Measuring mental health literacy – a review of scale-based measures

Low mental health literacy is associated with depression and anxiety among adults: a population-based survey of 16,715 adults in China

BACKGROUND

Mental health literacy is a predictor of health outcomes in psychological distress. However, limited research has explored whether low mental health literacy is associated with recent depression and anxiety.

METHODS

We used data from the Guangdong Mental Health Survey, a provincial representative and a population-based survey with a multistage stratified cluster random sampling method. We included adults aged 18 and above living in communities from September to December 2021 in Guangdong, China. Eligible participants were those who completed the mental health literacy questionnaire and assessments for depression and anxiety symptoms. We assessed the proportion of individuals with low mental health literacy by categories of psychological symptoms and whether low mental health literacy was associated with depressive and anxiety symptoms in the general population and subgroups.

RESULTS

A total of 16,715 adults were included. We found that individuals with more severe symptoms had a greater proportion of low mental health literacy- it went from 89.4% in participants without depression or anxiety to 96.2% in people who co-occurred with depression and anxiety (x2 = 21.457, P < 0.001). After controlling confounders, low mental health literacy was associated with depression (adjusted Odds Ratio, aOR [95%CI]:2.74 [1.92-4.04]) and anxiety (2.27 [1.49-3.64]) in the total sample, when compared with adequate mental health literacy.

CONCLUSIONS

This study found a positive association between low mental health literacy and the presence of depression and anxiety. Tackling inadequate mental health literacy may be a key strategy to promote psychological well-being across the lifespan, especially for young adults.

German translation and psychometric evaluation of the Mental Health Literacy Scale (MHLS-GER) in a general population sample and in patients with acute myocardial infarction

BACKGROUND

The Mental Health Literacy Scale (MHLS) is a scale-based measure with 35 items that assesses various aspects of mental health literacy. The original English version was developed in Australia and has been translated into several languages. The present study aimed to translate and culturally adapt the questionnaire for its use in Germany and to determine the psychometric properties of the German version of the MHLS (MHLS-GER) in two different samples.

METHODS

After translation and cultural adaptation, the MHLS-GER was administered via an online survey in a general population sample and via a postal survey in patients with acute myocardial infarction (AMI). Exploratory factor analysis and confirmatory factor analysis were conducted to determine the dimensionality. Furthermore, internal consistency, known-groups-validity and measurement invariance were evaluated.

RESULTS

Data of 517 participants of the general population sample and 786 participants of the AMI sample were analyzed. In both samples a four-factor structure yielded good model fit indices. The four subscales of the MHLS-GER including 31 items comprise the topics 'knowledge' (11 items), 'information seeking' (4 items), 'stigmatization' (9 items) and 'social distance' (7 items). All four subscales showed good internal consistency (Cronbach's alpha: 0.80 to 0.90, average inter-item correlation: 0.30-0.59) and were mostly invariant across the two samples. Participants with previous experience with mental disorders (personal or professional context) showed higher scores on the four subscales.

CONCLUSION

In contrast to the unidimensional structure of the original version, the MHLS-GER comprises four subscales. All subscales showed acceptable to good psychometric properties and can now be used to assess mental health literacy. Further validation studies to evaluate test-retest-reliability and responsiveness are required.

Drinking and mental health in middle adulthood: exploring the impact of wellbeing, mental health literacy, and drinking motives on risk of alcohol dependence

OBJECTIVES

Risky drinking is a concern among UK-based middle-aged adults. We aimed to explore the relationship between risky drinking, drinking motives, wellbeing, and mental health literacy (MHL).

METHOD

Cross-sectional analysis of online survey data completed by 193 UK-based adults aged 40-65 who drank alcohol, incorporating the Alcohol Use Disorders Identification Test (AUDIT); Drinking Motives Questionnaire-Revised (DMQ-R); Warwick-Edinburgh Mental Wellbeing Scale (WEMWBS); Mental Health Literacy Scale (MHLS) and demographic questions.

RESULTS

Coping, enhancement and conformity motives and gender significantly predicted higher AUDIT scores (measuring risky drinking). Enhancement motives were found to mediate the relationship between the self-help component of MHL and AUDIT scores, while coping motives mediated the association between wellbeing and AUDIT scores.

CONCLUSION

Findings support research emphasising the influence of drinking motives on risky drinking and highlights how low wellbeing may interact with coping motives to explain risky drinking among middle-aged adults, particularly men. Interventions supporting individuals to understand the relationship between drinking motives and risky drinking, develop adaptive coping strategies, and address the causes of low wellbeing, may be beneficial. However, as the sample was 84% ethnically White, 64% women, 85% educated to at least undergraduate level, and reported a relatively high mean socioeconomic status (6.98 out of 10), the results may not generalise beyond these groups. Future research should use stratified sampling to increase generalisability, as well as exploring whether alcohol-specific, component-specific, or disorder-specific MHL is associated with risky drinking and wellbeing.

Mental health app boost my mood (BMM) as preventive early intervention for adolescents with (sub)clinical depressive symptoms

BACKGROUND

Depression is a common mental disorder. Detecting (sub)clinical depressive symptoms in adolescents at an early stage and offering a low-threshold early intervention can minimize the risk of serious and/or long-term depression. As such, a digital intervention can be a low-threshold preventive and early intervention. This study aims to examine whether the Boost My Mood (BMM)-app is a suitable preventive early intervention for adolescents with (sub)clinical depressive symptoms.

METHODS

This naturalistic single-arm evaluation study (N = 50) was conducted in adolescents aged 16-21 with (sub)clinical depressive symptoms. Furthermore, the BMM-app was studied in relation to anxiety, worrying, stress, and sleeping problems. An exploratory objective was to determine whether positive expectations and social support are related to app use.

RESULTS

The study showed a significant decrease in not only depressive symptoms, but also anxiety, worrying and stress while using the BMM-app. Sleeping problems did not significantly decrease over time while using the BMM-app. The degree of use of the BMM-app and telling significant others about using the BMM-app were both not related to a decrease in depressive symptoms. The BMM-app was used significantly more when the adolescent had told relatives about their depressive symptoms.

CONCLUSIONS

A digital intervention, such as the BMM-app, can be a low-threshold preventive and early intervention for adolescents with (sub)clinical depressive symptoms. Beneficial effects of the BMM-app were reported on depressive symptoms as well as other aspects of quality of life, such as anxiety, worrying, and stress. Whereas several factors may have played a role in the current findings on depressive symptoms, there are reasons to assume that part of the reduction in symptoms could be attributed to the BMM-app. Although no causality can be assumed, this study is a first step in the implementation of preventive apps in mental health care.

Examining Factors Associated With Intention to Seek Professional Mental Health Support Among First-Generation Iranian Americans

PURPOSE

Research suggests immigrants are at a greater risk of mental health disorders compared to native-born populations. Thus, the current study investigated factors associated with professional mental help-seeking intention among American immigrants.

METHOD

A cross-sectional study was conducted with 207 first-generation Iranian Americans, and data were collected using survey questionnaires.

RESULTS

Younger Iranians living in western states in the United States and those with positive attitudes toward professional mental health services had greater intention to seek these services. Unexpectedly, those with better mental health literacy (MHL) held more mental health stigma (MHS).

CONCLUSION

Findings elucidated valuable insights into the complex dynamics among sociodemographic factors, acculturation, MHL, MHS, attitudes, and intentions toward professional mental health help-seeking. We also highlighted the intricate relationship between MHL and MHS, suggesting that strategies to improve MHL may not necessarily mitigate MHS within this community. Therefore, integrating anti-stigma, contact-based approaches to MHL programs could effectively reduce stigma while facilitating mental health help-seeking. [Journal of Psychosocial Nursing and Mental Health Services, xx(xx), xx-xx.].

