Assessing the determinants of mental health services utilization among adolescents aged 18–24 years in Kicukiro district, Rwanda

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Despite increased awareness, utilization of mental health services in Rwanda remains low, highlighting the need to understand factors influencing help-seeking behaviors in this population. Objectives This study aimed to assess the determinants of mental health service utilization among adolescents aged 18–24 years in Kicukiro District, Rwanda, focusing on socio-demographic characteristics, knowledge, attitudes, and access to services. Methodology: A quantitative analytical cross-sectional design was employed. A total of 384 adolescents were recruited using multistage sampling from schools, youth centers, and community settings. Data were collected via structured questionnaires covering socio-demographics, mental health knowledge, attitudes, and service utilization. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were conducted using SPSS 25 to identify factors associated with service use. Results Overall, 35.4% of adolescents reported having accessed mental health services, with depression (87.5%), anxiety (66.2%), and stress (55.9%) as the main reasons. Awareness of services was high (83.6%), but knowledge of specific access points, particularly digital platforms, was limited. Utilization was significantly associated with age, gender, and attitudes toward mental health. Adolescents aged 21–23 years were 3.8 times more likely to use services compared to those ≤ 20 years (AOR = 3.753; 95% CI: 1.861–7.570), while males had higher utilization than females (AOR = 5.810; 95% CI: 3.249–10.389). Positive attitudes strongly predicted service uptake. Conclusion Despite high awareness, the majority of adolescents in Kicukiro District do not access mental health services. Interventions should target attitude change, stigma reduction, and improved accessibility through community, school, and digital platforms to enhance adolescent mental health service utilization in Rwanda. Mental health services Utilization Adolescents Rwanda Figures Figure 1 Figure 2 INTRODUCTION Mental health disorders represent a significant and growing global public health concern, contributing substantially to morbidity, disability, and premature mortality. Recent global estimates indicate that nearly one in eight individuals lives with a mental disorder, with depression and anxiety being the most prevalent conditions among youth and young adults [ 1 ]. Suicide remains the fourth leading cause of death among individuals aged 15–29 years, highlighting the developmental vulnerability of older adolescents and emerging adults [ 1 ]. The age group of 18–24 years is a critical transitional period marked by identity exploration, increasing autonomy, academic and occupational pressures, and major social adjustments, all of which heighten susceptibility to mental health challenges [ 2 ]. The burden of mental health disorders is particularly pronounced in low- and middle-income countries (LMICs), where service availability and accessibility remain limited. Countries in Sub-Saharan Africa (SSA) allocate less than 1% of their national health budgets to mental health, and most report fewer than two mental health professionals per 100,000 population [ 3 ]. As a result, more than 75% of young people experiencing mental health problems in SSA do not receive professional care [ 4 ]. Barriers such as stigma, misinformation, low mental health literacy, economic constraints, and cultural preferences for traditional and religious healing practices continue to hinder help-seeking among adolescents [ 5 ]. Regional data from Kenya, Uganda, and Tanzania consistently show high prevalence of depression, anxiety, and psychological distress among adolescents, yet service utilization rates remain low due to stigma, limited awareness, and perceived lack of youth-friendly services [ 6 – 8 ]. Rwanda has made significant progress in strengthening its mental health care system through policy, community-based programming, and integration of mental health services within primary health care. The Rwanda Mental Health Strategic Plan (2020–2024) emphasizes decentralization, task-shifting, and youth mental health promotion, while national surveys indicate that approximately 20% of the population experiences mental health challenges including post-traumatic stress disorder, depression, and anxiety [ 9 , 10 ]. Despite these efforts, the utilization of mental health services among adolescents remains low. Evidence shows that fewer than 13% of individuals with mental health needs seek professional support, and adolescents and young adults are the least likely to access available services [ 10 , 11 ]. Factors such as stigma, financial limitations, service availability, and limited awareness continue to shape attitudes and behaviours surrounding mental health service use. Rapid urbanization, youth unemployment, substance use, academic pressures, and interpersonal violence contribute to heightened psychosocial stress among adolescents. Recent reports indicate that mental health conditions affect an estimated 36.7% of residents in the district, with a substantial burden among young people [ 12 ]. Although several community-based initiatives, such as the “Baho Neza” project, have sought to expand mental health awareness, reduce stigma, and improve access to care, utilization among adolescents remains disproportionately low, partly due to financial barriers, limited information about services, and perceived stigma [ 13 ]. These trends suggest the presence of systemic and community-level barriers that influence adolescents’ willingness and ability to seek professional mental health support. Recent studies across LMICs underscore the importance of understanding determinants of mental health service utilization, particularly among older adolescents, who often fall between child-focused and adult-focused mental health services [ 14 , 15 ]. Factors influencing utilization include individual perceptions of need, mental health literacy, family support, economic factors, cultural beliefs, availability of youth-friendly services, confidentiality concerns, and trust in health providers [ 5 , 8 , 15 , 16 ]. However, empirical evidence examining these determinants among adolescents aged 18–24 in Rwanda remains limited, despite increasing policy attention to youth mental health. Given the high burden of mental health problems and the low level of service use in Kicukiro District, there is a critical need for localized evidence to understand the factors that shape mental health service utilization among adolescents aged 18–24 years. Identifying these determinants will provide essential insights for designing targeted interventions, strengthening district-level mental health programming, and informing national strategies aimed at improving adolescent mental health outcomes in Rwanda. METHODS Study Design This study employed a quantitative analytical cross-sectional design to assess the determinants of mental health services utilization among adolescents and young adults aged 18–24 years. The design enabled the measurement of exposure variables and service utilization outcomes simultaneously within the study population, making it appropriate for identifying associations between individual, social, and health system factors and mental health service use. Study Setting The study was conducted in Kicukiro District, as shown in Fig. 1 , which presents a map of Rwanda. Kicukiro is one of the three administrative districts of Kigali City, Rwanda. Kigali City comprises 35 sectors distributed across Nyarugenge (10 sectors), Gasabo (15 sectors), and Kicukiro (10 sectors). Kicukiro District comprises the following sectors: Gahanga, Gatenga, Gikondo, Kagarama, Kanombe, Kicukiro, Kigarama, Masaka, Niboye, and Nyarugunga. Kicukiro District is a rapidly urbanizing area characterized by mixed residential, commercial, and industrial zones and a high concentration of adolescents and young adults. Data collection was conducted between July 5, 2025, and August 12, 2025, in selected schools, youth centers, community settings, and health facilities within the district. Study Population The study population consisted of adolescents and young adults aged 18–24 years who were residing in Kicukiro District at the time of data collection. This age group represents a critical developmental period during which many mental health conditions emerge, and service utilization decisions are formed. Participants were recruited from secondary schools, youth centers, community spaces, and health facilities to ensure diversity in socio-economic status, education level, and gender. Inclusion and Exclusion Criteria Inclusion Criteria Participants were eligible if they: Were aged 18–24 years at the time of data collection Were residents of Kicukiro District, Kigali City Were present at selected schools, youth centers, community settings, or health facilities Were able to comprehend and respond to the questionnaire in Kinyarwanda, English, or French Provided written informed consent Exclusion Criteria Participants were excluded if they: Had severe mental or physical conditions that impaired their ability to participate Were not residents of Kicukiro District Were unable to communicate in the study languages Declined or withdrew consent during the study Sampling Design and Sample Size Sampling Technique A multistage sampling strategy was employed. First, sectors within Kicukiro District were considered as primary strata. At the second stage, cells were selected systematically as primary sampling units. At the third stage, schools, youth centers, and community settings within selected cells were identified purposively based on availability. Finally, eligible participants within each site were selected using systematic random sampling, ensuring proportional representation across locations and gender. Sample Size Determination The sample size was calculated using Cochran’s formula for estimating proportions, assuming a 95% confidence level, a margin of error of 5%, and an estimated prevalence of mental health service utilization of 50% due to the absence of precise district-level estimates. $$\:n=\frac{{Z}^{2}p(1-p)}{{e}^{2}}$$ Where: n = required sample size Z = 1.96 (95% confidence level) p = 0.5 e = 0.05 The minimum sample size was calculated as 384 participants. To account for potential non-response and incomplete questionnaires, a 10% adjustment was applied, resulting in a final target sample size of 425 participants. The sample was proportionally distributed across selected cells and data collection sites, with efforts made to ensure equal representation of males and females to minimize gender-related response bias. Data Collection Tools Data were collected using a structured questionnaire developed specifically for this study, informed by validated tools and previous studies on adolescent mental health service utilization. The questionnaire consisted of four sections: Socio-demographic characteristics (age, sex, education, employment, living arrangement) Knowledge of mental health and mental health services Attitudes toward mental health services , including stigma, confidentiality, and perceived effectiveness Utilization of mental health services , including history of service use and perceived barriers The questionnaire was pretested prior to data collection to ensure clarity, relevance, and cultural appropriateness. Variables Outcome Variable The primary outcome variable was mental health services utilization , assessed by self-report of whether participants had ever accessed professional mental health services. Responses were dichotomized as: Yes (utilized services) No (did not utilize services) Independent Variables Independent variables included: Socio-demographic factors (age, sex, education level, employment status) Knowledge of mental health services Attitudes toward mental health services Perceived stigma Accessibility and affordability of services Social and family support factors Knowledge and attitude scores were computed and categorized into adequate/positive (≥ 60%) and inadequate/negative (< 60%) for analytical purposes. Data Collection Procedure Data collection was conducted by trained research assistants. Enumerators received training on ethical research conduct, confidentiality, informed consent, and sensitivity when discussing mental health topics. Questionnaires were administered in private settings to ensure participant comfort and confidentiality. Participation was voluntary, and respondents were free to withdraw at any time without consequences. Bias Control Several strategies were employed to minimize bias. Gender-balanced recruitment was ensured, proportional sampling was applied across cells, and systematic random sampling reduced selection bias. Standardized training of data collectors and pretesting of tools minimized information bias. Statistical Analysis Data were entered and analyzed using SPSS 25. Descriptive statistics were computed using frequencies, percentages, means, and standard deviations. At the bivariate level, chi-square tests were used to assess associations between independent variables and mental health service utilization. Variables with a p-value < 0.05 were entered into a multivariable logistic regression model to estimate adjusted odds ratios (AORs) and 95% confidence intervals. Statistical significance was set at p < 0.05. Ethical Considerations Ethical approval was obtained from the University of Rwanda, College of Medicine and Health Sciences Institutional Review Board (IRB), and authorization to conduct the study was granted by Kigali City authorities. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki for research involving human subjects. Written informed consent was obtained from all participants prior to data collection. Confidentiality and anonymity were strictly maintained throughout the study, and all data were securely stored in compliance with Rwanda’s Data Protection and Privacy Law (Law No. 058/2021). RESULTS Demographic and Socioeconomic Profile of Study Participants District (N = 384) Table 1 Socio-Demographic Characteristics of Adolescents Aged 18–24 Years in Kicukiro Variable Category Frequency Percent (%) Age 18–20 years 105 27.3 21–23 years 184 47.9 24 years 95 24.8 Total 384 100.0 Gender Male 148 38.5 Female 236 61.5 Total 384 100.0 Education Level Primary 27 7.0 Secondary 104 27.1 Tertiary/College 253 65.9 Total 384 100.0 Occupation Student 213 55.5 Employed 127 33.1 Unemployed 44 11.5 Total 384 100.0 Duration of Stay in Kicukiro < 1 year 49 12.7 2–3 years 83 21.6 4–6 years 44 11.5 ≥ 7 years 208 54.2 Total 384 100.0 Table 1 presents the socio-demographic characteristics of the 384 adolescents aged 18–24 years who participated in the study in Kicukiro District. Nearly half of the respondents (47.9%) were aged between 21 and 23 years, indicating that the sample was predominantly composed of individuals in late emerging adulthood. Participants aged 20 years or below constituted 27.3%, while those aged 24 years accounted for 24.8%, reflecting a relatively balanced age distribution across the target age range. In terms of gender, females comprised the majority of participants (61.5%), compared to 38.5% males. This gender distribution may reflect higher availability or willingness among female adolescents to participate in health-related research, a pattern commonly observed in mental health studies. Regarding educational attainment, the majority of respondents had attained a tertiary or college education (65.9%), followed by those with secondary education (27.1%). Only a small proportion (7.0%) had completed primary education. This suggests that the study population was relatively well-educated, which may influence awareness, attitudes, and help-seeking behaviors related to mental health services. More than half of the participants were students (55.5%), while 33.1% were employed and 11.5% were unemployed. The high proportion of students is consistent with the age group under study and highlights the importance of educational institutions as potential entry points for mental health interventions. Concerning duration of residence, over half of the participants (54.2%) had lived in Kicukiro for seven years or more, indicating long-term exposure to the district’s social and health environment. Smaller proportions had lived in the district for less than one year (12.7%), two to three years (21.6%), or four to six years (11.5%). Overall, the findings indicate that the study population consisted predominantly of female, well-educated adolescents, most of whom were students and long-term residents of Kicukiro District. These characteristics are important contextual factors that may influence mental health service utilization patterns among adolescents aged 18–24 years. Utilization Level of Mental Health Services As shown in Fig. 2 , the level of mental health service utilization among adolescents aged 18–24 years in Kicukiro District. Out of the 384 respondents, 136 (35.4%) reported having accessed mental health services at least once, while 248 (64.6%) indicated that they had never sought any mental health services. These findings indicate that although slightly more than one-third of adolescents have utilized mental health services, the majority, nearly two-thirds, have not. This highlights a substantial gap in mental health service utilization among adolescents in the district, suggesting the persistence of barriers to access and uptake within this population. Reasons for Seeking Mental Health Services Table 2 Main Reasons for Seeking Mental Health Services Among Adolescents (N = 384) Reason for Seeking Services Response Frequency Percent (%) Total (N = 136) % Anxiety Yes 90 23.4 66.2 No 46 12.0 33.8 Depression Yes 119 31.0 87.5 No 17 4.4 12.5 Stress Yes 76 19.8 55.9 No 60 15.6 44.1 Family issues Yes 60 15.6 44.1 No 76 19.8 55.9 Peer-related issues Yes 47 12.2 34.6 No 89 23.2 65.4 Self-esteem issues Yes 54 14.1 39.7 No 82 21.4 60.3 Substance abuse Yes 42 10.9 30.9 No 94 24.5 69.1 Other (specified) Yes 43 11.2 31.6 No 93 24.2 68.4 Among the 384 adolescents aged 18–24 years included in the study, 136 participants (35.4%) reported having utilized mental health services and were subsequently asked to indicate the reasons for seeking care. As shown in Table 2 , the most frequently reported reason for seeking mental health services was depression, with 119 respondents (87.5%) indicating this as a contributing factor. This finding suggests that depressive symptoms represent the dominant driver of mental health service utilization among adolescents in Kicukiro District. Anxiety was the second most commonly reported reason, cited by 90 participants (66.2%), followed by stress, which was reported by 76 respondents (55.9%). These findings indicate that internalizing mental health conditions, particularly mood- and anxiety-related challenges, constitute the primary motivations for service use in this population. In addition to psychological distress, psychosocial stressors were also prominent. Family-related issues were reported by 60 adolescents (44.1%), while self-esteem problems were indicated by 54 participants (39.7%). Peer-related challenges were reported by 47 respondents (34.6%), reflecting the significant role of interpersonal relationships during late adolescence and early adulthood. Furthermore, substance abuse–related concerns were reported by 42 participants (30.9%), highlighting the coexistence of substance use issues with mental health challenges among a substantial proportion of service users. Other unspecified reasons were reported by 43 respondents (31.6%), suggesting the presence of additional mental health or psychosocial concerns not captured in the predefined categories. Overall, these findings demonstrate that mental health service utilization among adolescents in Kicukiro District is largely driven by depression, anxiety, and stress, alongside important family, peer, and self-related challenges. This pattern underscores the need for integrated, youth-friendly mental health services that address both clinical symptoms and underlying psychosocial determinants. Awareness and Knowledge of Mental Health Services and Access Points Table 3 Awareness and Knowledge of Mental Health Services and Access Points Among Adolescents in Kicukiro District, Rwanda Variable Response Frequency Percent (%) Awareness of mental health services Yes 321 83.6 No 63 16.4 Counseling services Yes 262 68.2 No 122 31.8 Therapy (Individual or group) Yes 244 63.5 No 140 36.5 Psychiatric services Yes 227 59.1 No 157 40.9 Helplines Yes 213 55.5 No 171 44.5 Support groups Yes 204 53.1 No 180 46.9 Other services Yes 177 46.1 No 207 53.9 Health centers Yes 309 80.5 No 75 19.5 Hospitals Yes 275 71.6 No 109 28.4 Private clinics Yes 284 74.0 No 100 26.0 Community centers Yes 267 69.5 No 117 30.5 Religious institutions Yes 244 63.5 No 140 36.5 Online platforms Yes 163 42.4 No 221 57.6 I do not know Yes 127 33.1 No 257 66.9 Table 3 presents respondents’ awareness and knowledge of mental health services and access points in Kicukiro District. Overall, the findings indicate a high level of general awareness, with 83.6% (n = 321) of adolescents reporting awareness of mental health services, while 16.4% (n = 63) indicated no awareness. With regard to knowledge of specific mental health services, counseling services were the most widely recognized, reported by 68.2% (n = 262) of respondents, followed by individual or group therapy (63.5%, n = 244). Awareness of psychiatric services was reported by 59.1% (n = 227), while just over half of the participants (55.5%, n = 213) acknowledged the availability of mental health helplines. Knowledge of support groups was reported by 53.1% (n = 204), whereas fewer respondents (46.1%, n = 177) were aware of other mental health services, indicating variability in familiarity with the range of services available. Regarding knowledge of service access points, health centers were the most commonly identified locations for accessing mental health services (80.5%, n = 309), followed by private clinics (74.0%, n = 284) and hospitals (71.6%, n = 275). Additionally, community centers (69.5%, n = 267) and religious institutions (63.5%, n = 244) were frequently mentioned, reflecting the perceived role of community-based and faith-based settings in mental health support. In contrast, awareness of online platforms as access points was relatively low, with only 42.4% (n = 163) reporting familiarity. Notably, 33.1% (n = 127) of respondents indicated uncertainty about where mental health services could be obtained. Overall, while adolescents in Kicukiro District demonstrate high general awareness of mental health services, notable gaps persist in knowledge of specific service types and access points, particularly digital platforms. These findings underscore the need for strengthened mental health literacy and targeted information dissemination to improve adolescents’ navigation and utilization of available mental health services. Association of Socio-Demographic Characteristics, Knowledge, and Attitude with Mental Health Service Utilization Table 4 Association of Socio-Demographic Characteristics, Knowledge, and Attitude with Mental Health Service Utilization Among Adolescents in Kicukiro District, Rwanda Variable Category Yes No Chi-Square (χ²) p-value (Asymp. Sig.) Age ≤ 20 years 25 80 14.424 0.001 21–23 years 64 120 ≥ 24 years 47 48 Gender Male 24 124 38.813 0.001 Female 112 124 Education Level Primary 10 17 0.346 0.841 Secondary 39 65 Tertiary/College 87 166 Occupation Student 73 140 0.702 0.704 Employed 45 82 Unemployed 18 26 Residence in Kicukiro Yes 132 239 0.127 0.722 No 4 9 Duration of Stay in Kicukiro < 1 year 24 25 9.348 0.025 2–3 years 36 47 4–6 years 14 30 ≥ 7 years 62 146 Knowledge Levels Low (14–18) 85 140 3.300 0.192 Moderate (19–24) 8 28 High (25–28) 43 80 Attitude Levels Negative (5–8) 24 52 44.463 0.001 Neutral (9–12) 59 170 Positive (13–16) 53 26 As shown in Table 4 , a statistically significant association was observed between age and mental health service utilization (χ² = 14.424, p = 0.001). Adolescents aged 21–23 years and 24 years were more likely to report having utilized mental health services compared to those aged ≤ 20 years, among whom non-utilization was markedly higher. This suggests that older adolescents and young adults may have greater autonomy, awareness, or perceived need for mental health care. Gender was also significantly associated with service utilization (χ² = 38.813, p = 0.001). Female participants reported substantially higher utilization of mental health services compared to males, indicating potential gender-based differences in help-seeking behaviors, stigma perception, or mental health awareness. In contrast, education level showed no statistically significant association with mental health service utilization (χ² = 0.346, p = 0.841). Similarly, occupation status (χ² = 0.702, p = 0.704) and residence status in Kicukiro District (χ² = 0.127, p = 0.722) were not significantly related to service utilization, suggesting that these socio-demographic factors did not independently influence adolescents’ likelihood of accessing mental health services. However, the duration of stay in Kicukiro District was significantly associated with utilization (χ² = 9.348, p = 0.025). Adolescents who had lived in the district for a longer period, particularly those residing for seven years or more, were more likely to have accessed mental health services than those with shorter durations of residence. This may reflect greater familiarity with available services, stronger social networks, or improved health system navigation over time. Regarding psychosocial factors, knowledge level was not significantly associated with mental health service utilization (χ² = 3.300, p = 0.192), indicating that awareness alone may not be sufficient to translate into service use. In contrast, attitude toward mental health services demonstrated a strong and statistically significant association with utilization (χ² = 44.463, p = 0.001). Adolescents with positive attitudes were considerably more likely to utilize mental health services compared to those with negative or neutral attitudes, underscoring the critical role of perceptions, beliefs, and stigma in influencing help-seeking behavior. Overall, these findings highlight that age, gender, duration of residence, and attitudes toward mental health services are key determinants of mental health service utilization among adolescents in Kicukiro District, while socio-economic factors and knowledge levels alone appear less influential. This emphasizes the importance of attitude-focused and stigma-reduction interventions to improve mental health service uptake among adolescents. Logistic Regression Analysis of Socio-Demographic Factors and Attitude Levels Associated with Utilization of Mental Health Services Table 5 Logistic Regression Analysis of Socio-Demographic Factors and Attitude Levels Associated with Utilization of Mental Health Services Among Respondents in Kicukiro District Variable Category Yes No P-value AOR 95% C.I. for AOR (Lower) 95% C.I. for AOR (Upper) Age ≤ 20 years 25 80 0.001 — — — 21–23 years 64 120 — 3.753 1.861 7.570 ≥ 24 years 47 48 — 2.235 1.239 4.032 Gender Male 24 124 0.001 5.810 3.249 10.389 Female 112 124 — — — — Duration of Stay in Kicukiro < 1 year 24 25 0.108 0.458 0.220 0.953 2–3 years 36 47 — 0.602 0.326 1.112 4–6 years 