The impact of mental health literacy, stigma, and social support on attitudes toward mental health help-seeking

Help-seeking intention for mental illness and associated factors among Dessie town residents in Northeast Ethiopia

Despite the increasing global burden of mental illness and the availability of effective evidence-based treatments, many individuals with mental illness do not seek professional help. Therefore, this study aimed to assess help-seeking intention for mental illness and associated factors among Dessie town residents, Northeast Ethiopia, 2021. A community-based cross-sectional study was conducted among 501 Dessie town residents. The data were collected by face-to-face interview. The General Help Seeking Questionnaire was used to assess help-seeking intention. Bivariable and multivariable logistic regression analysis techniques were used. Finally, a statistically significant level was declared at a p-value less than 0.05. Among 501 participants, 67.5% were likely to seek help from health professionals. Being female (AOR = 4.695, 95% CI = 1.63- 13.50), being single (AOR = 0.330, 95% CI = 0.12-0.89), and having good knowledge (AOR = 3.030, 95% CI = 1.25-7.35) were significantly associated with help-seeking intention. This study indicated that the participants' help-seeking intention was inadequate. Sex, marital status, monthly income, and knowledge of mental illness were found to be associated with help-seeking intentions for mental illnesses. Therefore, community healthcare workers, healthcare administrators, and religious and community leaders should work to enhance the help-seeking intention of the community.

Factors Predicting Mental Health Literacy in Older Adults: A Community-Based Cross-Sectional Study

PURPOSE

To determine mental health literacy (MHL) levels of older adults and the predictive factors of MHL.

METHOD

This cross-sectional study was conducted between October and December 2022, with 410 older adults aged ≥65 years. A Personal Information Form and the Mental Health Literacy Scale were used for data collection. Independent samples t test, analysis of variance, and multiple linear regression were used to analyze the data.

RESULTS

Significant predictors of MHL in older adults were being aged 65 to 69 years, being female, being a university graduate, having an income more than expenses, receiving information from a health professional, interest in mental health, having friends or family members with mental illness, and good perception of health.

CONCLUSION

Older adults were found to have low levels of MHL. Mental health professionals should focus on community-based education and interventions to increase the MHL levels of older adults. [Journal of Psychosocial Nursing and Mental Health Services, 62(10), 31-40.].

A Reasoned Action Approach to Social Connection and Mental Health: Racial Group Differences and Similarities in Attitudes, Norms, and Intentions

This study employed a Reasoned Action Approach to investigate two communication behaviors that were being built into a statewide behavioral health campaign: initiating a conversation about one's own mental health struggles, and starting a conversation to discuss someone else's mental health difficulties. We examined whether the extent of attitudes, perceived norms, and perceived behavioral control regarding intent to perform these behaviors varied by racial identity. Using original survey data from Texans (N = 2,033), we conducted regression analyses for the two communication behaviors and found that intention to seek help was primarily explained by instrumental attitude, injunctive norm, descriptive norm, and perceived capacity; and intention to start a conversation to help someone else was primarily explained by instrumental attitude, injunctive norm, and perceived capacity. Additionally, we identified important common and distinct determinants of the two behaviors across different racial groups. Implications for health communication campaign message development and audience segmentation are discussed.

Mental Health Literacy Reduces the Impact of Internalized Stigma on Older Adults' Attitudes and Intentions to Seek Mental Health Services

OBJECTIVES

Older adults are the least likely age group to seek mental health services, and internalized stigma is an important reason why. We sought to further our understanding of which older adults are particularly likely to be affected by internalized stigma, and why, by investigating mental health literacy (MHL) as a moderator within the internalized stigma model of help-seeking.

METHODS

We utilized a conditional process analysis of cross-sectional, secondary data from 350 distressed older adults. Participants completed an online survey consisting of measures of distress, perceived control, experiential avoidance, MHL, public and self-stigma of seeking help, help-seeking attitudes, and conditional help-seeking intentions.

RESULTS

MHL moderated the internalized stigma model; distressed older adults with lower MHL were more likely to have public stigma internalized as self-stigma, which then reduced their intentions to seek help. More specifically, low MHL magnified the negative effect of self-stigma on attitudes and intentions.

CONCLUSIONS

These results increase our understanding of which older adults are less likely to seek mental health services: distressed older adults with poor MHL and high self-stigma.

CLINICAL IMPLICATIONS

MHL is a malleable construct that can be targeted by interventions designed to increase help-seeking among distressed older adults in need of professional help.

Advocacy through storytelling: challenging eating disorders and eating disorders stigma

BACKGROUND

Although eating disorders (EDs) are among the most stigmatised mental illnesses, a number of individuals break past this stigma and engage in ED advocacy by sharing their recovery stories. Little is known, however, about the role of such advocacy in their healing journeys.

METHODS

To bridge this gap, the authors examined the role of autobiographical oral storytelling in the ED recovery of adult advocates. Autobiographical oral history interviews were carried out with adult advocates (n = 16) recovering from EDs. The data were analysed using a mixture of actantial and thematic analyses. Authors also used activity theory to categorise how storytelling was translated into concrete social actions. Results were then interpreted through frameworks of embodiment and the intersectionality of identity.

RESULTS

Advocates chose to share their ED stories as a way to embody resilience and make meaning from their ED experiences. Beyond personal gains, the social benefits of sharing their stories included raising hope and openness to converse further with audiences, advocating for greater ED resources (e.g., ED literacy among school staff), and offering new training initiatives for healthcare professionals. The ties between storytelling and the unique aspects of one's identity are also discussed.

CONCLUSIONS

Engaging in advocacy through storytelling can positively affect both the advocates and the audiences with whom they connect. Future studies, informed by feminist biopsychosocial frameworks, can examine storytelling as a therapeutic intervention. Such frameworks serve as alternatives to biomedical models of EDs and mental illnesses. They also emphasise the need for broader changes that destabilise oppressive body cultures and display how storytelling can help mobilise change.

Mental health literacy and help-seeking intention among Chinese elite athletes: the mediating roles of stigma and social support

Objectives

Considering the importance of mental health help-seeking, researchers have closely examined the relationship between mental health literacy (MHL) and help-seeking intention (HSI). Furthermore, the high impact of stigma and the potential value of social support on HSI have been recognised. However, the relationship between these variables has not been fully tested within the context of Chinese elite athletes. This study addressed this gap by examining the relationship between MHL and HSI. Furthermore, it explored the mediating effects of public stigma, self-stigma, and social support on the relationship between MHL and HSI among Chinese elite athletes.

Methods

450 Chinese elite athletes (M age = 18.12, SD = 3.20, 46.2% female) self-reported their MHL, public stigma, self-stigma, social support, and HSI. Mediation analysis was conducted using the bootstrap approach of the PROCESS macro version 3.3 of SPSS 25.

Results

The results showed a significant positive correlation between MHL and HSI (r = 0.348). The results also demonstrated that MHL was a predictor of HSI (β = 0.337, 95%CI [0.249, 0.425], p < 0.001). Furthermore, 1) the indirect effect of MHL → public stigma→HSI was 0.024 and a 95%CI [0.003, 0.053]. Specifically, MHL predicted public stigma (Estimate = -0.151, 95%CI [-0.187, -0.045], p < 0.001), and public stigma predicted HSI (Estimate = -0.161, 95%CI [- 0.549, -0.164], p < 0.001); 2) the indirect effect of MHL → self-stigma→ HSI was 0.016 and 95%CI [0.002, 0.038]. Specifically, MHL predicted self-stigma (Estimate = -0.137, 95%CI [-0.069, -0.013], p < 0.01), and self-stigma predicted HSI (Estimate = -0.120, 95%CI [-1.181, -0.186], p < 0.01); as well as 3) the indirect effect of MHL → social support→HSI was 0.029 and a 95%CI [0.009, 0.055]. Specifically, MHL predicted social support (Estimate = 0.208, 95%CI [0.018, 0.047], p < 0.001), and social support predicted HSI (Estimate = 0.141, 95%CI [0.578, 2.442], p < 0.01). Additionally, the direct effects from MHL to HSI is (β = 0.452, 95%CI [0.304, 0.600], p < 0.001).

