Abstract
Depression and anxiety are two mental health disorders that pose a significant threat to university students. This is especially prevalent in low- and middle-income countries like South Africa, where resources for mental health service provision are limited. Digital mental health interventions (DMHIs) have arisen as an alternative in mental health service provision that could potentially bridge the existing treatment gap. Despite their availability, uptake remains low, while depression and anxiety levels remain distressingly high. This study aimed to investigate the interplay between mental health symptom severity, digital mental health intervention uptake, and barriers to access among South African university students. The study utilised a quantitative approach within a cross-sectional survey research design. Theoretically grounded in Ajzen’s Theory of Planned Behaviour, the study aimed to examine the behavioural factors influencing uptake, such as attitude, subjective norm, intention, and perceived behavioural control. The Generalized Anxiety Disorder Scale (GAD-7), the Patient Health Questionnaire (PHQ-9), the Electronic-Therapy Attitudes and Process Questionnaire (eTAP), and a self-developed Perceived Barriers Scale were administered to 996 university students aged 18-24 years who were recruited into the study. Key findings indicated that there was a negative relationship between depressive symptom severity and DMHI uptake and that barriers did not moderate the relationship, but were predictors associated with lower DMHI uptake. Female participants reported higher depressive and anxiety symptoms and more positive attitudes toward DMHIs compared to males. Younger participants reported higher depressive symptom severity, less perceived behavioural control, less social support, and more perceived barriers to accessing DMHIs compared to older participants. African participants endorsed higher depressive symptom severity, felt less perceived behavioural control, and experienced less social support in using DMHIs. They also reported a higher intention to use DMHIs even though they perceived greater barriers to access. The findings show that increasing DMHI uptake requires recognition that psychological, demographic, and behavioural factors influence students’ experiences of DMHIs. Thus, this study lays the groundwork for identifying the factors that may increase DMHI uptake in the future so that the declining mental health of university students is potentially mitigated.