Geographic, Demographic, and Cultural Influences on Mental Health Help-Seeking Attitudes of Ghanaian Junior High School Students

Geographic, Demographic, and Cultural Influences on Mental Health Help-Seeking Attitudes of Ghanaian Junior High School Students | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Geographic, Demographic, and Cultural Influences on Mental Health Help-Seeking Attitudes of Ghanaian Junior High School Students Vanessa Nana Ama Larbi, Enoch Azasu, Abass Tando Abubakar, Yaa Adutwumwaa Obeng, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9041674/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 11 You are reading this latest preprint version Abstract Young people continue to experience a myriad of mental health challenges. The ability to seek help for mental health challenges is crucial to improving life and wellbeing. This study examines the geographic, demographic, and cultural influences on mental health help-seeking attitudes among Ghanaian junior high school students. Using a quantitative approach, the research aims to identify key factors that shape adolescents' willingness to seek mental health support. This cross-sectional study was conducted over 3 weeks among 1702 junior high students in Ghana using validated questionnaires. The study aimed to examine attitudes toward seeking mental health services among Ghanaian students and how they differ across geographic regions, Sex, and Ethnic groups. Data were analyzed using variance analysis (ANOVA) and multiple regression in STATA version 17. A total of 1,702 participants were included in the study from across 5 regions of Ghana. The results demonstrated significant regional, sex, and ethnic differences in mental health-seeking attitudes. Mental health factors such as self-stigma and opinions about suicide were found to have the strongest influence on mental health-seeking attitudes among participants. The study emphasizes the need for comprehensive mental health education integrated into school curricula and the establishment of more effective counselling services led by trained professionals. mental health junior high students help-seeking behaviour Ghana mental health stigma BACKGROUND Mental health remains an essential aspect of overall well-being, yet it is less prioritized globally 1 and even more so among young people. 2 According to the World Health Organization, 10% to 20% of young people experience mental health problems (WHO, 2024) and estimates that half of adult mental health disorders begin in adolescence (WHO, 2024). Fifteen percent of the global burden of disease among 10 to 19-year-olds is accounted for, by mental illness-- with depression, anxiety and behavioral problems being some of the leading contributors 3 . The increasing exposures to stressors like trauma and adverse childhood experiences, bullying, peer pressure, social media use, among others, at a time of rapid physical, social and emotional changes with limited experience further continue to fuel the rising prevalence of mental illness among adolescents. 4 Yet, young people are among the least likely to seek help for such problems, requiring that practical steps are taken to understand the factors that facilitate or deter adolescents from accessing the interventions available for mental health issues. 5 Over the past decade, extensive research has been done on adolescent mental health, with themes spanning risk and protective factors; prevalence and epidemiology, impact of technology and social media; school-based interventions; COVID-19 and mental health; gender and intersectionality; interventions and treatment approaches; policy and advocacy; and mental health seeking behavior—the last of which is rather scant in sub-Saharan Africa, and emphasizes the need for a sociocultural context. More so, this diverse scope reflects the growing need to tackle mental health in this susceptible population with a holistic, evidence-based and culturally-sensitive intervention. 6 7 In Ghana, mental health concerns among young people are often under-recognized, and the importance of addressing mental health issues in schools is increasingly being acknowledged. Ghanaian adolescents, particularly those in Junior High School (JHS), face various emotional, social, and psychological challenges as they navigate a critical period of growth and development. These challenges often include academic pressure, social and peer relationships, family dynamics, and the emergence of personal identity. However, despite these stressors, seeking help for mental health issues remains a stigmatized or even taboo practice in many Ghanaian communities. This creates a barrier for students to receive the care and support they need during a pivotal time in their lives. The decision to seek help for mental health problems, however, is shaped by a range of interconnected factors. In particular, geographic, demographic, and cultural influences play a significant role in shaping the attitudes of young people towards mental health care and help-seeking behavior. Geographic location can impact access to mental health services, as urban students may have more opportunities to access professional help compared to their rural counterparts, where mental health services are often scarce or nonexistent. Additionally, demographic factors such as age, sex, socioeconomic status, and family structure can influence whether students feel empowered to seek help or whether they adhere to societal expectations about mental health. Culturally, Ghana is a nation that blends traditional beliefs with modern healthcare practices. Traditional healing methods, including spiritual or communal interventions, remain deeply embedded in Ghanaian society and often take precedence over formal psychiatric or psychological treatment. In many cases, mental health issues are attributed to spiritual causes, misdoings of the affected individual or family ‘curses’, which can complicate how young people perceive mental health professionals and their willingness to seek professional help. Furthermore, cultural stigmas surrounding mental illness, particularly the perception that mental health problems are a sign of weakness or moral failure, can discourage individuals from reaching out for assistance. For many students, the fear of being labelled as “mad” may outweigh the potential benefits of seeking professional care. Junior High School students, typically between the ages of 12 and 15, are at a critical stage in their cognitive and emotional development. At this age, students are increasingly aware of their mental health, yet may not have the coping mechanisms or resources to effectively manage mental health challenges. For some, the lack of supportive networks, both at home and at school, exacerbates the problem. While there have been efforts to integrate mental health education into the Ghanaian school system, significant gaps remain in terms of how mental health is understood and addressed within the context of the education system. Research on suicidal ideations among adolescents in Ghana have largely focused on the prevalence of suicidal ideations and predictors of suicide among middle school students 8 , high school students, 98 pregnant adolescent girls 10 and deaf adolescents. 11 Exposure to a friend's attempted suicide 12 as well as gender-specific factors have been identified as associated factors for suicidal ideations. For instance, females more likely to report personal and interpersonal adversities outside the family context, while males associated suicidal ideation with conflicts with parents. 12 Other studies highlighted the influence of factors such as bullying, substance use, and depression on suicidal ideation among adolescents in Ghana. 13 This research seeks to explore how geographic, demographic, and cultural factors influence the mental health help-seeking attitudes of Ghanaian Junior High School students. By examining how these various factors interact, this study aims to uncover the underlying reasons behind the reluctance or willingness to seek mental health support among adolescents in Ghana. Understanding these influences is vital for developing targeted interventions, educational programs, and policies that can help reduce stigma, increase access to mental health services, and ultimately improve the mental well-being of young people. The Health Belief Model (HBM) provides a valuable framework for exploring attitudes toward seeking mental health help among junior high school students in Ghana. By focusing on four key constructs of the HBM—perceived susceptibility, perceived severity, perceived benefits, and perceived barriers—we can evaluate these students' vulnerability to mental health issues, taking into account their geographic location, demographic factors (such as age and gender), and cultural beliefs. Cultural norms, gender roles, and geographic location can also affect how students see mental health issues—whether they deem them as a serious health problem or not. These factors also influence beliefs about the accessibility and effectiveness of available mental health services. Additionally, to promote mental health-seeking behaviors among students, we must identify the barriers that may exist. As mental health continues to emerge as a public health priority worldwide, this study will contribute to the growing body of knowledge on adolescent mental health in Ghana. The findings of this research will be of particular value to policymakers, educators, mental health professionals, and community leaders who seek to create more supportive environments for young people. By providing insights into the factors that influence help-seeking attitudes, this study will also inform efforts to design culturally appropriate mental health services that are accessible, acceptable, and effective for adolescents in Ghanaian schools. Aims of the Study The primary aim of this study was to examine attitudes toward mental health seeking among Ghanaian students and to investigate how these attitudes vary across different demographic and psychosocial factors. Specific Objectives (1) To assess the overall attitudes toward seeking psychological help among Ghanaian students. (2) To examine how attitudes toward seeking psychological help differ across: Geographic regions in Ghana Sex Religious affiliations Ethnic groups (3) To investigate the relationship between help-seeking attitudes and student preferences for confidants (school counsellors, teachers, friends, parents, or no one). (4) To evaluate whether willingness to discuss mental health issues is associated with attitudes toward seeking psychological help. (5) To analyze the relationship between: Attitudes toward seeking psychological help and opinions about suicide Attitudes toward seeking psychological help and self-stigma of mental illness METHODOLOGY Study Design This cross-sectional study involved Ghanaian junior high school students aged 12-18 years, who were randomly stratified across four geographical belts: Northern belt, Eastern Belt, Middle Belt and Southern Belt. A total of 1850 students expressed interest in participating in this study, but only 1702 completed the survey. Informed consent was obtained from parents or guardians through a written consent form, and students provided either verbal or written assent before participation. Participants were informed of their right to withdraw at any time without penalty. The surveys were completed anonymously over three weeks. This study was conducted in accordance with the ethical guidelines approved by the Institutional Review Board (IRB) of the University at Buffalo. Study Setting The study was conducted in junior high schools across Ghana, representing rural, peri-urban, and urban communities. Schools were selected to capture the diversity of educational and social contexts, ensuring the findings reflect the experiences of students nationwide. Participants were selected from four geographical belts across 5 regions: Northern Belt: Northern region. Eastern Belt: Volta region. Southern Belt: Greater Accra and Eastern regions. Middle Belt: Ashanti region. Data Collection Procedure The study employed the use of a structured questionnaire to collect data from respondents. Participants were recruited through their schools, with the assistance of school administrators and teachers. Schools were approached based on their location and enrolment numbers, and individual students were selected randomly from class lists. Recruitment materials included brochures and verbal presentations to explain the study’s purpose and procedures. Trained research assistants administered the surveys during school hours in a quiet