Table 1.
Study characteristics
| Reference and country (Author last name, year) |
Study design (data collection methods) | Measures of mh literacy /knowledge | Sample (N; n, % female) | Sample age (mean, [SD, age range]) | AIM |
|---|---|---|---|---|---|
| Upper Middle-Income Countries | |||||
|
Abdollahi et al. 2017 Malaysia |
Survey design—cross-sectional | Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS; Fischer and Farina, 1995) | 475; 232 (48.8%) | 17.29 [3.18, 15–21] | To examine attitudes towards seeking professional psychological help and explore relationships with personality attributes |
|
Ibrahim, Amit et al. 2019 Malaysia |
Survey design- cross-sectional | Mental Help Seeking Attitude Scale (MHSAS; Hammer et al. 2005) Depression Literacy Scale (Griffiths et al. 2005) Self-stigma of Seeking Help Scale (SSOSH; Vogel et al. 2006) General Help Seeking Questionnaire (GHSQ; Wilson et al. 2005) Beliefs Toward Mental Illness (BMI; Hirai and Clum, 2000) | 202; 137 (67.8%) | 17.03 [3.36, 13–25] | To examine the factors associated with mental help-seeking attitude among students from low-income households and residing in low-income settings. Differences in beliefs toward mental illness, stigma and help-seeking attitudes among university and secondary school students were investigated |
|
Ibrahim, Mohd Safien et al. 2020 Malaysia |
Quasi-experimental design | Mental Help Seeking Attitude Scale (MHSAS; Hammer et al. 2005) Depression Literacy Scale (Griffiths et al. 2005) Self-stigma of Seeking Help Scale (SSOSH; Vogel et al. 2006) General Help Seeking Questionnaire (GHSQ; Wilson et al. 2005) Beliefs Toward Mental Illness (BMI; Hirai and Clum, 2000) | 101; 61 (60%) | 14.61 [1.39, 13–17] | The study aimed to demonstrate the efficacy of the Malaysian Depression Literacy Program immediately after program delivery and at 3-month follow-up among adolescents from low-income populations demonstrating elevated depression levels |
|
Suttharangsee et al. 1997 Thailand |
Qualitative—ethnonursing | N/R | 23; 13 (56%) | 17 [N/R, N/R] ‡‡ | To assess views about what constitutes mental health and beliefs about factors for achieving and maintaining positive mental wellbeing |
|
Chan and Petrus Ng 2000 China (comparison with Hong Kong data) |
Survey design | Opinion About Mental Illness In Chinese Community (OMICC; Cohen & Struening, 1963) – adapted for this study |
China 789; 477 (60.4%) Hong Kong 2,223, 1196 (53.8%) |
16.82 [1.17, 12–18] Guangzhou 15.94 [1.20, 12–18] Hong Kong |
To explore attitudes and beliefs about mental illness |
|
Chen et al. 2014 China |
Survey design |
Self-Stigma of Help Seeking Scale (SSOHSS; Vogel et al., 2006), Perceived Devaluation-Discrimination Scale (PDDS; Link, 1987), Attitudes Toward Seeking Professional Psychological Help Scale (ATSPPHS; Fischer and Farina, 1995), Willingness To Psychological Help-Seeking Scale for Middle School Students (WTPHSS; Xu, 2008) |
251; 146 (58%) | 14.22 [1.46, 11–17] | To explore willingness to seek professional help for psychological problems, association with number of mental health problems and assess whether self-stigma and public stigma influences this relationship |
|
Tan et al. 2017 China |
Survey design—three-phase stratified cluster design |
Suicide Attitudes Inventory (Xiao et al. 1999) – based on the Suicide Attitude Questionnaire (Domino, 1982) and validated for Chinese populations. (Domino et al. 1982) | 6568; 3168 (48%) | 13.94 [1.83, 9–18] | To evaluate attitudes towards suicide and suicidal ideation and explore the relationship with mental health status |
|
Teo, Shi et al. 2020 China |
