Does major make a difference? Mental health literacy and its relation to college major in a diverse sample of undergraduate students

Abstract

Examining a large number of specific college majors and their association with mental health literacy (MHL) is an important step towards identifying at-risk groups at the college level. Though prior research has investigated MHL across student demographics such as gender, age, ethnicity, and level of education, the present study was the first to compare the MHL of undergraduate students across 19 different college majors. A total of 617 demographically and ethnically diverse undergraduate students (62.1% female; 69.3% non-white; mean age = 22.2 years; mean year in college = 2.8) reported their demographics, college experience, and college major, and completed an MHL measure that assessed knowledge of more than 20 psychological disorders and the application of that knowledge to real life scenarios. After controlling for gender, data were analyzed using ANOVA and post hoc comparisons to determine if differences in mental health literacy level were related to specific college majors. Results revealed that mental health literacy significantly differed across majors, F(18, 598) = 5.09, p < .001. Specifically, students majoring in accounting, nursing, business, biology, and those in a multidisciplinary category had significantly lower mental health literacy scores compared to the highest scoring major, psychology. We present empirical data about variations in mental health literacy across many different majors in higher education. Our findings provide a rationale for interventions for academic majors with lower MHL, as well as a rationale for training of college faculty and staff, for the purpose of improving psychological well-being in at-risk college students.

Introduction

The college population: an at-risk group

Psychological disorders among college students are a serious concern, with high prevalence rates occurring in this population [1, 2], and approximately one-third of students experiencing mental health issues such as depression, anxiety, and/or suicidal thoughts [3]. Understandably, the college years are a stressful time for many students due to a variety of issues that include social, financial, and educational challenges. But even more so, because most mental health issues typically develop by the mid-twenties [4], college students are especially at risk for the development of mental health challenges and an escalation of these disorders in the face of pre-existing issues.

Many recent studies confirm these concerns. According to the 2019 American College Health Association National College Health Assessment [5], which included reports from over 54,000 undergraduate students in the United States regarding their experiences within the past 12 months, more than 66% reported feeling overwhelming anxiety, 72% reported feeling very sad, and more than 46% reported having difficulty functioning as a result of feeling depressed. Additionally, the 2018–2019 Healthy Minds Study, which gathered data on more than 62,000 students from colleges within the United States, determined that 31% of respondents struggled with anxiety and 36% with depression [6]. Similar numbers were found in an international study conducted on college students across eight countries by the WHO (World Health Organization), where over 30% of first-year students reported having one or more of the following disorders at any time during the past 12 months: major depressive disorder, mania/hypomania, generalized anxiety disorder, panic disorder, alcohol use disorder, or drug use disorder [7].

Mental health in higher education

In recent years, in addition to educational and degree-granting efforts, colleges have been increasing resources towards improving the mental health of students. These efforts stem from the high prevalence of psychological disorders among college students [7, 8], as well as the psychological effects of COVID-19 on young adults [9–11]. Academic research on this topic has suggested ways to promote good mental health in college students with a focus on decreasing stigma and increasing help-seeking behaviors by promoting an atmosphere of positive mental health, as well as increasing awareness, education, and resources [12, 13].

Assessing mental health literacy as a starting point

An approach to identify college students’ vulnerability to mental health issues involves assessing students’ mental health literacy, which is the knowledge and beliefs that a person has regarding mental health that can help them recognize, manage, and prevent psychological disorders [14]. Included in the construct of mental health literacy is knowledge of the symptoms, causes, and risk factors of psychological disorders, attitudes about mental illness, and the ability to locate and utilize information and professional mental health services [14]. In studying these various factors, the significance is evident: increasing mental health literacy is imperative for early recognition and subsequent help-seeking behaviour. Indeed, previous research has found associations between higher levels of mental health literacy and greater willingness to disclose mental illness, improved help-seeking behaviours, and increased treatment use [15–17]. Most recently, a review study that sought to establish the association between mental health literacy and help-seeking behaviours [18] found a significant relationship between the two variables, supporting the idea that increased mental health literacy is linked to more positive mental health outcomes.