and controlled environment. Surveys were completed using paper forms. Data collection sessions lasted approximately 30 minutes, including an introduction to the survey and a debriefing session. The survey measures were administered in English, which is the language of instruction in junior high schools across Ghana. The measures had been previously piloted in 2022 during a study conducted by the same research team with a sample of 800 students from the Greater Accra Region. This prior study demonstrated the appropriateness, clarity, and reliability of the measures in the Ghanaian junior high school context. A robust safety plan was implemented to address any distress experienced by participants during the survey. Research assistants were trained to recognize signs of distress and provide immediate support. Participants expressing significant psychological distress were referred to school counsellors or local mental health professionals. Contact information for national mental health hotlines were also provided. Population and Sample This study targeted a nationally representative sample of junior high school students in Ghana, aged 12–18 years. A total of 1,850 students expressed interest in participating in the study, of whom 1,702 completed the survey, yielding a participation rate of 92%. This sample reflects the diversity of junior high school students in Ghana in terms of geography, sex, ethnicity, and socioeconomic status. Measures and Variables Prior to this study, we conducted a pilot study with 800 students from the Greater Accra region of Ghana, which demonstrated the appropriateness, clarity, and reliability of the measures in the Ghanaian junior high school context. Additionally, the measures had shown reliability in the previous applications in Ghana and were adapted for use in a nationally representative setting. The Questionnaire included validated tools and scales design to assess various mental health domains. The scale consisted of four main domains: Demographics (Age, sex, living situation, and educational level), Mental Health Indicators (Suicide ideation and behavior (WHO CIDI), anxiety and depression (PHQ-4)), Risk and Protective Factors (Parental support, financial hardship, resilience, bullying experiences, and loneliness) and social media and Internet Use (Patterns and potential addiction). Data Processing and Analysis The survey was administered using paper-based questionnaires in English and responses were entered into REDCAP for data management. Variables were coded, and statistical analyses were conducted using STATA version 17. Analysis of variance (ANOVA) and multiple regression models were employed to examine associations between demographic, behavioral, and psychosocial factors and mental health outcomes among students. Ethical considerations Informed consent was obtained from all participants and their guardians. Parents or legal guardians provided written consent, while students gave verbal or written assent before participation. Participants were informed of their right to withdraw at any time without penalty. IRB Approval The study received approval from the Institutional Review Board (IRB) of the University at Buffalo. Ethical considerations included confidentiality, anonymity, and the voluntary nature of participation. Data were de-identified before analysis to protect participants identities. This cross-sectional study involved Ghanaian junior high school students aged 12-18 years, who were randomly stratified across four geographical belts: Northern belt, Eastern Belt, Middle Belt and Southern Belt. A total of 1850 students expressed interest in participating in this study, but only 1702 completed the survey. Informed consent was obtained from parents or guardians through a written consent form, and students provided either verbal or written assent before participation. Participants were informed of their right to withdraw at any time without penalty. The surveys were completed anonymously over three weeks. This study was conducted in accordance with the ethical guidelines approved by the Institutional Review Board (IRB) of the University at Buffalo. RESULTS We examine attitudes toward seeking psychological help across various demographic and psychosocial variables in a sample of 1,709 Ghanaian Junior High school students. The result of the ANOVA as shown in Table 1 below revealed regional differences in attitudes toward seeking psychological help were highly significant (F (4, 1704) = 26.42, p < .001). Students from the Ashanti region demonstrated the most positive attitudes (M = 16.17, SD = 2.51), followed by those from the Northern region (M = 14.95, SD = 3.18). In contrast, students from Greater Accra reported the lowest mean attitudes (M = 14.17, SD = 3.02), with the Eastern (M = 14.21, SD = 2.92) and Volta (M = 14.27, SD = 3.34) regions also exhibiting relatively lower scores. Analysis by means of sex of respondents revealed significant differences in attitudes (F (1, 1577) = 6.83, p = .009), with females reporting more positive attitudes (M = 14.84, SD = 3.02) compared to males (M = 14.43, SD = 3.14). However, differences in attitudes based on religious affiliation were not statistically significant (F(4, 1664) = 1.36, p = .247). Among religious groups, Traditional African adherents had slightly higher mean scores (M = 14.96, SD = 3.39) compared to Christians (M = 14.71, SD = 3.04) and Muslims (M = 14.09, SD = 2.98). Significant differences were also observed among ethnic groups (F (6, 1633) = 4.77, p < .001). The Ashanti ethnic group reported the highest mean attitudes (M = 15.08, SD = 2.95), closely followed by participants from "Other" ethnic groups (M = 15.06, SD = 3.01). Conversely, the Mole-Dagbani group had the lowest attitudes (M = 13.81, SD = 2.36), while participants from the Ewe (M = 14.23, SD = 3.33), Ga (M = 14.22, SD = 3.06), and Fante (M = 14.30, SD = 2.67) ethnic groups reported intermediate scores. Regarding the person participants felt most comfortable talking to, significant differences were identified (F(4, 1619) = 9.19, p < .001). Participants who identified school counselors as their confidants had the highest mean attitudes (M = 15.92, SD = 3.25), albeit from a small sample (n = 36). Those who chose parents (n = 941) also had relatively high scores (M = 14.99, SD = 2.90). Finally, significant associations were observed between attitudes toward seeking psychological help and both opinions toward suicide (F (9, 1687) = 6.53, p < .001) and self-stigma of mental illness (F(20, 1681) = 4.56, p < .001). The overall mean attitude score across the sample was M = 14.62, SD = 3.08, reflecting moderate positive attitudes toward seeking psychological help. The multiple regression analysis examined predictors of attitudes toward seeking psychological help as presented in Table 2 . The overall model explained a significant proportion of the variance in attitudes toward seeking psychological help (R² = 0.128, F(8, 1667) = 30.47, p < .001). Self-stigma of mental illness emerged as a significant positive predictor (B = 0.147, SE = 0.023, β = .164, p < .001), indicating that lower levels of self-stigma were associated with more positive attitudes. Similarly, opinion toward suicide also significantly predicted attitudes (B = 0.215, SE = 0.050, β = .113, p < .001), with more accepting opinions associated with higher attitude scores. Sex had a small but significant effect (B = 0.367, SE = 0.158, β = .060, p < .05), with females exhibiting slightly more positive attitudes compared to males. Region was another significant predictor (B = 0.305, SE = 0.058, β = .141, p < .001), indicating that students from different regions showed varying levels of positive attitudes. Table 1 Descriptive Statistics and ANOVA Results for Attitudes Toward Seeking Psychological Help Across Study Variables Variable and Categories N (%) M SD F df p Region 26.417 4, 1704 < .001 Greater Accra 729 14.17 3.02 Volta 233 14.27 3.34 Ashanti 293 16.17 2.51 Eastern 260 14.21 2.92 Northern 194 14.95 3.18 Total 1,709 14.62 3.08 Sex 6.826 1, 1577 .009 Male 740 14.43 3.14 Female 839 14.84 3.02 Total 1,579 14.65 3.08 Religion 1.355 4, 1664 .247 Christian 1,491 14.71 3.04 Muslim 139 14.09 2.98 Traditional African 26 14.96 3.39 No Religion 2 14.50 3.54 Other 11 14.55 3.33 Total 1,669 14.66 3.05 Ethnic Group 4.772 6, 1633 < .001 Ashanti 461 15.08 2.95 Ga 133 14.22 3.06 Ewe 351 14.23 3.33 Dangme 214 14.66 3.09 Fante 178 14.30 2.67 Mole-Dagbani 32 13.81 2.36 Other 271 15.06 3.01 Total 1,640 14.66 3.05 Most Comfortable Person 9.186 4, 1619 < .001 School Counselor 36 15.92 3.25 Teacher 201 14.25 3.27 Friend 267 14.30 3.06 Parents 941 14.99 2.90 Nobody 179 13.89 3.23 Total 1,624 14.69 3.05 Willingness to Talk 0.729 1, 1635 .393 No 1,196 14.63 2.99 Yes 441 14.78 3.24 Total 1,637 14.67 3.06 Opinion and Reactions Toward Suicide 6.534 9, 1687 < .001 Total 1,697 14.62 3.08 Self-Stigma of Mental Illness 4.559 20, 1681 < .001 Total 1,702 14.62 3.08 Note. Higher scores indicate more positive attitudes toward seeking psychological help. Mean Square values: Region (Between = 236.120, Within = 8.938); Sex (Between = 64.593, Within = 9.463); Religion (Between = 12.562, Within = 9.273); Ethnic Group (Between = 43.896, Within = 9.199); Most Comfortable Person (Between = 83.766, Within = 9.119); Willingness to Talk (Between = 6.837, Within = 9.382); Opinion and Reactions Toward Suicide (Between = 60.188, Within = 9.211); Self-Stigma of Mental Illness (Between = 41.436, Within = 9.089). Table 2 Multiple Regression Analysis Predicting Attitudes Toward Seeking Psychological Help Predictor B SE β 95% CI Constant 10.256 0.640 — [9.001, 11.511] Self-stigma of mental illness 0.147 0.023 .164*** [0.101, 0.192] Opinion toward suicide 0.215 0.050 .113*** [0.117, 0.312] Willingness to talk to counselor 0.215 0.180 .031 [-0.138, 0.568] Most comfortable person to talk to 0.042 0.089 .013 [-0.132, 0.217] Religion -0.069 0.171 − .011 [-0.404, 0.266] Ethnic group -0.070 0.039 − .048 [-0.147, 0.007] Sex 0.367 0.158 .060* [0.057, 0.678] Region 0.305 0.058 .141*** [0.191, 0.420] Note. Dependent variable: Total Attitude towards seeking psychological help. 95% CI = 95% Confidence interval. * p < 0.05, ** p < 0.01, ** *p < 0.001. DISCUSSION The findings shed light on the multifaceted nature of mental health help-seeking attitudes among adolescents in Ghana. The analysis of attitudes toward seeking psychological help among Ghanaian students revealed significant regional differences, with students in the Ashanti region showing the most positive attitudes (M = 16.17). In contrast, the Greater Accra region had the lowest (M = 14.17). Sex differences indicated that girls had more positive attitudes (M = 14.84) compared to boys (M = 14.43). Ethnic group differences were also noted, with the Ashantis scoring highest (M = 15.08) and the Mole-Dagbani ethnic group the lowest (M = 13.81). Several studies highlight differences in mental health-seeking behavior among adolescents based on sex, geographical region, and ethnicity. A study published in the Journal of Adolescent Health found that adolescents in different geographic regions exhibit varying levels of willingness to seek mental health support. 14 Another study in the Journal of Counselling Psychology examined Vietnamese American and European American adolescents and found that Vietnamese American adolescents were less likely to seek help from mental health professionals despite reporting higher mental health needs. 15 Further illustrating these differences in mental health-seeking attitudes among adolescents based on ethnicity. Additionally, a study comparing white adolescents to racial and ethnic minority adolescents in America found that while minority adolescents are at a greater risk for mental disorders, they are less likely to utilize mental health services. Specifically, Black and Hispanic adolescents with depression are significantly less likely than their White peers to receive mental health care, regardless of the setting. Additionally, even when minority adolescents do seek treatment, they are more prone to terminating it prematurely. 16 17 18 Geographical and cultural factors emphasize the importance of considering local contexts when designing mental health support initiatives. These differences suggest that a one-size-fits-all approach to address mental health needs may not be effective. According to research adolescent males who experience mental health problems are the most unlikely group to engage with mental health services. 