Mental health literacy in children and adolescents in low- and middle-income countries: a mixed studies systematic review and narrative synthesis

Mental illnesses are the leading cause of disease burden among children and young people (CYP) globally. Low- and middle-income countries (LMIC) are disproportionately affected. Enhancing mental health literacy (MHL) is one way to combat low levels of help-seeking and effective treatment receipt. We aimed to synthesis evidence about knowledge, beliefs and attitudes of CYP in LMICs about mental illnesses, their treatments and outcomes, evaluating factors that can enhance or impede help-seeking to inform context-specific and developmentally appropriate understandings of MHL. Eight bibliographic databases were searched from inception to July 2020: PsycInfo, EMBASE, Medline (OVID), Scopus, ASSIA (ProQuest), SSCI, SCI (Web of Science) CINAHL PLUS, Social Sciences full text (EBSCO). 58 papers (41 quantitative, 13 qualitative, 4 mixed methods) representing 52 separate studies comprising 36,429 participants with a mean age of 15.3 [10.4-17.4], were appraised and synthesized using narrative synthesis methods. Low levels of recognition and knowledge about mental health problems and illnesses, pervasive levels of stigma and low confidence in professional healthcare services, even when considered a valid treatment option were dominant themes. CYP cited the value of traditional healers and social networks for seeking help. Several important areas were under-researched including the link between specific stigma types and active help-seeking and research is needed to understand more fully the interplay between knowledge, beliefs and attitudes across varied cultural settings. Greater exploration of social networks and the value of collaboration with traditional healers is consistent with promising, yet understudied, areas of community-based MHL interventions combining education and social contact.

Negative body image mental health literacy in women: Exploring aesthetic and functional concerns and the role of self-objectification

Despite its high prevalence in women, few studies have examined lay knowledge and beliefs about negative body image. Yet, studies applying mental health literacy to body image problems suggest recognition of appearance concerns is poor, which could impede help-seeking. The present study extended previous work by investigating problem recognition, beliefs and help-seeking for aesthetic and functional (physical ability focused) body image concerns in women, and the role of self-objectification in help-seeking. A within-subjects online survey design employing the mental health literacy paradigm was undertaken in a sample of 210 female-identifying adults residing in Australia (Mage = 31.25, SD = 12.76). Overall, results indicated that recognition of body image problems depicted via fictional text vignettes was limited. Moreover, recognition, as well as ratings of perceived prevalence, distress, sympathy, affective reactions, and help-seeking recommendations and intentions, were significantly greater for aesthetic compared to functional body image concerns. Self-objectification displayed significant negative associations with help-seeking recommendations for aesthetic (but not functional) concerns, and was not associated with help-seeking intentions. Findings suggest that negative body image mental health literacy is poor in women, particularly in relation to body functionality. More research is needed to facilitate help-seeking and reduce the impact of body image concerns in women.

Protective and risk factors of mental health of working age adults with adventitious total bilateral blindness and low vision: A scoping review protocol

Vision loss has been associated with mental health problems such as depression, anxiety, and post-traumatic stress disorder, which significantly impact lives of working age adults with adventitious total bilateral blindness and low vision. It is imperative, therefore, to prioritize the mental health in this population by exploring and understanding the factors that impact on their mental health. Hence, the objective of this scoping review is to identify and chart existing literature on the protective and risk factors of mental health of working age adults with adventitious total bilateral blindness and low vision. We developed this scoping review protocol in line with the Joanna Briggs Institute guidance. This scoping review will include publications in English language with no date restrictions exploring the protective and risk factors of mental health of our study population. A three-step search strategy will be employed. Searches will be carried out in the following databases: Medline, Embase, PsycInfo, PsycArticles, CINAHL and Web of Science. Search for grey literature will be conducted in Google, Google Scholar and Websites dedicated to information on visual impairment. Collated results will be imported into Endnote Basic (Clarivate) for deduplication. Two reviewers will independently conduct double screening of all the titles and abstracts in Rayyan- a web application, and full texts in Endnote while three other reviewers will conduct screening of a subset of for example 10% of titles and abstracts and full texts. Furthermore, two reviewers will independently conduct double data extraction while three other reviewers will revise, cross check, and correct any extraction errors. Extracted data will be presented in tabular formats and summarized descriptively in line with the research objectives. This scoping review will generate evidence on factors impacting the mental health of the working age adults with adventitious total bilateral blindness and low vision as well as critically highlight gaps in the literature. The findings will inform and critically underpin future empirical research which will explore the lived experiences of working age people with adventitious total bilateral blindness. Additionally, evidence from this review will inform the development of interventions in the promotion of mental health as well as assisting rehabilitation specialists and workers, public health practitioners and other relevant stakeholders in addressing the mental health needs of working age adults with adventitious total bilateral blindness and low vision.

The Relationship Between Mental Health Literacy, Overall Adaptation and Mental Health of University Freshers

BACKGROUND

Entering university is a big change in life. It can cause a lot of stress for new students. Stress can affect their mental health in a negative way. Mental health literacy is the knowledge and skills to deal with mental health issues. It can help new students cope better with stress and improve their mental health.

OBJECTIVE

To investigate the status of mental health literacy, overall adaptation, and mental health of university freshers, and to explore the influence of mental health literacy on the overall adaptation and mental health, as well as the mediating role of overall adaptation.

METHODS

The undergraduate freshers of 2022 from a comprehensive university in Henan Province were selected as the research participants using a cluster sampling method and were investigated by the general information questionnaire, mental health literacy scale (MHLS), the university student overall adaptation questionnaire (CSOAQ) and university personality inventory (UPI).

RESULTS

(1) The detection rate of mental health problems among freshers was 22.39%, and the mental health literacy (112.26 ± 9.66), overall adaptation (3.93 ± 0.93), mental health (10.90 ± 10.51) of freshers had significant differences in demographic variables. (2) Mental health literacy was significantly positively correlated with overall adaptation and mental health, and overall adaptation was significantly positively correlated with mental health. (3) Overall adaptation plays a mediating role in the impact of mental health literacy on mental health. (4) Gender plays a moderating role in the effects of overall adaptation on mental health.

CONCLUSION

The mental health literacy of university freshers could not only directly predict their mental health but also indirectly affect their mental health through overall adaptation, which is more significant among women.

Improving Children's Mental Health Literacy Through the Cocreation of an Intervention and Scale Validation: Protocol for the CHILD-Mental Health Literacy Research Study

BACKGROUND

Children's mental health is a public health priority, with 1 in 5 European children younger than 12 years having a behavioral, developmental, or psychological disorder. Mental health literacy (MHL) is a modifiable determinant of mental health, promoting psychological well-being and reducing mental health problems. Despite its significance, no interventions or scales currently exist for increasing and measuring MHL in this population.

OBJECTIVE

This study has dual objectives: (1) cocreating and evaluating an intervention on children's MHL, and (2) developing and validating a scale that measures children's MHL.

METHODS

Our study focuses on children aged 9-11 years attending primary school classes in various settings, including urban and rural areas, and priority education zones within a French department. Using a participatory research approach, we will conduct workshops involving children, parents, teachers, and 1 artist to cocreate an intervention comprising multiple tools (eg, a pedagogical kit and videos). This intervention will undergo initial evaluation in 4 classes through observations, interviews, and satisfaction questionnaires to assess its viability. Concurrently, the artist will collaborate with children to create the initial version of the CHILD-MHL scale, which will then be administered to 300 children. Psychometric analyses will validate the scale. Subsequently, we will conduct a cluster randomized controlled trial involving a minimum of 20 classes, using the CHILD-MHL scale scores as the primary end point to evaluate the intervention's efficacy. Additional interviews will complement this mixed methods evaluation. Both the intervention and the scale are grounded in the Child-Focused MHL model.

RESULTS

The first tool of the intervention is the pedagogical kit Le Jardin du Dedans, supported by the public organization Psycom Santé Mentale Info and endorsed by UNICEF (United Nations Children's Fund) France. The second tool is a handbook by the Pan American Health Organization and the World Health Organization, which is addressed to teachers to sensitize them to children's mental health problems. The third is a 5-page supplementary leaflet produced by the nongovernmental organization The Ink Link, which teaches children the notion of MHL. Finally, we produced 56 items of the MHL Scale and listed existing education policies for children's mental health.

CONCLUSIONS

After its robust evaluation, the intervention could be extended to several schools in France. The scale will be the first in the world to measure children's MHL. It will be used not only to evaluate interventions but also to provide data for decision makers to include MHL in all educational policies. Both the intervention and the scale could be translated into other languages.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/51096.

Individual differences in the expansiveness of mental disorder concepts: development and validation of concept breadth scales

BACKGROUND

What people consider to be a mental disorder is likely to influence how they perceive others who are experiencing problems and whether they seek help for their own problems. However, no measure is available to assess individual differences in the expansiveness or breadth of concepts of mental disorder. Four studies aimed to develop and validate two such measures. The Concept Breadth-Vertical (CB-V) scale assesses variability in the severity threshold at which unusual behavior or experience is judged to reflect disorder, whereas the Concept Breadth-Horizontal (CB-H) scale assesses variability in the range of phenomena judged to be disorders.