Factors associated with mental health literacy at the college level

In the quest to ascertain what contributes to knowledge of mental health at the college level, several studies have investigated factors associated with mental health literacy, with higher levels found for female students [19–26] and white students [22, 27]. Another factor associated with mental health literacy was a student’s mental health, where those with previous psychological diagnosis or history of mental health issues had higher mental health literacy [19, 21, 25]. Level of education has also been studied with results indicating that higher levels of education are associated with higher levels of mental health literacy [19, 23, 25, 26].

A variable uniquely and importantly related to college experience is college major. To our knowledge, eleven published studies have compared levels of mental health literacy across fields of study (see Appendix 1 for a review table of published studies that have compared mental health literacy across fields of study). In a study assessing factors related to mental health literacy of male college students, those majoring in STEM fields displayed lower mental health knowledge than those majoring in non-STEM fields [27]. Further differences relating to field of study were found in an analysis of college students’ ability to recognize symptoms of depression and schizophrenia. Specifically, those who had studied psychology and medicine were most adept at identifying the true symptoms for both of these disorders in comparison to students from other academic fields including law, economics, natural sciences, and philosophy/arts [24]. Supporting the finding that students of psychology and medicine have greater knowledge of mental health, a study investigating college students’ ability to recognize close to 100 psychiatric disorders found an association between participants who had studied psychology or psychiatry and knowledge of these disorders [20]. Similar results were found in a study on depression recognition, where students in the medical field performed better than students from other disciplines including law, arts and education, management and finance, science, and computing [28]. Additionally, in a study that included students in the fields of agricultural sciences, arts, and pharmaceutical sciences, highest rates of recognition of schizophrenia were found in students majoring in pharmaceutical sciences [29]. More recently, high performers on a mental health literacy assessment that included more than 20 psychiatric disorders were more likely to have majored in psychology or applied health science fields when compared to humanities/social sciences, business/economics/accounting, education, and STEM fields [25].

Overall, there is support for the idea that academic major is related to knowledge of mental health. However, studies on this topic are scarce, and the majority have assessed college students’ knowledge of 1–2 disorders, particularly depression and/or schizophrenia [24, 28–30] rather than having assessed for a wide range of disorders. More importantly, the investigated academic disciplines are oftentimes too few or too broad, hindering the identification of specific majors with lower mental health literacy in need of educational and/or psychological interventions. Interestingly, this issue has not affected studies of academic majors in other contexts, where both a greater number and narrower fields were examined, such as the relationship between academic disciplines and social mobility [31], the gender pay gap [32], mental illness and treatment use [33], and personality patterns [34]. With this in mind, a greater number of fields of study, which are also more specific, should be investigated for a more nuanced understanding of college major and its association with mental health literacy of college students.

Current study

The current study investigates variations in mental health literacy across academic disciplines. We improve upon limitations in the extant literature by assessing mental health literacy in more than 15 specific majors as opposed to clusters of academic fields. Additionally, we examine knowledge of more than 20 disorders from the DSM-5 [35] as opposed to a minimal number of disorders. In doing this, we strive to determine the contribution of major to variability in mental health literacy in college students. Our ultimate aim is to identify majors with low mental health literacy who may benefit from targeted clinical and educational interventions in the area of mental health.