19 While this finding corresponded with that of our study’s, Adjorlolo et al in examining Adverse life experiences and mental health of adolescents in Ghana, found there was no statistically significant difference in help-seeking for mental health support services between boys and girls, irrespective of whether the help was sought informally sources (e.g. faith healers) or formally (e.g. mental health professionals). 20 . The difference in the findings could be due to the difference in study population. The study on Adverse Life Events examined students distributed across 3 regions of Ghana namely: Greater Accra region, Eastern region and Central region 20 where as our study sampled students across five regions of Ghana. The majority of the participants were also aged between 16 and 17 years 20 and were Senior High School Students. The participants in our study were aged between 12 and 18 years. The ability and willingness of adolescents to seek mental health support can evolve with age. Younger adolescents (12–14 years) may have less awareness and understanding of mental health issues compared to older adolescents (15–18 years). This lack of awareness can make it difficult for them to recognize when they need help or know where to seek it. Older adolescents are generally more capable of independently seeking out and accessing mental health resources. They might have more opportunities to learn about mental health services through school programs as well as social media. The study by Adjorlolo et al also found that the prevalence of ALEs and their impact on mental health outcomes were largely similar among both male and female adolescents. 20 Implying that both boys and girls are equally affected by ALEs and thus equally likely to seek help further explaining why there was no significant difference in mental health seeking attitudes among boys and girls. The differences in mental health seeking attitudes among male and female adolescents, unearthed by our study, highlight the need for gender-sensitive approaches to mental health support. In evaluating the relationships between help-seeking and students' preference for confidants, the results also showed that participants felt most comfortable discussing issues with school counselors. At the same time, parents were the most frequently chosen confidants. This finding was similar to the research by Addy et al which found that Senior high school students preferred to seek mental health support from school guidance counsellors, teachers, and peers. 21 In Ghana, most school guidance counselling units are staffed by teachers or clergy members rather than trained school counsellors. This has led to concerns about their effectiveness, particularly regarding trust, confidentiality, and the absence of qualified professionals. 21 As a result, although participants feel most comfortable discussing mental health issues with school counsellors, they often choose to confide in their parents instead. The availability of mental health services for Ghanaian adolescents in schools is a mixed picture. While there are initiatives like the School Health Education Programme (SHEP) and projects by organizations such as BasicNeeds Ghana, there are still significant gaps in implementation and access, leaving a high level of unmet needs of mental health services for adolescents. SHEP aims to promote physical, social, and mental health through skills-based health education and the establishment of school health clubs while projects like those by BasicNeeds Ghana focus on increasing mental health information and services through youth-centered activities and periodic health screening sessions. Despite these initiatives, there are challenges in fully implementing adolescent mental health policies. A study highlighted that many planned strategies and programs were only partially implemented or not implemented at all due to factors like lack of financial resources and dependence on external funding. 22 Our study also revealed that there were no significant differences in willingness to discuss mental health issues between those willing (M = 14.78) and unwilling (M = 14.63). Globally there is an increasing willingness among adolescents to engage in discussions about mental health as their voices are being increasingly recognized in discussions around mental health. However, several barriers still exist such as stigma, lack of awareness, judgemental attitudes of service providers and inadequate services. 23 Additionally, significant relationships were found between attitudes toward seeking help and opinions on suicide as well as self-stigma related to mental illness. Several studies reveal significant relationships between attitudes toward seeking help, opinions on suicide, and self-stigma related to mental illness. These studies suggest that negative opinions about suicide and high self-stigma correlate with a decreased likelihood of seeking help. 2423 25 Mental Health Factors were found to have the strongest influence on health-seeking by adolescents in Ghana with self-stigma and suicide opinions both being significant predictors. Positive relationships were also found to be associated with more positive help-seeking attitudes. Mental health factors like self-stigma and opinions about suicide emerge as crucial determinants, emphasizing the need to address these barriers through targeted interventions. Qualitative research on cultural and societal barriers to mental health help-seeking in Ghana has highlighted several key challenges such as lack of or little knowledge of mental disorders and professional services; negative attitudes held towards mental health services; cultural and religious beliefs leading to over-reliance on traditional and spiritual interventions; and stigmatising beliefs that included self-stigmatisation, stigma and discrimination from family, the community, and healthcare providers. 26 IMPLICATIONS Policymakers can utilize the information in the creation of targeted mental health policies and programs that address the unique needs and barriers faced by junior high school students in Ghana. This information can be used to design culturally and gender-sensitive interventions. Schools are crucial in promoting mental health awareness and encouraging help-seeking behaviours among adolescents. The research buttresses the fact that there is an unmet mental health need and lends credence to the need to incorporate mental health education into the school curriculum, to train teachers and counsellors, and create supportive environments that facilitate open discussions about mental health. This research can support efforts to aimed at raising awareness about adolescent mental health issues in Ghana. Advocacy campaigns can use the findings to highlight the importance of addressing mental health and promoting help-seeking behaviours among young people. Limitations of Study Our study is not without limitations; notable was the researcher’s inability to select participants from each of the 16 regions of Ghana. However, this limitation was managed with the adoption of a stratified random sampling technique across geographical belts namely Northern, Southern, Eastern and Middle. There by increasing the representativeness of the sample. Our analyses were also based exclusively on self-reported data. Participants might not always provide accurate responses due to social desirability bias or fear of stigma. This can lead to underreporting or overreporting of mental health issues and help-seeking behaviours. A total of 1,850 students expressed interest in participating in the study, of whom 1,702 completed the survey, yielding a response rate of 92%. Participants may experience survey fatigue potentially affecting the quality of their responses. On the other hand, a response rate of 92% is highly advantageous and enhances the study's validity and reliability. The cross-sectional design also provides a snapshot in time and does not capture changes over time or causal relationships. Also, the study was restricted to only adolescents in Junior High Schools and school-going adolescents. Thus, the views and opinions of adolescents in Senior High Schools were not captured as well as adolescents who do not attend schools. Thus, findings might not be generalizable to the entire adolescent population. The study will mainly reflect the attitudes and behaviours of junior high students, missing out on insights from older adolescents and those not in the school system. Contrarily, focusing on junior high students allowed for a more detailed and specific analysis of this particular age group, which can be beneficial for targeted interventions. Recommendations Future research should include senior high students and out-of-school adolescents to provide a more comprehensive understanding of mental health help-seeking behaviors across different age groups and educational backgrounds. It is also recommended that longitudinal studies be conducted to track changes in mental health attitudes and behaviors over time and identify long-term trends. Lastly, research to explore the impact of cultural beliefs and practices on mental health and help-seeking behaviors in different regions of Ghana should be conducted. CONCLUSION In conclusion, the study on geographic, demographic, and cultural influences on mental health help-seeking attitudes among Ghanaian junior high school students provides valuable insights into the complex factors that shape adolescents' mental health behaviors. The findings emphasize the importance of addressing barriers such as stigma, lack of awareness, and cultural beliefs. The exclusion of senior high students and out-of-school adolescents highlights the need for future research to include these groups to capture a more comprehensive understanding of mental health help-seeking attitudes across different age groups and educational backgrounds. Overall, this study contributes to the growing body of literature on adolescent mental health in Ghana and provides actionable recommendations for policymakers, educators, and healthcare providers to improve mental health support and services for Ghanaian adolescents. By addressing the identified barriers and promoting a supportive environment, we can foster a culture where adolescents feel empowered to seek help and prioritize their mental well-being. Declarations Ethical consideration The study received approval from the Institutional Review Board (IRB) of the University at Buffalo. Informed consent was obtained from all participants and their guardians. Parents or legal guardians provided written consent, while students gave verbal or written assent before participation Consent for publication Yes, all participants have consented to the publication of the study. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request. Competing interests The authors declare that they have no competing interests Funding This project was sponsored by the authors of the manuscript Authors' contributions EA. conceived the study and developed the research question. AA and YO designed the study methodology and conducted the data collection. AA and EA also performed the data analysis VL, GA, and EH conducted data collection, drafted the initial manuscript, contributed to the interpretation of the findings and provided substantive revisions to the manuscript. DF provided supervision and contributed to the conceptualization of the study. DF and JK also assisted with methodological refinement and critically reviewed and edited the manuscript. All authors read and approved the final manuscript and agree to be accountable for all aspects of the work. Acknowledgements Thanks are communicated to the following colleagues who supported the writing and editing of the manuscript, but are not named in the authors’ list. These are Portia Sintim (KBTH, Department of Family Medicine) and Jeremiah Banini (KBTH, Department of Psychiatry) References Patel V, Saxena S, Lund C, et al. 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Lorenzo G, Di, Okechukwu CE, Signorelli M, Marciano L, Ostroumova M, Schulz PJ, Camerini A-L. Digital Media Use and Adolescents’ Mental Health During the Covid-19 Pandemic: A Systematic Review and Meta-Analysis. Front Public Health. 2022;9:793868. Mabrouk A, Mbithi G, Chongwo E, Too E, Sarki A, Namuguzi M, Atukwatse J, Ssewanyana D, Abubakar A. Mental health interventions for adolescents in sub-Saharan Africa: A scoping review. Front Psychiatry. 2022. https://doi.org/10.3389/FPSYT.2022.937723 . Azasu EK, Joe S. Correlates of Suicide Among Middle and High School Students in Ghana. J Adolesc Health. 2023;72:S59–63. Oppong Asante K, Kugbey N, Osafo J, Quarshie ENB, Sarfo JO. The prevalence and correlates of suicidal behaviours (ideation, plan and attempt) among adolescents in senior high schools in Ghana. SSM Popul Health. 