14 30 — 1.001 0.456 2.200 ≥ 7 years 62 146 — — — — Attitude Levels Negative (5–8) 24 52 0.001 6.393 2.968 13.768 Neutral (9–12) 59 170 — 8.090 4.246 15.414 Positive (13–16) 53 26 — — — — Constant — — — 0.001 0.132 — — As shown in Table 5 , Age was significantly associated with mental health service utilization. Adolescents aged 21–23 years were approximately 3.8 times more likely to utilize mental health services compared to those aged ≤ 20 years (AOR = 3.753; 95% CI: 1.861–7.570; p = 0.001). Those aged ≥ 24 years were also significantly more likely to utilize services than the youngest group (AOR = 2.235; 95% CI: 1.239–4.032). This indicates that older adolescents may have greater autonomy, awareness, or perceived need to seek mental health care. Gender showed a strong association with service utilization. Male adolescents were 5.8 times more likely to utilize mental health services compared to females (AOR = 5.810; 95% CI: 3.249–10.389; p = 0.001). This may reflect gender-specific help-seeking behaviors, societal expectations, or differences in perceived mental health needs. Duration of stay in Kicukiro District was not significantly associated with service utilization in the adjusted model. Adolescents who had lived in the district for less than one year were less likely to use mental health services compared to those residing for ≥ 7 years, but this was not statistically significant (AOR = 0.458; 95% CI: 0.220–0.953; p = 0.108). Attitude toward mental health services emerged as a major predictor of service utilization. Adolescents with negative attitudes were 6.4 times more likely to utilize services than those with positive attitudes (AOR = 6.393; 95% CI: 2.968–13.768; p = 0.001), and those with neutral attitudes were 8.1 times more likely (AOR = 8.090; 95% CI: 4.246–15.414; p = 0.001). This result highlights that adolescents’ perceptions, beliefs, and acceptance of mental health care strongly influence their likelihood of seeking services. The constant term was statistically significant (p = 0.001), indicating that the model is a good fit for predicting mental health service utilization based on the included variables. Overall, the logistic regression analysis underscores that age, gender, and attitude levels are key determinants of mental health service utilization among adolescents in Kicukiro District. Interventions aiming to improve utilization should prioritize attitude change and targeted support for younger adolescents and gender-specific outreach. DISCUSSION The findings of this study provide important insights into the utilization of mental health services among adolescents aged 18–24 years in Kicukiro District, Rwanda, and highlight several key patterns that align with broader evidence from low- and middle-income countries (LMICs). First, despite relatively high awareness of mental health services (83.6%), only 35.4% of adolescents reported ever utilizing such services. This underscores a persistent treatment gap that is documented widely in LMIC contexts, where formal mental health care utilization remains low even among those with significant need [ 17 , 18 ]. Socio-Demographic Patterns and Service Utilization The demographic profile showed that nearly half of participants were aged 21–23 years and that females comprised the majority of the sample. This is consistent with other LMIC studies demonstrating that older adolescents and females are more likely to use mental health services compared to younger individuals and males [ 17 , 19 ]. For example, a recent analysis of national adolescent health surveys from Kenya, Indonesia, and Vietnam found significantly greater odds of service use among older adolescents and females [ 18 ]. Such patterns may reflect a combination of greater autonomy, increased perceived need, and differential help-seeking norms among older youth [ 17 ]. However, the overall utilization remains low in comparison with the prevalence of mental health problems, suggesting substantial unmet need. Global evidence indicates that adolescents in middle-income regions often seek informal help (family, peers, teachers) rather than professional services, with formal service use often below 2% in some middle-income countries [ 19 , 20 ]. This substantial unmet need indicates that awareness alone does not ensure service uptake. Reasons for Seeking Services Consistent with other LMIC studies, internalizing problems such as depression, anxiety, and stress were the leading reasons for using mental health services. These findings resonate with other research indicating that internalizing symptoms drive help-seeking when services are accessed, yet many adolescents with such conditions still do not receive formal care [ 18 ]. In the NAMHS analysis, emotional problems and behavioral issues were primary drivers of service engagement, but overall access remained limited [ 17 ], highlighting a similar pattern to the current findings. Awareness, Knowledge, and Access Points Although the majority of adolescents were aware of available service types and access points (e.g., health centres, private clinics, and hospitals), knowledge was uneven, especially for digital or online platforms. Low mental health literacy has been identified as a key barrier to service utilization in LMIC settings, compounded by stigma and socio-cultural beliefs about mental health and its causes [ 20 ]. Studies in Africa and Asia emphasize that limited familiarity with formal services and where to find them contributes to low utilization [ 20 , 21 ], suggesting that targeted public education is needed to bridge the gap between awareness and actionable knowledge. Barriers to Utilization and Socio-Structural Influences Beyond knowledge, the association between attitudes toward mental health and service utilization was particularly strong in this study. Adolescents with neutral or negative attitudes had higher odds of using services than those with positive attitudes, potentially reflecting complex help-seeking dynamics whereby those exposed to services develop more critical attitudes through their experiences. Nonetheless, attitudinal barriers, including stigma, fear of judgment, and misconceptions, are well documented in LMICs and impede adolescents’ willingness to seek professional help [ 20 ]. A scoping review of barriers in African settings highlighted stigma, preference for traditional treatments, and unfamiliarity with mental health conditions as major obstacles [ 22 ]. Similarly, qualitative evidence from Rwanda points to fear of stigmatization, financial constraints, and sociocultural barriers as limiting mental health care use [ 23 ]. Structural challenges also play an important role. Limited availability of trained mental health professionals, scarcity of services, and lack of adolescent-friendly care pathways are widely reported in LMICs, and these systemic issues reinforce low utilization despite significant need [ 17 , 23 ]. Integration of mental health care into primary health services, task-sharing with non-specialists, and expansion of community-based supports have been proposed as ways to address these gaps [ 24 ]. Comparisons with Regional and Broader LMIC Evidence The low overall utilization observed in this study reflects broader patterns in LMICs: for example, nationally representative data from Kenya, Indonesia, and Vietnam show that less than one in ten adolescents with a mental disorder accessed care in the previous year [ 18 ]. Similarly, research across West Africa documents pervasive shortfalls in adolescent mental health services availability and utilization, with some districts reporting service provision rates as low as 9%–42% of expected need [ 20 ]. These comparisons illustrate that the barriers and patterns identified in Kicukiro District are not unique but part of a systemic issue in LMICs. Implications for Policy and Practice The results emphasize the need for multi-level interventions to improve adolescent mental health service utilization. Strategies that combine mental health education, community stigma reduction, school-based screening, and integration of services into primary health and community settings have shown promise in LMIC contexts [ 24 ]. For example, interventions that raise awareness, identify individuals in need, and actively promote help-seeking can strengthen the mental health care pathway [ 24 ]. Furthermore, digital tools, though currently under-recognized by adolescents in this study, represent potential avenues for improving accessibility if accompanied by efforts to increase digital literacy and culturally relevant content. Strengths and Limitations This study is strengthened by its focus on an urban LMIC population and its comprehensive examination of socio-demographic, attitudinal, and awareness factors. However, the cross-sectional design limits causal inference, and self-reported measures may be subject to bias. Future research should incorporate longitudinal designs and qualitative methods to deepen understanding of help-seeking dynamics. Conclusion This study highlights a substantial gap in mental health service utilization among adolescents aged 18–24 years in Kicukiro District, Rwanda. Although 83.6% of adolescents were aware of available services, only 35.4% reported having accessed mental health care, indicating that nearly two-thirds (64.6%) of adolescents have not sought professional support. Utilization was predominantly driven by internalizing mental health conditions, including depression (87.5% of users), anxiety (66.2%), and stress (55.9%), alongside family, peer, and self-esteem–related challenges. Key determinants of service use included age, gender, and attitudes toward mental health. Older adolescents (21–23 years) and males were more likely to seek services, while positive attitudes toward mental health strongly predicted utilization. Knowledge alone did not significantly influence service uptake, emphasizing that awareness without supportive attitudes or stigma reduction may be insufficient to drive help-seeking behaviors. These findings underscore the need for multi-level, youth-focused interventions that address attitudinal barriers, reduce stigma, and improve accessibility of services. Integrating mental health care into community and primary health settings, leveraging schools, and expanding digital platforms could enhance service reach. Strengthening mental health literacy and promoting positive perceptions of mental health care are critical to improving service utilization and addressing the psychosocial needs of adolescents in Rwanda. Declarations Ethics approval and consent to participate This study involved human participants and received ethical approval from the Mount Kenya University Institutional Review Board (IRB Committee). Informed consent was obtained from all participants prior to data collection to ensure full adherence to ethical research standards. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Data are shared in a manner that maintains confidentiality and protects the privacy of participants. Competing interests The authors declare that they have no competing interests, financial or non-financial. Funding This study did not receive any external funding. No funding body had any influence on the study design, data collection, analysis, interpretation, or writing of the manuscript. Authors’ contributions MAG: Conceptualization, study design, supervision, and manuscript review. JR: Data collection, data analysis, and drafting of the results section. YG: Literature review, methodology development, and writing of the introduction and discussion sections. All authors read and approved the final manuscript. Acknowledgements Not applicable. Authors’ information (optional) Not applicable. Questionnaires We confirm that the questionnaire used in our study was developed specifically for this study . An English language version of the full questionnaire has been uploaded as a supplementary file for your consideration. References World Health Organization, World Mental Health Report: Transforming Mental Health for All, Geneva, Switzerland: WHO. 2022. [Online]. Available: https://www.who.int/publications/i/item/9789240049338 Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005;62(6):593–602. 10.1001/archpsyc.62.6.593 . Union A. Continental Mental Health Strategy for Africa 2022–2032. Addis Ababa, Ethiopia: AU; 2022. Petagna M, Marley C, Guerra C, Calia C, Reid C. Mental Health Gap Action Programme intervention Guide (mhGAP-IG) for Child and Adolescent Mental Health in Low- and Middle-Income Countries (LMIC): A Systematic Review. Community Ment Health J. 2023;59(1):192–204. 10.1007/s10597-022-00981-3 . Henderson C, Evans-Lacko S, Thornicroft G. Mental illness stigma, help seeking, and public health programs. Am J Public Health. 2013;103(5):777–80. 10.2105/AJPH.2012.301056 . Kenya Ministry of Health. National Adolescent Mental Health Survey , Nairobi, Kenya: MoH, 2021. [Online]. Available: https://aphrc.org/wp-content/uploads/2022/10/K-NAMHS-report_2022.pdf Kyohangirwe L, Okello E, Namuli JD, Ndeezi G, Kinyanda E. Prevalence and factors associated with major depressive disorder among adolescents attending a primary care facility in Kampala, Uganda. Trop Doct. 2020;50(1):30–6. 10.1177/0049475519879586 . Umubyeyi A, Mogren I, Ntaganira J, Krantz G. Help-seeking behaviours, barriers to care and self-efficacy for seeking mental health care: a population-based study in Rwanda. Soc Psychiatry Psychiatr Epidemiol. 2016;51(1):81–92. 10.1007/s00127-015-1130-2 . Rwanda Ministry of Health, Rwanda Mental Health Strategic Plan 2020–2024, Kigali, Rwanda: MoH. 2020. [Online]. Available: https://www.rbc.gov.rw/fileadmin/user_upload/mental/National-Mental-health-Policy.pdf Centre RB. Mental Health Survey Report. Kigali, Rwanda: RBC; 2018. Smith SL, et al. Evaluating process and clinical outcomes of a primary care mental health integration project in rural Rwanda: a prospective mixed-methods protocol. BMJ Open. 2017;7(2):e014067. 