyright of their work and grant the journal/publisher the right of first publication, and their work shall be licensed under the Attribution-NonCommercial 4.0 International (CC BY-NC 4.0).

Under this licence, the author grants permission to third parties to download, reuse, reprint, modify, distribute and/or copy the content with attribution to the author. No permission from the author or publisher is required.

This broad licence is intended to facilitate free access to and unrestricted use of original works of all kinds. This ensures that published works remain free and accessible in perpetuity. Submitted manuscripts, once accepted, are immediately available to the public and permanently accessible free of charge on the journal’s official website (https://esp.as-pub.com/index.php/ESP). Allowing users to read, download, copy, print, search for or link to the full text of the article, or use it for other legal purposes. However, the use of the work must retain the author's signature, be limited to non-commercial purposes, and not be interpretative.

Click to download <Agreement on the Licence for the Use of Copyright on Environmental and Social Psychology>.

How to Cite

Kus Hanna Rahmi, Zakiyah Jamaluddin, Mahathir Yahaya, Azlini Binti Chik, Meiti Subardhini, Enung Huripah, & Adi Fahrudin. (2025). Barriers to accessing mental health services among university students: A systematic review. Environment and Social Psychology, 10(9), ESP-3936. https://doi.org/10.59429/esp.v10i9.3936

Barriers to accessing mental health services among university students: A systematic review

Kus Hanna Rahmi

Universitas Bhayangkara Jakarta Raya, Jakarta, 12550, Indonesia

Zakiyah Jamaluddin

Universiti Utara Malaysia, Sintok, Kedah, 06010, Malaysia

Mahathir Yahaya

Universiti Sains Malaysia, Penang, 11800, Malaysia

Azlini Binti Chik

Universiti Sultan Zainal Abidin (UnisZA), Terengganu, 20400, Malaysia

Meiti Subardhini

Politeknik Kesejahteraan Sosial Bandung, 40135, Indonesia

Enung Huripah

Politeknik Kesejahteraan Sosial Bandung, 40135, Indonesia

Adi Fahrudin

Universitas Esa Unggul, Jakarta, 11510, Indonesia


DOI: https://doi.org/10.59429/esp.v10i9.3936


Keywords: mental health services; university students; barriers to access; systematic review; intervention effectiveness; help-seeking behavior

Abstract

Background: University students worldwide face escalating mental health challenges, yet their access to appropriate psychological support services remains critically limited. Despite growing institutional awareness of student well-being needs, systematic barriers continue to impede effective service utilization, creating a concerning gap between mental health needs and actual service engagement.

Objective: This systematic review aims to comprehensively identify and analyze the multifaceted barriers that prevent university students from accessing mental health services, while simultaneously evaluating the effectiveness of interventions designed to address these obstacles.

Methods: Following PRISMA guidelines [1] We conducted an extensive systematic review by searching seven electronic databases, including PubMed, PsycINFO, ERIC, CINAHL, Web of Science, Scopus, and the Cochrane Library for studies published between January 2017 and December 2024. We included empirical studies examining barriers to accessing mental health services among university students aged 18-30 years. Study quality was rigorously assessed using the Mixed Methods Appraisal Tool [2] and Newcastle-Ottawa Scale [3]. Data synthesis employed structured narrative analysis complemented by quantitative analysis where appropriate.

Results: Our comprehensive search identified 2,847 initial records, from which 45 studies meeting strict inclusion criteria were analyzed, encompassing 78,392 participants across 23 countries. Through systematic analysis, three primary barrier categories emerged: individual-level barriers, including stigma, misconceptions, and help-seeking reluctance; structural barriers, encompassing financial constraints, service availability, and accessibility issues; and institutional barriers, involving inadequate resources, insufficient staff training, and system integration failures. Financial constraints emerged as the most frequently reported barrier across 69% of studies, followed closely by stigma-related concerns in 64% of studies and limited-service awareness in 58% of included research. Analysis of intervention studies revealed moderate effectiveness for comprehensive, multi-component approaches that address barriers at multiple levels simultaneously.

Conclusions: Multiple interconnected barriers create complex obstacles to university students' access to mental health services. The evidence strongly supports implementing multi-level interventions that simultaneously address individual, structural, and institutional factors rather than targeting isolated barriers. Future research should prioritize implementation science approaches and examine the long-term sustainability of barrier-reduction interventions in diverse university settings.

References

[1]. 1.M. J. Page et al., “The PRISMA 2020 statement: an updated guideline for reporting systematic reviews,” BMJ, p. n71, Mar. 2021, doi: 10.1136/bmj.n71.