Conclusion

Our findings provide empirical support for the roles of public stigma, self-stigma, and social support as mechanisms of behavioural change in MHL interventions. These factors increase HSI among elite athletes. Future studies should further test these mediating effects using experimental designs.

Exploring predictors of help-seeking behaviors among women with postpartum depression: A social media recruited sample

BACKGROUND

Postpartum depression is among the most common complications associated with child-bearing having a period prevalence rate of 17%. Despite the prevalence of postpartum depression, recognition and treatment remains low.

METHODS

This paper examines the predictors of help-seeking behavior among a sample (N = 326) of postpartum women. A cross-sectional survey was deployed, and participants were recruited via social media through snowball and convenient sampling techniques.

RESULTS

Binary logistic regression was used to analyze the data. Results indicate the severity of depression and favorable attitudes toward help-seeking were predictors of help-seeking behavior among postpartum women in this sample.

DISCUSSION/CONCLUSION

This study has implications for healthcare workers, including the allied health professions. Access to treatment is, in part, influenced by a woman's ability to ask for help from health professionals. Social workers and nurses have an opportunity to educate and discuss postpartum mental health and improve treatment seeking.

Psychological distress and attitudes toward seeking professional psychological help among Omani nurses: Strategies for nursing practice

BACKGROUND

This study investigated the psychological distress and attitudes toward seeking professional psychological help among Oman's nurses, highlighting the importance of changing negative attitudes toward mental health among healthcare professionals. Nurses face difficult circumstances and serve as role models. Creating supportive environments can improve treatment quality and public awareness and reduce social stigma, ultimately contributing to better care and quality of life.

MATERIALS AND METHODS

This study used a cross-sectional design with a convenience sampling approach. A sample of 205 nurses working in Oman completed the study questionnaires, including a sociodemographic questionnaire, the attitude toward seeking professional psychological distress scale, and the Kessler Psychological Distress Scale. The survey was distributed between May and June 2023.

RESULT

The study found that most participants had moderate psychological distress (43.22%, n = 67) and a low attitude toward seeking professional psychological help (66.67%, n = 48). There were significant differences in distress based on gender (P < 0.001), marital status (P < 0.001), and working department (F = 3.140, P = 0.004), while attitude had significant differences based on gender (P < 0.001) and marital status (P < 0.001). The study also found no significant correlation between psychological distress and attitudes toward seeking help among Oman's nurses (T (1, 204) = 0.019, P = 0.985), with a r2 of 0.005.

CONCLUSION

Nurses must be trained to handle stress and job strain from terminally ill patients, complex cases, and difficult situations. They should prioritize psychological assistance as a sign of strength and self-awareness as it demonstrates stability and self-awareness in nursing. This can be promoted by obtaining education, enhancing healthcare accessibility, and providing a support system.

Relationship between academic teaching staff' mental health literacy levels and beliefs toward mental illness

OBJECTIVE

The study aimed to determine the relationship between academic teaching staff' mental health literacy levels and beliefs toward mental illness.

METHODS

This cross-sectional study was conducted with 357 academic teaching staff working at a state university in Turkey between July 2021 and February 2022.

RESULTS

Significant predictors of academic teaching staff' beliefs toward mental illness were mental health literacy, department, receiving mental health literacy education, seeking psychiatric help before, having a family member with a mental disorder, willingness to work with someone with a mental disorder, experience with a student with a mental disorder in professional life, and thoughts that students with a mental disorder should continue education.

CONCLUSION

Mental health literacy is an important variable in reducing academic teaching staff' negative beliefs toward mental illness. Therefore, training programs can be planned to increase the mental health literacy levels of academic teaching staff and change their negative beliefs toward mental illness.

Modifiable predictors of mental health literacy in the educational context: a systematic review and meta-analysis

Mental health literacy is vital for well-being in educational settings, extending beyond academics to include social and emotional development. It empowers individuals, allowing them to recognize and address their mental health needs and provide essential support to their peers. Despite the acknowledged importance of modifiable factors, there is a noticeable research gap in those amenable to change through educational interventions. Thus, this systematic review aims to identify potentially modifiable predictors of mental health literacy in the educational context. A systematic search was conducted for quantitative studies published between 2019 and October 2023 using several databases following PRISMA guidelines. Studies needed to focus on potentially modifiable predictors of mental health literacy in the educational context. Study quality was assessed using the Appraisal tool for Cross-Sectional Studies (AXIS tool). In total, 3747 titles and abstracts were screened, 60 articles were assessed in full-text screening, and 21 were included in the review. Significant correlations between mental health literacy and modifiable predictors, including stigma toward professional help, self-efficacy, attitudes toward help-seeking, social support, positive psychological states, receiving mental health training, and psychological distress, were identified. By addressing these factors, educational institutions can cultivate community's adept in mental health, fostering an environment marked by empathy, understanding, and proactive engagement in addressing mental health issues. The implications serve as a foundation for future research, policy development, and implementing of practical strategies to enhance mental health literacy in diverse educational settings.

The relationship between mental health literacy and professional psychological help-seeking behavior among Chinese college students: mediating roles of perceived social support and psychological help-seeking stigma

Introduction

Mental health literacy is viewed as a significant factor that may facilitate an individual's pursuit of professional psychological assistance. However, it is important to explore further influencing factors that might underlie this association. This study, employing the framework of the Theory of Planned Behavior (TPB), aims to examine the relationship between mental health literacy and the behavior of seeking professional psychological help, with a focus on the potential mediating roles of perceived stigma and social support in this context.

Methods

We surveyed 911 college students in seven regions of China (406 males and 505 females, aged between 19 and 25 years old; M age = 19.65, SD = 1.41) utilizing self-report measures, including the Mental Health Literacy Questionnaire, Professional Psychological Help-Seeking Behavior Scale, Professional Psychological Help-Seeking Stigma Scale, and Perceived Social Support Scale. A chain mediation model was developed to analyze the interconnections between mental health literacy, stigma related to seeking psychological help, perceived social support, and professional psychological help-seeking behaviors.

Results

The mediation effect analysis indicates that: (1) mental health literacy significantly positively correlates with professional psychological help-seeking behaviors; (2) both perceived social support and professional psychological help-seeking stigma significantly mediate the relationship between mental health literacy and professional psychological help-seeking behavior; (3) perceived social support and the stigma associated with seeking professional psychological help play a chained mediating effect between mental health literacy and the behavior of seeking professional psychological help.

Discussion

This study found that mental health literacy indirectly facilitates professional psychological help-seeking behaviors by enhancing the perception of social support and reducing the stigma associated with seeking such help. These findings help in understanding how improving mental health literacy and perceived social support while reducing stigma can increase the likelihood of individuals seeking professional psychological assistance. The results are significant for enhancing the utilization of mental health services and implementing mental health education programs in universities.

Attitude towards seeking professional help for mental health among medical students In Karachi, Pakistan

Aim: In Pakistan, seeking help for mental health is considered a social stigma and a large number of medical students are suffering from mental health. This study aimed to investigate the attitude toward seeking professional care for mental health issues among medical students. Methodology: A cross-sectional study was conducted with a total of 316 students selected through multistage stratified cluster sampling. With each academic year 500 students were enrolled. Linear regression analysis was used to find the association of outcome and independent variables. Results: Around 56% of students had a negative attitude toward seeking professional help. Common predictors associated with a negative attitude were age (p < 0.001), academic year (p < 0.001) and with self-harm behavior (p < 0.001). Conclusion: University students generally had moderate intentions to seek counseling regarding mental health.