METHODS

In a pilot study (N = 201) for the CB-V, participants read vignettes of varying severity for each of the 10 mental disorders, and rated whether the subject had a disorder. Study 1 (N = 502) used exploratory factor analyses to examine 10 CB-V items from the pilot study and 20 vignette-based items for constructing the CB-H. Study 2 (N = 298) employed confirmatory factor analysis to validate the scales' structure and examined their convergent validity with a measure of harm concept breadth and their discriminant validity with measures of mental health literacy. Study 3 (N = 298) explored associations of the scales with other mental health variables, including stigma and help-seeking attitudes.

RESULTS

Study 1 supported the unifactorial structure of each item set, refined each set into a scale, and demonstrated acceptable reliabilities. Study 2 provided support for the scales' convergent and discriminant validities. Study 3 showed that the scales were associated negatively with stigma, and positively with help-seeking attitudes and self-reported mental health problems. Studies 2 and 3 further indicated that younger and more politically liberal participants hold broader concepts of mental disorder.

CONCLUSIONS

The new concept breadth scales are psychometrically sound measures of a promising new concept in the study of beliefs and attitudes about mental health. Potential future research directions are discussed.

Public knowledge and attitudes about mental health in older age in Germany - Focus on dementia and late-life depression

Older people with mental disorders represent a particularly vulnerable group in the health care system. Despite this, mental disorders in this group often remain undiagnosed or are not treated in accordance with guidelines, potentially due to a lack of knowledge or unfavorable attitudes regarding mental disorders in older individuals. Therefore, in an anonymous online survey of 1,284 participants (71.8% female, mean age 52.3 ± 18.0 years), we assessed knowledge and attitudes regarding mental health in old age in general and regarding dementia and late-life depression in particular. Regression analyses were conducted to determine predictors of higher knowledge and more favorable attitudes based on sociodemographic data. On average, participants answered 11 ± 2 out of 15 of the knowledge questions correctly. Items on the prevention of dementia, late-life depression symptoms, and associated suicide risk were most likely to be answered incorrectly. Participants showed less favorable attitudes towards people living with dementia than towards people with late-life depression, and higher knowledge scores were associated with more favorable attitudes. Our findings highlight a clear need for psychoeducation in the field of dementia and late-life depression, with a special emphasis on prevention-related knowledge. Fostering knowledge in this area is highly relevant, as it might positively influence attitudes towards older people with mental disorders, in turn facilitating health care and health-promoting behavior among older people.

Associations between dimensions of mental health literacy and adolescent help-seeking intentions

BACKGROUND

The majority of long-term mental health problems begin during adolescence. Low mental health literacy (MHL) may impede help-seeking for these problems. Although MHL is a multidimensional construct and adolescent help-seeking can be through formal and informal means, little is known about how dimensions of MHL influence these help-seeking intentions. This study examines associations between dimensions of MHL and formal and informal help-seeking intentions among adolescents. It also investigates whether informal help-seeking mediates the association between dimensions of MHL and formal help-seeking, and whether these associations are moderated by gender.

METHODS

A cross-sectional survey including measures of MHL, and help-seeking intentions was distributed to participants in 10 schools (12-17 years) across Scotland (n = 734). Data were analysed using Confirmatory Factor Analyses (CFA) and Structural Equation Modelling (SEM).

RESULTS

Confirmatory Factor Analyses identified two distinct dimensions of MHL: ability to identify a mental health problem, and knowledge of treatment efficacy. Only knowledge of treatment efficacy was associated with increased intention to seek formal and informal help. Ability to identify a mental health problem was negatively associated with both forms of help-seeking intentions. Informal help-seeking mediated the association between both forms of MHL and formal help-seeking. Gender did not moderate the associations between MHL and help-seeking.

CONCLUSIONS

Care should be taken when providing MHL interventions to ensure that adaptive forms of MHL are promoted. Future research should investigate possible mechanisms by which discrete forms of MHL influence adolescent help-seeking as well as investigating other potential moderators of MHL and help-seeking, such as stigma.

Mental health literacy of Chinese nurses from public general and psychiatric hospitals: a cross-sectional study

Background

Mental health literacy (MHL) is crucial to address issues related to mental illness. Nurses' MHL is even more important because they are expected to deal with both the physical and psychological consequences of mental disorders.

Objective

This study investigated the level, discrepancy, and characteristics of MHL among Chinese nurses from both public general and psychiatric hospitals; identified influential factors; and explored the relationship between MHL and mental health status.

Methods

Using a stratified cluster sampling method to select participants, a cross-sectional survey was conducted to describe the MHL of 777 nurses from 13 general and 12 psychiatric hospitals using the Chinese version of the Mental Health Literacy Scale, Patient Health Questionnaire-2, Generalized Anxiety Disorder-2, and a demographic questionnaire. A multiple regression analysis was used to determine the factors influencing MHL among the nurses recruited.

Results

The participants' total score on the Chinese version of the Mental Health Literacy Scale was 93.25 (SD = 10.52). Multiple regression analysis revealed that nurses who worked in psychiatric or higher-level hospitals, with higher professional titles or higher education had higher levels of overall MHL and core MHL, while those working in general hospitals, with shorter work duration, or who were unmarried had higher social acceptance of patients. Nurses' MHL was closely correlated with their mental health status.

Conclusion

The overall and core MHL of Chinese nurses were at a moderate level, with social acceptance remaining at a relatively low level. There is an urgent need for MHL promotion programs to improve the MHL of clinical nurses. The focus must be given to overall MHL, especially core MHL, for non-psychiatric nurses to enhance their competence in mental health promotion and identification; more emphasis should be placed on the social acceptance of patients with mental illnesses for psychiatric nurses to improve their provision of professional services. Better MHL would be a formula for improving nurses' own mental health and their mental health service competence.

Development and validation of a universal mental health literacy scale for adolescents (UMHL-A)

Mental health literacy (MHL) grows in importance as the prevalence of mental health conditions rises worldwide. There is a need for valid MHL measures especially among adolescents. The current study aims to develop and validate a Universal mental health literacy scale for adolescents (UMHL-A), a self report scale to assess MHL of children between ages 10 and 14 across all four components within Kutcher's framework for MHL. The development of the UMHL-A was initiated by a literature review and followed by item generation. Then, we tested the face and content validity of the scale via a delphi study, focus groups and cognitive interviews with the target group. Next with a convenience sample, we established the factor structure and construct validity of the scale using exploratory and confirmatory factor analyses. Lastly, we tested the scale convergent validity with other measures. The final form of the scale was refined on a representative sample of Czech asolescents. The UMHL-A scale comprises 17 items measuring four components of MHL. The scale has substantial methodological advantages in comparison to existing measures of MHL, especially considering its brevity and comprehensive coverage of MHL. Further studies are needed to test its application and validity globally.

Mental health literacy among primary healthcare workers in South Africa and Zambia

BACKGROUND

In developing countries, mental health literacy (MHL) still needs to be improved due to the high prevalence of mental disorders. It is widely recognized that MHL can improve health outcomes for both individuals and populations. Healthcare professionals' development in MHL is crucial to the prevention of mental disorders. The aim of this study was to assess MHL of primary healthcare (PHC) workers in South Africa (SA) and Zambia and determinants thereof. Limited evidence is available on the levels of MHL among PHC workers in the sub-Saharan Africa region, which faces a large burden of mental disorders.

METHODS

The study population for this cross-sectional survey comprised PHC workers (n = 250) in five provinces of SA and Zambia. MHL was measured with the Mental Health Literacy Scale (MHLS). We conducted a multivariate analysis to explore determinants of MHL.

RESULTS

Results showed moderate MHL among PHC professionals, but with a wide range from low to high MHL. Knowledge-related items had a greater dispersion than other attributes of MHL. PHC workers with more education showed a greater ability to recognize mental health-related disorders. Those who had experience in the use of mental health-related assessment scales or screening tools reported a higher total MHL. The results confirmed strong internal consistency for the MHLS.

CONCLUSION

The results highlighted varying mental health perceptions and knowledge in PHC. Implementation of specifically developed formal training programs and interventions to improve MHL in PHC workers to strengthen their competence may help bridge the treatment gap.