[2]. 2.Q. N. Hong et al., “The Mixed Methods Appraisal Tool (MMAT) version 2018 for information professionals and researchers,” Education for Information, vol. 34, no. 4, pp. 285–291, Dec. 2018, doi: 10.3233/EFI-180221.

[3]. 3.G. Wells et al., “The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses,” Ottawa, May 2021.

[4]. 4.R. P. Auerbach et al., “WHO World Mental Health Surveys International College Student Project: Prevalence and distribution of mental disorders.,” J Abnorm Psychol, vol. 127, no. 7, pp. 623–638, Oct. 2018, doi: 10.1037/abn0000362.

[5]. 5.P. Mortier et al., “The prevalence of suicidal thoughts and behaviours among college students: a meta-analysis,” Psychol Med, vol. 48, no. 4, pp. 554–565, Mar. 2018, doi: 10.1017/S0033291717002215.

[6]. 6.R. Bruffaerts et al., “Mental health problems in college freshmen: Prevalence and academic functioning,” J Affect Disord, vol. 225, pp. 97–103, Jan. 2018, doi: 10.1016/j.jad.2017.07.044.

[7]. 7.S. K. Lipson, E. G. Lattie, and D. Eisenberg, “Increased Rates of Mental Health Service Utilization by U.S. College Students: 10-Year Population-Level Trends (2007–2017),” Psychiatric Services, vol. 70, no. 1, pp. 60–63, Jan. 2019, doi: 10.1176/appi.ps.201800332.

[8]. 8.J. Hunt and D. Eisenberg, “Mental Health Problems and Help-Seeking Behavior Among College Students,” Journal of Adolescent Health, vol. 46, no. 1, pp. 3–10, Jan. 2010, doi: 10.1016/j.jadohealth.2009.08.008.

[9]. 9.J. J. Arnett, “Emerging adulthood: A theory of development from the late teens through the twenties.,” American Psychologist, vol. 55, no. 5, pp. 469–480, 2000, doi: 10.1037/0003-066X.55.5.469.

[10]. 10.R. C. Kessler, G. P. Amminger, S. Aguilar-Gaxiola, J. Alonso, S. Lee, and T. B. ??st??n, “Age of onset of mental disorders: a review of recent literature,” Curr Opin Psychiatry, vol. 20, no. 4, pp. 359–364, Jul. 2007, doi: 10.1097/YCO.0b013e32816ebc8c.

[11]. 11.C. J. Wilson, F. P. Deane, and J. Ciarrochi, “Measuring Help-Seeking Intentions: Properties of the General Help-Seeking Questionnaire,” Canadian Journal of Counselling, vol. 39, no. 1, 2005.

[12]. 12.M. S. Salzer, “A Comparative Study of Campus Experiences of College Students With Mental Illnesses Versus a General College Sample,” Journal of American College Health, vol. 60, no. 1, pp. 1–7, Jan. 2012, doi: 10.1080/07448481.2011.552537.

[13]. 13.A. Gulliver, K. M. Griffiths, and H. Christensen, “Perceived barriers and facilitators to mental health help-seeking in young people: a systematic review,” BMC Psychiatry, vol. 10, no. 1, p. 113, Dec. 2010, doi: 10.1186/1471-244X-10-113.

[14]. 14.L. Farrer et al., “Technology-Based Interventions for Mental Health in Tertiary Students: Systematic Review,” J Med Internet Res, vol. 15, no. 5, p. e101, May 2013, doi: 10.2196/jmir.2639.

[15]. 15.J. Higgins, J. Thomas, J. Chandler, M. Cumpston, T. Li, and M. Page, Cochrane Handbook for Systematic Reviews of Interventions., 2nd Edition. Chichester: John Wiley & Sons, 2019.

[16]. 16.J. Popay et al., Guidance on the Conduct of Narrative Synthesis in Systematic Reviews. Lancaster: Lancaster University, 2006.

[17]. 17.S. Shahwan et al., “The potential impact of an anti-stigma intervention on mental health help-seeking attitudes among university students,” BMC Psychiatry, vol. 20, no. 1, p. 562, Dec. 2020, doi: 10.1186/s12888-020-02960-y.

[18]. 18.M. Subramaniam et al., “Advancing Research to Eliminate Mental Illness Stigma: The Design and Evaluation of a Single-Arm Intervention Among University Students in Singapore,” Front Psychol, vol. 11, Jun. 2020, doi: 10.3389/fpsyg.2020.01151.