Survey design – cross-sectional | Questionnaire measuring perceptions of internet for help-seeking- origin, development or psychometric properties not reported | 1216; 614 (50.5%) | 14.21 [1.28, 11–17] | To predict intention to use cyber-counselling among Chinese adolescents using an extended theory of planned behaviour model |
|
Yu, Lou et al. 2019 China |
Multi-method qualitative study including photovoice, community mapping and focus group discussions | N/R | 90; 44 (48.8%) | 17.4 [1.3; 15–19] | To understand the factors that facilitate and hinder disadvantaged adolescents from obtaining the health information and services they need to secure good health |
|
Yamaguchi et al. 2014 China (comparison with Japan and South Korea) |
Survey design – cross-sectional with between group comparison | Selected items from the UK Pinfold Questionnaire (Pinfold et al., 2003) | 1011; 489 (48.4%) | N/R [N/R, 13–14] | To examine factors that influence stigmatising beliefs about mental health problems |
|
Eskin 1999 Turkey (comparison with Sweden) |
Survey design | Questionnaire developed specifically for the study – no information about development or adaptation given |
146; 71 (48.6%) Turkey 108; 49 (45.4%) Sweden |
16.1 [0.8, 14–18] Turkey 17.2 [0.9, 16–20] Sweden |
To explore attitudes and beliefs about prognosis, treatment and perceptions of mental illness and suicide |
|
Yilmaz-Gozu et al. 2013 Turkey |
Survey design – cross-sectional | Attitude Toward Seeking Professional Help Scale (ATSPHS; Ozbay, Yazıcı, Palancı and Koc, 1999) | 342; 198 (58%) | N/R [N/R, N/R] | To explore help-seeking attitudes including recognition of the need for help, stigma tolerance, interpersonal openness, confidence in mental health professionals and psychological distress |
|
Essau, Olaya et al. 2013 Iran |
Survey design | Mental Health Literacy for Depression questionnaire (Jorm et al., 1997)—original questionnaire was adapted and translated from English to Farsi | 1984; 1006 (50.7%) | 14.49 [1.7, 12–17] | To investigate recognition of depression, beliefs about causation and treatments and views about self-help for preventing depression in relations to socio-demographic characteristics and exposure to depression |
|
Aggarwal, Berk et al. 2016 South Africa |
Survey design – pre-intervention | Semi-structured questionnaire – development or psychometric properties not reported | 1999: 950 (47.5%) | 15.78 [1.78, 13–22] | To explore knowledge and recognition of depression symptoms and preferences for seeking support |
|
Shilubane et al. 2014 South Africa |
Qualitative | N/R | 56; 30 (53.6%) | N/R [N/R, 13–19] | To assess attitudes towards suicide, perceived risk factors and signs of potential suicide risk, awareness of available mental health care and beliefs about preventing suicide |
|
Morais et al. 2012 Brazil In Portugeuese |
Survey design | Access to Mental Health Care to Children – (AMHC; Kappler et al., 2004) – adapted for this study | 1,168; 619 (53%) | 15.80 [1.68, 10–21] | To explore the concepts of mental health and welling and understand self-help strategies to improve wellbeing |
|
Fukuda et al. 2016 Brazil |
Survey design – convenience sampling among three different schools, descriptive and correlational | Access to Mental Health Care to Children – (AMHC; Kappler et al., 2004) – adapted and validated by Aquina-Morais et al., 2014) | 1030; 540 (52.4%) | 15.3 [1.8, 8–21] | To explore attitudes towards professional psychological help, barriers to help-seeking comparing clinical and non-clinical samples |
|
Jenkins, Sanchez et al. 2019 Mexico In Spanish |
Mixed methods comprising quantitative (socio-demographic questionnaire and standardised symptom scales) and qualitative (in-depth ethnographic interviews, observation) components | N/R | 35; 20 (57.1%) | 15.9 [0.7, 15–17] | To generate an ethnographically informed understanding of contexts and processes that shape the emotional wellbeing and mental health of adolescents |