Mental health literacy questionnaire-short version for adults (MHLq-SVa): validation study in China, India, Indonesia, Portugal, Thailand, and the United States

BACKGROUND

Mental Health Literacy (MHL) has become a focus of research in recent decades, as a prerequisite for early identification and intervention for mental health problems. Although several instruments have been developed for assessing MHL, there is a need for brief and psychometrically sound measures to capture important aspects of MHL in large and diverse adult samples. The present study aimed to: (1) provide a revised and shorter version of a previously validated questionnaire for assessing MHL; and (2) examine the psychometric properties of the MHLq-SVa in student samples from six different countries (China, India, Indonesia, Portugal, Thailand, and United States).

METHODS

The study involved 2180 senior school and undergraduate students, aged between 17 and 25 years old, from China, India, Indonesia, Portugal, Thailand, and the United States. Participants responded to the Mental Health Literacy Questionnaire for young adults (MHLq-ya), in their native language, following its translation and adaptation for each culture. The MHLq-ya comprises 29 items, organized into four dimensions: Knowledge of mental health problems; Erroneous beliefs/stereotypes; First-aid skills and help-seeking behavior; Self-help strategies. Confirmatory factor analyses and internal consistency analyses were performed on the combined data.

RESULTS

Data from the different countries supported a shorter version of the questionnaire (MHLq-SVa), composed of 16 items that fit with previously defined dimensions. Internal consistency and between-factor correlations further supported the adequacy of the instrument's psychometric properties.

CONCLUSION

The study provided preliminary support for the construct validity and reliability of the MHLq-SVa as a measure for assessing MHL in young adults from six different countries and languages. Future studies are needed to further validate the measure and undertake multicultural comparisons of MHL in diverse samples from around the globe.

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.

Intervention in professional dance students to increase mental health- and nutrition literacy: A controlled trial with follow up

Introduction

There is a need to change the culture within the art of dance, as it has been associated with injuries and mental health consequences. This study evaluates an intervention designed to increase mental health literacy, enhance nutritional knowledge, reduce symptoms and effects of low energy availability, and strengthen understanding of sports nutrition and recovery strategies, in dance students of mixed genders.

Material and methods

A total of 125 dance students received three workshops, with 39 arts and crafts students serving as references. The results were evaluated by the Eating Disorder Examination questionnaire, the Low Energy Availability in Females questionnaire, the Hopkins Symptom Check List, and questions on mental health literacy, sports nutrition, and recovery knowledge.

Results

Dance students achieved sustained improvements in mental health and nutrition knowledge and temporary improvements in driven exercise (i.e., performing exercise because of a compulsive drive). No other benefits were identified from the intervention.

Conclusion

Our findings indicate the need for an ongoing education program to reduce the occurrence and development of negative mental health outcomes and low energy availability in professional dance students. Such approaches may not only improve the mental health of dance students but also potentially prevent the high frequency of injuries.

Mental health literacy of school-going adolescents in sub-Saharan Africa: a regional systematic review protocol

INTRODUCTION

Assessing mental health literacy has implications for the identification and treatment of mental health problems. Adolescents have been identified as a particularly important target group for initiating and improving mental health literacy. However, much of what we know about adolescent mental health literacy comes from high-income countries. This proposed review seeks to synthesise the available published primary evidence from sub-Saharan Africa on the status and measurement of mental health literacy among school-going adolescents.

METHODS AND ANALYSIS

We will perform a systematic review reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement (PRISMA-2020). We will systematically search selected global databases (EMBASE, PsycINFO, PubMed and MEDLINE) and regional electronic databases (African Index Medicus and African Journals OnLine) up to December 2021 for observational and qualitative studies published in English and French. The standard quality assessment criteria for evaluating primary research papers from a variety of fields (QualSyst criteria) will be used to appraise the methodological quality of the included studies. The Petticrew-Roberts 3-step approach to narrative synthesis will be applied to the included studies.

ETHICS AND DISSEMINATION

We will not seek ethical approval from an institutional review board, as this is a systematic review of available and accessible literature. When completed, the full report of this review will be submitted to a journal for peer-reviewed publication; the key findings will be presented at local and international conferences with-partial or full-focus on (adolescent) mental health (literacy).

PROSPERO REGISTRATION NUMBER

CRD42021229011.

Measuring health literacy: A systematic review and bibliometric analysis of instruments from 1993 to 2021

BACKGROUND

It has been about 30 years since the first health literacy instrument was developed. This study aimed to review all existing instruments to summarize the current knowledge on the development of existing measurement instruments and their possible translation and validation in other languages different from the original languages.

METHODS

The review was conducted using PubMed, Web of Science, Scopus, and Google Scholar on all published papers on health literacy instrument development and psychometric properties in English biomedical journals from 1993 to the end of 2021.

RESULTS

The findings were summarized and synthesized on several headings, including general instruments, condition specific health literacy instruments (disease & content), population- specific instruments, and electronic health. Overall, 4848 citations were retrieved. After removing duplicates (n = 2336) and non-related papers (n = 2175), 361 studies (162 papers introducing an instrument and 199 papers reporting translation and psychometric properties of an original instrument) were selected for the final review. The original instruments included 39 general health literacy instruments, 90 condition specific (disease or content) health literacy instruments, 22 population- specific instruments, and 11 electronic health literacy instruments. Almost all papers reported reliability and validity, and the findings indicated that most existing health literacy instruments benefit from some relatively good psychometric properties.

CONCLUSION

This review highlighted that there were more than enough instruments for measuring health literacy. In addition, we found that a number of instruments did not report psychometric properties sufficiently. However, evidence suggest that well developed instruments and those reported adequate measures of validation could be helpful if appropriately selected based on objectives of a given study. Perhaps an authorized institution such as World Health Organization should take responsibility and provide a clear guideline for measuring health literacy as appropriate.

Knowledge and Myths about Eating Disorders in a German Adolescent Sample: A Preliminary Investigation

Eating disorder mental health literacy (ED-MHL) refers to knowledge about the symptoms, causes, and treatment of eating disorders (EDs) and is an important factor in people’s attitudes towards individuals with EDs and help-seeking for EDs. Associations between ED-MHL, stigma, ED symptomatology, and gender were investigated in a sample of N = 194 German high school students. Knowledge and myths about EDs were assessed with 18 factual statements about EDs and agreement/disagreement with common myths about ED. Students also completed the Universal Stigma Scale (USS), the Weight Concerns Scale (WCS), and demographic items. Students judged M = 8.39 (SD = 3.40) statements correctly, while the average agreement with all ED myths was low (M = 0.19, SD = 0.14). Greater ED-MHL was associated with lower stigmatization of EDs. Male participants were less knowledgeable and more likely to agree with the ED myths. Participants displayed moderate ED-MHL; however, certain aspects such as ED risk factors or symptoms of specific disorders such as anorexia nervosa and bulimia nervosa were less well known. These results can inform the design of future MHL interventions for adolescents.

Mental health literacy among adolescents: Evidence from a community-based study in Delhi

BACKGROUND

Mental Health Literacy (MHL) is the ability to recognize mental disorders, along with knowledge of professional help available, effective self-help strategies, skills to give support to others, and knowledge of how to prevent mental disorders. Adequate MHL is linked to better health-seeking behavior and management of mental illness.

AIM

To assess the MHL related to depression and anxiety among adolescents of age 15 to 19 years residing in Delhi.

METHODS

A survey was conducted among adolescents in southeast Delhi. MHL was assessed using sex-matched vignettes of Common Mental Disorders (CMDs) like depression and anxiety. MHL was assessed under domains of identifications of disorders, help-seeking behavior, knowledge about prevention, and stigmatizing attitude toward the respective illness. Statistical analysis was done in STATA and percentage of participants with adequate MHL in various domains was calculated, and difference between various groups was examined using chi-square test.

RESULTS

A total of 491 adolescents participated (response rate of 87.2%) of whom a 50.3% were girls and 57.8% were 15 to 17 years of age. Only 50 (10.2%) participants identified depression vignette as that of depression and 51 (10.4%) identified vignette of anxiety disorder as the same. No statistically significant gender differential in MHL was seen (p value = .8). The stigmatizing attitude, assessed by asking a series of questions suggesting stigma toward the particular illness, was observed among almost all participants (depression -99.4%, and anxiety disorders -96.1%). 18.3% and 18.7% of participants reported correct knowledge about the prevention of depression and anxiety respectively. Four hundred and twenty-two (86%) identified the need to seek help for symptoms reported in vignettes. Of these, 234 (55%) preferred parents, and 62 (14.7%) look after friends for any help.