Investigating the use of support in secondary school: the role of self-reliance and stigma towards help-seeking

Purpose: Adolescents are the least likely to seek help for their mental health problems. School may be an important route to improve early recognition of adolescents with mental health problems in need for support, but little is known about the barriers to school support.Materials and methods: Data were collected in a longitudinal cohort study of Dutch adolescents (age 12-16) in secondary school (n = 956). We assessed the relation between level of psychosocial problems at the beginning of the school year (T1) and the support used in school at the end of that school year (T2), whether the willingness to talk to others (measured at T1) mediates this relation, and whether stigma towards help-seeking (T1) moderates this mediation.Results: Adolescents with more psychosocial problems were more likely to use support in school and were less willing to talk to others about their problems, but the willingness to talk to others was not a mediator. Stigma moderated the relationship between psychosocial problems and willingness to talk to others.Conclusions: Most adolescents with psychosocial problems get support in Dutch secondary school regardless of their willingness to talk to others about their problems. However, perceiving stigma towards help-seeking makes it less likely for someone to talk about their problems.

Evaluating mental health literacy amongst US college students: a cross sectional study

Objective: This study examined levels of mental health literacy amongst US university students, as well as relationships between mental health literacy, help-seeking behaviors, and mental health outcomes. Participants: Three hundred and twenty-six (326) US university students participated in this study online. Methods: Participants filled out questionnaires that assessed their mental health literacy, intentions to seek support, psychological distress, wellbeing, and self-compassion. Results: The mean mental health literacy score was 123.96 (SD = 16.01). Women scored significantly higher than men (p < .01) on mental health literacy. Individuals who had a previous mental disorder diagnosis had significantly higher scores than those with no previous diagnosis (p < .01). A significant positive relationship was found between mental health literacy and self-compassion (p < .01). Conclusions: Our research highlights significant differences between women and men in relation to mental health literacy, psychological distress, and help-seeking behavior. There is a need to design culturally competent interventions that involve diverse students.

Mental health literacy among Arab men living in high-income Western countries: A systematic review and narrative synthesis

While interest in mental health literacy (MHL) is growing rapidly, cross-cultural research focusing on MHL is developing more slowly. This inaugural systematic review explored the recognition and beliefs about the causes of mental health disorders amongst Arab men living in high income Western countries (HIWC), their help-seeking beliefs, behaviors, and sources of help, as well as barriers and facilitators to help-seeking. Six electronic database searches were conducted using Medline, Embase, ProQuest Dissertations & Theses Global, PsycINFO, Scopus, and Web of Science. These searches yielded a total of 9,460 citations. After applying inclusion criteria through both database and manual hand searches, 46 studies were identified. The findings corresponded with four of the socioecological model's five factors: intrapersonal, interpersonal, societal, and institutional. Intrapersonal factors included attributing mental health illness to life and migration stressors, and religious reasons. Interpersonal and societal factors included men favoring informal help-seeking sources as stigma was a barrier to formal help-seeking. Institutional factors around the perceived cultural competence of healthcare professionals and access difficulties were obstacles to seeking formal help. The growth in Arab migration to HIWC highlights the need for culturally tailored care. Research is needed to understand the perspectives of healthcare providers working with Arab men in addition to how men's stigmatizing attitudes are an obstacle to formal help-seeking. Interventions should be designed to address the unique mental health needs of Arab men, recognizing that some explanatory beliefs may not align with current Western models of mental health. Moreover, efforts should be made to integrate men's informal sources of support into treatment planning.

Social support in obsessive-compulsive disorder: The relationships between social support and readiness to change

Social support is widely beneficial for individuals suffering from mental health disorders. Preliminary work suggests that it is influential in the treatment of obsessive-compulsive disorder (OCD), but no studies have investigated the importance of social support as it relates to readiness to change (RTC, a relevant variable in treatment-seeking populations. The present study aimed to investigate this relationship as well as broadly characterize support-seeking experiences in those with OCD. Results indicated that, on average, participants with OCD have positive experiences of sharing their symptoms, that others tend to react well to such sharing, and sharing tends to positively affect one's relationship to their diagnosis. We further found that subjective experience of sharing symptoms and internalized stigma moderately predicts RTC. This study suggests nonprofessional social support may be a practical and impactful adjunct to OCD treatment by influencing motivation to change, though future work is needed to validate this pilot study.

Relationship between mental health literacy and professional psychological help-seeking attitudes in China: a chain mediation model

BACKGROUND

Mental health literacy is considered an important factor in promoting professional psychological help-seeking attitudes. However, it is important to clarify the emotional and behavioral factors that underlie this association. Drawing from the ABC model of attitudes and the Health Disclosure Decision-Making Model, this study aimed to examine the mediating role of psychological help-seeking stigma and distress disclosure in the relationship between mental health literacy and professional psychological help-seeking attitudes.

METHODS

We collected data from 827 participants in seven regions of China (597 female; Mage = 26.019, SD = 5.592 years old) using self-report measures, including the Mental Health Literacy Scale, Questionnaire of Stigma for Seeking Professional Psychological Help, Distress Disclosure Index, and Attitudes Toward Seeking Professional Psychological Help-Short Form. A chain mediation model was built to examine the relationships among mental health literacy, psychological help-seeking stigma, distress disclosure, and professional psychological help-seeking attitudes.

RESULTS

The results of the analyses showed a positive association between mental health literacy and professional psychological help-seeking attitudes, with psychological help-seeking stigma and distress disclosure playing mediating roles in this relationship. Furthermore, even after controlling for participants' age, gender, and education, the chain mediation effect of psychological help-seeking stigma and distress disclosure on the relationship between mental health literacy and professional psychological help-seeking attitudes was observed among the Chinese population.

CONCLUSIONS

These findings underscore the significance of mental health literacy in shaping professional psychological help-seeking attitudes, while emphasizing the need to account for psychological help-seeking stigma and distress disclosure when examining this association. Additionally, the model proposed in this study provides a valuable framework for promoting the utilization of professional mental health services.

Validation and psychometric testing of the Arabic version of the mental health literacy scale among the Saudi Arabian general population

OBJECTIVE

This study aimed to validate the Arabic Version of the Mental Health Literacy Scale (Arabic-MHLS) among the Saudi Arabian general population, assessing its internal consistency, test-retest reliability, and structural validity.

METHODS

A total of 700 Arabic-speaking Saudi adults were randomly selected to complete the electronic questionnaire in May 2023, which generated 544 participants. Data were coded and stored in the ZdataCloud research data collection system database. Test-retest reliability was assessed using a subsample of 48 participants who completed the questionnaire twice, with a one-week interval. Structural validity was examined using confirmatory factor analysis (CFA) and Exploratory Factor Analysis (EFA).

RESULTS

The Arabic-MHLS demonstrated good internal consistency (Cronbach's alpha = 0.87) and test-retest reliability (intraclass correlation coefficient = 0.89). EFA revealed a four-factor model closely resembling the model identified in the Slovenian validation of MHLS, with factor loadings ranging from 0.40 to 0.85. The four factors included knowledge of mental health disorders, knowledge of help-seeking, knowledge of self-help strategies, and knowledge of professional help also showed good internal consistency.

CONCLUSION

The Arabic-MHLS is a valid and reliable tool for assessing mental health literacy in the Saudi Arabian general population. However, further research is needed to refine the measurement tool and understand the complex relationships between mental health literacy and other mental health-related concepts. This will contribute to the development of targeted interventions and policies aimed at improving mental health literacy and promoting mental well-being in the Saudi Arabian population and beyond.

