Mental disorders are among the leading causes of health-related burden worldwide (1). According to the World Health Organisation (WHO), one in every eight people globally suffered from a mental illness in 2019, with anxiety and depressive disorders being the most prevalent. In 2020, the COVID-19 pandemic increased the number of individuals living with anxiety and depressive disorders (2). Despite the availability of preventative and treatment options, a significant number of those with mental illnesses demonstrate low levels of help-seeking (2, 3). Additionally, many individuals who do seek mental health care fail to adhere to their treatment plans (3). According to the Saudi National Mental Health Survey, 20.2% of the Saudi population had at least one DSM-IV/CIDI disorder in the previous 12 months, with only 13.7% of these individuals seeking professional assistance (4, 5).

Students engaged in health profession disciplines face pronounced stress, often attributable to academic pressures, competition for higher grades, limited leisure opportunities, and other factors potentially detrimental to their mental well-being (6). The prevalence of depression, anxiety, burnout, and stress among medical students has steadily increased, leading to unfavourable consequences such as unprofessional behaviours, chronic health issues, diminished quality of life, and poor educational achievement. Therefore, these issues not only pose significant economic and societal challenges but also have potential ramifications for the quality of future patient care (3, 7). Despite being well-informed about mental health, many medical students are reluctant to seek out and utilise mental health services to address their personal challenges during their time in medical school (8, 9).

Over recent years, mental disorders among medical students have received considerable research attention, with numerous studies aimed at estimating the prevalence and risk factors of mental problems (7, 9, 10). Globally, around 12–50% of undergraduate university students have one or more mental health issues (11). Even though it is expected that medical students have better access to mental health services, help-seeking behaviour might be influenced by a variety of variables such as financial concerns, lack of awareness, difficulty in accessing services, and intrapersonal dilemma (12–15). Moreover, cultural factors such as family background, religion, and social norms have an impact on how interact with mental issues (12, 14, 16). Gaining a deeper insight into the disparity between the recognition of treatment needs and the actual provision of care can guide administrative strategies to better address students’ mental health concerns. In light of this, our study endeavoured to assess the perceived need for mental health services and identify the barriers hindering help-seeking among undergraduate medical students in the Eastern Province of Saudi Arabia.

The prevalence of mental health disorders among undergraduate medical students is believed to be higher than in other individuals of comparable age in the general population (20). This heightened vulnerability is often attributed to the stress associated with studying medicine (21). In this study, the reported prevalence of depression (33%) was consistent with that reported in a meta-analysis study spanning 43 countries (20). However, the study by Ewid et al., which aimed to investigate the impact of the COVID-19 pandemic on the mental health of Saudi medical students, reported a slightly lower prevalence (23%) (22). The discrepancy between their findings and ours might be attributed to the fact that the majority of our participants were female, and studies have indicated that females are generally more susceptible to psychological distress (22).

Unmet mental health needs are believed to place a significant strain on community health and productivity (20). According to the current study, nearly 4 in 10 students reported a perceived need for professional mental health support. This perceived need was particularly pronounced among female students and those with a personal history of psychiatric illness. Such a high level of perceived need has been reported in previous studies (23, 24). Despite the high proportion of students reporting depressive symptoms and expressing a perceived need for help, these services remain underutilised. In this study, only 16.2% of students who felt a need for treatment sought professional help in the previous 12 months. Such utilisation rates, ranging from 18 to 23%, have also been observed among university students in recent studies conducted in Egypt and the United States (23, 25). It is worth noting that, in our study, students with severe depression were more likely to recognise a need for treatment and subsequently seek help compared to those with mild and moderate depression, which is consistent with previous literature (3, 26). This suggests that many students delay seeking care, even though early-stage cases are often easier to address (3).

Various factors could explain this unmet demand for help. However, in our study, the dominant barrier was attitudinal, with most students preferring to tackle their problems independently, hoping issues would naturally resolve, or feeling reluctant to share their emotions and thoughts. This observation is in line with a previous study that identified a preference for self-management as a significant obstacle to seeking formal mental health care among university students experiencing depression and anxiety (27). Additionally, our results underscore the prevailing hypothesis linking mental health literacy with tendencies towards help-seeking behaviours (3, 6). These findings emphasise the relevance of cultural diversity, which continues to have a crucial role in attitudes about mental disease treatment. In Saudi Arabia, a predominantly Muslim population country, a considerable number of people believe that mental illness is a result of insufficient religiosity and are hesitant to seek professional help, despite significant advancements in the mental health care system (15).