|
Gonzalez-Fuentez et al. 2016 Mexico In Spanish |
Mixed methods comprising quantitative survey derived from qualitative analysis | Scale development of psychological well-being | 1635; 856 (52.35) | N/R [N/R, 14–20] | To qualitatively evaluate the meaning of psychological wellbeing for adolescents and design and validate a scale to measure this construct |
|
Paula et al. 2009 Brazil |
Qualitative—focus groups and key informant interviews with families and service providers | N/R | 46; 28 (60.1%) | 13.7 [N/R, 11–16] | To explore views about the causes of emotional and behavioural problems and experiences of seeking care |
|
Gomez-Respetro et al. 2021 Colombia |
Survey design- nationally representative sample from household survey | Single item: self-report inquiring whether an adolescent had been told they had a mental health problem by a professional | 1754; N/R | N/R [N/R, 7–18] | The aim was to determine potential factors associated with whether mental disorders and problems are recognized in the Colombian population, specifically adolescents |
|
Jackson 2007§¶ Jamaica |
Survey design | Opinions about Mental Illness, (OMI; Stuening & Cohen, 1963), Attitudes Toward Seeking Professional Psychological Help Scale, (ATSPPHS; Fischer & Turner, 1970 “Where Do You Go To For Help” Questionnaire –scale development by the author for this study, no psychometric properties reported | 339; 193 (57%) | 17.18 [0.76, 15–19] | To explore attitudes towards seeking professional psychological help, beliefs about mental illness and help-seeking preferences and investigate in relation to symptoms of mental illness |
|
Maloney, Abel et al. 2020 Jamaica |
Survey design – cross-sectional | Attitudes Toward Seeking Professional Psychological Help (ATSPPHS; Fischer & Turner, 1970) Survey adapted from Ben-Zeev et al., 2017 – no psychometric properties reported | 56; 32 (57%) | N/R [N/R, 10–19] | To conduct a feasibility study to determine the viability of deploying digital mental health resources in Jamaica to adolescent populations, with a particular focus on identifying variations in infrastructure and preferences between rural and urban populations |
|
Williams 2012§ Jamaica |
Survey design – cross-sectional | “Where Do You Go To For Help” Questionnaire –scale development by the author for this study, no psychometrics reported | 339; 193 (57%) | 17.18 [0.76, 15–19] | To explore preferences for professional help-seeking and beliefs about treatment usefulness for different mental health problems |
|
Williams 2014§ Jamaica |
Survey design – cross-sectional | Attitudes Toward Seeking Professional Psychological Help (ATSPPHS; Fischer & Turner, 1970) modified by Atkinson and Gim, 1989; Opinions About Mental Illness Scale (OMI; Cohen & Struening, 1962) | 339; 193 (57%) | 17.18 [0.76, 15–19] | To examine the contribution of beliefs about aetiology, beliefs about mental illness and causation and socio-demographic factors to attitudes towards psychological help-seeking |
|
Williams 2013§ Jamaica |
Survey design – cross-sectional | Attitudes Toward Seeking Professional Psychological Help (ATSPPHS; Fischer & Turner, 1970) |
339; 193 (57%) Jamaican 81; 12 (15%) African American |
17.18 [0.76, 15–19] Jamaican 15.98 [1.13, 14–18] African American |
To evaluate attitudes towards psychological help-seeking and draw comparison with a high-income country |
|
Cankovic et al. 2013 Serbia In Serbian |
Survey design | Suicide Opinion Questionnaire (Domino, 1996) | 254; N/R (N/R) | N/R [N/R, 13–19] | To explore attitudes towards suicide |