Materials and methods

Participants and procedure

Undergraduate students attending a large, urban, public university in the northeast United States were recruited to participate. Members of the research team contacted course instructors across various academic departments to request permission to administer a paper-and-pencil questionnaire during classroom sessions. Other efforts included in-person recruitment at heavily populated campus locations (e.g., student lounges, libraries, outdoor campus quads), online recruitment via campus subject pool listings, and by the posting and distribution of flyers, which informed students about open administration sessions. To be eligible, individuals had to be actively enrolled at the undergraduate level and be at or over the age of 18 years old. Those who met the eligibility criteria and expressed interest in participating were given an overview of the study from an IRB-approved script, which outlined the general study aims, confidentiality procedures, and rights to voluntary participation or withdrawal from the study. Those who agreed to participate were then administered the questionnaire, which took approximately 30–40 min. Upon completion, participants were compensated with either $5 cash or subject pool credit.

Measure

We used the Mental Health Literacy Assessment for college students (MHLA-c; [36]), which is a multiple-choice measure with three validated alternate forms that each contain 18 items and assess similar mental health literacy domains. The measure was validated on a sample of over 1200 demographically diverse college students from a university located in the northeast United States. Items focus on knowledge of more than 20 psychological disorders including their causes, risk factors, symptoms, treatment, course, and prognosis, as well as the application of this knowledge to real world situations such as recognizing symptoms in daily life, having insight, assisting others, utilizing professional help, and preventing poor outcomes. Rabin et al. [36] showed psychometric support for the MHLA-c including internal consistency reliability (Kuder–Richardson formula 20 values 0.74 to 0.75 for all forms), evidence of content and construct validity, and uni-dimensionality (based on an exploratory factor analysis).

Study variables

Given issues with participant burden, participants were randomly assigned to complete either all three forms of the MHLA-c or just two forms. In addition to completing the MHLA-c, all participants reported their age, gender, sexual orientation, ethnicity, and current year of study. Participants also reported their college major from a predetermined list of 21 majors (psychology, biology, accounting, computer science, nursing, health-nutrition, communication, speech, education, political science, business, finance, English, film, economics, mathematics, engineering, sociology, chemistry, TV-radio, and theatre) or by providing a different major within an open-ended “other” category option. To obtain the final set of majors, the following criteria were implemented: (1) participants who stated that their major was undeclared were excluded from the analysis; (2) majors endorsed by only a few participants were excluded from the analysis; (3) participants who chose more than one major, where one of the declared majors was psychology, were placed into the psychology category, supported by previous literature that found that psychology majors or those with coursework in psychology had higher levels of mental health literacy [20, 24, 25, 37]; and (4) participants who had declared more than one major, none of which was psychology, were included under the “multidisciplinary” category. The final dataset contained 19 levels of majors, including 15 individual majors (accounting, biology, business, chemistry, computer science, criminal justice, education, engineering, English, health-nutrition, kinesiology, mathematics, nursing, political science, psychology), three combined majors (finance & economics, speech & communication, and TV-radio & film), and a multidisciplinary category.

Statistical analyses

As participants answered either two or three forms, raw MHLA-c scores were converted into percent correct scores (one score per participant) and descriptive statistics were calculated to determine means, standard deviations, and skewness. Because the female gender has been repeatedly associated with higher mental health literacy in both the general population [38–40] and the college population [20, 22, 24–26, 28, 41], we removed the effect of gender on MHLA-c scores using a simple linear regression, and we used the residuals from the regression analysis for all further analyses.

In order to examine the effect of academic majors on mental health literacy (i.e., MHLA-c scores), after gender effects were removed, a one-factor analysis of variance (ANOVA) was conducted with academic major (with 19 levels) as the between subjects factor and the residuals from the simple linear regression as the dependent variable. Due to the large number of levels (19) and variable group sizes for each major, a permutation test was used to test the null hypothesis that academic major has no effect on mental health literacy. In the permutation test, the observations were resampled 5000 times without replacement such that their group labels were reordered. ANOVA was then conducted for each permuted sample to generate a sampling distribution for the F-statistic under the null. Then, the original F-statistic was compared to this distribution to determine its occurrence due to chance [42]. Lastly, pairwise comparisons were conducted using post-hoc Tukey tests at the 0.05 significance level. All statistical analyses were performed using the jamovi and R software programs [43, 44].

