An early detection model for anxiety, depression, and suicidal ideation among undergraduate students at public universities in Namibia

Abstract

Background: Mental health challenges among university students are an increasing global public health concern, with anxiety, depression, and suicidal ideation significantly affecting students’ well-being, academic performance, and daily functioning. Persistent anxiety and depression are associated with increased morbidity, while suicidal ideation remains an important indicator of severe psychological distress and risk of suicide. In Namibia, among the undergraduates, these mental health conditions are further intensified by academic pressure, financial hardship, social adjustment difficulties, childhood adversities, and cultural barriers that discourage open discussion of emotional distress. Despite the growing burden of student mental health problems, there is limited context-specific evidence on their prevalence, predictors, students’ coping mechanisms, and the practices of mental health service providers in the early identification and support of affected students in Namibian public universities. This study, therefore, sought to investigate anxiety, depression, and suicidal ideation among undergraduate students in Namibian public universities and to develop a contextual understanding of coping practices and early identification support systems. Method: The study employed a convergent parallel mixed-methods cross-sectional design across four phases. Phase I comprised three sub-objectives. Sub-objective one, which employed a quantitative research approach, with 578 samples drawn from 41,861 undergraduate participants at the Namibia University of Science and Technology (NUST) and the University of Namibia (UNAM), the only two public universities in Namibia. Participants were recruited from across four regions: Khomas, Ohangwena, //Karas, and Omusati. Data were collected using a self-administered questionnaire comprising the Beck Anxiety Inventory, Patient Health Questionnaire-9, and Columbia Suicide Severity Rating Scale. Quantitative data were analysed using SPSS version 30 through descriptive statistics, Pearson’s correlation coefficients, bivariate regression, and hierarchical multiple regression. Sub-Objective two employed an exploratory qualitative approach using semi-structured interviews to examine the coping mechanisms of 13 purposively sampled undergraduate students. Sub-Objective three explored the practices of 11 mental healthcare service providers in early detection and support of students experiencing anxiety, depression, and suicidal ideation in Namibia. Qualitative data were analysed using Braun and Clarke’s six-step thematic analysis framework, supported by ATLAS.ti version 8. Phase II of this study was to conceptualise the findings that informed Phase III, which involved developing, describing, and ii evaluating the model. The integration of findings informed the development of a context-specific model for early detection, grounded in the Health Belief Model, Interprofessional Shared Decision-Making model, and Chinn and Kramer’s theory-generating approach. Phase IV developed the guidelines for operationalising the model. Results: The quantitative findings revealed a high prevalence of mental health challenges among students, with 50.7% reporting moderate to severe anxiety, 73.2% meeting the criteria for depression, and 9.1% reporting an active suicidal plan. The qualitative findings generated key themes related to institutional gaps, peer-led early detection, stigma and cultural resistance, academic collaboration, informal support networks, and socio-economic vulnerabilities. Mental health service providers reported that their efforts to identify and support students were constrained by stigma, staff shortages, inadequate mental health facilities, and limited engagement of academic staff in mental health activities. Students described a range of coping strategies, including problem-focused efforts to manage stress, seeking peer and informal support, and avoidance behaviours, with emotional distress often linked to academic stressors, difficult childhood experiences, and cultural barriers to disclosure and help-seeking. Implications: The study contributes to knowledge by providing an evidence-based, integrated model to enhance early identification and intervention for student mental health challenges. It further offers practical recommendations to strengthen institutional mental health systems, promote interdisciplinary collaboration, and improve student well-being in higher education settings. The findings informed the development of a contextually relevant Early Detection Model to strengthen coordinated screening, early identification, referral pathways, and collaborative mental health support within university settings. The study contributes important empirical evidence to the limited literature on student mental health in Namibia and provides a foundation for strengthening institutional policies, multidisciplinary collaboration, and culturally responsive interventions aimed at improving student wellbeing and preventing mental health crises, including suicide, in higher education contexts. Conclusion: The study suggests that future researchers in the field of mental health focus on mixed-methods and longitudinal designs to produce evidence that guides mental health policy, practice, and curriculum development. Additionally, public universities should shift iii from reactive to proactive interventions that identify, support, and empower students, helping them succeed amid academic pressures and socio-economic challenges.