The Role of Interpersonal Communication in Mental Health Literacy Interventions for Young People: A Theoretical Review

School-based mental health literacy (MHL) programs can increase knowledge, reduce stigma, and encourage help-seeking behaviors in school-aged children. Yet, MHL intervention effects are inconsistent and unsustainable over time, and scholars have called for more theoretical work to address these limitations. The purpose of this theoretical review is to investigate how theory is utilized in MHL interventions, explore the interpersonal communication processes integrated in MHL interventions, and uncover the theoretical assumptions made in MHL interventions about interpersonal communication. We identified 27 articles for inclusion and utilized both content and interpretive analyses. Findings suggest that very few MHL interventions are based in theory; interpersonal communication is a central component within MHL programming; and numerous assumptions are made about interpersonal communication within MHL interventions that need to be addressed theoretically and empirically. Accordingly, we recommend that MHL intervention content and delivery practices are grounded in interpersonal communication theory related to disclosure and social support (seeking and provision). Additionally, teaching disclosure and social support skills may be a productive way for MHL interventions to help students build self-efficacy in communication about mental health for themselves and others.

Mental health status of pregnant women during COVID-19 in healthcare centers of Iran: A cross-sectional study

BACKGROUND AND OBJECTIVE

The COVID-19 pandemic impacted every single aspect of life. In addition to being a public health emergency, the COVID-19 outbreak impacted the mental health of individuals, especially pregnant women. This study aimed to examine the mental health status of pregnant women and also the effect of sociodemographic factors on their mental health status during COVID-19 in healthcare centers of Iran.

METHODS

This cross-sectional, analytical-descriptive study was conducted among pregnant women referring to healthcare centers in Shoushtar, Iran, in 2021. Multistage cluster sampling was used to select participants. Data were collected using the General Health Questionnaire-28 (GHQ-28). Data were analyzed using SPSS software version 22. The Pearson correlation coefficient was used to examine the association between quantitative variables. A generalized linear model (GLM) was applied to estimate the effect of independent variables on the dependent variable (mental health).

RESULTS

A total of 197 participants with a mean ± SD age of 27.85 ± 6.37 years took part in this study. The total mean score of mental health was estimated at 17.47±8.20. The highest mean ± SD score was, respectively, related to social dysfunction (6.63 ± 2.86), anxiety and insomnia (5.28 ± 3.53), and somatic symptoms (4.17 ± 3.27). Mental health disorder was significantly correlated with participants' age (R = .223, P = .00), number of pregnancy (gravida) (R = .272, P = .00), number of births (para) (R = 0.272, P = .00), and number of abortions (R = .172, P = .015). About 80% of pregnant women did not reveal impaired mental health conditions or psychological distress, while 19.3% showed scores that indicate probable mental health conditions.

CONCLUSION

Social dysfunction was the most common mental health problem among pregnant women. It is necessary to pay more attention to the mental health status of pregnant women during a pandemic. Interventions such as practical strategies to promote social support and improve pregnant women's mental health during pregnancy are highly important.

Helpful elements in a brief work-oriented intervention targeting musculoskeletal and mental health literacy

Musculoskeletal and mental health complaints are common in the general population and frequent reasons for healthcare utilization and work absence. Illness perceptions, coping expectancies, rumination and self-stigma are important factors in the management of these health complaints and factors closely linked to health literacy (HL). The aims of the study were to identify helpful elements in a brief intervention (BI) targeting HL regarding common musculoskeletal and mental health complaints and to identify patient perceptions of how the intervention was helpful and whether it affected their subsequent coping. Three focus group interviews with 14 patients were conducted. Systematic text condensation was used for the analysis, supported by the health literacy skill (HLS) framework to sharpen the focus on intervention elements related to the acquisition and utilization of HLSs. Results revealed the importance of receiving comprehensible health information and guidance, the use of metaphors to create recognizable narratives and the use of practical examples and exercises. Normalizing the experienced health complaints, together with a safe and accommodating clinical environment, facilitated the change process. The BI initiated processes that contributed to acceptance, resilience and empowerment, aiding work-life balance and return to work. The study presents authentic narratives of value for future focus in BI.

Attitudes and intentions toward seeking professional psychological help among Chinese healthcare workers during the COVID-19 pandemic

Background

It has been suggested that healthcare workers (HCWs) are experiencing massive stressors that threaten their mental health during the COVID-19 pandemic, but little is known about their attitudes and intentions toward seeking professional psychological help. This study aimed to investigate the attitudes and intentions of Chinese HCWs toward seeking professional psychological help during the COVID-19 pandemic and the associated factors.

Methods

A total of 1,224 Chinese HCWs working in hospitals were recruited online from 12 hospitals in Hunan province in China for a survey conducted in November 2022. The Chinese version of the attitudes toward seeking professional psychological help scale-short form (ATSPPH-SF) and the general help-seeking questionnaire (GHSQ) were separately used to assess the attitudes and intentions of the respondents toward seeking professional psychological help. Demographic and socio-psychological data were collected using a self-developed questionnaire, the perceived social support scale, the self-stigma of seeking help scale, and the patient health questionnaire-9 scale.

Results

The 1,208 HCWs in the final analysis showed relatively negative attitudes and low intentions toward seeking professional psychological help during the COVID-19 pandemic. Results of the multiple linear regression analysis showed that female sex (p = 0.031), experience of psychological learning (p < 0.001), and social support (p < 0.001) had a positive predictive effect on the attitudes of these HCWs toward seeking professional psychological help, whereas self-stigma of seeking help (p < 0.001) and depressive symptoms (p < 0.001) exerted negative effects. Moreover, experience of psychological learning (p = 0.004) and social support (p < 0.001) had a positive predictive effect on the intentions of these HCWs toward seeking professional psychological help, whereas divorced marital status (p = 0.011) and self-stigma of seeking help (p < 0.001) exerted negative effects.

Conclusion

The overall attitudes and intentions of HCWs toward seeking professional psychological help were not optimistic. Effective interventions targeted at influencing factors should be formulated to promote the professional psychological help-seeking attitudes and intentions of HCWs who are at risk of developing mental health problems.

Perceived Stress and Mental Health Literacy Among Chinese Preschool Teachers: A Moderated Mediation Model of Anxiety and Career Resilience

Purpose

Chinese public mental health is currently characterized by a high prevalence of mental ill health and a low consultation rate, due primarily to the nation's low mental health literacy. Previous studies have shown that occupational stress may be a risk factor for mental health literacy. In China, preschool teachers are under high pressure; however, few studies have examined the mechanisms that mediate and moderate the relationship between preschool teachers' feelings of stress and their mental health literacy.

Methods

A questionnaire was administered to 2352 preschool teachers to explore the relationship between their stress perceptions and mental health literacy.

Results

Preschool teachers' perceived stress was significantly and negatively associated with their mental health literacy, with anxiety playing a partially mediating role. Preschool teachers' career resilience moderated the relationship between perceived stress and anxiety. Perceived stress positively predicted anxiety for teachers with low levels of career resilience; for teachers with high levels of career resilience, perceived stress still positively predicted anxiety, and the higher the level of career resilience, the weaker the positive prediction of stress perception on anxiety.

Conclusion

Perceived stress directly predicted mental health literacy among preschool teachers, and also indirectly predicted mental health literacy through the mediating role of anxiety. Career resilience moderated the relationship between stress perception and anxiety. These findings provide new perspectives on the treatment and prevention of preschool teachers' mental ill health.

Caregiver and care recipient health literacy, social support and connectedness on caregiver psychological morbidity: A cross-sectional dyad survey

BACKGROUND

Caregivers play an important role supporting people diagnosed with cancer, yet report significant unmet information and support needs that impact on their psychological wellbeing. Health literacy and social connectedness are key factors that influence wellbeing, yet few studies have examined their relative role in psychological wellbeing of carers. This study investigated relationships between caregiver and care recipient health literacy, social support, and social connectedness on psychological morbidity in a cancer setting.