CONCLUSION

Adolescents residing in Delhi reported poor MHL for Common Mental Disorders. High stigma and poor help-seeking behavior was also observed among the participants toward CMDs.

A deep learning based method for intelligent detection of seafarers' mental health condition

Mental health monitoring of seafarers is an important part of achieving normal development of the ocean shipping industry. In this paper, a dual subjective-objective testing scheme is proposed to achieve a more effective and intelligent assessment of seafarers' mental health status. Firstly, a new seafarers' mental health test scale (SMHT) is revised based on fuzzy factor analysis and the test data of 283 marine practitioners are analyzed using SPSS v24 software; secondly, this paper proposes an intelligent framework module for immersive subjective emotion extraction based on natural language processing, namely semantic summary extraction (SSE), speech emotion extraction (SEE), using hybrid scoring mechanism to obtain semantic and emotion matching values and assist the seafarer mental health scale to obtain the final correction score. The results showed that the assessment results of the SMHT scale exhibited good reliability (Cronbach's alpha of 0.852 [Formula: see text] and retest reliability R of [Formula: see text]) and scale association validity (for SCL-90, ([Formula: see text]). In addition, the calibration rate of the subject-object dual test method was improved by approximately 12.05% compared to the traditional mental health scale. Finally, the advantages and disadvantages of this solution were compared with mental health testing techniques such as CAT, machine learning, SCL-90, and fMRI, and the method demonstrated more accurate psychological testing results, providing a simple and intelligent solution for standardized psychological testing of seafarers.

Effectiveness and Implementation Outcome Measures of Mental Health Curriculum Intervention Using Social Media to Improve the Mental Health Literacy of Adolescents

Purpose

Globally, adolescent mental health problems reportedly manifest more severely in individuals with lower mental health literacy. Mental health curriculum interventions using social media have been associated with positive implementation outcomes. This study aimed to investigate whether such an intervention significantly improves adolescent mental health literacy and is associated with positive implementation outcome measures.

Methods

This study employed a quasi-experimental design, comparing the before-and-after difference between the intervention group (n₁=77) and the control group (n₁=76). A mental health literacy module was delivered using social media. Data were collected using validated questionnaires. Effect size and difference-in-differences model calculations (and associated 95% confidence intervals, CI) were conducted alongside other descriptive analyses.

Results

The estimated intervention effect size and difference-in-differences estimates were greater than zero. The effect was greater in the intervention than in the control group (p<0.05) despite sex and age differences. The effect size estimate provided by Cohen’s d and Hedges’ g values was medium-to-large (d/g=0.429–0.767, p<0.05). The difference-in-differences reflected a significant effect (DID=0.348, CI: 0.154–0.542, p<0.001) in increasing mental health literacy despite differences associated with sex, age, and school grade. The intervention program was acceptable, appropriate, feasible, and satisfactory, and more than 80% of participants said they agree to completely agree with these implementation outcomes. Resources and personal and family-related factors were among the perceived influencing factors determining the effectiveness and implementation outcome measures.

Conclusion

The intervention program effectively improved the mental health literacy of adolescents. It has been highlighted that social media interventions for mental health promotion could be practical and scalable; however, there is a need to take into account socio-demographic differences and barriers to inclusion/compliance.

Student and Nature Interactions and Their Impact on Mental Health during the COVID-19 Pandemic

Passive and active interactions with nature reduce stress, anxiety, and depression. Populations that experience increased stress often have fewer interactions with nature due to many factors. More recently, the COVID-19 pandemic has created a new stressor for all populations due to sickness, isolation, financial burdens, or other factors. University students were particularly impacted due to the change to online modalities, which isolated them from other students. To assess if any negative or other consequences were experienced and if nature factors could mitigate them, we examined how plant interactions affected university students (N = 353) in an online learning environment. Two modified Depression Anxiety Stress Surveys (DASS; Depression Anxiety Stress and Academic Stress, DASA) were administered over two semesters in 2020 to survey students on these interactions with nature. During the two semesters, most students experienced extremely severe self-reported mental health adversities. Further correlations between DASA scores and responses about nature interactions, home environments, plant exposure, and plant access showed that outdoor interactions were positively related to better self-reported mental health scores. However, the concerning and lingering effects of the pandemic were evidenced in our research as DASA scores increased across the two semesters. Nevertheless, going outdoors and interacting with nature brings some benefits that lessen the severity of depression, anxiety, and stress.

Conducting Systematic Reviews of the Quality and Psychometric Properties of Health-Related Measurement Instruments: Finding the Right Tool for the Job

Many health-related measurement instruments have been developed to measure psychological constructs and whilst several instruments are usually available for a particular study, finding the right tool for the job is important. Systematic reviews of measurement properties of instruments have long been identified as a valuable strategy to ensure that we select the right tool to assess mental health. There are many important steps and procedures to guide these types of systematic reviews to find the "best fit" and this paper summarizes some of these key processes and steps. The selection of instrument(s) to use should be made considering the most recent comprehensive review of the quality of the outcome measurement instrument based on unbiased assessment of its psychometric properties, responsiveness, and generalizability of results. Researchers planning to conduct a systematic review of health-related measurement instruments should design the review beforehand using standardized frameworks. Conducting systematic reviews of the quality and psychometric properties of health-related measurement instruments is important to ensure we choose the best tool for the research question and target population.

Understanding client engagement in digital mental health interventions: An investigation of the eTherapy Attitudes and Process Questionnaire

Aims

Digital mental health services may increase the accessibility and affordability of mental health treatments. However, client dropout a low use is often reported. The purpose of the current study was to investigate the structural validity of the e‐Therapy Attitudes and Process (eTAP) questionnaire, as a theoretically based (theory of planned behavior) tool for understanding ongoing client engagement intentions with digital mental health treatments. The possible role of eHealth literacy in predicting behavioral intentions to use digital mental health treatments was also examined.

Methods

Participants were 244 Australian‐based adults aged between 18 and 56 years, who were currently using a digital mental health tool. Data were collected via online survey.

Results

Confirmatory Factor Analysis was conducted, with good model fit obtained following two theoretically supported modifications. Moderated hierarchical regression supported the utility of the theory of planned behavior in predicting behavioral intentions, with attitudes emerging as a strong and consistent individual predictor. No support was found for the moderating role or individual significance of eHealth literacy.

Conclusions

These findings support the clinical and research use of the eTAP as a theory‐based measure to understand client engagement in digital mental health interventions. The study also highlights the need for interventions to target attitudes to improve clients' ongoing engagement in digital mental health.

Validation of the Persian version of the mental health literacy scale in Iran

The present study was designed to validate an English version of the mental health literacy scale into Persian, in Iran. Statistical population consisted of all residents of 22 municipal districts of Tehran, Iran, in 2018. Multistage sampling methods were used (sample size = 1026). All participants filled the Mental Health Literacy scale; 12-item General Health Questionnaire; Multidimensional Health Locus of Control scale and a demographic checklist. Exploratory and confirmatory factor analysis, the intra-class correlation coefficient was used for analysing data. All analyses were run with SPSS and AMOS Graphics version 18. Exploratory factor analysis revealed five components (24 items) explaining 21.68%, 20.24%, 8.97%, 6.48% and 5.36% of the variance respectively (totally explained variance = 62.74%). Confirmatory factor analysis showed an acceptable goodness-of-fit (CMIN/DF = 3.19, GFI = 0.887, CFI = 0.893, IFI = 0.894, TLI = 0.877, RMSEA = 0.065). The values of Cronbach's alpha showed satisfactory internal consistency. Two clinical correlates of mental health literacy were investigated. The structure of the mental health literacy scale was to some extent different from the one in O'Connor et al. study, but it was consistent with the definition of MHL presented by Jorm et al. This is the first Persian version of the MHL in the general population in Iran and undoubtedly needs to be checked on more studies.