10.1136/bmjopen-2016-014067 . Lee JO, et al. Unemployment and substance use problems among young adults: Does childhood low socioeconomic status exacerbate the effect? Soc Sci Med. 2015;143:36–44. 10.1016/j.socscimed.2015.08.016 . Ministry of Health Rwanda, Baho Neza Project Evaluation Report, Kigali R. MoH, 2022. [Online]. Available: https://www.migeprof.gov.rw/news-detail/government-launches-baho-neza-integrated-campaign-to-promote-healthy-and-happy-families-1 Salaheddin K, Mason B. Identifying barriers to mental health help-seeking among young adults in the UK: a cross-sectional survey. Br J Gen Pract. 2016;66(651):e686–92. 10.3399/bjgp16X687313 . MacDonald K, Fainman-Adelman N, Anderson KK, Iyer SN. Pathways to mental health services for young people: a systematic review. Soc Psychiatry Psychiatr Epidemiol. 2018;53(10):1005–38. 10.1007/s00127-018-1578-y . Rwanda UNICEF. Adolescent Mental Health and Well-being Report , Kigali, Rwanda: UNICEF, 2023. [Online]. Available: https://www.unicef.org/esa/media/16501/file/UNICEF-Rwanda-Case-Study-Child-Adolescent-Mental-Health-2025.pdf Wahdi AE, et al. Mental health service use among adolescents in three low- and middle-income countries: An analysis of the National Adolescent Mental Health Surveys. Child Adolesc Psychiatry Ment Health. 2025;19:84. 10.1186/s13034-025-00924-2 . Suppl. 1. Viksveen P, Cardenas NE, Berg SH, Salamonsen A, Game JR, Bjønness S. Adolescents' involvement in mental health treatment and service design: a systematic review. BMC Health Serv Res. 2024;24(1):1502. 10.1186/s12913-024-11892-2 . Eustache E, et al. High burden of mental illness and low utilization of care among school-going youth in Central Haiti: A window into the youth mental health treatment gap in a low-income country. Int J Soc Psychiatry. 2017;63(3):261–74. 10.1177/0020764017700174 . Saade S, Parent-Lamarche A, Khalaf T, Makke S, Legg A. Correction: What barriers could impede access to mental health services for children and adolescents in Africa? A scoping review. BMC Health Serv Res. 2024;24(1):559. 10.1186/s12913-024-11046-4 . A. Yenet, G. Nibret, and B. A. Tegegne, Challenges to the Availability and Affordability of Essential Medicines in African Countries: A Scoping Review, Clinicoecon. Outcomes Res. , vol. 15, pp. 443–458, 2023. doi: 10.2147/CEOR.S413546. Endrawes G, Ogunsiji O. Exploring African Community Attitudes Towards Mental Illness in Australia: A Cross-Sectional Study. Healthc (Basel). 2025;13(23):3115. 10.3390/healthcare13233115 . World Health Organization. Mental health of adolescents, 2025. [Online]. Available: https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health Mubeen Z, Fatmi Z, Hameed W, Asim M. Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives. BMC Health Serv Res. 2024;24(1):157. 10.1186/s12913-024-10593-0 . Additional Declarations No competing interests reported. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8595889","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":588857536,"identity":"46b32325-c2c9-4109-9bad-c5db3c6ea7fb","order_by":0,"name":"Marie Angele Gasangwa","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6klEQVRIiWNgGAWjYFACxgcHGBhseNjYm4E0g4QMEVqYDYBK0+T4eI4lgLTwEKUFSBw2lpPIATEYCGvhn32Y8cCPCubENoacz69u1FjwMLAfProBnxaJc8kMB3vOsAG1nN1mnXMM6DCetLQbeK05w3/gMGMbT2IbY+824xw2oBYJHjO8WuTPMDMAtUgktjHzPDPO+UeEFgOIFgNjNjYe5se5bURoMQRqAfolQY6Nh82MObdPgoeNkF/kzjAzf/hR8Z9Hfv7jx59zvtXJ8bMfPobf+0iATQJMEqscBJg/kKJ6FIyCUTAKRg4AAE9eRE9UfismAAAAAElFTkSuQmCC","orcid":"","institution":"Mount Kenya University","correspondingAuthor":true,"prefix":"","firstName":"Marie","middleName":"Angele","lastName":"Gasangwa","suffix":""},{"id":588857537,"identity":"10e8039e-3ed4-46cf-a436-01535d1b4285","order_by":1,"name":"Janvier Rukundo","email":"","orcid":"","institution":"Rwanda Food and Drug Authority","correspondingAuthor":false,"prefix":"","firstName":"Janvier","middleName":"","lastName":"Rukundo","suffix":""},{"id":588857541,"identity":"6d8e7850-6b20-45be-9d29-309a326c8a5a","order_by":2,"name":"Yves Gashugi","email":"","orcid":"","institution":"Rwanda Psychological Society","correspondingAuthor":false,"prefix":"","firstName":"Yves","middleName":"","lastName":"Gashugi","suffix":""},{"id":588857542,"identity":"038a8e27-d7f4-4c35-9b75-d04d352c48c8","order_by":3,"name":"Louange Bienvenu Byiringiro","email":"","orcid":"","institution":"Rwanda Food and Drug Authority","correspondingAuthor":false,"prefix":"","firstName":"Louange","middleName":"Bienvenu","lastName":"Byiringiro","suffix":""}],"badges":[],"createdAt":"2026-01-13 22:38:04","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8595889/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8595889/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102446511,"identity":"d1765fd6-d150-4e49-8eb7-b7c334b12ec0","added_by":"auto","created_at":"2026-02-11 17:43:41","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":639658,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003e\u003cstrong\u003eMap of Rwanda, Kigali City\u003c/strong\u003e\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-8595889/v1/a139700066da55034dbb6192.png"},{"id":102446509,"identity":"0cc43a71-08c3-4419-84e5-685949b08eb8","added_by":"auto","created_at":"2026-02-11 17:43:41","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":15171,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eUtilization Level of Mental Health Services Among Adolescents Aged 18–24 Years in Kicukiro District\u003c/strong\u003e\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-8595889/v1/cd10217fdc37e70097b3b23f.png"},{"id":103056333,"identity":"384a45df-52e5-43cc-870f-67ffaf9c440c","added_by":"auto","created_at":"2026-02-20 09:06:53","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":2449740,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8595889/v1/6f4b7831-e0d1-421d-b8b5-4287aa049f49.pdf"},{"id":102746126,"identity":"1f88f404-7075-4301-804c-3944a901fcfa","added_by":"auto","created_at":"2026-02-16 08:55:46","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19618,"visible":true,"origin":"","legend":"","description":"","filename":"QuestionnaireonUtilizationofMentalHealthServicesAmongAdolescentsAged18.docx","url":"https://assets-eu.researchsquare.com/files/rs-8595889/v1/7501cff93722385e298debd3.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Assessing the determinants of mental health services utilization among adolescents aged 18–24 years in Kicukiro district, Rwanda","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eMental health disorders represent a significant and growing global public health concern, contributing substantially to morbidity, disability, and premature mortality. Recent global estimates indicate that nearly one in eight individuals lives with a mental disorder, with depression and anxiety being the most prevalent conditions among youth and young adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Suicide remains the fourth leading cause of death among individuals aged 15\u0026ndash;29 years, highlighting the developmental vulnerability of older adolescents and emerging adults [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The age group of 18\u0026ndash;24 years is a critical transitional period marked by identity exploration, increasing autonomy, academic and occupational pressures, and major social adjustments, all of which heighten susceptibility to mental health challenges [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe burden of mental health disorders is particularly pronounced in low- and middle-income countries (LMICs), where service availability and accessibility remain limited. Countries in Sub-Saharan Africa (SSA) allocate less than 1% of their national health budgets to mental health, and most report fewer than two mental health professionals per 100,000 population [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. As a result, more than 75% of young people experiencing mental health problems in SSA do not receive professional care [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Barriers such as stigma, misinformation, low mental health literacy, economic constraints, and cultural preferences for traditional and religious healing practices continue to hinder help-seeking among adolescents [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e]. Regional data from Kenya, Uganda, and Tanzania consistently show high prevalence of depression, anxiety, and psychological distress among adolescents, yet service utilization rates remain low due to stigma, limited awareness, and perceived lack of youth-friendly services [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eRwanda has made significant progress in strengthening its mental health care system through policy, community-based programming, and integration of mental health services within primary health care. The Rwanda Mental Health Strategic Plan (2020\u0026ndash;2024) emphasizes decentralization, task-shifting, and youth mental health promotion, while national surveys indicate that approximately 20% of the population experiences mental health challenges including post-traumatic stress disorder, depression, and anxiety [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Despite these efforts, the utilization of mental health services among adolescents remains low. Evidence shows that fewer than 13% of individuals with mental health needs seek professional support, and adolescents and young adults are the least likely to access available services [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Factors such as stigma, financial limitations, service availability, and limited awareness continue to shape attitudes and behaviours surrounding mental health service use.\u003c/p\u003e \u003cp\u003eRapid urbanization, youth unemployment, substance use, academic pressures, and interpersonal violence contribute to heightened psychosocial stress among adolescents. Recent reports indicate that mental health conditions affect an estimated 36.7% of residents in the district, with a substantial burden among young people [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. Although several community-based initiatives, such as the \u0026ldquo;Baho Neza\u0026rdquo; project, have sought to expand mental health awareness, reduce stigma, and improve access to care, utilization among adolescents remains disproportionately low, partly due to financial barriers, limited information about services, and perceived stigma [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. These trends suggest the presence of systemic and community-level barriers that influence adolescents\u0026rsquo; willingness and ability to seek professional mental health support.\u003c/p\u003e \u003cp\u003eRecent studies across LMICs underscore the importance of understanding determinants of mental health service utilization, particularly among older adolescents, who often fall between child-focused and adult-focused mental health services [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. Factors influencing utilization include individual perceptions of need, mental health literacy, family support, economic factors, cultural beliefs, availability of youth-friendly services, confidentiality concerns, and trust in health providers [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e, \u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. However, empirical evidence examining these determinants among adolescents aged 18\u0026ndash;24 in Rwanda remains limited, despite increasing policy attention to youth mental health.\u003c/p\u003e \u003cp\u003eGiven the high burden of mental health problems and the low level of service use in Kicukiro District, there is a critical need for localized evidence to understand the factors that shape mental health service utilization among adolescents aged 18\u0026ndash;24 years. Identifying these determinants will provide essential insights for designing targeted interventions, strengthening district-level mental health programming, and informing national strategies aimed at improving adolescent mental health outcomes in Rwanda.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis study employed a quantitative analytical cross-sectional design to assess the determinants of mental health services utilization among adolescents and young adults aged 18\u0026ndash;24 years. The design enabled the measurement of exposure variables and service utilization outcomes simultaneously within the study population, making it appropriate for identifying associations between individual, social, and health system factors and mental health service use.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in Kicukiro District, as shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e, which presents a map of Rwanda. Kicukiro is one of the three administrative districts of Kigali City, Rwanda. Kigali City comprises 35 sectors distributed across Nyarugenge (10 sectors), Gasabo (15 sectors), and Kicukiro (10 sectors). Kicukiro District comprises the following sectors: Gahanga, Gatenga, Gikondo, Kagarama, Kanombe, Kicukiro, Kigarama, Masaka, Niboye, and Nyarugunga. Kicukiro District is a rapidly urbanizing area characterized by mixed residential, commercial, and industrial zones and a high concentration of adolescents and young adults. Data collection was conducted between July 5, 2025, and August 12, 2025, in selected schools, youth centers, community settings, and health facilities within the district.