2017;3:427–34. Quarshie ENB, Dickson ED, Quarshie SNS, Kpebu SEA, Oppong Asante K. Suicidal ideation and suicide attempt among pregnant adolescent girls in Ghana: a cross-sectional study. Gen Psychiatr. 2025. https://doi.org/10.1136/GPSYCH-2024-101643 . Quarshie ENB, Fobi D, Acheampong EK, Honu-Mensah CM, Fobi J, Appau O, Andoh-Arthur J, Oppong Asante K. Suicidal behaviours among deaf adolescents in Ghana: a cross-sectional study. J Public Health (Oxf). 2022;44:E10–9. Nii-Boye Quarshie E, Odame SK. Suicidal ideation and associated factors among school-going adolescents in rural Ghana. https://doi.org/10.1007/s12144-021-01378-3 Amoah A. (2019) SUCIDAL IDEATION AMONG IN-SCHOOL ADOLESENTS IN GHANA. https://ir.ucc.edu.gh/xmlui/bitstream/handle/123456789/4004/AMOAH%2c%20A.%2c%202019.pdf?sequence=1&isAllowed=y . Accessed 29 Mar 2025. Jorns-Presentati A, Napp AK, Dessauvagie AS, et al. The prevalence of mental health problems in sub-Saharan adolescents: A systematic review. PLoS ONE. 2021;16:e0251689. Guo S, Nguyen H, Weiss B, Ngo VK, Lau AS. Linkages Between Mental Health Need and Help-Seeking Behavior Among Adolescents. Moderating Role of Ethnicity and Cultural Values; 2015. Lu W, Todhunter-Reid A, Mitsdarffer ML, Muñoz-Laboy M, Yoon AS, Xu L. Barriers and Facilitators for Mental Health Service Use Among Racial/Ethnic Minority Adolescents: A Systematic Review of Literature. Front Public Health. 2021;9:641605. Lu W. Adolescent Depression: National Trends, Risk Factors, and Healthcare Disparities. Am J Health Behav. 2019;43:181–94. Lu W. Treatment for Adolescent Depression: National Patterns, Temporal Trends, and Factors Related to Service Use Across Settings. J Adolesc Health. 2020;67:401–8. Slade T, Johnston A, Teesson M, Whiteford H, Burgess P, Pirkis J, Saw S. (2009) The Mental health of Australians 2: report on the 2007 national survey of mental health and wellbeing. PsycEXTRA Dataset. https://doi.org/10.1037/E676562010-001 Adjorlolo S, Anum A, Huang KY. Adverse life experiences and mental health of adolescents in Ghana: a gendered analysis. Int J Adolesc Youth. 2022;27:444–56. Addy ND, Agbozo F, Runge-Ranzinger S, Grys P. Mental health difficulties, coping mechanisms and support systems among school-going adolescents in Ghana: A mixed-methods study. PLoS ONE. 2021;16:e0250424. Agblevor EA, Darko NA, Acquah PA, Addom S, Mirzoev T, Agyepong IA. (2023) We have nice policies but… implementation gaps in the Ghana adolescent health service policy and strategy (2016–2020). Front Public Health. https://doi.org/10.3389/FPUBH.2023.1198150 Abuosi AA, Anaba EA. Barriers on access to and use of adolescent health services in Ghana. J Health Res. 2019;33:197–207. Calear AL, Batterham PJ, Christensen H. Predictors of help-seeking for suicidal ideation in the community: risks and opportunities for public suicide prevention campaigns. Psychiatry Res. 2014;219:525–30. Daliri DB, Aninanya GA, Laari TT, Abagye N, Dei-Asamoa R, Afaya A. Exploring the barriers to mental health service utilization in the Bolgatanga Municipality: the perspectives of family caregivers, service providers, and mental health administrators. BMC Health Serv Res. 2024;24:1–9. Komu CK, Ngigi M, Ambrose |, Melson J. Barriers and Facilitators to Accessing Mental Health Services for Adults in Sub-Saharan Africa: A Systematic Review. Mental Health Sci. 2025;3:e70006. 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-9041674","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":606338391,"identity":"770cd426-edb6-4249-b905-44154ae8fbc7","order_by":0,"name":"Vanessa Nana Ama Larbi","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA5klEQVRIiWNgGAWjYHACZihmYHwAJHj4SNHCbADSwkaKFjYJMElIPf+0w48Nfu6wljM43nus8muOnQwbA/PDRzfwaJG4nWac2Hsm3djgzLm027LbkoEOYzM2zsFnze0E4wO8bYcTt93IMbstuY0ZqIWHTRqfFvnb6Z8P/m07XL/t/huzYslt9YS1GNzOMU4G2pJgdoPHjPHjtsOEtRjezik2lm1LN9x/JsdYmnHbcR42ZgJ+kbudvlnybZu1vGT7GcOPP7dV2/OzNz98jNf7yICZB0wSqxwEGH+QonoUjIJRMApGDAAAXPpGia2mKXoAAAAASUVORK5CYII=","orcid":"","institution":"Korle Bu Teaching Hospital","correspondingAuthor":true,"prefix":"","firstName":"Vanessa","middleName":"Nana Ama","lastName":"Larbi","suffix":""},{"id":606338393,"identity":"78b52f0c-9040-48a2-a245-78fdab984e7c","order_by":1,"name":"Enoch Azasu","email":"","orcid":"","institution":"University of Buffalo","correspondingAuthor":false,"prefix":"","firstName":"Enoch","middleName":"","lastName":"Azasu","suffix":""},{"id":606338394,"identity":"ea6bac1e-1662-49a0-b732-af3adc1f4192","order_by":2,"name":"Abass Tando Abubakar","email":"","orcid":"","institution":"Hawa Memorial Saviour Hospital","correspondingAuthor":false,"prefix":"","firstName":"Abass","middleName":"Tando","lastName":"Abubakar","suffix":""},{"id":606338395,"identity":"f2123412-ece9-4ff1-8245-bdaa73980157","order_by":3,"name":"Yaa Adutwumwaa Obeng","email":"","orcid":"","institution":"St. Patrick’s Catholic Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yaa","middleName":"Adutwumwaa","lastName":"Obeng","suffix":""},{"id":606338396,"identity":"9c64e7ca-8ed6-49f5-bf4f-a21e224d909a","order_by":4,"name":"Gilbert Appertey","email":"","orcid":"","institution":"Korle Bu Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Gilbert","middleName":"","lastName":"Appertey","suffix":""},{"id":606338397,"identity":"5cb1c27b-14e9-40f0-ad62-0159e359b39f","order_by":5,"name":"Enam Heletsi","email":"","orcid":"","institution":"Korle Bu Teaching Hospital","correspondingAuthor":false,"prefix":"","firstName":"Enam","middleName":"","lastName":"Heletsi","suffix":""},{"id":606338398,"identity":"1b1a30a6-d941-438a-8f0f-027e817c8f0a","order_by":6,"name":"Delali Fiagbe","email":"","orcid":"","institution":"University of Ghana Medical School","correspondingAuthor":false,"prefix":"","firstName":"Delali","middleName":"","lastName":"Fiagbe","suffix":""},{"id":606338399,"identity":"ca250a04-ed17-4bd9-a5f8-a33a83b33559","order_by":7,"name":"James-Paul Kretchy","email":"","orcid":"","institution":"Central University","correspondingAuthor":false,"prefix":"","firstName":"James-Paul","middleName":"","lastName":"Kretchy","suffix":""}],"badges":[],"createdAt":"2026-03-05 15:08:32","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9041674/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9041674/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":104808726,"identity":"b2255ed1-6753-4b3c-b728-1e752b1c2da0","added_by":"auto","created_at":"2026-03-17 12:39:40","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":841422,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9041674/v1/818e4d4f-692a-46d3-ae1b-27765ec28776.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Geographic, Demographic, and Cultural Influences on Mental Health Help-Seeking Attitudes of Ghanaian Junior High School Students","fulltext":[{"header":"BACKGROUND","content":"\u003cp\u003eMental health remains an essential aspect of overall well-being, yet it is less prioritized globally\u0026nbsp;\u003csup\u003e1\u003c/sup\u003e and even more so among young people.\u0026nbsp;\u003csup\u003e2\u003c/sup\u003e\u0026nbsp; According to the World Health Organization, 10% to 20% of young people experience mental health problems\u0026nbsp;(WHO, 2024)\u0026nbsp;and estimates that half of adult mental health disorders begin in adolescence\u0026nbsp;(WHO, 2024). Fifteen percent of the global burden of disease among 10 to 19-year-olds is accounted for, by mental illness-- with depression, anxiety and behavioral problems being some of the leading contributors\u0026nbsp;\u003csup\u003e3\u003c/sup\u003e. The increasing exposures to stressors like trauma and adverse childhood experiences, bullying, peer pressure, social media use, among others, at a time of rapid physical, social and emotional changes with limited experience further continue to fuel the rising prevalence of mental illness among adolescents.\u0026nbsp;\u003csup\u003e4\u003c/sup\u003e Yet, young people are among the least likely to seek help for such problems, requiring that practical steps are taken to understand the factors that facilitate or deter adolescents from accessing the interventions available for mental health issues.\u003csup\u003e5\u003c/sup\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOver the past decade, extensive research has been done on adolescent mental health, with themes spanning risk and protective factors; prevalence and epidemiology, impact of technology and social media; school-based interventions; COVID-19 and mental health; gender and intersectionality; interventions and treatment approaches; policy and advocacy; and mental health seeking behavior—the last of which is rather scant in sub-Saharan Africa, and emphasizes the need for a sociocultural context. More so, this diverse scope reflects the growing need to tackle mental health in this susceptible population with a holistic, evidence-based and culturally-sensitive intervention.\u003csup\u003e6\u003c/sup\u003e \u003csup\u003e7\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eIn Ghana, mental health concerns among young people are often under-recognized, and the importance of addressing mental health issues in schools is increasingly being acknowledged. Ghanaian adolescents, particularly those in Junior High School (JHS), face various emotional, social, and psychological challenges as they navigate a critical period of growth and development. These challenges often include academic pressure, social and peer relationships, family dynamics, and the emergence of personal identity. However, despite these stressors, seeking help for mental health issues remains a stigmatized or even taboo practice in many Ghanaian communities. This creates a barrier for students to receive the care and support they need during a pivotal time in their lives.\u003c/p\u003e\n\u003cp\u003eThe decision to seek help for mental health problems, however, is shaped by a range of interconnected factors. In particular, geographic, demographic, and cultural influences play a significant role in shaping the attitudes of young people towards mental health care and help-seeking behavior. Geographic location can impact access to mental health services, as urban students may have more opportunities to access professional help compared to their rural counterparts, where mental health services are often scarce or nonexistent. Additionally, demographic factors such as age, sex, socioeconomic status, and family structure can influence whether students feel empowered to seek help or whether they adhere to societal expectations about mental health.\u003c/p\u003e\n\u003cp\u003eCulturally, Ghana is a nation that blends traditional beliefs with modern healthcare practices. Traditional healing methods, including spiritual or communal interventions, remain deeply embedded in Ghanaian society and often take precedence over formal psychiatric or psychological treatment. In many cases, mental health issues are attributed to spiritual causes, misdoings of the affected individual or family ‘curses’, which can complicate how young people perceive mental health professionals and their willingness to seek professional help. Furthermore, cultural stigmas surrounding mental illness, particularly the perception that mental health problems are a sign of weakness or moral failure, can discourage individuals from reaching out for assistance. For many students, the fear of being labelled as “mad” may outweigh the potential benefits of seeking professional care.\u003c/p\u003e\n\u003cp\u003eJunior High School students, typically between the ages of 12 and 15, are at a critical stage in their cognitive and emotional development. At this age, students are increasingly aware of their mental health, yet may not have the coping mechanisms or resources to effectively manage mental health challenges. For some, the lack of supportive networks, both at home and at school, exacerbates the problem. While there have been efforts to integrate mental health education into the Ghanaian school system, significant gaps remain in terms of how mental health is understood and addressed within the context of the education system.\u003c/p\u003e\n\u003cp\u003eResearch on suicidal ideations among adolescents in Ghana have largely focused on the prevalence of suicidal ideations and predictors of suicide among middle school students \u003csup\u003e8\u003c/sup\u003e, high school students, \u003csup\u003e98\u003c/sup\u003e pregnant adolescent girls\u003csup\u003e10\u003c/sup\u003e and deaf adolescents. \u003csup\u003e11\u003c/sup\u003e\u0026nbsp; Exposure to a friend's attempted suicide\u003csup\u003e12\u003c/sup\u003e as well as gender-specific factors have been identified as associated factors for suicidal ideations. For instance, females more likely to report personal and interpersonal adversities outside the family context, while males associated suicidal ideation with conflicts with parents. \u003csup\u003e12\u003c/sup\u003e Other studies highlighted the influence of factors such as bullying, substance use, and depression on suicidal ideation among adolescents in Ghana.