METHODS

This cross-sectional study included 125 caregiver-cancer care recipient dyads. Participants completed the Health Literacy Survey-EU-Q16, Social Connectedness Scale-Revised, the Medical Outcomes Study-Social Support Survey, and the Depression, Anxiety and Stress Scale-21 (DASS21). Relationships between factors were examined using hierarchical multiple regression with care recipient factors entered at Step 1 and caregiver factors at Step 2.

RESULTS

Most caregivers provided care for their spouse (69.6%); caregivers mean total DASS21 score was 24.38 (SD = 22.48). Mean DASS21 subscale scores for depression, anxiety, stress in caregivers were 4.02 (SD = 4.07), 2.7 (SD = 3.64), and 5.48 (SD = 4.24) respectively, suggesting normal range of depression and stress, and mild anxiety. Care recipients had a diagnosis of breast (46.4%), gastrointestinal (32.8%), lung (13.6%), or genitourinary (7.2%) cancer, and a mean DASS21 score of 31.95 (SD = 20.99). Mean DASS21 subscale scores for depression, anxiety, stress in care recipients were 5.10 (SD = 4.18), 4.26 (SD = 3.65), and 6.62 (SD = 3.99) respectively, suggesting mild depression and anxiety, and normal stress scores. Regression analyses showed that only caregiver factors (age, illness/disability, health literacy and social connectedness) were independent predictors of caregiver psychological morbidity (F [10,114] = 18.07, p < 0.001).

CONCLUSION(S)

Only caregiver, and not care recipient, factors were found to influence caregiver psychological morbidity. While both health literacy and social connectedness influenced caregiver psychological morbidity, perceived social connectedness had the strongest influence. Interventions that ensure caregivers have adequate health literacy skills, as well as understand the value of social connection when providing care, and are supported to develop skills to seek support, have the potential to promote optimal psychological wellbeing in cancer caregivers.

Evaluation of an online suicide prevention program to improve suicide literacy and to reduce suicide stigma: A mixed methods study

Low-threshold e-health approaches in prevention to reduce suicide stigma are scarce. We developed an online program containing video reports on lived experience of suicide and evidence-based information on suicidality. We evaluated the program by a mixed methods design. We examined pre-post-changes of program completers (n = 268) in suicide literacy, suicide stigma (self and perceived), and self-efficacy expectation of being able to seek support in psychologically difficult situations using linear mixed models. To examine reported changes and helpful program elements 12-26 weeks after program completion, we content analyzed transcripts of telephone interviews (n = 16). Program completers showed more suicide literacy (Cohen's d = .74; p < .001), higher self-efficacy expectations to seek support (d = .09; p < .01), lower self-stigma (subscales glorification/normalization: d = -.13, p = .04; isolation/depression: d = -.14; p = .04; stigma: d = -.10; p = .07; n = 168) compared to baseline. We found no significant differences in perceived suicide stigma. We identified lived experience reports, the possibility of sharing own narrative on stigma and suicidality, and information on support as helpful elements. The current online program can increase suicide literacy and self-efficacy expectations to seek support and reduce self-stigma. We recommend a larger randomized controlled trial with longer follow-up to confirm these findings.

Mental Health Literacy and Stigma in a Municipality in the North of Portugal: A Cross-Sectional Study

Portugal has Europe's second-highest prevalence of psychiatric illnesses, and this is the reason why mental health literacy (MHL) and stigma should be addressed. This study aimed to investigate the mental health literacy and stigma levels among different groups of people from Póvoa de Varzim, a municipality in the north of Portugal. Students, retired people, and professionals (education, social, and healthcare fields) were recruited using a convenience sample from June to November 2022. Participants' MHL levels were evaluated using the Mental Health Promoting Knowledge Scale (MHPK), Mental Health Literacy Measure (MHLM) and Mental Health Knowledge Schedule (MAKS). Stigma levels were evaluated using Community Attitudes towards Mental Illness (CAMI) and the Reported and Intended Behaviour Scale (RIBS). A total of 928 questionnaires were filed. The respondents included 65.70% of women, a mean age of 43.63 (±26.71) years and 9.87 (±4.39) years of school education. MHL increased with age, education level and was higher in women (p < 0.001). A higher level of MHL was seen in health professionals (p < 0.001). Findings revealed that older people stigmatized people with mental illness more (p < 0.001), and the female gender stigmatize less (p < 0.001). In addition, results showed that stigma decreased with higher mental health literacy (r between 0.11 and 0.38; p < 0.001). To conclude, specific campaigns that promote mental health literacy should be tailored to specific profiles within this population to address those that have more stigma.

Chinese college students' help-seeking behavior: An application of the modified theory of planned behavior

Chinese college students have a high incidence of psychological problems but rarely seek professional psychological help. Despite this fact, there have been few studies of the help-seeking behavior of Chinese college students with mental health problems. This research aims to use a modified model based on the theory of planned behavior (TPB) to explore the intentions and behaviors of Chinese college students with psychological problems in seeking professional psychological help. A total of 319 Chinese college students were recruited to measure attitude, stigma, coping efficiency, help-seeking intention, help-seeking behavior, and demographic variables. The results showed that attitudes were the most powerful predictor of intentions to seek help, followed by coping effectiveness and stigma. In addition, a multigroup analysis showed that the model was valid across genders. Our research results show that the TPB-based model can effectively explain the intentions and behaviors of college students with psychological problems in seeking professional help. Using our results, families, schools, and society could design intervention measures to enhance students' help-seeking intentions and behaviors.

Surviving Child Abuse in People With Mental Illness: A Grounded Theory Approach

The aim of this qualitative study was to examine the process of surviving child abuse in people with a mental illness in order to develop an explanatory theory. The study utilized the grounded theory approach. Seventeen community-dwelling adults with a mental illness who had experienced child abuse were interviewed. For the in-depth interview, the lifeline interview method was used. Data were collected from July 14, 2019, to February 28, 2020. The constant comparative method was used for analysis, to identify similarities and differences between different statements, and similar phenomena or theories were compared and analyzed continuously. The central phenomena were "losing oneself" and "in a precarious state." Participants used "expressing," "standing on one's own feet," and "avoiding" as coping strategies. Observed outcomes were "making life work for them" and "living with others." The core category was "losing myself, embracing myself as someone in a precarious state, and being reborn as the master of my life." Positive religious coping, having a supportive network, and emotional or physical distance from difficult situations played a major role in surviving participants' experiences of child abuse and being victimized because of their mental illness. Our findings provide a theoretical basis for understanding people with mental illness who have survived child abuse, and suggest that opportunities for sharing their stories, facilitating self-reliance, and avoiding the causes of their difficulties all play a role in their healing process. Based on this study, it is expected that clinical experts and policy developers will be able to formulate evidence-based interventions and policies.

Mental Health Stigma Among Generation Z Students in Salafi Islamic Boarding Schools

Salafi Islamic boarding schools adhering to traditional religious learning can potentially create mental health issues. The mental health problems often experienced by Generation Z students in Islamic boarding schools potentially led to the emergence of stigma. This study aims to describe mental health stigma among Generation Z students in Salafi Islamic boarding schools. It used a quantitative design and a survey approach. The population was Generation Z students in Salafi Islamic boarding schools. Furthermore, there were 155 samples by stratified random sampling. This study was carried out in 3 boarding schools in Bantur District, Malang Regency, from January to February 2022. The variable was mental health stigma. The data were collected by distributing a questionnaire to Generation Z students at Salafi Islamic boarding schools in the Bantur District. The questionnaire used the Peer Mental Health Stigmatization Scale (PMHSS). The PMHSS consisted of 2 indicators: Stigma agreement (self-stigma) and stigma awareness (social stigma). Data analysis used median and percentile values because the data was not normally distributed. Normality test used Kolmogorov-Smirnov using SPSS Statistics 25. The results showed that social stigma had a median value of 40, self-stigma had 40, and overall mental health stigma had 80. In conclusion, Generation Z students in the Salafi Islamic boarding schools had a high mental health stigma. Therefore, efforts to reduce and prevent the Stigma in Salafi Islamic boarding schools through a technology-centered approach and cross-sectorial collaboration with Public Health Center or health workers are crucial.

Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic

BACKGROUND

Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms.

METHOD

The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic.

RESULTS

More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship.

CONCLUSION

Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.

Further Examination of the Psychometric Properties of the Multicomponent Mental Health Literacy Scale: Evidence from Chinese Elite Athletes

This study aimed to examine the psychometric properties of the Multicomponent Mental Health Literacy Scale (MMHLS) among Chinese elite athletes. Particularly, the factorial validity, convergent validity, discriminant validity, concurrent validity, internal-consistency reliability, and test-retest reliability of the MMHLS were examined. A total of 320 participants were recruited from the Guangdong provincial sports training center in China. Data collection was conducted between 30 June and 31 July 2020 using electronic questionnaires. Confirmatory factor analysis (CFA), Rasch analysis, correlation analysis and independent-sample t-tests were conducted using Mplus 8.3 and ConQuest 2.0. The CFA results supported the factorial validity of the three-dimensional MMHLS, consisting of knowledge-oriented MHL, beliefs-oriented MHL, and resource-oriented MHL. Cronbach's alpha and composite reliability coefficients supported the internal-consistency reliability of the MMHLS. Moreover, the convergent and discriminant validities were supported for the subdimension of MHL-Knowledge, MHL-Beliefs, and MHL-Resources. Concurrent validity was demonstrated through correlations between MMHLS, help-seeking attitudes, and stigma. Rasch analysis provided further evidence of the psychometric quality of the instrument in terms of its dimensionality, item fit statistics, and rating scale effectiveness. Finally, test-retest reliability was 0.66 after one month. In conclusion, the 24-item three-dimensional MMHLS was verified to be a reliable and valid measurement of mental health literacy in Chinese elite athletes.

Investigation of the relationship between mental health literacy of adults and attitude towards seeking psychological help and stigma by the immediate environment

PURPOSE

This study aims to examine the relationship between mental health literacy and attitudes toward psychological help-seeking and stigma by the immediate environment.

DESIGN AND METHODS

This descriptive and cross-sectional research was conducted with 352 parents in 2021.

FINDINGS

It was observed that there was a significant positive relationship between mental health literacy level and attitude toward psychological help-seeking. There was a negative relationship between mental health literacy level and stigma by the immediate environment.

PRACTICE IMPLICATIONS

The results point to the need for interventions to improve mental health literacy in society.

Exploring the Factors Associated with Mental Health Attitude in China: A Structural Topic Modeling Approach

Mental health attitude has huge impacts on the improvement of mental health. In response to the ongoing damage the COVID-19 pandemic caused to the mental health of the Chinese people, this study aims to explore the factors associated with mental health attitude in China. To this end, we extract the key topics in mental health-related microblogs on Weibo, the Chinese equivalent of Twitter, using the structural topic modeling (STM) approach. An interaction term of sentiment polarity and time is put into the STM model to track the evolution of public sentiment towards the key topics over time. Through an in-depth analysis of 146,625 Weibo posts, this study captures 12 topics that are, in turn, classified into four factors as stigma (n = 54,559, 37.21%), mental health literacy (n = 32,199, 21.96%), public promotion (n = 30,747, 20.97%), and social support (n = 29,120, 19.86%). The results show that stigma is the primary factor inducing negative mental health attitudes in China as none of the topics related to this factor are considered positive. Mental health literacy, public promotion, and social support are the factors that could enhance positive attitudes towards mental health, since most of the topics related to these factors are identified as positive ones. The provision of tailored strategies for each of these factors could potentially improve the mental health attitudes of the Chinese people.

Examining causal attributions for depression, alcohol use disorder, and schizophrenia in a diverse sample of international students at U.S. universities

ObjectivesInternational students face increased vulnerability for mental health challenges, but underutilize counseling compared to their domestic peers. We examined beliefs regarding the causes of mental illness, known as attributions, which may impact treatment-seeking and stigma. Participants: Surveys were collected from 680 international students at U.S. universities. Methods: We sent invitations to a computer-based survey disseminated via international student email lists. The survey explored mental health attributions for depression, alcohol use disorder, and schizophrenia. Results: Attributions differed significantly by disorder. Depression and alcohol use were attributed to social stress and perceived as controllable and influenced by personal weakness and lifestyle choices. Schizophrenia was often attributed to hereditary/biological causes. Differences also emerged based on the participants' acculturation, region of origin, and religiosity. Conclusions: Attributions influence perceptions of mental illness and may lead to stigma. Providers should incorporate discussions of attribution in student outreach and counseling to address potential impacts on care-seeking.

Evaluating the Therapeutic Alliance With a Free-Text CBT Conversational Agent (Wysa): A Mixed-Methods Study

The present study aims to examine whether users perceive a therapeutic alliance with an AI conversational agent (Wysa) and observe changes in the t‘herapeutic alliance over a brief time period. A sample of users who screened positively on the PHQ-4 for anxiety or depression symptoms (N = 1,205) of the digital mental health application (app) Wysa were administered the WAI-SR within 5 days of installing the app and gave a second assessment on the same measure after 3 days (N = 226). The anonymised transcripts of user's conversations with Wysa were also examined through content analysis for unprompted elements of bonding between the user and Wysa (N = 950). Within 5 days of initial app use, the mean WAI-SR score was 3.64 (SD 0.81) and the mean bond subscale score was 3.98 (SD 0.94). Three days later, the mean WAI-SR score increased to 3.75 (SD 0.80) and the mean bond subscale score increased to 4.05 (SD 0.91). There was no significant difference in the alliance scores between Assessment 1 and Assessment 2.These mean bond subscale scores were found to be comparable to the scores obtained in recent literature on traditional, outpatient-individual CBT, internet CBT and group CBT. Content analysis of the transcripts of user conversations with the CA (Wysa) also revealed elements of bonding such as gratitude, self-disclosed impact, and personification. The user's therapeutic alliance scores improved over time and were comparable to ratings from previous studies on alliance in human-delivered face-to-face psychotherapy with clinical populations. This study provides critical support for the utilization of digital mental health services, based on the evidence of the establishment of an alliance.

Evaluation of beliefs and attitudes among caregivers of child labor about mental disorders first aid and stigma

BACKGROUND

The beliefs and attitudes of caregivers of working children about mental health issues and first aid and their attitudes about the stigma of mental health problems can affect their motivation to seek professional help for affected children. This study aimed to assess the mental health literacy among caregivers of child labor about first aid for mental health and their attitudes about the stigma of mental disorders.

METHODS

The Depression Health Literacy Questionnaire has been used in this cross-sectional study. All caregivers of working children who were willing to participate were included in the study. This group is covered by a Non-Governmental Organization (NGO) located in the 17th district of Tehran.

RESULTS

Questionnaires completed by 131 caregivers were analyzed. The average age of the participants was 32.6 (± 7.9) years. Of which 130 (99.2%) were mothers. Amongst, only 37 individuals (28.2%) were confident in their ability to help their children in case of depression symptoms. A majority of participants, 109 (83.2%), believed that asking a depressed child about suicidal ideation was harmful.

CONCLUSION

According to the findings of this study, the literacy among caregivers of child labor about mental health first aid in our study needs to be improved. There is also a need for educational and community-based programs to reduce the stigma about mental health disorders, including depression.

Worker and manager perceptions of the utility of work-related mental health literacy programmes delivered by community organisations: a qualitative study based on the theory of planned behaviour

OBJECTIVES

Reluctance to seek help is a leading contributor to escalating mental injury rates in Australian workplaces. We explored the benefit of using community organisations to deliver mental health literacy programmes to overcome workplace barriers to help-seeking behaviours.

