Digital Mental Health Applications: Utilization, Perceptions, and Barriers Among Medical Students at Umm Al-Qura University, Makkah, Saudi Arabia, 2024, A Cross-Sectional Study

Introduction

Mental health problems are higher among university students than among their peers. Medical students acquire more professional knowledge and skills than students in other majors. As a result, emotional disturbances and stress levels are very high amongst medical students.¹ Medical students between the ages of 18 and 24 are more susceptible to developing mental diseases, such as anxiety disorders, psychiatric comorbidity, and major depressive disorder.² Mental illnesses result in negative personal and professional consequences, such as physician impairment, social isolation, and burnout.^1,2 Additionally, if these mental illnesses were left untreated, they may result in negative coping mechanisms, such as smoking, self-harm, substance abuse, and alcohol consumption.¹

Medical students encounter numerous challenges that contribute to immense psychological and academic pressure. These pressures stem from various factors, including the intricate nature of the medical curriculum, demanding duty hours, the vast and complex body of medical knowledge, significant financial burdens associated with educational expenses, and notably reduced leisure time when compared to their counterparts in other professional fields.²

Mental health issues are highly prevalent among medical students. A systematic review and meta-analysis by Sarokhani et al. (2013) found that 33% (95% CI: 32-34%) of university students experienced depression.³ Similarly, Quek et al. (2019) reported a global prevalence of anxiety among medical students of 33.8% (95% CI: 29.2-38.7%).² These findings underscore the urgent need for mental health support and targeted interventions in this population.

The prevalence of mental illness among medical students can be attributed to cultural or social reasons.⁴ While mental health disorders have been documented for many years, the rising prevalence of conditions such as anxiety and depression among medical students in developing countries warrants greater attention.^5,6 Depression among medical students poses significant risks, including detrimental impacts on academic performance, increased suicidal ideation, and potential substance use. Several underlying factors contribute to this mental health challenge, notably the immense academic pressure these students face and the critical nature of their future responsibilities regarding patient safety. Additionally, the medical curriculum often presents a stark contrast to prior educational experiences. Additionally, the prevalence of depression does not differ significantly between male and female medical students.⁷

Over the past decade, technology has significantly impacted mental health care by facilitating access to mental health care and reducing costs through mobile apps.⁸ While extensive research has been conducted on this topic in Western countries, a notable scarcity of studies in other cultural contexts remains. For example, in Saudi Arabia, the prevalence of smartphone and internet usage is significantly high, supported by governmental initiatives such as the SEHA Virtual Hospital and various mobile health (mHealth) applications. Despite this conducive environment, there is a limited body of research focused specifically on the effectiveness and usage of digital mental health applications within this region.⁸

Undergraduate medical students are increasingly confronted with a range of mental health challenges, including elevated levels of depression, anxiety, and stress.² Largely attributable to the rigorous academic environment, societal stigma, and inadequate access to traditional mental health services.^2,9 In this context, digital mental health applications present a promising alternative; however, their acceptance, efficacy, and overall impact among medical students in Saudi Arabia remain underexplored.

Severe mental illnesses can pose a challenge to the successful use of digital mental health applications.⁹ Another factor that depends on the user is the user’s experience in using such applications.¹⁰ Additionally, the technology implemented in the application and the technical errors can be a barrier for the users.^9,10 Considerations, such as technical assistance, program training, and customizing the application to be suitable for each user, are required.¹¹

There exists a notable deficiency in the existing literature concerning medical students’ perceptions of digital mental health applications, as well as the barriers they encounter while utilizing these resources. This gap highlights the need for further investigation into the attitudes and experiences of medical students in relation to the accessibility and efficacy of such applications in supporting mental health. This study aims to investigate the utilization, perceptions, and barriers associated with digital mental health apps among medical students at Umm Al-Qura University. Additionally, it seeks to assess the demographic and psychological predictors of mental health applications engagement with this cohort.

Materials & methods

Results

Out of the 255 participants, the majority were aged between 18 and 24 years (n = 230, 90.2%), and 51.8% were female (n = 132). Most respondents were single (n = 238, 93.3%) and affiliated with the College of Medicine at Umm Al-Qura University in Makkah (n = 235, 92.1%), reflecting a predominantly medical student population. Representation spanned all six academic years, with the highest proportions observed in the third year (n = 60, 23.5%) and fourth year (n = 61, 23.9%). More than half reported a monthly household income below 5,000 SAR (n = 157, 61.6%), and 17.6% (n = 45) indicated having children or dependents.

Technology access through smartphones (n = 201, 78.8%) and tablets (n = 190, 74.5%) were more commonly used than desktop or laptop computers (n = 116, 45.5%). A smaller proportion (n = 41, 16.1%) reported using non-smart mobile phones, while only five participants (2.0%) indicated they did not use any digital devices. Detailed demographic characteristics are presented in ( Table 1).

Discussion

This study investigated the factors affecting the use of mental health applications among medical students at Umm Al-Qura University using SEM and logistic regression. Despite high smartphone ownership 201 (78.8%) and digital literacy, only 64 (25.1%) reported mental health app usage. These results reflect a broader underutilization of non-digital mental health tools, consistent with findings from a study conducted by Aldaweesh et al. (2024), which reported that most clinics use paper for assessment and the CBT tools, despite the wide use of smartphones.⁸ Despite their different population, these findings highlight a larger issue relevant to our study, the underutilization of digital mental health aids in technologically advanced workplaces. Our clinical findings show that students with many smartphones did not use mental health apps. This suggests that psychological, structural, or cultural barriers may prevent people from participating in different situations.¹² In Saudi Arabia, privacy and stigma regarding mental health are major concerns.