The stigma associated with mental health was the second most frequently reported obstacle in our research. In contrast, a study by Noorwali et al. indicated stigma as the principal factor deterring young Saudi adults from pursuing mental health services (14). These findings might be attributed to the persisting stigmatisation of mental illnesses in Arab nations, characterised by prevailing negative sentiments surrounding mental disorders and associated medical services (28). Furthermore, it is widely acknowledged that doctors and medical students are hesitant to engage in therapy, particularly for mental problems. In addition, it has been hypothesised that doctors stigmatise mental illness more than the general population because of the idea that seeking care for a mental condition may negatively affect one’s legal licence to practise medicine (9, 29).

Although our participants rated instrumental barriers the lowest overall, Egyptian medical students identified them as their most significant barrier (23). This discrepancy might be attributed to the relative accessibility of Saudi Arabia’s healthcare system, which offers cost-free psychiatric services (3). Even with the presence of qualified mental health mentors and a dedicated teaching referral clinic aimed at assisting distressed students, nearly 40% were unaware of these resources. These findings are consistent with the Osborn et al. research, which revealed that in countries with high incomes, university mental health services are frequently underused (30). Notably, younger students in our study were more likely to identify instrumental challenges, possibly due to junior students’ lack of awareness about the university’s mental health facilities and their accessibility. These findings are in line with previous studies, which found that a majority of university students were uninformed about their institution’s mental health services (27, 31). Interestingly, students with a history of academic failure and those who had previously sought mental health services were more likely to experience stigma- and instrumental-related barriers. In line with earlier Saudi research which indicates that the primary factors behind the unmet need for mental health care in Saudi Arabia are more attitudinal than related to service availability or delivery (3).

Our study’s findings contribute significantly to the literature addressing the underutilisation of help-seeking services, potentially helping to mitigate the burden of mental disorders among medical students. The pattern of barriers to unmet treatment needs in this study was mainly students’ attitudes and stigma rather than the availability of mental health care, therefore university mental health service providers might benefit from taking specific steps towards this point, including providing students with comprehensive orientation sessions about available services and locations, organise workshops to enhance awareness and reduce stigma, as well as placing a greater emphasis on the roles of mentorship and counselling.

While this research stands as the first analysis of perceived needs and barriers concerning mental health service usage among Saudi medical students, it has certain limitations. First, its cross-sectional design restricts drawing causal conclusions. Second, the use of self-reported questionnaires could lead to recall bias. Third, the sensitivity of the subject matter could have influenced how participants responded to specific questions. Moreover, participants were only selected from the Eastern Province of Saudi Arabia, which may restrict the results’ generalizability. Lastly, the study does not explore in depth the issues related to students who begin but do not complete treatment, an area that should be addressed in future research.

In conclusion, mental illnesses are prevalent among undergraduate medical students. Concurrently, while there is a pronounced perceived need for professional mental health support, actual service utilisation remains low. The primary obstacles to seeking mental care were found to be attitudinal and stigma-related barriers. Enhancing mental health literacy could play a pivotal role in addressing these unmet treatment requirements.

The original contributions presented in the study are included in the article/supplementary material, further inquiries can be directed to the corresponding author.

The study was approved by the Ethical Committee of King Faisal University, Al Ahsa, Saudi Arabia (Ref. No: KFU-REC-2022-MAY-ETHICS31; date: 24 May 2022). Additionally, participants received a brief description of the study’s purpose and a link to a non-personalised consent form.

ZA: Conceptualization, Data curation, Formal analysis, Funding acquisition, Investigation, Methodology, Project administration, Resources, Software, Supervision, Validation, Visualization, Writing – original draft, Writing – review & editing. MS: Data curation, Formal analysis, Investigation, Methodology, Resources, Software, Validation, Writing – original draft, Writing – review & editing. AA-K: Data curation, Investigation, Writing – original draft, Writing – review & editing. JA: Data curation, Investigation, Writing – original draft, Writing – review & editing. RB: Data curation, Investigation, Writing – original draft, Writing – review & editing. MB: Data curation, Investigation, Writing – original draft, Writing – review & editing. RA: Data curation, Investigation, Writing – original draft, Writing – review & editing. NA-m: Data curation, Investigation, Writing – original draft, Writing – review & editing. MA: Data curation, Investigation, Writing – original draft, Writing – review & editing.