Mental health literacy and gender differences in psychotherapy utilisation among university students: a cross-sectional study

Abstract Background University students experience elevated psychological distress, and women are more likely than men to engage in psychotherapy. Mental health literacy is associated with gender differences in psychotherapy utilisation and may represent one factor associated with these observed differences. This study examined the role of mental health literacy in gender differences in psychotherapy utilisation among university students. Subject and methods Cross-sectional data from the 2022 EUniWell survey were analysed for 3362 students at the University of Cologne. Psychotherapy utilisation was the dependent variable, gender the independent variable, and mental health literacy was included as a key explanatory variable. Depressive symptoms and perceived stigma were included as control variables. The Karlson–Holm–Breen method was used to decompose the association between gender and psychotherapy utilisation within a logistic regression framework. Results Female students reported higher mental health literacy and higher psychotherapy utilisation. Gender was significantly associated with psychotherapy utilisation (odds ratio (OR) = 1.35, 95% confidence interval (CI) [1.10, 1.65]). After adjusting for mental health literacy, the association was substantially attenuated and no longer statistically significant (OR = 1.03, 95% CI [0.85, 1.25]). A statistically significant indirect association through mental health literacy was observed. Conclusion The findings suggest that mental health literacy may represent an important factor associated with gender differences in psychotherapy utilisation. If this is confirmed in longitudinal and interventional studies, interventions targeting mental health literacy may contribute to reducing gender disparities in psychotherapy utilisation. Due to the cross-sectional design, causal inferences cannot be drawn.