|
Pejovic-Milovancevic et al. 2009 Serbia |
Pre and post-test design |
Opinion about Mental Illness (OMI; Stuening & Cohen, 1963) |
63; N/R (N/R) | N/R [N/R, 15] | To evaluate awareness of mental health-related issues and assess stigmatising behaviours prior to receiving mental health awareness sessions |
| Lower Middle-Income Countries | |||||
|
Attygalle et al. 2017 Sri Lanka |
Survey design—descriptive cross-sectional | Australian National Survey on Mental Health Literacy (Reavley & Jorm, 2011) – modelled on this questionnaire | 1002; 421 (42%) | 14.00 [0.94, 13–16] | To explore recognition of mental health problems, attitudes towards seeking professional help and views about potential treatment outcomes |
|
Nastasi and Borja 2015# Chapter 6 Adelson et al India |
Qualitative—focus groups and ecomap activities | N/R | 37; 37 (100%) | N/R, [N/R, 12–20] | To explore stressors and protective factors for psychological wellbeing |
|
Sharma et al. 2017 India |
Survey design—cross-sectional | Australian National Survey on Mental Health Literacy (Reavley & Jorm, 2011) – adapted and modified for Indian context | 354; 168 (47.5%) | N/R [N/R, 13–17] | To evaluate depression recognition, help-seeking intentions, and beliefs about interventions, causes, risk factors, outcomes, and stigmatizing attitudes |
|
Parikh, Michelson et al. 2019 India |
Multi-method qualitative (stakeholder interviews and focus group discussions) | N/R | 191; 112 (58.7%) | N/R [N/R, 11–17] | To elicit the views of diverse stakeholders including adolescents in two urban settings in India about their priorities and preferences for school-based mental health services |
|
Shadowen et al. 2019 India |
Mixed methods – quasi-experimental design with qualitative inquiry | N/R | 15; N/R (N/R) | N/R; [N/R, 12–14] | To measure the impact of an after-school resilience-building program for a group of marginalized Indian schoolchildren in rural farming villages of Tamil Nadu, India |
|
Afifi 2004 Egypt |
Survey design – multistage stratified random sampling | Attitude Towards Suicide Scale (ATSS; Eskin, 2004) | 1621; 801 (49.4%) | 15.77 [1.36, 14–19] | To evaluate attitudes towards suicide and the relationship between ideation and attempts |
|
Nguyen et al. 2013 Vietnam |
Multi-method qualitative (stakeholder interviews, key informant interviews, focus groups) | N/R | 138; 83 (60%) | N/R [N/R, 15–18] | To explore perceptions of mental health and views about what are the risks for mental health problems alongside identifying stakeholder strategies to improve mental health |
|
Nguyen, Dang et al. 2020 Vietnam and Cambodia (Cambodia – least developed country class) |
Experimental evaluation (pre-post randomised design) in Vietnam (study 1) and preliminary efficacy study in Cambodia (study 2) | Mental Health Knowledge and Attitude Test (Kutcher & Wei, 2017) | Study 1: 2539; 1320 (52%) Study 2: 275; 171 (62%) |
N/R [N/R, N/R] Study 1: 15 (median) Study 2: 16 (median) |
To evaluate the efficacy of an evidence-based MHL program in Vietnam adapting an existing program and assess portability in a pilot efficacy study in neighbouring Cambodia |
|
Thai, Vu et al. 2020 Vietnam |
Survey design- cross-sectional cluster sampling | Mental Health Literacy Scale (MHLS; O’Connor & Casey, 2015) General Help-Seeking Questionnaire (GHSQ; Wilson et al. 2005) | 1075; (56.2%) | N/R [N/R, N/R] | To evaluate the level of mental health literacy and help-seeking preferences in high school students in Ho Chi Minh City, Vietnam |
|
Willenberg, Wulan et al. 2020 Indonesia |
Qualitative – focus group discussions | N/R | 86; 41 (47.7%) | 17 [N/R; 16–18] †† | To understand conceptualisations and perceived determinants of mental health from the perspective of Indonesian adolescents |