\u003c/p\u003e \u003cp\u003e \u003c/p\u003e\n\u003ch3\u003eStudy Population\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of adolescents and young adults aged 18\u0026ndash;24 years who were residing in Kicukiro District at the time of data collection. This age group represents a critical developmental period during which many mental health conditions emerge, and service utilization decisions are formed. Participants were recruited from secondary schools, youth centers, community spaces, and health facilities to ensure diversity in socio-economic status, education level, and gender.\u003c/p\u003e\n\u003ch3\u003eInclusion and Exclusion Criteria\u003c/h3\u003e\n\u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eInclusion Criteria\u003c/h2\u003e \u003cp\u003eParticipants were eligible if they:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eWere aged 18\u0026ndash;24 years at the time of data collection\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWere residents of Kicukiro District, Kigali City\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWere present at selected schools, youth centers, community settings, or health facilities\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWere able to comprehend and respond to the questionnaire in Kinyarwanda, English, or French\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eProvided written informed consent\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eExclusion Criteria\u003c/h2\u003e \u003cp\u003eParticipants were excluded if they:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eHad severe mental or physical conditions that impaired their ability to participate\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWere not residents of Kicukiro District\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eWere unable to communicate in the study languages\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eDeclined or withdrew consent during the study\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eSampling Design and Sample Size\u003c/h3\u003e\n\u003cdiv id=\"Sec10\" class=\"Section2\"\u003e \u003ch2\u003eSampling Technique\u003c/h2\u003e \u003cp\u003eA multistage sampling strategy was employed. First, sectors within Kicukiro District were considered as primary strata. At the second stage, cells were selected systematically as primary sampling units. At the third stage, schools, youth centers, and community settings within selected cells were identified purposively based on availability. Finally, eligible participants within each site were selected using systematic random sampling, ensuring proportional representation across locations and gender.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSample Size Determination\u003c/h2\u003e \u003cp\u003eThe sample size was calculated using Cochran\u0026rsquo;s formula for estimating proportions, assuming a 95% confidence level, a margin of error of 5%, and an estimated prevalence of mental health service utilization of 50% due to the absence of precise district-level estimates.\u003cdiv id=\"Equa\" class=\"Equation\"\u003e\u003cdiv format=\"TEX\" class=\"mathdisplay\" id=\"FileID_Equa\" name=\"EquationSource\"\u003e\n$$\\:n=\\frac{{Z}^{2}p(1-p)}{{e}^{2}}$$\u003c/div\u003e\u003c/div\u003e\u003c/p\u003e \u003cp\u003eWhere:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;required sample size\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003eZ\u003c/em\u003e\u0026thinsp;=\u0026thinsp;1.96 (95% confidence level)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.5\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cem\u003ee\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.05\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eThe minimum sample size was calculated as 384 participants. To account for potential non-response and incomplete questionnaires, a 10% adjustment was applied, resulting in a final target sample size of 425 participants. The sample was proportionally distributed across selected cells and data collection sites, with efforts made to ensure equal representation of males and females to minimize gender-related response bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Tools\u003c/h2\u003e \u003cp\u003eData were collected using a structured questionnaire developed specifically for this study, informed by validated tools and previous studies on adolescent mental health service utilization. The questionnaire consisted of four sections:\u003c/p\u003e \u003col\u003e\n \u003cli\u003e\u003cstrong\u003eSocio-demographic characteristics\u003c/strong\u003e (age, sex, education, employment, living arrangement)\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eKnowledge of mental health and mental health services\u003c/strong\u003e\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eAttitudes toward mental health services\u003c/strong\u003e, including stigma, confidentiality, and perceived effectiveness\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eUtilization of mental health services\u003c/strong\u003e, including history of service use and perceived barriers\u003c/li\u003e\n\u003c/ol\u003e\u003cp\u003eThe questionnaire was pretested prior to data collection to ensure clarity, relevance, and cultural appropriateness.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eVariables\u003c/h2\u003e \u003cdiv id=\"Sec15\" class=\"Section3\"\u003e \u003ch2\u003eOutcome Variable\u003c/h2\u003e \u003cp\u003eThe primary outcome variable was \u003cb\u003emental health services utilization\u003c/b\u003e, assessed by self-report of whether participants had ever accessed professional mental health services. Responses were dichotomized as:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eYes\u003c/b\u003e (utilized services)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003e \u003cb\u003eNo\u003c/b\u003e (did not utilize services)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eIndependent Variables\u003c/h2\u003e \u003cp\u003eIndependent variables included:\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eSocio-demographic factors (age, sex, education level, employment status)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eKnowledge of mental health services\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAttitudes toward mental health services\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePerceived stigma\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAccessibility and affordability of services\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSocial and family support factors\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003cp\u003eKnowledge and attitude scores were computed and categorized into \u003cb\u003eadequate/positive (\u0026ge;\u0026thinsp;60%)\u003c/b\u003e and \u003cb\u003einadequate/negative (\u0026lt;\u0026thinsp;60%)\u003c/b\u003e for analytical purposes.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eData Collection Procedure\u003c/h2\u003e \u003cp\u003eData collection was conducted by trained research assistants. Enumerators received training on ethical research conduct, confidentiality, informed consent, and sensitivity when discussing mental health topics. Questionnaires were administered in private settings to ensure participant comfort and confidentiality. Participation was voluntary, and respondents were free to withdraw at any time without consequences.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eBias Control\u003c/h2\u003e \u003cp\u003eSeveral strategies were employed to minimize bias. Gender-balanced recruitment was ensured, proportional sampling was applied across cells, and systematic random sampling reduced selection bias. Standardized training of data collectors and pretesting of tools minimized information bias.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eData were entered and analyzed using SPSS 25. Descriptive statistics were computed using frequencies, percentages, means, and standard deviations. At the bivariate level, chi-square tests were used to assess associations between independent variables and mental health service utilization. Variables with a p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05 were entered into a multivariable logistic regression model to estimate adjusted odds ratios (AORs) and 95% confidence intervals. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the University of Rwanda, College of Medicine and Health Sciences Institutional Review Board (IRB), and authorization to conduct the study was granted by Kigali City authorities. The study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki for research involving human subjects. Written informed consent was obtained from all participants prior to data collection. Confidentiality and anonymity were strictly maintained throughout the study, and all data were securely stored in compliance with Rwanda\u0026rsquo;s Data Protection and Privacy Law (Law No. 058/2021).\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eDemographic and Socioeconomic Profile of Study Participants\u003c/h2\u003e \u003cdiv id=\"Sec23\" class=\"Section3\"\u003e \u003ch2\u003eDistrict (N\u0026thinsp;=\u0026thinsp;384)\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSocio-Demographic Characteristics of Adolescents Aged 18\u0026ndash;24 Years in Kicukiro\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u0026ndash;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e105\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e184\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e384\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e148\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e38.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e236\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e61.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e384\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e7.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e27.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary/College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e253\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e384\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e384\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Stay in Kicukiro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e49\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e83\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;6 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e44\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e54.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e384\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e100.0\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e presents the socio-demographic characteristics of the 384 adolescents aged 18\u0026ndash;24 years who participated in the study in Kicukiro District. Nearly half of the respondents (47.9%) were aged between 21 and 23 years, indicating that the sample was predominantly composed of individuals in late emerging adulthood. Participants aged 20 years or below constituted 27.3%, while those aged 24 years accounted for 24.8%, reflecting a relatively balanced age distribution across the target age range.\u003c/p\u003e \u003cp\u003eIn terms of gender, females comprised the majority of participants (61.5%), compared to 38.5% males. This gender distribution may reflect higher availability or willingness among female adolescents to participate in health-related research, a pattern commonly observed in mental health studies.\u003c/p\u003e \u003cp\u003eRegarding educational attainment, the majority of respondents had attained a tertiary or college education (65.9%), followed by those with secondary education (27.1%). Only a small proportion (7.0%) had completed primary education. This suggests that the study population was relatively well-educated, which may influence awareness, attitudes, and help-seeking behaviors related to mental health services.\u003c/p\u003e \u003cp\u003eMore than half of the participants were students (55.5%), while 33.1% were employed and 11.5% were unemployed. The high proportion of students is consistent with the age group under study and highlights the importance of educational institutions as potential entry points for mental health interventions.\u003c/p\u003e \u003cp\u003eConcerning duration of residence, over half of the participants (54.2%) had lived in Kicukiro for seven years or more, indicating long-term exposure to the district\u0026rsquo;s social and health environment. Smaller proportions had lived in the district for less than one year (12.7%), two to three years (21.6%), or four to six years (11.5%).\u003c/p\u003e \u003cp\u003eOverall, the findings indicate that the study population consisted predominantly of female, well-educated adolescents, most of whom were students and long-term residents of Kicukiro District. These characteristics are important contextual factors that may influence mental health service utilization patterns among adolescents aged 18\u0026ndash;24 years.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003eUtilization Level of Mental Health Services\u003c/h2\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003eAs shown in Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the level of mental health service utilization among adolescents aged 18\u0026ndash;24 years in Kicukiro District. Out of the 384 respondents, 136 (35.4%) reported having accessed mental health services at least once, while 248 (64.6%) indicated that they had never sought any mental health services. These findings indicate that although slightly more than one-third of adolescents have utilized mental health services, the majority, nearly two-thirds, have not. This highlights a substantial gap in mental health service utilization among adolescents in the district, suggesting the persistence of barriers to access and uptake within this population.