\u003csup\u003e13\u003c/sup\u003e\u003c/p\u003e\n\u003cp\u003eThis research seeks to explore how geographic, demographic, and cultural factors influence the mental health help-seeking attitudes of Ghanaian Junior High School students. By examining how these various factors interact, this study aims to uncover the underlying reasons behind the reluctance or willingness to seek mental health support among adolescents in Ghana. Understanding these influences is vital for developing targeted interventions, educational programs, and policies that can help reduce stigma, increase access to mental health services, and ultimately improve the mental well-being of young people.\u003c/p\u003e\n\u003cp\u003eThe Health Belief Model (HBM) provides a valuable framework for exploring attitudes toward seeking mental health help among junior high school students in Ghana. By focusing on four key constructs of the HBM—perceived susceptibility, perceived severity, perceived benefits, and perceived barriers—we can evaluate these students' vulnerability to mental health issues, taking into account their geographic location, demographic factors (such as age and gender), and cultural beliefs.\u003c/p\u003e\n\u003cp\u003eCultural norms, gender roles, and geographic location can also affect how students see mental health issues—whether they deem them as a serious health problem or not. These factors also influence beliefs about the accessibility and effectiveness of available mental health services.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAdditionally, to promote mental health-seeking behaviors among students, we must identify the barriers that may exist.\u003c/p\u003e\n\u003cp\u003eAs mental health continues to emerge as a public health priority worldwide, this study will contribute to the growing body of knowledge on adolescent mental health in Ghana. The findings of this research will be of particular value to policymakers, educators, mental health professionals, and community leaders who seek to create more supportive environments for young people. By providing insights into the factors that influence help-seeking attitudes, this study will also inform efforts to design culturally appropriate mental health services that are accessible, acceptable, and effective for adolescents in Ghanaian schools.\u003c/p\u003e\n\u003ch2\u003eAims of the Study\u003c/h2\u003e\n\u003cp\u003eThe primary aim of this study was to examine attitudes toward mental health seeking among Ghanaian students and to investigate how these attitudes vary across different demographic and psychosocial factors.\u003c/p\u003e\n\u003ch2\u003eSpecific Objectives\u003c/h2\u003e\n\u003cp\u003e(1) To assess the overall attitudes toward seeking psychological help among Ghanaian\u003c/p\u003e\n\u003cp\u003estudents.\u003c/p\u003e\n\u003cp\u003e(2) To examine how attitudes toward seeking psychological help differ across:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eGeographic regions in Ghana\u003c/li\u003e\n \u003cli\u003eSex\u003c/li\u003e\n \u003cli\u003eReligious affiliations\u003c/li\u003e\n \u003cli\u003eEthnic groups\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003e(3) To investigate the relationship between help-seeking attitudes and student preferences\u003c/p\u003e\n\u003cp\u003efor confidants (school counsellors, teachers, friends, parents, or no one).\u003c/p\u003e\n\u003cp\u003e(4) To evaluate whether willingness to discuss mental health issues is associated with\u003c/p\u003e\n\u003cp\u003eattitudes toward seeking psychological help.\u003c/p\u003e\n\u003cp\u003e(5) To analyze the relationship between:\u003c/p\u003e\n\u003cul\u003e\n \u003cli\u003eAttitudes toward seeking psychological help and opinions about suicide\u003c/li\u003e\n \u003cli\u003eAttitudes toward seeking psychological help and self-stigma of mental illness\u003c/li\u003e\n\u003c/ul\u003e"},{"header":"METHODOLOGY","content":"\u003ch2\u003eStudy Design\u003c/h2\u003e\n\u003cp\u003eThis cross-sectional study involved Ghanaian junior high school students aged 12-18 years, who were randomly stratified across four geographical belts: Northern belt, Eastern Belt, Middle Belt and Southern Belt. A total of 1850 students expressed interest in participating in this study, but only 1702 completed the survey. Informed consent was obtained from parents or guardians through a written consent form, and students provided either verbal or written assent before participation. Participants were informed of their right to withdraw at any time without penalty. The surveys were completed anonymously over three weeks. This study was conducted in accordance with the ethical guidelines approved by the Institutional Review Board (IRB) of the University at Buffalo.\u003c/p\u003e\n\u003ch2\u003eStudy Setting\u003c/h2\u003e\n\u003cp\u003eThe study was conducted in junior high schools across Ghana, representing rural, peri-urban, and urban communities. Schools were selected to capture the diversity of educational and social contexts, ensuring the findings reflect the experiences of students nationwide. Participants were selected from four geographical belts across 5 regions:\u003c/p\u003e\n\u003cp\u003eNorthern Belt: Northern region.\u003c/p\u003e\n\u003cp\u003eEastern Belt: Volta region.\u003c/p\u003e\n\u003cp\u003eSouthern Belt: Greater Accra and Eastern regions.\u003c/p\u003e\n\u003cp\u003eMiddle Belt: Ashanti region.\u003c/p\u003e\n\u003ch2\u003eData Collection Procedure\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eThe study employed the use of a structured questionnaire to collect data from respondents. Participants were recruited through their schools, with the assistance of school administrators and teachers. Schools were approached based on their location and enrolment numbers, and individual students were selected randomly from class lists. Recruitment materials included brochures and verbal presentations to explain the study’s purpose and procedures.\u003c/p\u003e\n\u003cp\u003eTrained research assistants administered the surveys during school hours in a quiet and controlled environment. Surveys were completed using paper forms. Data collection sessions lasted approximately 30 minutes, including an introduction to the survey and a debriefing session. The survey measures were administered in English, which is the language of instruction in junior high schools across Ghana. The measures had been previously piloted in 2022 during a study conducted by the same research team with a sample of 800 students from the Greater Accra Region. This prior study demonstrated the appropriateness, clarity, and reliability of the measures in the Ghanaian junior high school context. A robust safety plan was implemented to address any distress experienced by participants during the survey. Research assistants were trained to recognize signs of distress and provide immediate support. Participants expressing significant psychological distress were referred to school counsellors or local mental health professionals. Contact information for national mental health hotlines were also provided.\u003c/p\u003e\n\u003ch2\u003ePopulation and Sample\u003c/h2\u003e\n\u003cp\u003eThis study targeted a nationally representative sample of junior high school students in Ghana, aged 12–18 years. A total of 1,850 students expressed interest in participating in the study, of whom 1,702 completed the survey, yielding a participation rate of 92%. This sample reflects the diversity of junior high school students in Ghana in terms of geography, sex, ethnicity, and socioeconomic status.\u003c/p\u003e\n\u003ch2\u003eMeasures and Variables\u003c/h2\u003e\n\u003cp\u003ePrior to this study, we conducted a pilot study with 800 students from the Greater Accra region of Ghana, which demonstrated the appropriateness, clarity, and reliability of the measures in the Ghanaian junior high school context. Additionally, the measures had shown reliability in the previous applications in Ghana and were adapted for use in a nationally representative setting.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eThe Questionnaire included validated tools and scales design to assess various mental health domains. The scale consisted of four main domains: Demographics (Age, sex, living situation, and educational level), Mental Health Indicators (Suicide ideation and behavior (WHO CIDI), anxiety and depression (PHQ-4)), Risk and Protective Factors (Parental support, financial hardship, resilience, bullying experiences, and loneliness) and social media and Internet Use (Patterns and potential addiction).\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eData Processing and Analysis\u003c/h2\u003e\n\u003cp\u003eThe survey was administered using paper-based questionnaires in English and responses were entered into REDCAP for data management. Variables were coded, and statistical analyses were conducted using STATA version 17. Analysis of variance (ANOVA) and multiple regression models were employed to examine associations between demographic, behavioral, and psychosocial factors and mental health outcomes among students.\u003c/p\u003e\n\u003ch2\u003eEthical considerations\u0026nbsp;\u003c/h2\u003e\n\u003cp\u003eInformed consent was obtained from all participants and their guardians. Parents or legal guardians provided written consent, while students gave verbal or written assent before participation. Participants were informed of their right to withdraw at any time without penalty.\u003c/p\u003e\n\u003ch3\u003eIRB Approval\u003c/h3\u003e\n\u003cp\u003eThe study received approval from the Institutional Review Board (IRB) of the University at Buffalo. Ethical considerations included confidentiality, anonymity, and the voluntary nature of participation. Data were de-identified before analysis to protect participants identities.\u003c/p\u003e\n\u003cp\u003eThis cross-sectional study involved Ghanaian junior high school students aged 12-18 years, who were randomly stratified across four geographical belts: Northern belt, Eastern Belt, Middle Belt and Southern Belt. A total of 1850 students expressed interest in participating in this study, but only 1702 completed the survey. Informed consent was obtained from parents or guardians through a written consent form, and students provided either verbal or written assent before participation. Participants were informed of their right to withdraw at any time without penalty. The surveys were completed anonymously over three weeks. This study was conducted in accordance with the ethical guidelines approved by the Institutional Review Board (IRB) of the University at Buffalo.\u003c/p\u003e"},{"header":"RESULTS","content":"\u003cp\u003eWe examine attitudes toward seeking psychological help across various demographic and psychosocial variables in a sample of 1,709 Ghanaian Junior High school students.\u003c/p\u003e \u003cp\u003eThe result of the ANOVA as shown in Table \u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e below revealed regional differences in attitudes toward seeking psychological help were highly significant (F (4, 1704)\u0026thinsp;=\u0026thinsp;26.42, p \u0026lt; .001). Students from the Ashanti region demonstrated the most positive attitudes (M\u0026thinsp;=\u0026thinsp;16.17, SD\u0026thinsp;=\u0026thinsp;2.51), followed by those from the Northern region (M\u0026thinsp;=\u0026thinsp;14.95, SD\u0026thinsp;=\u0026thinsp;3.18). In contrast, students from Greater Accra reported the lowest mean attitudes (M\u0026thinsp;=\u0026thinsp;14.17, SD\u0026thinsp;=\u0026thinsp;3.02), with the Eastern (M\u0026thinsp;=\u0026thinsp;14.21, SD\u0026thinsp;=\u0026thinsp;2.92) and Volta (M\u0026thinsp;=\u0026thinsp;14.27, SD\u0026thinsp;=\u0026thinsp;3.34) regions also exhibiting relatively lower scores.\u003c/p\u003e \u003cp\u003eAnalysis by means of sex of respondents revealed significant differences in attitudes (F (1, 1577)\u0026thinsp;=\u0026thinsp;6.83, p = .009), with females reporting more positive attitudes (M\u0026thinsp;=\u0026thinsp;14.84, SD\u0026thinsp;=\u0026thinsp;3.02) compared to males (M\u0026thinsp;=\u0026thinsp;14.43, SD\u0026thinsp;=\u0026thinsp;3.14). However, differences in attitudes based on religious affiliation were not statistically significant (F(4, 1664)\u0026thinsp;=\u0026thinsp;1.36, p = .247). Among religious groups, Traditional African adherents had slightly higher mean scores (M\u0026thinsp;=\u0026thinsp;14.96, SD\u0026thinsp;=\u0026thinsp;3.39) compared to Christians (M\u0026thinsp;=\u0026thinsp;14.71, SD\u0026thinsp;=\u0026thinsp;3.04) and Muslims (M\u0026thinsp;=\u0026thinsp;14.09, SD\u0026thinsp;=\u0026thinsp;2.98).