A study conducted by Al Dweik et al. in the UAE found that the use of mental health applications post-COVID-19 has significantly accelerated. About 228 (95.0%) of the participants stated the importance of mental health services, and about 173 (72.0%) found virtual consultations as effective as in-person therapy. Moreover, 144 (60.0%) of mental visits were teleassessments.¹³ The data confirm our finding that life-stage characteristics and cognitive perceptions-particularly stress and mental health awareness-drive app usage among medical students.

SEM analysis showed excellent model fit (CFI = 1.000, TLI = 1.029, RMSEA <0.001, SRMR = 0.027). Key findings included the latent construct of Cognitive Influence being significantly linked to perceived mental health importance and resource awareness, which was a significant predictor of app use. This aligns with a web-based survey administered to a randomly selected sample of 500 community college students from April 16 to June 30, 2020. Borghouts et al. (2021) reported in their study that participants who used mental health applications had one or more of these factors: perceived stress, need to seek help for mental health concerns, social influence of other people, privacy concerns, and past use of mental health services. Additionally, stress leads to seeking help. Stress is one of the most common mental health issues. Approximately 220 (44.0%) of participants in their study suffered from stress. Borghouts et al. reported that there is a direct relationship between the stress that students experience and the use of mental health applications.¹⁰ Conversely, social influence and technology compatibility showed no significant direct pathways to cognitive influence, indicating possible mediation by unmeasured variables. Covariance analysis revealed a positive relationship between Social Influence and Technology Compatibility (p = 0.011), suggesting potential indirect effects on user behavior. Additionally, Ervasti et al. (2019) suggested that self-reported stress strongly correlated with stress management applications use in a survey study conducted at the University of Helsinki’s mailing lists.¹¹ Our results indicate that in the Saudi student population, psychological relevance and internal motivation drive digital mental health engagement more than external social or technological factors, an important consideration for culturally sensitive intervention design.

Logistic regression identified two key demographic predictors for mental health app usage: third-year students and those without caregiving responsibilities had a decreased likelihood of usage (p = 0.039), possibly due to academic pressures. Students in this academic year may be less inclined or less likely to engage with mental health applications compared to other year groups. Those without dependents showed lower utilization, indicating caregiving responsibilities may heighten the need for such resources and might be associated with higher engagement in mental health support tools. This shows that academic-stage difficulties and obligations may increase support tool use. These findings align with Borghouts et al. (2021), who emphasized personal obligations and mental health requirements determine app usage,¹⁰ and with the findings from the national Healthy Minds Study, 2013-2021 by Lipson et al. (2022), who showed that students with more life demands are more likely to seek mental health support.¹⁴ Other factors such as age, gender, income, and college affiliation did not show significant associations, although some coefficient instability was noted in certain subgroups, necessitating further research. This is consistent with the survey study conducted by Apolinário-Hagen et al. (2019), which indicated that psychological moods impacted app engagement more than static demographics.¹⁵ Although there is extensive access to the internet in Saudi Arabia, the stigma associated with mental health is still severe. As a result, internal cognitive and emotional factors may have a greater impact on adoption than socioeconomic position.

Topics such as stigma, a lack of Arabic content, and worries about privacy are brought to light. These are issues that are particularly pertinent in the context of Saudi culture. Aldaweesh et al. stated that most clinicians were aware of consultation applications, such as Labayh, Famcare, and Estenarh. However, fewer clinicians were aware of applications that were used to provide mental health services. English-speaking patients were referred to use applications such as Headspace. The Arabic content in mental health applications is lacking. Only 1 (2.0%) clinician used the CBT-based Arabic applications.⁸ Our study found that students used mental health applications rarely, highlighting the need for culturally sensitive and distinct mental health solutions. Anonymous, Arabic-language, and religiously and socially compliant apps may be more accepted. Lipson et al. (2021) found that 30% of university students sought therapy, and only 5.4% of them sought therapy on campus in an annual cross-sectional survey.¹⁴ These findings collectively confirm our results and suggest that the utilization of mental health applications among medical students is more significantly influenced by cognitive perspectives and academic stage characteristics than by technological or demographic variables. This is the case when all factors are considered. The dissemination of additional information, the reduction of stigma, and the creation of applications that are compatible with cultural and linguistic requirements could all contribute to the increase in the use of mobile applications among Saudi medical students. Consequently, this underscores a significant possibility for intervention. Our results reinforce the view that life context, rather than static factors like gender or income, is a more reliable predictor of digital mental health tool adoption in student populations.

Conclusions

This study explores the psychological and demographic factors affecting the usage of mental health applications among medical students. Although the structural model showed strong fit, key constructs like Social Influence and Technology Compatibility did not directly affect Cognitive Influence, indicating potential mediation by other variables. The findings indicated that third-year students and individuals without dependents were less likely to utilize mental health applications, highlighting the influence of life-stage factors on help-seeking behaviors and digital mental health engagement. The cultural emphasis on privacy, particularly among female users, underscores the need for features prioritizing confidentiality. The findings offer valuable implications for future research and mental health technology development. Addressing cognitive barriers and enhancing cultural relevance are crucial for increasing adoption in this demographic.

Institutional review board statement

The study was conducted in accordance with the Declaration of Helsinki, and approved by the Institutional Review Board of Umm Al-Qura University. Protocol code HAPO-02-K-012-2024-10-2234.