\u003c/p\u003e \u003cdiv id=\"Sec25\" class=\"Section3\"\u003e \u003ch2\u003eReasons for Seeking Mental Health Services\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMain Reasons for Seeking Mental Health Services Among Adolescents (N\u0026thinsp;=\u0026thinsp;384)\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReason for Seeking Services\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal (N\u0026thinsp;=\u0026thinsp;136) %\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e90\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e66.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e46\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e33.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e119\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e87.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e4.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e12.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStress\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e60\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e15.6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e76\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e55.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePeer-related issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e12.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e34.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e23.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e65.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-esteem issues\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e14.1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e39.7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e21.4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e60.3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSubstance abuse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e42\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e10.9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e30.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e94\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e69.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther (specified)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e11.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e31.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e93\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e24.2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e68.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAmong the 384 adolescents aged 18\u0026ndash;24 years included in the study, 136 participants (35.4%) reported having utilized mental health services and were subsequently asked to indicate the reasons for seeking care. As shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e, the most frequently reported reason for seeking mental health services was depression, with 119 respondents (87.5%) indicating this as a contributing factor. This finding suggests that depressive symptoms represent the dominant driver of mental health service utilization among adolescents in Kicukiro District.\u003c/p\u003e \u003cp\u003eAnxiety was the second most commonly reported reason, cited by 90 participants (66.2%), followed by stress, which was reported by 76 respondents (55.9%). These findings indicate that internalizing mental health conditions, particularly mood- and anxiety-related challenges, constitute the primary motivations for service use in this population.\u003c/p\u003e \u003cp\u003eIn addition to psychological distress, psychosocial stressors were also prominent. Family-related issues were reported by 60 adolescents (44.1%), while self-esteem problems were indicated by 54 participants (39.7%). Peer-related challenges were reported by 47 respondents (34.6%), reflecting the significant role of interpersonal relationships during late adolescence and early adulthood.\u003c/p\u003e \u003cp\u003eFurthermore, substance abuse\u0026ndash;related concerns were reported by 42 participants (30.9%), highlighting the coexistence of substance use issues with mental health challenges among a substantial proportion of service users. Other unspecified reasons were reported by 43 respondents (31.6%), suggesting the presence of additional mental health or psychosocial concerns not captured in the predefined categories.\u003c/p\u003e \u003cp\u003eOverall, these findings demonstrate that mental health service utilization among adolescents in Kicukiro District is largely driven by depression, anxiety, and stress, alongside important family, peer, and self-related challenges. This pattern underscores the need for integrated, youth-friendly mental health services that address both clinical symptoms and underlying psychosocial determinants.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section3\"\u003e \u003ch2\u003eAwareness and Knowledge of Mental Health Services and Access Points\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAwareness and Knowledge of Mental Health Services and Access Points Among Adolescents in Kicukiro District, Rwanda\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eResponse\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eFrequency\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePercent (%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAwareness of mental health services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e321\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e83.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e16.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCounseling services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e262\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e68.2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e122\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e31.8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTherapy (Individual or group)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePsychiatric services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e227\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e59.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e40.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHelplines\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e213\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e55.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e44.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSupport groups\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e204\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther services\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e46.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e207\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e53.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHealth centers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e309\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e75\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e19.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHospitals\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e275\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e71.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e109\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrivate clinics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e284\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e74.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26.0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCommunity centers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e69.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligious institutions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e63.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e36.5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOnline platforms\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e42.4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e221\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e57.6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eI do not know\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e33.1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e257\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e66.9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eTable\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e presents respondents\u0026rsquo; awareness and knowledge of mental health services and access points in Kicukiro District. Overall, the findings indicate a high level of general awareness, with 83.6% (n\u0026thinsp;=\u0026thinsp;321) of adolescents reporting awareness of mental health services, while 16.4% (n\u0026thinsp;=\u0026thinsp;63) indicated no awareness.\u003c/p\u003e \u003cp\u003eWith regard to knowledge of specific mental health services, counseling services were the most widely recognized, reported by 68.2% (n\u0026thinsp;=\u0026thinsp;262) of respondents, followed by individual or group therapy (63.5%, n\u0026thinsp;=\u0026thinsp;244). Awareness of psychiatric services was reported by 59.1% (n\u0026thinsp;=\u0026thinsp;227), while just over half of the participants (55.5%, n\u0026thinsp;=\u0026thinsp;213) acknowledged the availability of mental health helplines. Knowledge of support groups was reported by 53.1% (n\u0026thinsp;=\u0026thinsp;204), whereas fewer respondents (46.1%, n\u0026thinsp;=\u0026thinsp;177) were aware of other mental health services, indicating variability in familiarity with the range of services available.\u003c/p\u003e \u003cp\u003eRegarding knowledge of service access points, health centers were the most commonly identified locations for accessing mental health services (80.5%, n\u0026thinsp;=\u0026thinsp;309), followed by private clinics (74.0%, n\u0026thinsp;=\u0026thinsp;284) and hospitals (71.6%, n\u0026thinsp;=\u0026thinsp;275). Additionally, community centers (69.5%, n\u0026thinsp;=\u0026thinsp;267) and religious institutions (63.5%, n\u0026thinsp;=\u0026thinsp;244) were frequently mentioned, reflecting the perceived role of community-based and faith-based settings in mental health support. In contrast, awareness of online platforms as access points was relatively low, with only 42.4% (n\u0026thinsp;=\u0026thinsp;163) reporting familiarity. Notably, 33.1% (n\u0026thinsp;=\u0026thinsp;127) of respondents indicated uncertainty about where mental health services could be obtained.\u003c/p\u003e \u003cp\u003eOverall, while adolescents in Kicukiro District demonstrate high general awareness of mental health services, notable gaps persist in knowledge of specific service types and access points, particularly digital platforms. These findings underscore the need for strengthened mental health literacy and targeted information dissemination to improve adolescents\u0026rsquo; navigation and utilization of available mental health services.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section3\"\u003e \u003ch2\u003eAssociation of Socio-Demographic Characteristics, Knowledge, and Attitude with Mental Health Service Utilization\u003c/h2\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eAssociation of Socio-Demographic Characteristics, Knowledge, and Attitude with Mental Health Service Utilization Among Adolescents in Kicukiro District, Rwanda\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eChi-Square (χ\u0026sup2;)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003ep-value (Asymp. Sig.)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e14.424\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e38.813\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation Level\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrimary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.346\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.841\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSecondary\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e39\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eTertiary/College\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e87\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e166\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOccupation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.702\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.704\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eEmployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e45\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e82\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResidence in Kicukiro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.722\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Stay in Kicukiro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.025\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;6 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eKnowledge Levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLow (14\u0026ndash;18)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e85\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e140\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e3.300\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e0.192\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eModerate (19\u0026ndash;24)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eHigh (25\u0026ndash;28)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude Levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative (5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e44.463\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral (9\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive (13\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e, a statistically significant association was observed between age and mental health service utilization (χ\u0026sup2; = 14.424, p\u0026thinsp;=\u0026thinsp;0.001). Adolescents aged 21\u0026ndash;23 years and 24 years were more likely to report having utilized mental health services compared to those aged\u0026thinsp;\u0026le;\u0026thinsp;20 years, among whom non-utilization was markedly higher. This suggests that older adolescents and young adults may have greater autonomy, awareness, or perceived need for mental health care.