\u003c/p\u003e \u003cp\u003eSignificant differences were also observed among ethnic groups (F (6, 1633)\u0026thinsp;=\u0026thinsp;4.77, p \u0026lt; .001). The Ashanti ethnic group reported the highest mean attitudes (M\u0026thinsp;=\u0026thinsp;15.08, SD\u0026thinsp;=\u0026thinsp;2.95), closely followed by participants from \"Other\" ethnic groups (M\u0026thinsp;=\u0026thinsp;15.06, SD\u0026thinsp;=\u0026thinsp;3.01). Conversely, the Mole-Dagbani group had the lowest attitudes (M\u0026thinsp;=\u0026thinsp;13.81, SD\u0026thinsp;=\u0026thinsp;2.36), while participants from the Ewe (M\u0026thinsp;=\u0026thinsp;14.23, SD\u0026thinsp;=\u0026thinsp;3.33), Ga (M\u0026thinsp;=\u0026thinsp;14.22, SD\u0026thinsp;=\u0026thinsp;3.06), and Fante (M\u0026thinsp;=\u0026thinsp;14.30, SD\u0026thinsp;=\u0026thinsp;2.67) ethnic groups reported intermediate scores.\u003c/p\u003e \u003cp\u003eRegarding the person participants felt most comfortable talking to, significant differences were identified (F(4, 1619)\u0026thinsp;=\u0026thinsp;9.19, p \u0026lt; .001). Participants who identified school counselors as their confidants had the highest mean attitudes (M\u0026thinsp;=\u0026thinsp;15.92, SD\u0026thinsp;=\u0026thinsp;3.25), albeit from a small sample (n\u0026thinsp;=\u0026thinsp;36). Those who chose parents (n\u0026thinsp;=\u0026thinsp;941) also had relatively high scores (M\u0026thinsp;=\u0026thinsp;14.99, SD\u0026thinsp;=\u0026thinsp;2.90).\u003c/p\u003e \u003cp\u003eFinally, significant associations were observed between attitudes toward seeking psychological help and both opinions toward suicide (F (9, 1687)\u0026thinsp;=\u0026thinsp;6.53, p \u0026lt; .001) and self-stigma of mental illness (F(20, 1681)\u0026thinsp;=\u0026thinsp;4.56, p \u0026lt; .001). The overall mean attitude score across the sample was M\u0026thinsp;=\u0026thinsp;14.62, SD\u0026thinsp;=\u0026thinsp;3.08, reflecting moderate positive attitudes toward seeking psychological help.\u003c/p\u003e \u003cp\u003eThe multiple regression analysis examined predictors of attitudes toward seeking psychological help as presented in Table \u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e. The overall model explained a significant proportion of the variance in attitudes toward seeking psychological help (R\u0026sup2; = 0.128, F(8, 1667)\u0026thinsp;=\u0026thinsp;30.47, p \u0026lt; .001). Self-stigma of mental illness emerged as a significant positive predictor (B\u0026thinsp;=\u0026thinsp;0.147, SE\u0026thinsp;=\u0026thinsp;0.023, β\u0026thinsp;=\u0026thinsp;.164, p \u0026lt; .001), indicating that lower levels of self-stigma were associated with more positive attitudes. Similarly, opinion toward suicide also significantly predicted attitudes (B\u0026thinsp;=\u0026thinsp;0.215, SE\u0026thinsp;=\u0026thinsp;0.050, β\u0026thinsp;=\u0026thinsp;.113, p \u0026lt; .001), with more accepting opinions associated with higher attitude scores. Sex had a small but significant effect (B\u0026thinsp;=\u0026thinsp;0.367, SE\u0026thinsp;=\u0026thinsp;0.158, β\u0026thinsp;=\u0026thinsp;.060, p \u0026lt; .05), with females exhibiting slightly more positive attitudes compared to males. Region was another significant predictor (B\u0026thinsp;=\u0026thinsp;0.305, SE\u0026thinsp;=\u0026thinsp;0.058, β\u0026thinsp;=\u0026thinsp;.141, p \u0026lt; .001), indicating that students from different regions showed varying levels of positive attitudes.\u003c/p\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\u003eDescriptive Statistics and ANOVA Results for Attitudes Toward Seeking Psychological Help Across Study Variables\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" 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=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable and Categories\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eN (%)\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eM\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cem\u003eF\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cem\u003edf\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cem\u003ep\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRegion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e26.417\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4, 1704\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGreater Accra\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.02\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVolta\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e233\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.27\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.34\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAshanti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e293\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e16.17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.51\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEastern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.92\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNorthern\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e194\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.95\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.18\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,709\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.08\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSex\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.826\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1, 1577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.009\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e740\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.43\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.14\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e839\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.02\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,579\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.65\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.08\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eReligion\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e1.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4, 1664\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.247\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,491\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.71\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.04\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e139\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.98\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTraditional African\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e26\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.96\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.39\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Religion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.50\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.54\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.55\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.33\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,669\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.05\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEthnic Group\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.772\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e6, 1633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAshanti\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.95\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e133\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.06\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEwe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e351\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.33\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDangme\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e214\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.09\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFante\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e178\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.67\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMole-Dagbani\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e32\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.36\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOther\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e271\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.01\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.66\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.05\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMost Comfortable Person\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e9.186\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e4, 1619\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool Counselor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e15.92\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.25\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTeacher\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e201\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.25\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.27\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFriend\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e267\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.30\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.06\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e941\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.99\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.90\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNobody\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e179\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e13.89\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.23\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,624\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.69\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.05\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWillingness to Talk\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.729\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1, 1635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.393\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e2.99\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e441\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.78\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.24\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,637\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.67\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.06\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOpinion and Reactions Toward Suicide\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e6.534\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e9, 1687\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTotal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e1,697\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e14.62\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e3.08\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eSelf-Stigma of Mental Illness\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e4.559\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e20, 1681\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eTotal\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e1,702\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e14.62\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e3.08\u003c/b\u003e\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 \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"7\"\u003e\u003cem\u003eNote. Higher scores indicate more positive attitudes toward seeking psychological help. Mean Square values: Region (Between =\u0026thinsp;236.120, Within =\u0026thinsp;8.938); Sex (Between =\u0026thinsp;64.593, Within =\u0026thinsp;9.463); Religion (Between =\u0026thinsp;12.562, Within =\u0026thinsp;9.273); Ethnic Group (Between =\u0026thinsp;43.896, Within =\u0026thinsp;9.199); Most Comfortable Person (Between =\u0026thinsp;83.766, Within =\u0026thinsp;9.119); Willingness to Talk (Between =\u0026thinsp;6.837, Within =\u0026thinsp;9.382); Opinion and Reactions Toward Suicide (Between =\u0026thinsp;60.188, Within =\u0026thinsp;9.211); Self-Stigma of Mental Illness (Between =\u0026thinsp;41.436, Within =\u0026thinsp;9.089).