Prevalence and determinants of psychotropic drug self-medication among medical students at the university of Gondar, Ethiopia: the role of mental health stigma.

Psychotropic drug self-medication defined in this study as the use of psychotropic medications without a prescription or professional medical guidance is a growing concern among university students, particularly within high-pressure environments such as medical schools. This study aimed to investigate the prevalence, motivations, and psychosocial impacts of psychotropic drug self-medication among medical students at the University of Gondar, Ethiopia, with a focus on the role of mental health stigma in influencing help-seeking behaviors. A cross-sectional mixed-methods design was used to assess the prevalence, associated factors, and psychosocial influences of psychotropic self-medication among medical students, with a focus on mental health stigma. Quantitative data were collected from 284 undergraduate medical students using a structured questionnaire to estimate prevalence and identify sociodemographic, academic, and mental health correlates. Qualitative data were obtained through in-depth interviews with 8-10 medical students and 2-3 mental health professionals to explore motivations, stigma-related perceptions, and barriers to formal help-seeking. Quantitative data were analyzed using descriptive statistics and bivariate and multivariate logistic regression, while qualitative data were analyzed thematically to complement and contextualize the quantitative findings. A total of 33.5% (n = 95) of participants reported using psychotropic self-medications at some point. Among those who self-medicated, anxiolytics were the most commonly used (42.1%, n = 40), followed by antidepressants (31.6%, n = 30) and stimulants (21.1%, n = 20). The primary reasons for self-medication included academic stress (52.6%, n = 50), sleep problems (31.6%, n = 30), and mood regulation (15.8%, n = 15). Sociodemographic factors such as urban residency (AOR = 1.95, 95% CI: 1.03-3.69, p = 0.041) and higher family income (AOR = 2.10, 95% CI: 1.12-3.96, p = 0.020) were significantly associated with increased psychotropic drug use without a prescription. Mental health also played a significant role, with participants experiencing moderate-to-severe depression and anxiety more likely to engage in self-medication. Perceived mental health stigma was another crucial factor, as students reporting high stigma were nearly twice as likely to self-medicate (AOR = 1.92, 95% CI: 1.09-3.37, p = 0.025). Qualitative findings highlighted academic pressure, sleep disturbances, and emotional exhaustion as triggers for self-medication, while perceived mental health stigma was a major barrier to seeking formal support, with many students fearing judgment from peers, faculty, and family. Psychotropic drug self-medication is prevalent among medical students at the University of Gondar, with approximately one-third reporting self-medication use. Both quantitative and qualitative findings indicate that academic stress, mental health symptoms, and perceived stigma are key determinants influencing self-medication and hindering formal help-seeking. These results highlight the need for stigma-reduction strategies, strengthened campus mental health services, and improved regulation of psychotropic medication access within medical training institutions to support student mental well-being.