DESIGN

This study used a qualitative application of the theory of planned behaviour to examine underlying beliefs that may influence worker's intentions to participate in mental health literacy programmes delivered by community organisations and manager support for them.

SETTING

This study took place within three large white-collar organisations in the Australian state of Victoria.

PARTICIPANTS

Eighteen workers and 11 managers (n=29) were interviewed to explore perspectives of the benefits of such an approach.

RESULTS

Community organisations have six attributes that make them suitable as an alternative mental health literacy programme provider including empathy, safety, relatability, trustworthiness, social support and inclusivity. Behavioural beliefs included accessibility, understanding and objectivity. The lack of suitability and legitimacy due to poor governance and leadership was disadvantages. Normative beliefs were that family and friends would most likely approve, while line managers and colleagues were viewed as most likely to disapprove. Control beliefs indicated that endorsements from relevant bodies were facilitators of participation. Distance/time constraints and the lack of skills, training and lived experiences of coordinators/facilitators were seen as barriers.

CONCLUSIONS

Identifying workers' beliefs and perceptions of community organisations has significant implication for the development of effective community-based strategies to improve worker mental health literacy and help seeking. Organisations with formal governance structures, allied with government, peak bodies and work-related mental health organisations would be most suitable. Approaches should focus on lived experience and be delivered by qualified facilitators. Promoting supervisor and colleague support could improve participation. Models to guide cross-sector collaborations to equip community organisations to deliver work-related mental health literacy programmes need to be explored.

How Social Support Impact Teachers' Mental Health Literacy: A Chain Mediation Model

Teachers have an important social role, and their mental health literacy is very important to their own abilities as educators and to the growth and development of those they educate. This study explored the mechanism underlying the influence of social support on teachers' mental health literacy by conducting a questionnaire survey of 573 teachers. The results showed that social support can influence teachers' mental health literacy not only through the separate effects of life satisfaction and coping tendency but also through the chain mediation effect of life satisfaction and coping tendency; however, the direct effect of social support on the teachers' mental health literacy is not significant. This study is conducive to understanding the internal mechanism underlying the relationship between social support and mental health literacy. It reminded us that when formulating mental health literacy promotion programs for teachers, we should not only provide adequate social support to improve but also should pay attention to improvements in their coping tendencies and life satisfaction.

Why Is It Difficult for Social Network Members to Support People Living with Mental Illnesses?: Linking Mental Illness Uncertainty to Support Provision

For people living with mental illness, support from social network members, including family, romantic partners, and friends, is critical but often inadequate. However, robust theoretical explanations for why it might it be difficult to support people living with mental illness are lacking. We assessed an appraisal-based model of uncertainty, hypothesizing that fear and anxiety and supportive communication efficacy mediate the association between mental illness uncertainty and support provision (i.e., quantity and quality). We also predicted that perceptions of others' communication about their mental illness (i.e., ambiguity and volume) would exacerbate feelings of fear and anxiety in relation to uncertainty. Analyses of data gathered from 300 individuals across the United States (Mage = 34.07, SD = 9.49; 50% female) supported our central prediction; uncertainty had a negative direct or indirect effect on all support types and overall support quality, partly through decreases in supportive communication efficacy. Counter to predictions, fear and anxiety positively predicted support quantity for all types. Findings of this study point to a difficult situation for social network members: although uncertainty seems to motivate support provision by activating fear and anxiety, this effect could be undermined for forms of support that require complex communication skills (e.g., emotional, esteem, overall quality) through corresponding decreases in supportive communication efficacy. We discuss the theoretical and practical implications of this research for social support and relationships within the context of mental illness.

Slovenian Validation of the Mental Health Literacy Scale (S-MHLS) on the General Population: A Four-Factor Model

The aim of the present validation study is to determine the psychometric properties of the Slovenian version of the Mental Health Literacy Scale. For this purpose, the factorial structure, internal consistency, cross-cultural, convergent and discriminant validity were assessed. The measure was translated and adapted to Slovenian context through a blind back-translation process. It was applied to a representative sample of the Slovenian adult population via an online research panel. A total of 1189 participants (598 women), aged between 18 and 95 years (M = 46.7, SD = 16.2) completed the survey. Confirmatory and exploratory factor analyses, reliability analyses, hypothesis testing, and correlational analyses were conducted. The analyses rejected a hypothesised unidimensional model and demonstrated that a four-factor model with 27 items was the most theoretically and psychometrically adequate. The Slovenian version of Mental Health Literacy Scale (S-MHLS) consists of the following factors: (1) Attitudes Towards People With Mental Health Problems, (2) General Attitudes Towards Mental Health Problems and Help-Seeking, (3) Recognition of Mental Health Disorders and (4) Knowledge About Seeking Mental Health Information. The factors have adequate construct validity and internal consistency, which is also adequate for the entire S-MHLS. However, a decreased scope of the content might result in an inadequate representation of the construct of mental health literacy. In addition, the psychometric interpretation of the MHLS varies widely in validation studies across different linguistic contexts. Therefore, we propose a further improvement of the instrument with a psychometrically and theoretically sound multifactorial structure that demonstrates strong cross-cultural validity.

A Structural Equation Modeling of Mental Health Literacy in Healthcare Students

Background: There is a high prevalence of mental illness among healthcare students, and most students with mental health problems are reluctant to seek help from mental health professionals. Help-seeking is a component of mental health literacy (MHL). Although MHL is conceptualized as multi-dimensional, a theory-based multi-construct of MHL is still lacking. We aimed to build a theory-based multi-construct of MHL to explore the pathways of help-seeking. Methods: The data were obtained from a survey on MHL among healthcare students in 2018 (n = 1294). The Mental Health Literacy Scale for Healthcare Students was used to measure the maintenance of positive mental health, recognition of mental illness, mental illness stigma attitudes, help-seeking efficacy, and help-seeking attitudes. Descriptive analysis and structural equation modeling (SEM) were conducted. Results: The findings of the SEM model indicated recognition of mental illness had a positive direct effect on both help-seeking efficacy and maintenance of positive mental health. Additionally, help-seeking efficacy fully mediated the relationship between recognition of mental illness and help-seeking attitudes. Conclusions: Help-seeking efficacy plays a significant role in healthcare students' willingness to seek professional help when mental health care is needed. Accordingly, improving help-seeking efficacy strategies would increase the use of mental health services and contribute to the prevention of mental health problems.

Stress of COVID-19, Anxiety, Economic Insecurity, and Mental Health Literacy: A Structural Equation Modeling Approach

The COVID-19 pandemic is currently a global health threat attributed to negatively affecting the mental health and well-being of people globally. The purpose of the current study is to examine the mediating roles of economic insecurity and mental health literacy in the relationship between stress about COVID-19 and anxiety. Results from the current study using a large sample of Chinese college students (N = 1,334) showed that stress of COVID-19 was positively associated with economic insecurity and anxiety while negatively associated with mental health literacy, which in turn was negatively associated with anxiety. These results elucidate our understanding of the role of mediators in stress about COVID-19 and anxiety. The findings are useful in terms of providing evidence for tailoring interventions and implementing preventative approaches to mitigate anxiety due to stress of COVID-19. Based on the present findings and within the context of COVID-19, the potential utility of promoting MHL to reduce the psychopathological consequences of COVID-19 is discussed.

Global research activity on mental health literacy

Background

Evidence showed that mental health literacy reduces stigma and promotes help-seeking intentions. This study provides a bibliometric analysis of global research activity on mental health literacy. A bibliometric method was applied using Scopus. The term “mental health literacy” was searched in the title, abstract, and author keywords for the study period from 1900 to 2019. Conventional bibliometric indicators and mapping were generated.