[19]. 19.S. Yamaguchi et al., “Effects of Short-Term Interventions to Reduce Mental Health–Related Stigma in University or College Students,” Journal of Nervous & Mental Disease, vol. 201, no. 6, pp. 490–503, Jun. 2013, doi: 10.1097/NMD.0b013e31829480df.

[20]. 20.A. K. Ibrahim, S. J. Kelly, C. E. Adams, and C. Glazebrook, “A systematic review of studies of depression prevalence in university students,” J Psychiatr Res, vol. 47, no. 3, pp. 391–400, Mar. 2013, doi: 10.1016/j.jpsychires.2012.11.015.

[21]. 21.D. C. Jessop, M. Reid, and L. Solomon, “Financial concern predicts deteriorations in mental and physical health among university students,” Psychol Health, vol. 35, no. 2, pp. 196–209, Feb. 2020, doi: 10.1080/08870446.2019.1626393.

[22]. 22.S. Negash et al., “Worsened Financial Situation During the COVID-19 Pandemic Was Associated With Depressive Symptomatology Among University Students in Germany: Results of the COVID-19 International Student Well-Being Study,” Front Psychiatry, vol. 12, Dec. 2021, doi: 10.3389/fpsyt.2021.743158.

[23]. 23.P. Barnett, L.-L. Arundell, H. Matthews, R. Saunders, and S. Pilling, “‘Five hours to sort out your life’: qualitative study of the experiences of university students who access mental health support,” BJPsych Open, vol. 7, no. 4, p. e118, Jul. 2021, doi: 10.1192/bjo.2021.947.

[24]. 24.F. Kählke, P. Hasking, A.-M. Küchler, and H. Baumeister, “Mental health services for German university students: acceptance of intervention targets and preference for delivery modes,” Front Digit Health, vol. 6, Feb. 2024, doi: 10.3389/fdgth.2024.1284661.

[25]. 25.R. E. Recabarren, C. Gaillard, M. Guillod, and C. Martin-Soelch, “Short-Term Effects of a Multidimensional Stress Prevention Program on Quality of Life, Well-Being and Psychological Resources. A Randomized Controlled Trial,” Front Psychiatry, vol. 10, Mar. 2019, doi: 10.3389/fpsyt.2019.00088.

[26]. 26.J. D. Worsley, A. Pennington, and R. Corcoran, “Supporting mental health and wellbeing of university and college students: A systematic review of review-level evidence of interventions,” PLoS One, vol. 17, no. 7, p. e0266725, Jul. 2022, doi: 10.1371/journal.pone.0266725.

[27]. 27.D. K. Ahorsu et al., “Effect of a peer‐led intervention combining mental health promotion with coping‐strategy‐based workshops on mental health awareness, help‐seeking behavior, and wellbeing among university students in Hong Kong,” Int J Ment Health Syst, vol. 15, no. 1, p. 6, Dec. 2021, doi: 10.1186/s13033-020-00432-0.

[28]. 28.J. Chung, M. E. Mundy, I. Hunt, A. Coxon, K. R. Dyer, and S. McKenzie, “An Evaluation of an Online Brief Mindfulness-Based Intervention in Higher Education: A Pilot Conducted at an Australian University and a British University,” Front Psychol, vol. 12, Oct. 2021, doi: 10.3389/fpsyg.2021.752060.

[29]. 29.X.-G. Gong, L.-P. Wang, G. Rong, D.-N. Zhang, A.-Y. Zhang, and C. Liu, “Effects of online mindfulness-based interventions on the mental health of university students: A systematic review and meta-analysis,” Front Psychol, vol. 14, Feb. 2023, doi: 10.3389/fpsyg.2023.1073647.

[30]. 30.E. Charbonnier et al., “Effects of an online self-help intervention on university students’ mental health during COVID-19: A non-randomized controlled pilot study,” Computers in Human Behavior Reports, vol. 5, p. 100175, Mar. 2022, doi: 10.1016/j.chbr.2022.100175.

[31]. 31.P. Cuijpers et al., “The World Health Organization World Mental Health International College Student initiative: An overview,” Int J Methods Psychiatr Res, vol. 28, no. 2, Jun. 2019, doi: 10.1002/mpr.1761.

[32]. E. Medlicott et al., “The Mental Health and Wellbeing of University Students: Acceptability, Effectiveness, and Mechanisms of a Mindfulness-Based Course,” Int J Environ Res Public Health, vol. 18, no. 11, p. 6023, Jun. 2021, doi: 10.3390/ijerph18116023.



21 Woodlands Close #02-10, Primz Bizhub,Postal 737854, Singapore

Email:editorial_office@as-pub.com