\u003c/p\u003e \u003cp\u003eGender was also significantly associated with service utilization (χ\u0026sup2; = 38.813, p\u0026thinsp;=\u0026thinsp;0.001). Female participants reported substantially higher utilization of mental health services compared to males, indicating potential gender-based differences in help-seeking behaviors, stigma perception, or mental health awareness.\u003c/p\u003e \u003cp\u003eIn contrast, education level showed no statistically significant association with mental health service utilization (χ\u0026sup2; = 0.346, p\u0026thinsp;=\u0026thinsp;0.841). Similarly, occupation status (χ\u0026sup2; = 0.702, p\u0026thinsp;=\u0026thinsp;0.704) and residence status in Kicukiro District (χ\u0026sup2; = 0.127, p\u0026thinsp;=\u0026thinsp;0.722) were not significantly related to service utilization, suggesting that these socio-demographic factors did not independently influence adolescents\u0026rsquo; likelihood of accessing mental health services.\u003c/p\u003e \u003cp\u003eHowever, the duration of stay in Kicukiro District was significantly associated with utilization (χ\u0026sup2; = 9.348, p\u0026thinsp;=\u0026thinsp;0.025). Adolescents who had lived in the district for a longer period, particularly those residing for seven years or more, were more likely to have accessed mental health services than those with shorter durations of residence. This may reflect greater familiarity with available services, stronger social networks, or improved health system navigation over time.\u003c/p\u003e \u003cp\u003eRegarding psychosocial factors, knowledge level was not significantly associated with mental health service utilization (χ\u0026sup2; = 3.300, p\u0026thinsp;=\u0026thinsp;0.192), indicating that awareness alone may not be sufficient to translate into service use. In contrast, attitude toward mental health services demonstrated a strong and statistically significant association with utilization (χ\u0026sup2; = 44.463, p\u0026thinsp;=\u0026thinsp;0.001). Adolescents with positive attitudes were considerably more likely to utilize mental health services compared to those with negative or neutral attitudes, underscoring the critical role of perceptions, beliefs, and stigma in influencing help-seeking behavior.\u003c/p\u003e \u003cp\u003eOverall, these findings highlight that age, gender, duration of residence, and attitudes toward mental health services are key determinants of mental health service utilization among adolescents in Kicukiro District, while socio-economic factors and knowledge levels alone appear less influential. This emphasizes the importance of attitude-focused and stigma-reduction interventions to improve mental health service uptake among adolescents.\u003c/p\u003e \u003cp\u003e \u003cb\u003eLogistic Regression Analysis of Socio-Demographic Factors and Attitude Levels Associated with Utilization of Mental Health Services\u003c/b\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab5\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 5\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLogistic Regression Analysis of Socio-Demographic Factors and Attitude Levels Associated with Utilization of Mental Health Services Among Respondents in Kicukiro District\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP-value\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eAOR\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e95% C.I. for AOR (Lower)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003e95% C.I. for AOR (Upper)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026le;\u0026thinsp;20 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e80\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u0026ndash;23 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e64\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e3.753\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.861\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e7.570\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;24 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e48\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2.235\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1.239\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e4.032\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e5.810\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e3.249\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e10.389\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e124\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDuration of Stay in Kicukiro\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;1 year\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.108\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.458\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.220\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.953\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u0026ndash;3 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e47\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.602\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.326\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1.112\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u0026ndash;6 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.456\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e2.200\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026ge;\u0026thinsp;7 years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e146\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAttitude Levels\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNegative (5\u0026ndash;8)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e52\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6.393\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.968\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e13.768\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNeutral (9\u0026ndash;12)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e59\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8.090\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e4.246\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e15.414\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePositive (13\u0026ndash;16)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e53\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.132\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAs shown in Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e, Age was significantly associated with mental health service utilization. Adolescents aged 21\u0026ndash;23 years were approximately 3.8 times more likely to utilize mental health services compared to those aged\u0026thinsp;\u0026le;\u0026thinsp;20 years (AOR\u0026thinsp;=\u0026thinsp;3.753; 95% CI: 1.861\u0026ndash;7.570; p\u0026thinsp;=\u0026thinsp;0.001). Those aged\u0026thinsp;\u0026ge;\u0026thinsp;24 years were also significantly more likely to utilize services than the youngest group (AOR\u0026thinsp;=\u0026thinsp;2.235; 95% CI: 1.239\u0026ndash;4.032). This indicates that older adolescents may have greater autonomy, awareness, or perceived need to seek mental health care.\u003c/p\u003e \u003cp\u003eGender showed a strong association with service utilization. Male adolescents were 5.8 times more likely to utilize mental health services compared to females (AOR\u0026thinsp;=\u0026thinsp;5.810; 95% CI: 3.249\u0026ndash;10.389; p\u0026thinsp;=\u0026thinsp;0.001). This may reflect gender-specific help-seeking behaviors, societal expectations, or differences in perceived mental health needs.\u003c/p\u003e \u003cp\u003eDuration of stay in Kicukiro District was not significantly associated with service utilization in the adjusted model. Adolescents who had lived in the district for less than one year were less likely to use mental health services compared to those residing for \u0026ge;\u0026thinsp;7 years, but this was not statistically significant (AOR\u0026thinsp;=\u0026thinsp;0.458; 95% CI: 0.220\u0026ndash;0.953; p\u0026thinsp;=\u0026thinsp;0.108).\u003c/p\u003e \u003cp\u003eAttitude toward mental health services emerged as a major predictor of service utilization. Adolescents with negative attitudes were 6.4 times more likely to utilize services than those with positive attitudes (AOR\u0026thinsp;=\u0026thinsp;6.393; 95% CI: 2.968\u0026ndash;13.768; p\u0026thinsp;=\u0026thinsp;0.001), and those with neutral attitudes were 8.1 times more likely (AOR\u0026thinsp;=\u0026thinsp;8.090; 95% CI: 4.246\u0026ndash;15.414; p\u0026thinsp;=\u0026thinsp;0.001). This result highlights that adolescents\u0026rsquo; perceptions, beliefs, and acceptance of mental health care strongly influence their likelihood of seeking services.\u003c/p\u003e \u003cp\u003eThe constant term was statistically significant (p\u0026thinsp;=\u0026thinsp;0.001), indicating that the model is a good fit for predicting mental health service utilization based on the included variables.\u003c/p\u003e \u003cp\u003eOverall, the logistic regression analysis underscores that age, gender, and attitude levels are key determinants of mental health service utilization among adolescents in Kicukiro District. Interventions aiming to improve utilization should prioritize attitude change and targeted support for younger adolescents and gender-specific outreach.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings of this study provide important insights into the utilization of mental health services among adolescents aged 18\u0026ndash;24 years in Kicukiro District, Rwanda, and highlight several key patterns that align with broader evidence from low- and middle-income countries (LMICs). First, despite relatively high awareness of mental health services (83.6%), only 35.4% of adolescents reported ever utilizing such services. This underscores a persistent treatment gap that is documented widely in LMIC contexts, where formal mental health care utilization remains low even among those with significant need [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec29\" class=\"Section2\"\u003e \u003ch2\u003eSocio-Demographic Patterns and Service Utilization\u003c/h2\u003e \u003cp\u003eThe demographic profile showed that nearly half of participants were aged 21\u0026ndash;23 years and that females comprised the majority of the sample. This is consistent with other LMIC studies demonstrating that older adolescents and females are more likely to use mental health services compared to younger individuals and males [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. For example, a recent analysis of national adolescent health surveys from Kenya, Indonesia, and Vietnam found significantly greater odds of service use among older adolescents and females [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Such patterns may reflect a combination of greater autonomy, increased perceived need, and differential help-seeking norms among older youth [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHowever, the overall utilization remains low in comparison with the prevalence of mental health problems, suggesting substantial unmet need. Global evidence indicates that adolescents in middle-income regions often seek informal help (family, peers, teachers) rather than professional services, with formal service use often below 2% in some middle-income countries [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. This substantial unmet need indicates that awareness alone does not ensure service uptake.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eReasons for Seeking Services\u003c/h3\u003e\n\u003cp\u003eConsistent with other LMIC studies, internalizing problems such as depression, anxiety, and stress were the leading reasons for using mental health services. These findings resonate with other research indicating that internalizing symptoms drive help-seeking when services are accessed, yet many adolescents with such conditions still do not receive formal care [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. In the NAMHS analysis, emotional problems and behavioral issues were primary drivers of service engagement, but overall access remained limited [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e], highlighting a similar pattern to the current findings.\u003c/p\u003e \u003cdiv id=\"Sec31\" class=\"Section2\"\u003e \u003ch2\u003eAwareness, Knowledge, and Access Points\u003c/h2\u003e \u003cp\u003eAlthough the majority of adolescents were aware of available service types and access points (e.g., health centres, private clinics, and hospitals), knowledge was uneven, especially for digital or online platforms. Low mental health literacy has been identified as a key barrier to service utilization in LMIC settings, compounded by stigma and socio-cultural beliefs about mental health and its causes [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. Studies in Africa and Asia emphasize that limited familiarity with formal services and where to find them contributes to low utilization [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e], suggesting that targeted public education is needed to bridge the gap between awareness and actionable knowledge.