Results

The search query found 945 documents. The earliest documents were published in 1997. The retrieved documents received an average of 25.3 citations per document and an h-index of 67. Authors from 68 different countries participated in publishing the retrieved documents. Australia ranked first (n=354, 37.5%) followed distantly by the USA (n=172, 18.2%). In total, 362 different journals participated in publishing the retrieved documents. The Australian and New Zealand Journal of Psychiatry (n=43, 11.8%) ranked first followed by the BMC Psychiatry (n=40, 11.0%). Documents published in the BMC Psychiatry journal received the highest number (60.4) of citations per document. In total, 3906 authors participated in publishing the retrieved documents. The average number of authors per document was 4.1. Jorm, A.F ranked first (n=96, 10.2%). Data analysis indicated that the University of Melbourne (n=136, 14.1%) ranked first in the number of publications.

Conclusions

Literature on “mental health literacy” is growing rapidly mainly in high-income countries. Research collaboration between active countries and low- and middle-income countries is important since many developing countries lack expertise and the infrastructure for mental health literacy research.

Intentions to Seek Mental Health Services During the COVID-19 Pandemic Among Chinese Pregnant Women With Probable Depression or Anxiety: Cross-sectional, Web-Based Survey Study

BACKGROUND

Mental health problems are prevalent among pregnant women, and it is expected that their mental health will worsen during the COVID-19 pandemic. Furthermore, the underutilization of mental health services among pregnant women has been widely documented.

OBJECTIVE

We aimed to identify factors that are associated with pregnant women's intentions to seek mental health services. We specifically assessed pregnant women who were at risk of mental health problems in mainland China.

METHODS

A web-based survey was conducted from February to March, 2020 among 19,515 pregnant women who were recruited from maternal health care centers across various regions of China. A subsample of 6248 pregnant women with probable depression (ie, those with a score of ≥10 on the 9-item Patient Health Questionnaire) or anxiety (ie, those with a score of ≥5 on the 7-item General Anxiety Disorder Scale) was included in our analysis.

RESULTS

More than half (3292/6248, 52.7%) of the participants reported that they did not need mental health services. Furthermore, 28.3% (1770/6248) of participants felt that they needed mental health services, but had no intentions of seeking help, and only 19% (1186/6248) felt that they needed mental health services and had intentions of seek help. The results from our multivariate logistic regression analysis showed that age, education level, and gestational age were factors of not seeking help. However, COVID-19-related lockdowns in participants' cities of residence, social support during the COVID-19 pandemic, and trust in health care providers were protective factors of participants' intentions to seek help from mental health services.

CONCLUSIONS

Interventions that promote seeking help for mental health problems among pregnant women should also promote social support from health care providers and trust between pregnant women and their care providers.

Suicide literacy and suicide stigma - results of a population survey from Germany

BACKGROUND

While a growing number of studies analyze the magnitude and predictors of mental health literacy, little is known about suicide-specific knowledge and beliefs ("suicide literacy").

AIMS

To examine suicide literacy among the German population and to investigate associations between suicide literacy and suicide stigma.

METHODS

Telephone interviews were conducted in Germany (N = 2002, response rate: 47.3%). The literacy of suicide scale (LOSS-SF) was used covering the knowledge domains "signs," "risk factors," "causes/nature" and "treatment/prevention." In multiple regression analyses, associations between the LOSS-SF and the three dimensions "stigma," "normalization/glorification," and "depression/isolation" of the stigma of suicide scale (SOSS-SF) were examined controlling for several covariates.

RESULTS

Respondents showed most knowledge concerning "treatment and prevention" (>80% correct answers). Lower suicide literacy was found in the domains "risk factors" (33-60% correct answers) and "signs for suicidal ideation" (45-53%). Suicide literacy was negatively associated with age, while it was positively associated with education, own affliction, and personal contact. Moreover, suicide literacy showed negative associations with all three dimensions of the SOSS-SF.

CONCLUSIONS

There are deficits in suicide literacy in the German public that may increase suicide stigma. Addressing those deficits in information-campaigns and encouraging personal contact could help decrease suicide stigma.

A Matched Control Trial of a Mental Health Literacy Intervention for Parents in Community Sports Clubs

This controlled trial evaluated the effectiveness of a mental health literacy intervention for parents delivered through community sport clubs. In total, 540 parents (321 females, 219 males) of adolescent athletes participated in a brief educational workshop on youth mental health (n = 352) or a community-matched control group (n = 188). Generalised linear mixed models revealed no significant improvements in the intervention group compared to control in the primary mental health literacy outcomes, at 1 month follow-up. However, parents in the intervention group were more likely to seek formal help for themselves, had increased confidence and knowledge to help someone experiencing a mental health disorder, experienced reduced psychological distress, and perceived more support from other parents in their sport club, relative to the control group. Overall, the findings suggest that a brief educational intervention delivered through community sports clubs can positively affect some components of parents' mental health literacy.

Mental health literacy at the public health level in low and middle income countries: An exploratory mixed methods study in Vietnam

PURPOSE

Mental health literacy (MHL) is key for mental health development, particularly in low-and-middle-income countries (LMIC) where mental health resources are limited. MHL development can be thought of as occurring at two levels: the individual person level (via direct contact, with specifically-targeted individuals), and the public health level (via indirect contact through public media, targeting the general public). Each approach has advantages and disadvantages.

METHODS

The present mixed methods study assessed the status of and best approaches for development of mental health literacy in the Southeast Asian LMIC Vietnam. Because there has been relatively little discussion of MHL development at the public health level, this assessment focused on the public health level, although not exclusively. Because mental health professionals generally have the most in-depth understanding of their mental health system, study participants were 82 Vietnamese mental health professionals who completed a quantitative survey, with 48 participating in focus groups.

RESULTS

Most of the professionals viewed MHL in Vietnam as low or very low, and that it was difficult or very difficult for the general public to find effective mental health services. Main barriers underlying these problems and more generally for developing MHL in Vietnam identified in the focus groups were: (a) misinformation in the media regarding mental health and mental illness; (b) lack of licensure for non-medical mental health professionals (e.g., psychologists; social workers); (c) lack of interest in mental health from upper-level leadership.

CONCLUSIONS

To the best of our knowledge, this is the first study assessing professionals' perceptions regarding mental health literacy at both the public health and individual-person levels. Although sampling was restricted to Vietnamese professionals, results may provide initial preliminary guidance for other LMIC considering mental health literacy development at multiple levels.

The Behavioral Model of Health: Education, Behavioral Health Factors, and Stigma as Predictors of Help-Seeking Attitudes

Per the behavioral model of health, help-seeking attitudes (and even behavioral health service use) are a function of predisposing and enabling individual characteristics (e.g. demographic characteristics, health beliefs), as well as contextual characteristics (resources, social structures such as education etc.). While researchers have examined how demographic (gender and ethnicity) and socioeconomic (education and income) characteristics, psychological factors, and internal barriers relate to help-seeking attitudes, the majority of these works have investigated how different variables independently act on help-seeking attitudes in lieu of more comprehensively investigating how they operate in tandem. The purpose of the current study was to examine how demographic (gender and ethnicity) and socioeconomic (education and income) characteristics, behavioral health factors, and internal barriers relate to help-seeking attitudes in a diverse sample of primary care patients. We also sought to examine differences in demographic and socioeconomic characteristics in mental health literacy, stigma, and help-seeking attitudes. Participants were 286 primary care patients. Results from this study indicate that a combination of socioeconomic characteristics (i.e. education), behavioral health factors (level of distress and history of behavioral health service utilization), and internal barriers (personal stigma) predicted help-seeking attitudes among primary care patients. There was an inverse relationship between education and personal stigma and help-seeking attitudes such that higher levels of education and higher levels of personal stigma were associated with more negative help-seeking attitudes.