Background: Globally, the prevalence of mental distress (anxiety and depression) is high in the general population. However, the prevalence of anxiety and depressive symptoms is even higher among university students, especially in low- and middle-income countries (LMICs). However, the majority (90%) of people experiencing distress, including university students in LMICs, do not sufficiently receive evidence-based psychological interventions, because of stigma, instrumental and attitudinal related barriers. There is limited evidence on perceived need and barriers to receiving mental healthcare. Barriers to mental health services are also associated with the explanatory models individuals have with regard to their mental distress. Socio-culturally determined processes account for how individuals assign belief and attribute meaning to health, illness and suffering, which results in causal attributions and expectations of suitable treatment and related outcome. Little is known about how university students in Ethiopia conceptualize their mental distress, perceive their symptoms and their causes, or how they understand the severity, onset, treatment preference, impacts and coping strategies for their distress. The lack of published evidence on the feasibility and acceptability of psychological interventions for students with mental distress provides an opportunity to explore culturally adapted psychological therapy for university students in LMICs who have high levels mental distress and accompanying dysfunction.rnObjectives: The purpose of this study is to first assess the prevalence of mental distress, the need for professional mental healthcare, and barriers to the delivery of services to affected students. Second, to explore the explanatory models for mental distress and third, to evaluate the feasibility of Interpersonal Psychotherapy adapted for Ethiopia (IPT-E) among undergraduate students in Wolaita Sodo University.rnMethods: Explanatory sequential design was used for this dissertation thesis. In study one: A cross-sectional research design with multi-stage sampling technique was used to recruit 1135 undergraduate students. Symptoms of mental distress were screened using the Self-Reporting Questionnaire (SRQ) and a score of eight and above was used to identify positive cases. The perceived need for professional mental healthcare was assessed using the â€—Yes or Noâ€˜ response item, and barriers to receiving mental healthcare were assessed using Barriers to Access to CareEvaluation (BACE). Descriptive statistics (percentage, frequency, mean and standard deviation) were employed to summarize the demographic characteristics of the participants and to identify commonly reported barriers to receive mental health services. Pearson chi-square test was used to examine the association between the demographic variables with mental healthcare need. It was also used to investigate the association between the demographic variables with the five most commonly reported barriers to receive mental health services. The association of demographic variables with the total mean scores of BACE-III sub-scales was modeled using multiple linear regression. Besides, the association between demographic factors and mental distress was analyzed using logistic regression. In study two: A phenomenological research design was employed and data were collected from 21 participants using locally adapted Short Explanatory Model Interview. Frame-work analysis was used with the assistance of open code software 4.02. Conducting studies one and two using these methods provided inputs for the interventional study three; since there was no prior feasibility study of Ethiopian Interpersonal Psychotherapy (IPT-E) for students in Ethiopia.rnStudy three: A quasi-experimental single-group pre-post-test study design was used for 24 participants. Client Satisfaction Questionnaire was used to measure the acceptability of the IPT-E. World Health Organization Disability Assessment Scale and SRQ tools were used to assess functional impairment and mental distress, respectively. As indicators of the feasibility of IPT-E, consent, treatment completion, the mean number of sessions attended, and attrition were analyzed, whereas the treatment satisfaction was an indicator of acceptability of IPT-E. Descriptive statistics were used to summarize the demographic variables, feasibility and acceptability of IPT-E. Changes from pre- to post-tests of mental distress and functioning were analyzed using paired t-test and Wilcoxon signed-rank tests. The quantitative data were analyzed using Statistical Packages for the Social Sciences version 20, whereas the qualitative data analysis was assisted by open code software 4.02.rnResults: The prevalence of mental distress was 34.6%. Most of the students experienced their mental distress as mixed symptoms and they labeled them as anxiety or stress. The onset of mental distress ranged from six months to four years during their University stay. The most commonly reported causal explanations were psychosocial factors. Students perceived that their psychological distress was severe so that it mainly affected their mind, which in turn negativelyimpacted their interactions with others, their academic result, their emotions, and their motivation to study. Almost all of the students received care from alternative sources, although they wanted to receive care from mental health professionals. The need for professional mental health service was 70.5%. The top five reported barriers to receiving this service were: (a) thinking the problem would get better with no intervention, (b) being unsure where to go to get professional help, (c) wanting to solve the problem without intervention, (d) denying a mental health problem existed and (e) preferring to get alternative forms of mental care. IPT-E was feasible, where rates of consent accounted for 100%, completion rate 92.31%, attrition rate 7.69% and the mean number of sessions attended was 8. The total mean score of treatment satisfaction was 27.83. After the delivery of IPT-E, symptoms of mental distress had significantly decreased (M = 14, SD = 4 to M = 3, SD = 3, P = 0.001) and functioning had improved (M = 34, SD = 11 to M = 23, SD = 8, P = 0.001).rnConclusions: The high prevalence of mental distress, the paucity of professional mental healthcare and the report of barriers to access it among undergraduate students is a call to address this disparity. IPT-E was feasible and acceptable and it showed promising results in decreasing symptoms of mental distress and improving functioning among university students. Therefore, scaling-up this intervention at the national level and implementing it in higher education institutions in Ethiopia is an important consideration. This would take into account the explanatory models of students with regard to their psychological distress and potentially address the burden of mental distress and reduce the mental health treatment gap among university students.rnRecommendations: Based on the study findings, these are the recommendations:rnï¶ The prevalence of mental distress and mental health treatment gap are alarmingly high in the university settings; therefore, policy makers and higher officials in the universities should reconsider the access to psychological services for students with mental distress.rnï¶ Mental health providers in universities should ensure mental health services are accessible to students and advertise these services for better utilization.rnï¶ Developing preventive mental health education strategies that enhance mental health literacy and knowledge is essential to address the high prevalence of mental distressalong with creating conducive environment that promote and sustain positive mental health for every university student.rnï¶ Exploring the explanatory models for mental distress among university students is an important part of understanding the studentsâ€˜ needs for mental healthcare and the successful implemention of locally feasible and acceptable evidence-based mental health interventions.rnï¶ Future randomized controlled trial of IPT-E along with longer follow-up period would secure the promising mental health outcomes of IPT-E to further scale-up the service in similar settings.