\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\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\u003eMultiple Regression Analysis Predicting Attitudes Toward Seeking Psychological Help\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=\"char\" char=\".\" 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=\"left\" 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\u003ePredictor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cem\u003eB\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cem\u003eSE\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eβ\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95% CI\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e10.256\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.640\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026mdash;\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[9.001, 11.511]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSelf-stigma of mental illness\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.023\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.164***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.101, 0.192]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOpinion toward suicide\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.113***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.117, 0.312]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWillingness to talk to counselor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.215\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.180\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.031\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[-0.138, 0.568]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMost comfortable person to talk to\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.013\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[-0.132, 0.217]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.069\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.011\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[-0.404, 0.266]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEthnic group\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.039\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026minus;\u0026thinsp;.048\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[-0.147, 0.007]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.060*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.057, 0.678]\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRegion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.058\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.141***\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e[0.191, 0.420]\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\u003e \u003cem\u003eNote.\u003c/em\u003e Dependent variable: Total Attitude towards seeking psychological help. 95% CI\u0026thinsp;=\u0026thinsp;95% Confidence interval. *\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.05, **\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.01, **\u003cem\u003e*p\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThe findings shed light on the multifaceted nature of mental health help-seeking attitudes among adolescents in Ghana. The analysis of attitudes toward seeking psychological help among Ghanaian students revealed significant regional differences, with students in the Ashanti region showing the most positive attitudes (M\u0026thinsp;=\u0026thinsp;16.17). In contrast, the Greater Accra region had the lowest (M\u0026thinsp;=\u0026thinsp;14.17). Sex differences indicated that girls had more positive attitudes (M\u0026thinsp;=\u0026thinsp;14.84) compared to boys (M\u0026thinsp;=\u0026thinsp;14.43). Ethnic group differences were also noted, with the Ashantis scoring highest (M\u0026thinsp;=\u0026thinsp;15.08) and the Mole-Dagbani ethnic group the lowest (M\u0026thinsp;=\u0026thinsp;13.81).\u003c/p\u003e \u003cp\u003eSeveral studies highlight differences in mental health-seeking behavior among adolescents based on sex, geographical region, and ethnicity. A study published in the Journal of Adolescent Health found that adolescents in different geographic regions exhibit varying levels of willingness to seek mental health support. \u003csup\u003e14\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAnother study in the Journal of Counselling Psychology examined Vietnamese American and European American adolescents and found that Vietnamese American adolescents were less likely to seek help from mental health professionals despite reporting higher mental health needs.\u003csup\u003e\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e Further illustrating these differences in mental health-seeking attitudes among adolescents based on ethnicity.\u003c/p\u003e \u003cp\u003eAdditionally, a study comparing white adolescents to racial and ethnic minority adolescents in America found that while minority adolescents are at a greater risk for mental disorders, they are less likely to utilize mental health services. Specifically, Black and Hispanic adolescents with depression are significantly less likely than their White peers to receive mental health care, regardless of the setting. Additionally, even when minority adolescents do seek treatment, they are more prone to terminating it prematurely. \u003csup\u003e16 17 18\u003c/sup\u003e Geographical and cultural factors emphasize the importance of considering local contexts when designing mental health support initiatives. These differences suggest that a one-size-fits-all approach to address mental health needs may not be effective.\u003c/p\u003e \u003cp\u003eAccording to research adolescent males who experience mental health problems are the most unlikely group to engage with mental health services.\u003csup\u003e\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u003c/sup\u003e While this finding corresponded with that of our study\u0026rsquo;s, Adjorlolo et al in examining Adverse life experiences and mental health of adolescents in Ghana, found there was no statistically significant difference in help-seeking for mental health support services between boys and girls, irrespective of whether the help was sought informally sources (e.g. faith healers) or formally (e.g. mental health professionals).\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The difference in the findings could be due to the difference in study population. The study on Adverse Life Events examined students distributed across 3 regions of Ghana namely: Greater Accra region, Eastern region and Central region\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e where as our study sampled students across five regions of Ghana. The majority of the participants were also aged between 16 and 17 years\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e and were Senior High School Students. The participants in our study were aged between 12 and 18 years. The ability and willingness of adolescents to seek mental health support can evolve with age. Younger adolescents (12\u0026ndash;14 years) may have less awareness and understanding of mental health issues compared to older adolescents (15\u0026ndash;18 years). This lack of awareness can make it difficult for them to recognize when they need help or know where to seek it. Older adolescents are generally more capable of independently seeking out and accessing mental health resources. They might have more opportunities to learn about mental health services through school programs as well as social media.\u003c/p\u003e \u003cp\u003eThe study by Adjorlolo et al also found that the prevalence of ALEs and their impact on mental health outcomes were largely similar among both male and female adolescents.\u003csup\u003e\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e Implying that both boys and girls are equally affected by ALEs and thus equally likely to seek help further explaining why there was no significant difference in mental health seeking attitudes among boys and girls.\u003c/p\u003e \u003cp\u003eThe differences in mental health seeking attitudes among male and female adolescents, unearthed by our study, highlight the need for gender-sensitive approaches to mental health support.\u003c/p\u003e \u003cp\u003e In evaluating the relationships between help-seeking and students' preference for confidants, the results also showed that participants felt most comfortable discussing issues with school counselors. At the same time, parents were the most frequently chosen confidants. This finding was similar to the research by Addy et al which found that Senior high school students preferred to seek mental health support from school guidance counsellors, teachers, and peers. \u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eIn Ghana, most school guidance counselling units are staffed by teachers or clergy members rather than trained school counsellors. This has led to concerns about their effectiveness, particularly regarding trust, confidentiality, and the absence of qualified professionals. \u003csup\u003e21\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAs a result, although participants feel most comfortable discussing mental health issues with school counsellors, they often choose to confide in their parents instead.\u003c/p\u003e \u003cp\u003eThe availability of mental health services for Ghanaian adolescents in schools is a mixed picture. While there are initiatives like the School Health Education Programme (SHEP) and projects by organizations such as BasicNeeds Ghana, there are still significant gaps in implementation and access, leaving a high level of unmet needs of mental health services for adolescents. SHEP aims to promote physical, social, and mental health through skills-based health education and the establishment of school health clubs while projects like those by BasicNeeds Ghana focus on increasing mental health information and services through youth-centered activities and periodic health screening sessions.\u003c/p\u003e \u003cp\u003eDespite these initiatives, there are challenges in fully implementing adolescent mental health policies. A study highlighted that many planned strategies and programs were only partially implemented or not implemented at all due to factors like lack of financial resources and dependence on external funding. \u003csup\u003e22\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eOur study also revealed that there were no significant differences in willingness to discuss mental health issues between those willing (M\u0026thinsp;=\u0026thinsp;14.78) and unwilling (M\u0026thinsp;=\u0026thinsp;14.63).\u003c/p\u003e \u003cp\u003eGlobally there is an increasing willingness among adolescents to engage in discussions about mental health as their voices are being increasingly recognized in discussions around mental health. However, several barriers still exist such as stigma, lack of awareness, judgemental attitudes of service providers and inadequate services. \u003csup\u003e23\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eAdditionally, significant relationships were found between attitudes toward seeking help and opinions on suicide as well as self-stigma related to mental illness. Several studies reveal significant relationships between attitudes toward seeking help, opinions on suicide, and self-stigma related to mental illness. These studies suggest that negative opinions about suicide and high self-stigma correlate with a decreased likelihood of seeking help.\u003csup\u003e2423 25\u003c/sup\u003e\u003c/p\u003e \u003cp\u003eMental Health Factors were found to have the strongest influence on health-seeking by adolescents in Ghana with self-stigma and suicide opinions both being significant predictors. Positive relationships were also found to be associated with more positive help-seeking attitudes. Mental health factors like self-stigma and opinions about suicide emerge as crucial determinants, emphasizing the need to address these barriers through targeted interventions.\u003c/p\u003e \u003cp\u003eQualitative research on cultural and societal barriers to mental health help-seeking in Ghana has highlighted several key challenges such as lack of or little knowledge of mental disorders and professional services; negative attitudes held towards mental health services; cultural and religious beliefs leading to over-reliance on traditional and spiritual interventions; and stigmatising beliefs that included self-stigmatisation, stigma and discrimination from family, the community, and healthcare providers.