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

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