Results

Data were collected from 683 undergraduate student participants. Due to exclusion criteria (see Methods section above), 66 participants were removed from the statistical analysis resulting in a final sample size of 617 participants. Specifically, 35 participants did not report a major or stated their major as undeclared, and 30 participants reported majors that were endorsed by too few participants. Additionally, one participant who only answered a single question correctly on the MHLA-c was removed.

A power analysis using G*Power (version 3.1.9.3; [45]) indicated that the required sample size to achieve 80% power for detecting a medium effect (f = 0.2), at a significance criterion of α = 0.05 for a one-factor between subjects ANOVA with 19 groups, was N = 532. Thus, the final sample size of N = 617 was adequate for the current study analysis. A chi-square analysis showed no difference between the dropped and retained data for age, gender, and ethnicity. Socio-demographic information for the analytic sample (n = 617) is given in Table 1.

Table 1.

Socio-demographic characteristics of the analytic sample (n = 617)

Age M (SD): 22.2 (4.76) years
Gender	n	%
Male	220	35.7
Female	383	62.1
Gender Non-binary	5	0.8
Gender Nonconforming	1	0.2
Genderqueer	2	0.3
Prefer Not to Answer	5	0.8
Not Listed	1	0.2
Race/Ethnicity
Black/African American	131	21.2
White/Caucasian	189	30.6
Asian American/Pacific Islander	136	22.0
Hispanic/Latinx	100	16.2
Native/Indigenous American	2	0.3
Multiracial	54	8.8
Prefer Not to Answer	2	0.3
Not Listed	3	0.5
Year in College
First	71	11.5
Second	170	27.6
Third	179	29.0
Fourth	132	21.4
Fifth	41	6.6
Sixth	3	0.5
Other***	20	3.2

*Note. Data were missing for age (n = 5)

**Note. Three participants identified as transgender

***Note. Includes students who reported being in a year > 6, pursuing a second degree, or being a non-degree student

The final set of majors included in the analysis in order of highest to lowest mean MHLA-c scores with a summary of the descriptive statistics can be found in Table 2. Results of mean scores indicated that psychology scored the highest while accounting scored the lowest, with all majors having low scores, based on a traditional college grading scale (i.e., D [60–69%] and F [below 60%]).

Table 2.

List of majors with descriptive statistics for MHLA-c scores (as percent correct)

Major	N	Mean	Std. Deviation	Skewness
Psychology	242	65.40	17.90	− 0.62
English	9	64.80	9.00	0.92
TV-Radio & Film	17	64.20	13.00	− 1.67
Kinesiology	14	60.40	16.60	− 0.40
Engineering	25	59.80	13.50	− 0.46
Chemistry	13	59.60	18.60	− 1.00
Education	37	58.30	19.10	− 0.20
Speech & Communication	17	58.00	12.30	− 0.24
Political Science	9	57.00	17.50	0.13
Biology	63	55.10	17.00	− 0.04
Health-Nutrition	27	53.20	18.10	0.28
Mathematics	14	53.10	23.20	− 0.03
Finance & Economics	13	49.90	20.30	− 0.38
Business	34	48.90	18.60	0.26
Computer science	20	48.80	13.50	0.30
Criminal Justice	9	47.90	10.80	0.31
Nursing	18	47.20	15.90	0.45
Multidisciplinary	15	46.00	16.00	− 0.45
Accounting	21	44.70	14.70	0.28

A simple linear regression with gender as the independent variable (coded as 1 for female gender and 0 for other genders) and the raw MHLA-c scores as the dependent variable was conducted. The gender effect was significant based on a permutation test [F(1, 615) = 19.36, p < 0.001, R² = 0.029], but only explained less than 3% of the total variance in the MHLA-c scores.

