Navigating the Stigma: mental health stigma and associated factors among non-health Saudi university students

Abstract Background Mental health stigma remains an important barrier to help-seeking and the utilization of appropriate mental health support services, particularly among university students. Aim This study aimed to assess mental health stigma and identify its associated factors among non-health university students at the University of Ha’il in Saudi Arabia. Methods A descriptive cross-sectional design with convenience sampling was used. Data were collected from 339 non-health students using a self-administered Google Forms questionnaire distributed through WhatsApp student groups affiliated with the non-health colleges at the University of Ha’il. The Mental Health Knowledge Questionnaire (MHKQ) and the Value-Based Stigma Inventory (VASI) were used to assess mental health knowledge and stigma, respectively. Knowledge-score comparisons were performed using the Mann–Whitney U and Kruskal–Wallis H tests. Factors associated with the continuous total stigma score were examined using multivariable linear regression with HC3 robust standard errors. Statistical significance was set at p < 0.05. Results The participants were predominantly female (78.2%); 38.9% were aged 18–<20 years, and 28.6% were in the second academic year. The median mental health knowledge score was 10.0 (Q1–Q3: 0.0–13.0), and 120 participants (35.4%) obtained a total MHKQ score of zero, indicating a pronounced floor effect. Re-audit of the item coding and total-score calculation identified no missing, invalid, or arithmetic scoring errors. In the adjusted complete-sample model, higher MHKQ scores were associated with lower stigma (B = − 0.234, 95% CI: −0.401 to − 0.068, p = 0.006); however, after excluding all-zero MHKQ scores, the coefficient reversed direction (B = 0.373, 95% CI: 0.015 to 0.732, p = 0.041), demonstrating instability of the knowledge–stigma association. Conclusion Mental health stigma among non-health university students was associated with several sociodemographic and experiential factors. The MHKQ–stigma coefficient was not robust to the exclusion of all-zero knowledge scores and should not be interpreted as a stable directional association. The pronounced MHKQ floor effect warrants further item-level and psychometric evaluation of the Arabic version before strong inferences are made about the relationship between measured knowledge and stigma in this population. Universities remain an appropriate setting for evaluating culturally responsive mental health education and stigma-reduction programs and for facilitating access to psychological counseling and referral services.