|
Estrada, Nonaka et al. 2019 Phillipines |
Mixed methods comprising quantitative (cross-sectional survey) and qualitative (in-depth interviews) components | N/R |
183; 58 (33.9%) Study 1: 171, Study 2: 12 |
N/R [N/R, N/R] | To describe the prevalence of suicidal ideation and behaviours, attitudes towards suicide among adolescent learners in alternative education. Additionally, relationships between suicidal ideation, behaviours, participant characteristics, attitudes and alternative learning environment were evaluated |
|
Dardas, 2018†¶ Jordan |
Survey design—nationally representative, school-based sample |
Depression Etiological Beliefs Scale (Samouilhan & Seabi, 2010; Wadian, 2013), Depression treatment seeking scale (Barney, Griffiths, Jorm, & Christensen, 2006) Depression Stigma Scale (Griffiths et al., 2008) | 1389; 820 (59%) |
N/R [N/R, 12–17] §§ 168 (7.0%) 12 259 (11%) 13 357 (15%) 14 396 (17%) 15 839 (36%) 16 312 (14%) 17 |
To explore beliefs about depression causation, stigmatising beliefs and the likelihood of seeking help in relation to depression symptoms |
|
Dardas et al. 2018† Jordan |
Survey design – pilot study to assess feasibility of obtaining nationally representative sample | N/R | 88; 35 (40%) | 16 [0.5, 15–17 | To examine the methodology for research examining depression stigma and attitudes towards professional help-seeking in relation to depression severity |
|
Dardas, Shoqirat et al. 2019 Jordan |
Qualitative – focus group discussions | N/R | 92; 56 (61%) | 15 [N/R, 14–17} | To capture adolescents’ experiences of depression, identify perceived contributing factors and assess attitudes towards depression interventions |
|
Rahman, Mubbashar et al. 1998 Pakistan |
Quasi-experimental design – control group with no randomisation to a school mental health programme | Measure designed for this study – no development or validation reported |
100; 50 (50%) intervention, 50 (50%) control |
N/R [N/R, 12–16] | To evaluate awareness of mental health-related problems prior to receiving mental health awareness programme |
|
Khalil et al. 2020 Pakistan |
Survey design-cross-sectional | Paediatric Self-Stigmatization Scale (PaedS) Kaushik, A., Papachristou, E., Dima, D., Fewings, S., Kostaki, E., Ploubidis, G.B., Kyriakopoulos, M., 2017) | 110; 55 (50%) | N/R [N/R, 8–17] | To measure the stigma associated with mental illness in children with a variety of psychiatric diagnoses |
|
Callan et al. 1983 Papua New Guinea (comparison with Australian data) |
Survey design- correlational analysis and content analysis of free text responses | Scale developed for this study from existing measures (Brockman and D'Arcy, 1978; Trute & Loewen, 1978; Dieman et al., 1973; Nunnally, 1961) |
Papua New Guinea 133; 57 (42.3%) Australia 144; 51 (35.4%) |
17 [N/R, N/R] males 16 [N/R, N/R] females (PNG students only) |
To explore attitudes and beliefs about mental illnesses and treatment |
|
Aluh et al. 2018 Nigeria |
Survey design – descriptive cross-sectional | Friend in Need Questionnaire (Burns and Rapee, 2006) | 285; 143 (50.20%) | 14 [N/R, 12–18] ‡‡ | To explore knowledge and recognition of depression and help-seeking behaviours |
|
Bella et al. 2012* Nigeria |
Survey design—qualitative thematic analysis of free text responses | N/R | 164; 85 (52%) | 14.8 [1.8, 10–18] | To explore views about mental illness, causation, manifestations and treatment |
|
Bella-Awusah et al. 2014 Nigeria |
Quasi-experimental design -two group pre-test–post-test control group design without randomisation | World Psychiatric Association Anti-stigma Schools Project/UK Pinfold Questionnaire (Pinfold et al. 2003) – adapted for this study |