We then removed the effect of gender from the MHLA-c scores by computing residual scores from the regression analysis. A one-factor ANOVA, with academic major as the between-subject factor, and the residual scores as the dependent variable, was significant based on a permutation test, [F(18, 598) = 5.09, p < 0.001, R² = 0.11, ${\eta }^2$= 0.031]. Homogeneity of variance was tested with a Bartlett’s test (p = 0.08) and normality was tested with a Shapiro–Wilk test (p = 0.24), thus satisfying the necessary assumptions for the ANOVA despite the unequal sample sizes. A post-hoc power analysis (G*Power version 3.1.9.3 [45]) with the obtained partial ${\eta }^2$= 0.031 (effect f = 0.18) and total sample size of 617 at a significance criterion of $\alpha$ = 0.05 indicated that the current study achieved 78% power for detecting a medium effect size.

Post hoc comparisons using Tukey tests were then used to compare the mean residual scores of psychology, which was the highest scoring major, with every other major. Results indicated that students majoring in biology, business, nursing, accounting, and those in the multidisciplinary category scored significantly lower compared to psychology majors after controlling for gender (Table 3).

Table 3.

Post-hoc Tukey tests comparing all other majors with psychology (after removing gender effects)

All majors—psychology comparison†	Mean difference (Residuals)	t-value	df	p-value
Accounting	− 20.04***	− 5.16	598	< 0.001
Multidisciplinary	− 19.85**	− 4.37	598	0.002
Nursing	− 18.90**	− 4.53	598	0.001
Criminal Justice	− 14.88	− 2.57	598	0.555
Business	− 14.68**	− 4.69	598	< 0.001
Computer Science	− 13.43	− 3.38	598	0.080
Finance & Economics	− 12.22	− 2.51	598	0.549
Health-Nutrition	− 11.59	− 3.34	598	0.089
Biology	− 9.53*	− 3.94	598	0.012
Mathematics	− 8.93	− 1.91	598	0.924
Speech & Communication	− 7.72	− 1.80	598	0.953
Education	− 7.33	− 2.43	598	0.610
Political Science	− 6.56	− 1.13	598	1.000
Chemistry	− 5.07	− 1.04	598	1.000
Kinesiology	− 3.54	− 0.75	598	1.000
Engineering	− 2.13	− 0.59	598	1.000
English	− 0.94	− 0.16	598	1.000
TV-Radio & Film	− 0.34	− 0.08	598	1.000

Note. *p < 0.05, **p < 0.01, ***p < 0.001; df degrees of freedom

Note. ^†All residuals are computed as each major minus psychology

Discussion

The present study sought to determine if mental health literacy was related to college major in a sample of undergraduate students that was highly diverse. Mental health literacy was assessed using the MHLA-c, a multiple-choice test that measured knowledge of multiple disorders and the application of that knowledge to daily life. Although much has been addressed in the literature regarding the variables associated with mental health literacy in the general population (e.g., gender, age, ethnicity, previous experience with mental health issues), less has been studied in relation to the college population, and even less so regarding college major. The few studies that have investigated college major have focused on general domains of study or a limited number of majors, preventing the identification of specific majors with lower mental health literacy. Thus, we attempted to narrow the focus to specific areas of study through the investigation of individual majors.

Results of a one-factor ANOVA indicated that college major was indeed associated with mental health literacy scores. Post hoc Tukey tests were then used to compare every major to the major that scored the highest on our measure, which was psychology. After controlling for the effect of gender, students in accounting, nursing, business, biology, and the multidisciplinary category were found to have scores that were significantly lower than scores of students majoring in psychology. These findings are particularly important and align with the purpose of our study, which was to identify college majors with low mental health literacy scores for the future goal of developing mental health interventions in this high-risk population.