Validation and Psychometric Testing of the Chinese Version of the Mental Health Literacy Scale Among Nurses

The Mental Health Literacy Scale (MHLS) is the most widely used and strong theory-based measurement tool to gain an understanding of mental health knowledge and ability. This study aimed to test the psychometric properties of the Chinese version of the Mental Health Literacy Scale (MHLS-C) and to document the norm and its influential factors of mental health literacy among nurses. The MHLS was translated following Brislin's translation model and tested with a sample of 872 clinical registered nurses. The Jefferson Scale of Empathy-Health Professionals (JSE-HP), Patient Health Questionnaire-2 (PHQ-2), and Generalized Anxiety Disorder-2 (GAD-2) were administered to assess convergent validity. The minimum average partial test, parallel analysis and confirmatory factor analysis supported 4 first-order 2 second-order structure. The 4 factors were named "knowledge of mental disorder," "ability to seek information and help," "recognition of mental disorder," and "acceptance of patients with mental illness," with factor 1-3 were summarized into MHLS-Core (Core literacy subscale) and factor 4 as MHLS-SA (Social acceptance subscale). The MHLS-C was moderately negatively correlated with the PHQ-2 and GAD-2 (-0.111, -0.081) and highly positively correlated with JSE-HP (0.492). The Cronbach's α was 0.85 for the overall scale and 0.89 and 0.93 for two subscales. The test-retest reliability was good, with intraclass correlation coefficients (ICCs) of 0.80 for the whole scale, and 0.79 and 0.94 for two subscales. As an approximately normal distribution, the 50 th percentile for the MHLS-C was 99, with 50 th percentiles of 74 and 20 for MHLS-Core and MHLS-SA. Higher position, higher professional credentials, higher hospital hierarchy, other specialist hospital, psychiatric hospital and unmarried status were positive predictors. The 29-item MHLS-C, with two subscales of MHLS-Core and MHLE-SA, is a stable and validated tool to measure mental health literacy. MHLS-Core could be used independently to measure the core content of mental health literacy. It may be applicable for Chinese health professionals, but need further validation among the general public. MHL curriculum and a targeted culturally appropriate program for acceptance for health professionals, especially for those in general hospitals and with less working tenure, may be recommended.

Construct validity and internal consistency of the revised Mental Health Literacy Scale in South African and Zambian contexts

AIM

The aim of this study was to evaluate the construct validity and internal consistency of the revised Mental Health Literacy Scale (MHLS) in South Africa (SA) and Zambia.

DESIGN

This cross-sectional study was conducted between October 2018 and December 2019.

METHODS

The study population comprised PHC workers (n = 454) in five districts in SA and Zambia. Principal component analysis (PCA) was used to explore the construct validity, and Cronbach's alpha was applied to measure the internal consistency of the MHLS.

RESULTS

Cronbach's alpha values for three attributes were below the appropriate level, but the value was strong (0.804) for the whole scale. The study found nine components explaining ~59% of the total variance of variables. All MHLS items loaded to main attributes based on the theory of MHL. The results stated that the revised version of the MHLS is a construct valid instrument with strong internal consistency.

Development and psychometric properties of the Knowledge and Attitudes to Mental Health Scales (KAMHS): a psychometric measure of mental health literacy in children and adolescents

BACKGROUND

Adolescence is a crucial period for the acquisition of good mental health behaviours, which are the foundation for health and wellbeing in later life. Improved knowledge about mental health and improved help-seeking behaviours have been shown to lead to better mental health outcomes. Mental health literacy (MHL) is multifaceted (e.g., knowledge about symptoms, the stigma around mental health, good mental health practices, etc.). Measures are needed that can assess these different aspects of MHL. Measurement of mental health literacy is currently limited due to a lack of reported psychometric instruments with known psychometric properties. Given that most mental health problems start in early adolescence, a scale is needed that is reliable and valid in this age group.

METHODS

The development and validation of the psychometric instrument (termed the Knowledge and Attitudes to Mental Health Scales: KAMHS) entailed two phases: 1) item generation based on an evidence-based intervention programme: The Guide; and 2) item reduction through exploratory factor analysis (EFA), and confirmatory factor analysis (CFA) for factor structure and psychometric assessment. Participants were 559 Year 9 pupils in secondary schools across Wales aged between 13 and 14 years.

RESULTS

Results from the CFA indicated an acceptable fit of the model to the data. The KAMHS showed good internal constancy and moderate test-retest validity (.40-.64).

CONCLUSIONS

The final version of the KAMHS contains 50 items that are appropriate for use in children and adolescents. These results suggest that the KAMHS can be used over time to assess the efficacy of interventions aimed at increasing the mental health literacy of adolescent populations.

ANALYSIS OF MENTAL HEALTH LITERACY AND PSYCHOLOGICAL DISTRESS AS PREDICTORS OF PSYCHOLOGICAL WELL-BEING IN SRIWIJAYA UNIVERSITY STUDENTS

Introduction. This research focused on answering questions: how mental health literacy and psychological distress act as predictors of psychological well-being in Sriwijaya University students. Methodology.This research used quantitative method, by conducting instrument preparation, data collection, and analysis of data results to see the role of the independent variables on the dependent variable. Psychological well-being was measured using an instrument in a form of psychological scale referred to Psychological Scale by Ryff & Keyes (1995). Meanwhile, psychological distress was measured using WHO Self-Reporting Questionnaire 20 (SRQ-20) Indonesian version, and Mental Health Literacy measurement was adapted from O’Connor and Casey (2015). The participants of this research were consisted of 418 college students. Results.The analysis results show that there is a role of mental health literacy and psychological distress together on psychological well-being, thus the hypothesis is accepted. Major hypothesis test was done using multiple linear regression which shows a correlation value (R) of 0.586 and a significance of 0.001 (p<0.05). For the results of minor hypothesis test, it is known that the beta value is 0.143 and the P value is 0.022 (p>0.05), this indicates that there is a role for mental health literacy on psychological well-being, thus the hypothesis is accepted. In addition, it is known that psychological well-being and psychological distress show a beta value of -1.945 and a P value of 0.001 (p>0.05), this indicates that there is a role for psychological distress on psychological well-being thus the hypothesis is accepted. Conclusions.The percentage of mental health literacy and psychological pressure influences on psychological well-being (R adjusted) is 0.343, this also shows that the contribution of mental health literacy and psychological distress together on psychological well-being is 34.3%, while the rest is the contribution of other variables not examined in this study

Mental health and wellbeing coordinators in primary schools to support student mental health: protocol for a quasi-experimental cluster study

BACKGROUND

Half of mental health disorders begin before the age of 14, highlighting the importance of prevention and early-intervention in childhood. Schools have been identified globally by policymakers as a platform to support good child mental health; however, the majority of the research is focused on secondary schools, with primary schools receiving very little attention by comparison. The limited available evidence on mental health initiatives in primary schools is hindered by a lack of rigorous evaluation. This quasi-experimental cluster study aims to examine the implementation and effectiveness of a Mental Health and Wellbeing Co-ordinator role designed to build mental health capacity within primary schools.

METHODS

This is a primary (ages 5-12) school-based cluster quasi-experimental study in Victoria, Australia. Before baseline data collection, 16 schools selected by the state education department will be allocated to intervention, and another 16 matched schools will continue as 'Business as Usual'. In intervention schools, a mental health and well-being coordinator will be recruited and trained, and three additional school staff will also be selected to receive components of the mental health training. Surveys will be completed by consenting staff (at 2-, 5-, 10- and 17-months post allocation) and by consenting parents/carers (at 3-, 10- and 17-months post allocation) in both intervention and business as usual schools. The primary objective is to assess the change in teacher's confidence to support student mental health and wellbeing using the School Mental Health Self-Efficacy Teacher Survey. Secondary objectives are to assess the indirect impact on systemic factors (level of support, prioritisation of child mental health), parent and teachers' mental health literacy (stigma, knowledge), care access (school engagement with community-based services), and student mental health outcomes. Implementation outcomes (feasibility, acceptability, and fidelity) and costs will also be evaluated.

DISCUSSION

The current study will examine the implementation and effectiveness of having a trained Mental Health and Wellbeing Coordinator within primary schools. If the intervention increases teachers' confidence to support student mental health and wellbeing and builds the capacity of primary schools it will improve student mental health provision and inform large-scale mental health service reform.

TRIAL REGISTRATION

The trial was retrospectively registered in the Australian New Zealand Clinical Trials Registry (ANZCTR) on July 6, 2021. The registration number is ACTRN12621000873820 .

