Determinants of Mental Health Service Utilisation and the Role of Health Insurance among Government and Private Sector Employees in Mogadishu, Somalia: A Cross-Sectional Survey

Abdulrazaq Yusuf Ahmed* and Abdirahman Yusuf Ahmed

Background: The provision of health insurance within fragile, conflict-affected settings such as Somalia does not automatically guarantee improved access to essential mental healthcare services. Despite the proliferation of insurance products, especially Islamic Takaful schemes, the translation of insurance coverage into tangible service utilisation remains hindered by multifaceted barriers. This study investigates the determinants of formal mental health service use among salaried employees in Mogadishu, with a particular focus on the roles of insurance enrolment, insurance literacy, and stigma within this urban workforce.

Methods: Employing a quantitative, cross-sectional design, data were collected from 385 full-time government and private sector employees in Mogadishu.

Stratified random sampling ensured representation across employment sectors. The survey incorporated an adapted Andersen Behavioural Model of Health Services Use to assess sociodemographic characteristics, perceived stigma, insurance status, awareness of mental health benefits (as a proxy for insurance literacy), and psychological distress. Multivariate logistic regression analysis was conducted to identify independent predictors of formal mental health service utilisation.

Results: Among respondents, 35.1% reported significant psychological distress, yet only 15.1% accessed formal mental health services. High perceived stigma emerged as a substantial deterrent to service use (OR = 0.45), and mere enrolment in insurance schemes did not correlate with increased utilisation. Notably, insured individuals who were aware that their insurance covered mental health services demonstrated a markedly higher likelihood of seeking formal care (OR = 3.50). Tertiary education also positively influenced utilisation rates (OR = 2.10).

Conclusions: The findings underscore that offering insurance alone is insufficient to enhance mental health service access in Somalia; clarity and communication regarding benefits are paramount. Policy interventions should mandate transparent coverage for mental health, strengthen insurance literacy, and implement stigma reduction strategies to foster uptake of evidence-based care and improve population mental health outcomes.

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Published on: Nov 12, 2025 Pages: 11-18

Full Text PDF Full Text HTML DOI: 10.17352/apt.000066
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