\u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e\u003c/p\u003e\n\u003ch3\u003eIMPLICATIONS\u003c/h3\u003e\n\u003cp\u003ePolicymakers can utilize the information in the creation of targeted mental health policies and programs that address the unique needs and barriers faced by junior high school students in Ghana. This information can be used to design culturally and gender-sensitive interventions.\u003c/p\u003e \u003cp\u003eSchools are crucial in promoting mental health awareness and encouraging help-seeking behaviours among adolescents. The research buttresses the fact that there is an unmet mental health need and lends credence to the need to incorporate mental health education into the school curriculum, to train teachers and counsellors, and create supportive environments that facilitate open discussions about mental health.\u003c/p\u003e \u003cp\u003eThis research can support efforts to aimed at raising awareness about adolescent mental health issues in Ghana. Advocacy campaigns can use the findings to highlight the importance of addressing mental health and promoting help-seeking behaviours among young people.\u003c/p\u003e \u003cp\u003eLimitations of Study\u003c/p\u003e \u003cp\u003eOur study is not without limitations; notable was the researcher\u0026rsquo;s inability to select participants from each of the 16 regions of Ghana. However, this limitation was managed with the adoption of a stratified random sampling technique across geographical belts namely Northern, Southern, Eastern and Middle. There by increasing the representativeness of the sample.\u003c/p\u003e \u003cp\u003eOur analyses were also based exclusively on self-reported data. Participants might not always provide accurate responses due to social desirability bias or fear of stigma. This can lead to underreporting or overreporting of mental health issues and help-seeking behaviours.\u003c/p\u003e \u003cp\u003eA total of 1,850 students expressed interest in participating in the study, of whom 1,702 completed the survey, yielding a response rate of 92%. Participants may experience survey fatigue potentially affecting the quality of their responses. On the other hand, a response rate of 92% is highly advantageous and enhances the study's validity and reliability.\u003c/p\u003e \u003cp\u003eThe cross-sectional design also provides a snapshot in time and does not capture changes over time or causal relationships.\u003c/p\u003e \u003cp\u003eAlso, the study was restricted to only adolescents in Junior High Schools and school-going adolescents. Thus, the views and opinions of adolescents in Senior High Schools were not captured as well as adolescents who do not attend schools. Thus, findings might not be generalizable to the entire adolescent population. The study will mainly reflect the attitudes and behaviours of junior high students, missing out on insights from older adolescents and those not in the school system. Contrarily, focusing on junior high students allowed for a more detailed and specific analysis of this particular age group, which can be beneficial for targeted interventions.\u003c/p\u003e \u003cp\u003eRecommendations\u003c/p\u003e \u003cp\u003eFuture research should include senior high students and out-of-school adolescents to provide a more comprehensive understanding of mental health help-seeking behaviors across different age groups and educational backgrounds. It is also recommended that longitudinal studies be conducted to track changes in mental health attitudes and behaviors over time and identify long-term trends. Lastly, research to explore the impact of cultural beliefs and practices on mental health and help-seeking behaviors in different regions of Ghana should be conducted.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eIn conclusion, the study on geographic, demographic, and cultural influences on mental health help-seeking attitudes among Ghanaian junior high school students provides valuable insights into the complex factors that shape adolescents' mental health behaviors. The findings emphasize the importance of addressing barriers such as stigma, lack of awareness, and cultural beliefs. The exclusion of senior high students and out-of-school adolescents highlights the need for future research to include these groups to capture a more comprehensive understanding of mental health help-seeking attitudes across different age groups and educational backgrounds. Overall, this study contributes to the growing body of literature on adolescent mental health in Ghana and provides actionable recommendations for policymakers, educators, and healthcare providers to improve mental health support and services for Ghanaian adolescents. By addressing the identified barriers and promoting a supportive environment, we can foster a culture where adolescents feel empowered to seek help and prioritize their mental well-being.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical consideration\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe study received approval from the Institutional Review Board (IRB) of the University at Buffalo. Informed consent was obtained from all participants and their guardians. Parents or legal guardians provided written consent, while students gave verbal or written assent before participation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eYes, all participants have consented to the publication of the study.\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 on reasonable request.\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\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis project was sponsored by the authors of the manuscript\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eEA. conceived the study and developed the research question. AA and YO designed the study methodology and conducted the data collection.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAA and EA also performed the data analysis\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eVL, GA, and EH conducted data collection, drafted the initial manuscript, contributed to the interpretation of the findings and provided substantive revisions to the manuscript.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eDF provided supervision and contributed to the conceptualization of the study. DF and JK also assisted with methodological refinement and critically reviewed and edited the manuscript.\u003c/p\u003e\n\u003cp\u003eAll authors read and approved the final manuscript and agree to be accountable for all aspects of the work.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThanks are communicated to the following colleagues who supported the writing and editing of the manuscript, but are not named in the authors\u0026rsquo; list. These are Portia Sintim (KBTH, Department of Family Medicine) and Jeremiah Banini (KBTH, Department of Psychiatry)\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePatel V, Saxena S, Lund C, et al. The Lancet Commissions The Lancet Commission on global mental health and sustainable development Executive summary. 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Predictors of help-seeking for suicidal ideation in the community: risks and opportunities for public suicide prevention campaigns. Psychiatry Res. 2014;219:525\u0026ndash;30.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDaliri DB, Aninanya GA, Laari TT, Abagye N, Dei-Asamoa R, Afaya A. Exploring the barriers to mental health service utilization in the Bolgatanga Municipality: the perspectives of family caregivers, service providers, and mental health administrators. BMC Health Serv Res. 2024;24:1\u0026ndash;9.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKomu CK, Ngigi M, Ambrose |, Melson J. Barriers and Facilitators to Accessing Mental Health Services for Adults in Sub-Saharan Africa: A Systematic Review. Mental Health Sci. 2025;3:e70006.\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":"child-and-adolescent-psychiatry-and-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caph","sideBox":"Learn more about [Child and Adolescent Psychiatry and Mental Health](http://capmh.biomedcentral.com)","snPcode":"13034","submissionUrl":"https://submission.nature.com/new-submission/13034/3","title":"Child and Adolescent Psychiatry and Mental Health","twitterHandle":"@IACAPAP","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"mental health, junior high students, help-seeking behaviour, Ghana, mental health stigma","lastPublishedDoi":"10.21203/rs.3.rs-9041674/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9041674/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eYoung people continue to experience a myriad of mental health challenges. The ability to seek help for mental health challenges is crucial to improving life and wellbeing. This study examines the geographic, demographic, and cultural influences on mental health help-seeking attitudes among Ghanaian junior high school students. Using a quantitative approach, the research aims to identify key factors that shape adolescents' willingness to seek mental health support. This cross-sectional study was conducted over 3 weeks among 1702 junior high students in Ghana using validated questionnaires. The study aimed to examine attitudes toward seeking mental health services among Ghanaian students and how they differ across geographic regions, Sex, and Ethnic groups. Data were analyzed using variance analysis (ANOVA) and multiple regression in STATA version 17. A total of 1,702 participants were included in the study from across 5 regions of Ghana. The results demonstrated significant regional, sex, and ethnic differences in mental health-seeking attitudes. Mental health factors such as self-stigma and opinions about suicide were found to have the strongest influence on mental health-seeking attitudes among participants. The study emphasizes the need for comprehensive mental health education integrated into school curricula and the establishment of more effective counselling services led by trained professionals.\u003c/p\u003e","manuscriptTitle":"Geographic, Demographic, and Cultural Influences on Mental Health Help-Seeking Attitudes of Ghanaian Junior High School Students","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-03-16 09:05:28","doi":"10.21203/rs.3.rs-9041674/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-14T13:23:11+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"209931614156594826307234907356901044921","date":"2026-05-11T19:59:51+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"139828555512677943113133380306809544181","date":"2026-05-11T07:15:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"239454746160841280871166456048463221375","date":"2026-04-09T19:04:04+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-04-06T12:09:22+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"325591202162074789032624879803069298450","date":"2026-04-04T19:43:01+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"218755772599419717415908702936164342201","date":"2026-03-15T12:01:02+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-03-13T09:32:59+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-13T09:29:44+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-06T06:02:10+00:00","index":"","fulltext":""},{"type":"submitted","content":"Child and Adolescent Psychiatry and Mental Health","date":"2026-03-05T15:01:14+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"child-and-adolescent-psychiatry-and-mental-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"caph","sideBox":"Learn more about [Child and Adolescent Psychiatry and Mental Health](http://capmh.biomedcentral.com)","snPcode":"13034","submissionUrl":"https://submission.nature.com/new-submission/13034/3","title":"Child and Adolescent Psychiatry and Mental Health","twitterHandle":"@IACAPAP","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"em","reportingPortfolio":"BMC/SO AJ","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9c9ea59e-de5b-4f66-bcf5-5e10b8e29c42","owner":[],"postedDate":"March 16th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-14T13:23:11+00:00","index":73,"fulltext":""},{"type":"reviewerAgreed","content":"209931614156594826307234907356901044921","date":"2026-05-11T19:59:51+00:00","index":72,"fulltext":""},{"type":"reviewerAgreed","content":"139828555512677943113133380306809544181","date":"2026-05-11T07:15:19+00:00","index":69,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-03-16T09:05:28+00:00","versionOfRecord":[],"versionCreatedAt":"2026-03-16 09:05:28","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9041674","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9041674","identity":"rs-9041674","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}