Initial Validation of a Chinese Version of the Mental Health Literacy Scale Among Chinese Teachers in Henan Province

Background: Teachers' Mental health literacy (MHL) is one of the important factors that influence students' mental health literacy and even their mental health status. A valid, comprehensive measure is needed to adequately identify MHL levels in the Chinese teachers. Thus, this study aimed to validate a Chinese version of the Mental Health Literacy Scale (MHLS) among Chinese teachers. Methods: A total of 367 Chinese primary and secondary school teachers in Henan province were enrolled to complete the Chinese version of MHLS and several validation measures. Results: A parallel analysis supported a four-factor structure model of the Chinese version, but because of the low communalities and mean factor loadings, the univariate structure of the original scale was selected. Additionally, the criterion construct validity of the Chinese version was supported by significant correlations with self-efficacy in coping with mental health problems, mental health status, the stigma associated with receiving mental health treatment, and socially distancing from patients with mental illness. The Cronbach's α of the Chinese version was acceptable. Females, younger teachers, teachers with higher educational level, and full-time mental health teachers showed higher levels of MHL. Conclusion: The Chinese version of MHLS is a valid and reliable tool to assess the level of Chinese teachers' MHL.

Development, item analysis, and initial reliability and validity of three forms of a multiple-choice mental health literacy assessment for college students (MHLA-c)

Despite increasing rates of mental health disorders among college students, there are a limited number of validated mental health literacy measures that can be quickly administered and scored in this population. We developed a 54-item multiple-choice measure, consisting of three forms with 18 items on each form. Our items focus on knowledge of more than 20 mental health disorders including their etiology, risk factors, diagnoses, symptoms, treatment, course, and outcome, as well as the application of this knowledge to real world situations. Data were collected on three independent samples of undergraduate students enrolled at an urban public university system in the northeast United States: pilot (n=292), test refinement (n=1,272), and validation (n=683). Basic demographics for the combined test refinement and validation samples were: age=22 ± 4.9 years; 62.2% female; 71.7% non-White. We report on the development of the Mental Health Literacy Assessment-college (MHLA-c) and provide support for its reliability and validity. We also provide descriptive statistics, stratified by gender, college major, and personal experience with a mental health issue to enable its use in diverse settings. The MHLA-c may be useful in measuring knowledge of mental health disorders and related topics among college students. Moreover, the availability of parallel forms will facilitate its use within educational or interventional studies that employ pre-post testing designs.

Not Enough Money and Too Many Thoughts: Exploring Perceptions of Mental Health in Two Ugandan Districts Through the Mental Health Literacy Framework

Mental health disorders account for a heavy disease burden in Uganda. In order to provide culturally appropriate mental health prevention and treatment approaches, it is necessary to understand how mental health is conceptualized in the population. Three focus group discussions (FGDs) and 31 in-depth interviews (IDIs) were conducted with men and women aged 14 to 62 years residing in rural, urban, and semi-urban low-income communities in central and western Uganda to explore perceptions and knowledge of mental health. Interpretive thematic analysis was undertaken; results were organized through the lens of the mental health literacy framework. Environmental and societal stressors were identified as primary underlying causes of poor mental health. While participants recognized symptoms of poor mental health, gaps in mental health literacy also emerged. Mental health resources are needed in this setting and additional qualitative work assessing knowledge and attitudes toward mental health care seeking behavior can inform the development of acceptable integrated services.

Mental Health Literacy Scale Arabic Version: A Validation Study Among Saudi University Students

Mental health problems significantly affect students' university education. However, studies about mental health literacy (MHL) among Saudi university students are very limited. The two-fold objective of this study was to validate an Arabic version of the Mental Health Literacy Scale (MHLS) and assess the MHL of university students. The study participants involved 339 female students. Psychometric evaluation of the MHLS-Arabic version was conducted, and correlation and regression analyses were performed. The scale was successfully cross culturally adapted and found to be valid and reliable. The highest MHL indicator was the students' perception of confidence in using a computer or telephone to inquire about mental illness data. Conversely, the lowest MHL indicator was the student's disagreement with the notion that mental infirmity is not an actual medical challenge. Marital status, college attended, and academic level were found to have statistically significant effects on the MHL of university students. The Arabic version of the MHLS validly and reliably assessed MHL. This work adds to existing evidence for assessing MHL and can help administrators formulate better strategies to improve the MHL of university students.

Mental Health Literacy and Confidence in a Sample of Student Athletic Therapists

Intercollegiate student-athletes appear to be a high-risk population with respect to mental health. Student athletic therapists are one of the groups with whom these athletes may be comfortable disclosing concerns. The current study investigated the relationship between mental health literacy and mental health referral efficacy in a sample of intercollegiate student therapists. One hundred and eleven student athletic therapists (81 female, 29 male, 1 nondiscloure) competed a revised version of the multicomponent mental health literacy measure and a four-item measure of mental health referral efficacy. T tests revealed statistically significant differences in mental health literacy by gender and personal history, and a multiple linear regression revealed a significant model predicting referral efficacy from mental health literacy. There are several implications of these results, particularly when working with a high-risk population of student-athletes.

Mental health literacy of the Lebanese population (MHeLLP): a cross-sectional study

Purpose

This study primarily aims to evaluate the mental health literacy (MHL) of the Lebanese adult population in an attempt to yield results that can help fill the gap in the literature and support the development of new strategies to counter mental health stigma.

Design/methodology/approach

A cross-sectional survey was composed of the Mental Health Knowledge Schedule and select questions from the Community Attitudes toward the Mentally Ill and MHL Scale. The surveys were collected from a representative population of sample size (n = 386) among the different governorates of Lebanon. The participants, aged 18–65 years and literate, were recruited between July 2018 and September 2018 from supermarkets widely distributed across the country.

Findings

The results showed that the Lebanese population possesses average knowledge and certain stigmatizing attitudes toward mental illnesses. Curricular education and awareness campaigns may help refine the image of mental illness among the population.

Originality/value

To the best of the authors’ knowledge, this paper is one of the first in Lebanon to assess the MHL of its population as a whole. It gives insight into the common misconceptions about mental illness and patterns of the related stigma that are prevalent in the Lebanese society today.

Psychometric Properties of the Persian Version of Mental Health Literacy Scale

BACKGROUND

Due to the lack of an instrument to measure mental health literacy among Persian/Farsi speaking people, this study was conducted to examine the psychometric properties of the Persian version of the Mental Health Literacy Scale (P-MHLS).

PARTICIPANTS AND METHODS

The 2019 cross-sectional study with 992 participants was conducted in Tabriz, Iran. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to establish the construct validity of the P-MHLS. The internal consistency/reliability was estimated by computing Cronbach's coefficient alpha. Feasibility of the scale was examined and item response theory (IRT) models were applied to characterize the test items.

RESULTS

An exploratory factor analysis of data resulted in five factors, which included 30 of the 35 items and accounted for 42.00% of the variance. The construct validity of the 5-factor model was supported by the results of our confirmatory factor analysis. The factors were the 1) ability to recognize mental disorders, 2) confidentiality of mental health practitioners, 3) skills of mental health information seeking, 4) beliefs about mental illnesses, and 5) attitudes toward patients with mental illness.

CONCLUSION

The study provides initial support for the use of the MHLS among Persian/Farsi speaking adults to assess mental health literacy.

A systematic literature review of existing conceptualisation and measurement of mental health literacy in adolescent research: current challenges and inconsistencies

BACKGROUND

With an increased political interest in school-based mental health education, the dominant understanding and measurement of mental health literacy (MHL) in adolescent research should be critically appraised. This systematic literature review aimed to investigate the conceptualisation and measurement of MHL in adolescent research and the extent of methodological homogeneity in the field for meta-analyses.

METHODS

Databases (PsycINFO, EMBASE, MEDLINE, ASSIA and ERIC) and grey literature were searched (1997-2017). Included articles used the term 'mental health literacy' and presented self-report data for at least one MHL domain with an adolescent sample (10-19 years). Definitions, methodological and contextual data were extracted and synthesised.