The finding that psychology majors in our study achieved the highest scores aligns with previous research [20, 24, 25, 37]. However, though psychology majors’ average score (M = 65.2%) was the highest across all the majors investigated, this score was actually low based on a traditional college grading scale (i.e., A[90–100%], B[80–89%], C[70–79%], D[60–69%], F[Below 60%]). This may be tied to variation in coursework among psychology majors, where some students focus on areas of psychology such as social psychology, neuropsychology, industrial/organizational psychology, or cognitive psychology, and thus may not have had exposure to psychology classes related to mental health (e.g., abnormal psychology, psychopathology, counseling psychology, psychological disorders of childhood). Indeed, in a separate sample of undergraduate students, higher mental health literacy scores were associated with having taken a course related to clinical psychology [25], something that psychology majors in our sample might not have taken within their coursework.

It is important to note that psychology majors comprised 40% of the sample, which may be due to a combination of factors including that our study was related to psychology as well as being executed through a psychology department, possibly attracting psychology majors more so than other majors. However, while our sample reflects an over-representation of psychology majors, it nonetheless contributes to the power and increased reliability of comparisons made against this major.

Our main finding was that mean mental health literacy scores for accounting, business, biology, nursing, and the multidisciplinary category were significantly lower than the mean scores for psychology. Though it is challenging to draw direct comparisons between these results and previous research due to the investigation of broad categories of majors rather than specific majors, there is, nonetheless, evidence that parallels our findings.

Accounting and business majors achieved low mental health literacy scores, with accounting having had the lowest mean score across all majors. These findings correspond to a study which found that students in the faculty of management and finance, which included accounting and business, had one of the lowest mental health literacy scores compared to all other majors investigated [28]. Though this one point of comparison serves as a starting point, additional research is needed to establish a more definitive conclusion.

Our finding that biology majors had low mental health literacy scores is supported by a study where students of natural science displayed low levels of mental health literacy [24]. Further support comes from a study in which students from STEM fields had lower knowledge of mental health than did students from non-STEM fields [27]. Particularly surprising in our results, however, is that despite engineering and chemistry being part of STEM, their means were not significantly lower than the mean of psychology. This may be the result of chemistry and engineering students in our sample performing unusually well or may imply that their higher performance has gone undetected in previous research due to being grouped with STEM fields.

The low scores observed for nursing majors are difficult to align with previous research because there are no published studies comparing the mental health literacy of nursing students to other majors. Rather, existing studies have examined the mental health literacy of nursing students in relation to training or length of time in nursing school [46, 47]. It can be argued, though, that a point of comparison can be made between nursing and medical students because both groups are part of the medical field. However, previous research has found that medical students did well on assessments of mental health literacy [24, 28] contrasting the performance of nursing students in our study. This difference could be the result of variations in academic curricula, level of training, and/or length of training in the clinical field. In light of this, an added focus on increasing mental health awareness and knowledge in nursing curricula and clinical exposure would be beneficial.

The multidisciplinary category was comprised of various combinations of dual majors that students chose as their fields of study. The one common factor was that no students in this category endorsed psychology as their major (see Methods section), which may have contributed to the low mean score of this group. Due to the homogenous nature of the majors included in this category, comparison to previous research, as well as future investigation, would be difficult to conduct.

It is interesting to note that health-nutrition, mathematics, and finance & economics had mean scores which were more than 10 points lower on average than psychology, yet these results did not reach significance. These null findings, which were most likely due to the low sample size of these majors, should nonetheless be taken into account considering the difference in performance between these majors and psychology.

Our non-significant findings for most of our majors seem to be the result of psychology achieving a low mean score, thus minimizing the gap and lessening the number of majors that were significantly lower in comparison. However, every major investigated in our study achieved a mean score on the MHLA-c at or below 65.2%, which echoes the findings in the literature of low mental health literacy in the general population [48].