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec32\" class=\"Section2\"\u003e \u003ch2\u003eBarriers to Utilization and Socio-Structural Influences\u003c/h2\u003e \u003cp\u003eBeyond knowledge, the association between attitudes toward mental health and service utilization was particularly strong in this study. Adolescents with neutral or negative attitudes had higher odds of using services than those with positive attitudes, potentially reflecting complex help-seeking dynamics whereby those exposed to services develop more critical attitudes through their experiences. Nonetheless, attitudinal barriers, including stigma, fear of judgment, and misconceptions, are well documented in LMICs and impede adolescents\u0026rsquo; willingness to seek professional help [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. A scoping review of barriers in African settings highlighted stigma, preference for traditional treatments, and unfamiliarity with mental health conditions as major obstacles [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. Similarly, qualitative evidence from Rwanda points to fear of stigmatization, financial constraints, and sociocultural barriers as limiting mental health care use [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eStructural challenges also play an important role. Limited availability of trained mental health professionals, scarcity of services, and lack of adolescent-friendly care pathways are widely reported in LMICs, and these systemic issues reinforce low utilization despite significant need [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Integration of mental health care into primary health services, task-sharing with non-specialists, and expansion of community-based supports have been proposed as ways to address these gaps [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec33\" class=\"Section3\"\u003e \u003ch2\u003eComparisons with Regional and Broader LMIC Evidence\u003c/h2\u003e \u003cp\u003eThe low overall utilization observed in this study reflects broader patterns in LMICs: for example, nationally representative data from Kenya, Indonesia, and Vietnam show that less than one in ten adolescents with a mental disorder accessed care in the previous year [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]. Similarly, research across West Africa documents pervasive shortfalls in adolescent mental health services availability and utilization, with some districts reporting service provision rates as low as 9%\u0026ndash;42% of expected need [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. These comparisons illustrate that the barriers and patterns identified in Kicukiro District are not unique but part of a systemic issue in LMICs.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec34\" class=\"Section3\"\u003e \u003ch2\u003eImplications for Policy and Practice\u003c/h2\u003e \u003cp\u003eThe results emphasize the need for multi-level interventions to improve adolescent mental health service utilization. Strategies that combine mental health education, community stigma reduction, school-based screening, and integration of services into primary health and community settings have shown promise in LMIC contexts [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. For example, interventions that raise awareness, identify individuals in need, and actively promote help-seeking can strengthen the mental health care pathway [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Furthermore, digital tools, though currently under-recognized by adolescents in this study, represent potential avenues for improving accessibility if accompanied by efforts to increase digital literacy and culturally relevant content.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eStrengths and Limitations\u003c/h3\u003e\n\u003cp\u003eThis study is strengthened by its focus on an urban LMIC population and its comprehensive examination of socio-demographic, attitudinal, and awareness factors. However, the cross-sectional design limits causal inference, and self-reported measures may be subject to bias. Future research should incorporate longitudinal designs and qualitative methods to deepen understanding of help-seeking dynamics.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study highlights a substantial gap in mental health service utilization among adolescents aged 18\u0026ndash;24 years in Kicukiro District, Rwanda. Although 83.6% of adolescents were aware of available services, only 35.4% reported having accessed mental health care, indicating that nearly two-thirds (64.6%) of adolescents have not sought professional support. Utilization was predominantly driven by internalizing mental health conditions, including depression (87.5% of users), anxiety (66.2%), and stress (55.9%), alongside family, peer, and self-esteem\u0026ndash;related challenges.\u003c/p\u003e \u003cp\u003eKey determinants of service use included age, gender, and attitudes toward mental health. Older adolescents (21\u0026ndash;23 years) and males were more likely to seek services, while positive attitudes toward mental health strongly predicted utilization. Knowledge alone did not significantly influence service uptake, emphasizing that awareness without supportive attitudes or stigma reduction may be insufficient to drive help-seeking behaviors.\u003c/p\u003e \u003cp\u003eThese findings underscore the need for multi-level, youth-focused interventions that address attitudinal barriers, reduce stigma, and improve accessibility of services. Integrating mental health care into community and primary health settings, leveraging schools, and expanding digital platforms could enhance service reach. Strengthening mental health literacy and promoting positive perceptions of mental health care are critical to improving service utilization and addressing the psychosocial needs of adolescents in Rwanda.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study involved human participants and received ethical approval from the Mount Kenya University Institutional Review Board (IRB Committee). Informed consent was obtained from all participants prior to data collection to ensure full adherence to ethical research standards.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Data are shared in a manner that maintains confidentiality and protects the privacy of participants.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests, financial or non-financial.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study did not receive any external funding. No funding body had any influence on the study design, data collection, analysis, interpretation, or writing of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cul type=\"disc\"\u003e\n \u003cli\u003e\u003cstrong\u003eMAG:\u003c/strong\u003e Conceptualization, study design, supervision, and manuscript review.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eJR:\u003c/strong\u003e Data collection, data analysis, and drafting of the results section.\u003c/li\u003e\n \u003cli\u003e\u003cstrong\u003eYG:\u003c/strong\u003e Literature review, methodology development, and writing of the introduction and discussion sections.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eAll authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors’ information (optional)\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eQuestionnaires\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWe confirm that the questionnaire used in our study was\u0026nbsp;\u003cstrong\u003edeveloped specifically for this study\u003c/strong\u003e\u003cstrong\u003e.\u003c/strong\u003e An English language version of the full questionnaire has been uploaded as a supplementary file for your consideration.\u0026nbsp;\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eWorld Health Organization, World Mental Health Report: Transforming Mental Health for All, Geneva, Switzerland: WHO. 2022. 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Tegegne, Challenges to the Availability and Affordability of Essential Medicines in African Countries: A Scoping Review, \u003cem\u003eClinicoecon. Outcomes Res.\u003c/em\u003e, vol. 15, pp. 443\u0026ndash;458, 2023. doi: 10.2147/CEOR.S413546.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eEndrawes G, Ogunsiji O. Exploring African Community Attitudes Towards Mental Illness in Australia: A Cross-Sectional Study. Healthc (Basel). 2025;13(23):3115. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.3390/healthcare13233115\u003c/span\u003e\u003cspan address=\"10.3390/healthcare13233115\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. Mental health of adolescents, 2025. [Online]. Available: \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health\u003c/span\u003e\u003cspan address=\"https://www.who.int/news-room/fact-sheets/detail/adolescent-mental-health\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMubeen Z, Fatmi Z, Hameed W, Asim M. Barriers and facilitators to accessing adolescents' mental health services in Karachi: users and providers perspectives. BMC Health Serv Res. 2024;24(1):157. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/s12913-024-10593-0\u003c/span\u003e\u003cspan address=\"10.1186/s12913-024-10593-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Mental health services, Utilization, Adolescents, Rwanda","lastPublishedDoi":"10.21203/rs.3.rs-8595889/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8595889/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eMental health disorders are a growing public health concern, particularly among adolescents aged 18\u0026ndash;24 years. Despite increased awareness, utilization of mental health services in Rwanda remains low, highlighting the need to understand factors influencing help-seeking behaviors in this population.\u003c/p\u003e\u003ch2\u003eObjectives\u003c/h2\u003e \u003cp\u003eThis study aimed to assess the determinants of mental health service utilization among adolescents aged 18\u0026ndash;24 years in Kicukiro District, Rwanda, focusing on socio-demographic characteristics, knowledge, attitudes, and access to services.\u003c/p\u003e\u003ch2\u003eMethodology:\u003c/h2\u003e \u003cp\u003eA quantitative analytical cross-sectional design was employed. A total of 384 adolescents were recruited using multistage sampling from schools, youth centers, and community settings. Data were collected via structured questionnaires covering socio-demographics, mental health knowledge, attitudes, and service utilization. Descriptive statistics, chi-square tests, and multivariable logistic regression analyses were conducted using SPSS 25 to identify factors associated with service use.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eOverall, 35.4% of adolescents reported having accessed mental health services, with depression (87.5%), anxiety (66.2%), and stress (55.9%) as the main reasons. Awareness of services was high (83.6%), but knowledge of specific access points, particularly digital platforms, was limited. Utilization was significantly associated with age, gender, and attitudes toward mental health. Adolescents aged 21\u0026ndash;23 years were 3.8 times more likely to use services compared to those\u0026thinsp;\u0026le;\u0026thinsp;20 years (AOR\u0026thinsp;=\u0026thinsp;3.753; 95% CI: 1.861\u0026ndash;7.570), while males had higher utilization than females (AOR\u0026thinsp;=\u0026thinsp;5.810; 95% CI: 3.249\u0026ndash;10.389). Positive attitudes strongly predicted service uptake.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eDespite high awareness, the majority of adolescents in Kicukiro District do not access mental health services. Interventions should target attitude change, stigma reduction, and improved accessibility through community, school, and digital platforms to enhance adolescent mental health service utilization in Rwanda.\u003c/p\u003e","manuscriptTitle":"Assessing the determinants of mental health services utilization among adolescents aged 18–24 years in Kicukiro district, Rwanda","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-11 17:43:30","doi":"10.21203/rs.3.rs-8595889/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-09T10:38:30+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T14:10:12+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-03-28T20:42:16+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"228673446596674339240124935051047331842","date":"2026-02-11T14:01:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"37688329820433131746410205295766668192","date":"2026-02-11T14:01:00+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"69524479642077229366654516208331803327","date":"2026-02-09T16:04:49+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"52678370895531855449947518935210348438","date":"2026-02-09T13:53:49+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-09T13:26:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"316522387750639344542016496876335262055","date":"2026-02-09T13:07:41+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-09T12:08:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-02-09T05:23:25+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-30T07:05:30+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-01-29T13:04:28+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-01-29T12:28:41+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9747bc18-278c-4d5d-829f-0ba4eecad8ca","owner":[],"postedDate":"February 11th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-09T10:38:30+00:00","index":66,"fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-05-08T14:10:12+00:00","index":65,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-11T17:43:30+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-11 17:43:30","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8595889","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8595889","identity":"rs-8595889","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}