154; approximately 50% were female in intervention (51.9%) and control (50.7%) |
15.3 [1.6, 10–18] intervention 14.3 [2.0, 10–18] control |
To assess the impact of a school-based mental health awareness programme in mental health literacy and stigmatising beliefs |
|
Dogra et al. 2012* Nigeria |
Survey design – cross-sectional | World Psychiatric Association Anti-stigma Schools Project in Canada (World Psychiatric Association, 2000) – adapted to Nigerian context | 164; 85 (52.1%) | 14.8 [1.8, 10–18] | To explore knowledge and attitudes towards mental health and illness including stigmatising beliefs |
|
Oduguwa et al. 2017 Nigeria |
Quantitative—quasi-experimental with an intervention and control group | UK Pinfold Questionnaire (Pinfold, 2003) –adapted, translated and validated for use in Nigeria | 205; 95 (47%) | 14.91 [1.3, 10–17] | To explore attitudes, knowledge and stigmatising beliefs about mental illness prior to receiving mental health awareness training |
|
Ola et al. 2015 Nigeria |
Survey design – participants were children whose parents were psychiatric inpatients in the mental health unit of the Lagos State University Teaching Hospital |
Selected items from previous studies (Adewuya and Makanjuola, 2008; Ani et al., 2011) – no psychometric properties reported | 67; 43 (64%) | 13.34 [2.87, 7–18] | To explore beliefs about mental illness and perceived risks for mental distress in children whose parents have mental illness |
|
Ronzoni et al. 2010* Nigeria |
Cross-sectional survey with qualitative analysis of free text responses | World Psychiatric Association’s anti-stigma schools project in Canada (World Psychiatric Association, 2000)/UK Pinfold Questionnaire (Pinfold et al., 2003) | 164; 81 (49.4%) |
N/R [N/R, 12–18] §§ 24 (14.7%) 10–12 51(31.1%) 13–14 52 (31.2%) 15–16 36 (22%) 17–18 |
To explore views about mental illness, mental health problems, stigmatising beliefs and beliefs about causes |
|
Ndetei, Mutiso et al. 2016 Kenya |
Survey – random school clusters selected from 2 districts in Kenya and 23 schools from each cluster selected using simple random sampling, students in classes in selected clusters participated | Self-Stigma of Mental Illness Scale (SSMIS; Corrigan et al., 2006) – stereotype agreement subscale used, translated into local languages | 4585; 2290 (49.9%) | 10.4 [2.5, 5–21] | To investigate stigmatizing beliefs about mental illness and examine the relationship with socio-demographic factors |
|
Secor-Turner, Randall et al. 2016 Kenya |
Qualitative | N/R | 64; 32 (50%) | 16.2 [N/R, 12–26] | To evaluate perceived barriers and facilitators of health in a cultural context |
|
Tamburrino et al.2020 Kenya |
Qualitative interviews | N/R | 7; N/R | N/R [N/R, 14–17] | To explore how youth stakeholders conceptualize mental illness, contributing factors and required supports for disadvantaged young people in Kenya |
|
Glozah 2015 Ghana |
Qualitative study using semi-structured interview | N/R | 11; 6 (54.5%) | 16.86 [N/R, N/R] | To explore perspectives of interpersonal support for personal wellbeing |
| Least Developed Countries | |||||
|
Nalukenge, Martin et al. 2018 Uganda |
Qualitative interviews | N/R | 19; 11 (58%) | 14 [N/R, 12–17] †† | To explore perspectives and beliefs about mental illness causation among children with positive HIV status |
|
Dhadphale 1979 Zambia |
Survey design | N/R | 69; 69 (100%) | N/R [N/R, 14–19] | To explore perspectives of spirit possession, recognition of treatment need and help-seeking |
*Using the same data
†Using the same data
§Using the same data
¶Dissertation
#Book/monograph
**N/R = not reported
††Median and/or IQR reported
‡‡Mode reported
§§Proportions reported in age bands