RESULTS

Ninety-one articles were identified. There was evidence of conceptual confusion, methodological inconsistency and a lack of measures developed and psychometrically tested with adolescents. The most commonly assessed domains were mental illness stigma and help-seeking beliefs; however, frequency of assessment varied by definition usage and study design. Recognition and knowledge of mental illnesses were assessed more frequently than help-seeking knowledge. A mental-ill health approach continues to dominate the field, with few articles assessing knowledge of mental health promotion.

CONCLUSIONS

MHL research with adolescent samples is increasing. Results suggest that a better understanding of what MHL means for this population is needed in order to develop reliable, valid and feasible adolescent measures, and explore mechanisms for change in improving adolescent mental health. We recommend a move away from 'mental disorder literacy' and towards critical 'mental health literacy'. Future MHL research should apply integrated, culturally sensitive models of health literacy that account for life stage and acknowledge the interaction between individuals' ability and social and contextual demands.

Recognition and beliefs about treatment for mental disorders in mainland China: a systematic review and meta-analysis

PURPOSE

This review aimed to systematically investigate the Chinese public's ability to recognize specific mental disorders and their knowledge and beliefs about available treatments.

METHODS

Eight electronic databases were searched to identify quantitative studies examining recognition of depression, anxiety and/or schizophrenia, knowledge and beliefs about treatments, and/or correlates of each of the three constructs among the general population in China. Prevalence estimates were calculated for themes under each construct. Effect size r was computed for each relationship between an independent variable and one of the three constructs.

RESULTS

A total of 65 studies (N = 174,253) were included in this review. Depression (25.4%), anxiety (18.2%) and schizophrenia (18.4%) had low recognition rates. More than 80% of people agreed that one should seek professional help for mental illnesses, but fewer than 40% were likely to use professional services for their own mental health issues. Regarding psychiatric medications, 57% of the respondents agreed that medications should be taken regularly, but more than 60% believed that they would be harmful. Gender, income, residential area, occupation, education and marital status were significantly associated with level of mental health knowledge.

CONCLUSIONS

The public's level of mental health literacy related to recognition of specific mental disorders, and knowledge and beliefs about treatments is still relatively low. The government should consider public education campaigns to improve this.

Mental health first aid for the UK Armed Forces

Education programmes in mental health literacy can address stigma and misunderstanding of mental health. This study investigated self-rated differences in knowledge, attitudes and confidence around mental health issues following participation in a bespoke Mental Health First Aid (MHFA) training course for the Armed Forces. The mixed methods approach comprised quantitative surveys and qualitative interviews. A survey, administered immediately post-training (n = 602) and again at 10-months post-attendance (n = 120), asked participants to rate their knowledge, attitudes and confidence around mental health issues pre- and post-training. Quantitative findings revealed a significant increase in knowledge, positive attitudes and confidence from the post-training survey which was sustained at 10-months follow-up.Semi-structured telephone interviews (n = 13) were conducted at follow-up, 6-months post-attendance. Qualitative findings revealed that participation facilitated an ‘ambassador’ type role for participants. This study is the first to have investigated the effect of MHFA in an Armed Forces community. Findings show participants perceived the training to increase knowledge regarding mental health and to enhance confidence and aptitude for identifying and supporting people with mental health problems. Results suggest that such an intervention can provide support for personnel, veterans and their families, regarding mental health in Armed Forces communities.

A Systematic Review of Parent and Caregiver Mental Health Literacy

This study aimed to systematically review the current body of research on parent and caregiver mental health literacy. Electronic databases were searched in January 2018 with 21 studies meeting inclusion criteria. A narrative synthesis of quantitative and qualitative studies was conducted. Findings across studies suggest that parents and caregivers had limited mental health knowledge. Factors associated with help-seeking included cultural and religious beliefs, financial and knowledge barriers, fear and mistrust of treatment services, and stigma. Notable limitations include non-representative samples, cross-sectional research designs, and use of inconsistent and non-validated study measures. Research would benefit from more diverse samples, an increased focus on prevention, and controlled trials of educational programmes targeting mental health literacy.

Psychische Gesundheitskompetenz am Arbeitsplatz

Zusammenfassung. Das Mental Health Literacy tool for the Workplace (MHL-W; Moll, Zanhour, Patten, Stuart & MacDermid, 2017 ) ist ein vignettenbasiertes Instrument mit 16 Items zur Messung psychischer Gesundheitskompetenz im Arbeitskontext. Nach der Übersetzung ins Deutsche sowie einer Anpassung der Vignetten anhand einer qualitativen Expertenbefragung, wurde das MHL-W-G an zwei deutschsprachigen Stichproben mit 122 Studierenden sowie 317 Berufstätigen hinsichtlich Reliabilität, Konstruktvalidität, Messinvarianz, Geschlechtereffekte und Faktorstruktur analysiert. Erstmalig wurde die Faktorenstruktur (EFA/CFA) des MHL-W-G untersucht: Im Gegensatz zu dem von Moll et al. (2017) ursprünglich angenommenen einfaktoriellen Modell zeigte ein Modell zweiter Ordnung eine deutlich bessere Passung. Weiterführende Analysen ergaben gute interne Konsistenzen und Intraklassenkorrelationen. Die Ergebnisse deuten auf Messinvarianz des MHL-W-G unabhängig vom Geschlecht hin. Insgesamt lassen die psychometrischen Eigenschaften den Schluss zu, dass mithilfe des MHL-W-G psychische Gesundheitskompetenz am Arbeitsplatz reliabel und valide erfasst werden kann.

Design and Development Process of a Youth Depression Screening m-Health Application for Primary Health Care Workers in South Africa and Zambia: An Overview of the MEGA Project

Literature indicates a high prevalence and burden of mental illness in youths world-wide, which may be even higher in low- and middle-income countries (LMIC), such as South Africa and Zambia. Additionally, there is a lack of knowledge regarding youth depression amongst many primary health care (PHC) practitioners. The principal goal of the MEGA project is to provide youth with better access to mental health services and appropriate care, by developing a mental health screening mobile application tool to be used in PHC settings in South Africa and Zambia. In this study, we will use a mixed methods multi-center study design. In phase one, we will investigate the mental health literacy of PHC practitioners to identify areas in need of development. Based on the needs identified, we will develop and test a mobile health application to screen for common youth mental health problems in phase two. In phase three, we will implement and evaluate a tiered education and training program in the use of the m-health application. In the final phase, we will evaluate the acceptability and feasibility of the m-health application in PHC centres across South Africa and Zambia. Evidence suggests that PHC practitioners should routinely consider mental illness when assessing youth. However, common psychiatric disorders remain largely undetected and untreated in PHC settings. By identifying limitations in PHC workers knowledge with regard to youth mental health, we aspire to improve the depression care provided to youth in Southern Africa and Zambia by developing and implementing a locally relevant m-health application.

How to Measure Knowledge About Mental Disorders? Validation of the Italian Version of the MAKS

The aim of this study is to validate the Italian version of the Mental Health Knowledge Schedule (MAKS-I). The validation process included: linguistic validation; analysis of the feasibility; face validity; internal consistency; floor and the ceiling effects; divergent validity. Multiple linear regression was performed to examine the relationship between mental health knowledge and independent variables. MAKS-I was administered to 453 people. The linguistic validation was successful and face validity of the questionnaire showed no critical issues. The estimated composite reliability was 0.638. Divergent validity was supported by lack of statistical significant correlation between MAKS-I and RIBS-I with a positive correlation index. Participation in seminars or conferences related to the issue of mental health stigma, gender, qualification and having a first or second-degree relatives with a psychiatric disorder can be considered possible predictors of the MAKS-I score. MAKS-I is a reliable questionnaire to assess mental health knowledge and familiarity with psychiatric clinical conditions in Italian language.

The Level of Mental Health Literacy Among Athletic Staff in Intercollegiate Sport

Mental health literacy (MHL), the knowledge and attitudes that aid in recognition, management and prevention of mental health issues, could help maintain positive mental health within the athletic community. As coaches and athletic therapists (ATs) frequently and routinely interact with athletes, this study focused on the MHL of these individuals. Eighty participants (24 females, 54 males; 57 coaches, 18 ATs) completed an on-line version of the MHL Scale. Average MHL score was 131.48, which, is relatively equal to scores seen in university students and a general population. No significant difference was detected between coaches and ATs but females reported significantly higher MHL scores than males. There was a significant negative correlation between MHL and total experience. These results have potentially strong clinical ramifications as increased MHL in this context can affect facilitators and barriers towards seeking help in a high-risk population.