Study limitations

Although our results suggest that certain academic majors are more aligned with lower mental health literacy than others, these findings should be interpreted with caution and be viewed in light of the study’s limitations. As the methodology was correlational, causal links between university areas of study and mental health literacy cannot be conclusively drawn. Additionally, because of practical issues preventing random selection of participants, we instead used a convenience sample. This approach may have inadvertently excluded those students who were absent from class due to mental health issues, which may have thus impacted our results. Furthermore, due to voluntary participation, we had a high percentage (62.5%) of women and a high percentage (40.8%) of psychology majors in our sample, which may limit generalizability. Most importantly, some majors had a small sample size, and replication with a larger sample would be necessary to confirm our results.

Future directions

Our endeavour with regard to future directions is to address the mental health needs of undergraduate college students by developing interventions such as workshops and courses intended to target students from low-performing majors. Specifically, we aim to develop educational and clinical interventions to: (1) increase knowledge of psychological disorders and their symptoms and treatments; (2) foster awareness of mental health issues such as early recognition and help seeking; and (3) increase awareness of the various counseling services available on campus. Though such interventions are important for students across campus, it is especially critical to identify and then focus on students with poorer mental health literacy, such as those from low-scoring majors.

Implications: all hands on deck

Addressing the mental health needs in higher education settings requires a multi-pronged approach and assistance from all fronts, where both faculty and higher education officers across campuses work towards implementing such interventions. For example, practitioners in college counseling centers can conduct workshops on mental health education that focus on awareness of symptoms, self-care, and where to get help on campus. Making such workshops available, especially to those majors who scored low on mental health literacy, via increased advertisement in certain areas on campus, could draw in students most in need of such interventions. Stronger alliances should also be forged between college counseling centers and academic departments, where faculty and students across departments are made aware of college mental health resources. College professionals, as well, such as those in student services departments, can aid in developing student-led initiatives such as a mental health club or peer support project that includes students from both high and low-scoring majors, where students can support the psychological well-being of their peers across disciplines. Additionally, faculty should incorporate student well-being into their course curriculum in a manner appropriate across disciplines (see [49–51] for an understanding of how psychological well-being can be successfully incorporated into the curriculum). Finally, and possibly most importantly, changes in mental health policy should be made by college leaders where a mental health education class is required for all students, and possibly incorporated into the college’s core curriculum. Implementing all of these educational and clinical interventions could be a starting point for data to be collected to ascertain the improvements in mental health in college students, with the long-term goal of improving psychological well-being across the entire college population.

Conclusion

High rates of psychological disorders among college students make them a vulnerable group where mental health literacy is important. This study was the first to investigate the relationship between a large number of specific undergraduate academic majors and mental health literacy, using a measure that taps both conceptual knowledge of psychological disorders and the application of that knowledge to real life situations. Our findings revealed that students majoring in accounting, nursing, business, biology, and those in a multidisciplinary category scored significantly lower on average compared to students in the highest scoring major, which was psychology. These results point towards opportunities for training to address the mental health needs of undergraduate students from diverse backgrounds by recognizing those with low mental health literacy based on a variable that is central to college experience—college major. Identification of these majors is important in providing a rationale for educational and clinical interventions, with the long-term goal of improving mental health literacy and psychological health across diverse student groups.

Appendix 1

See Table 4.

Table 4.

Review table of published studies that have compared mental health literacy across fields of study

Authors	Title	Demographics	Majors/faculty	Topic(s) and method of assessment	Results (related to field of study)
Aluh et al.    [29]	Cross-sectional survey of mental health literacy among undergraduate students of the University of Nigeria	n = 389 Gender 64.9% female 35.1% male Age  < 18 years 9.8% 18–24 years 75.8% 25–30 years 13.7%  > 30 years 0.8% Ethnicities not reported	▪ Agricultural sciences ▪ Arts ▪ Pharmaceutical sciences	Vignette depicting a college student with schizophrenia followed by questions assessing participants’ ability to recognize the disorder in the vignette and their recommendations for help	The pharmaceutical science major had the largest percentage of students who correctly identified schizophrenia and recommended psychiatric help; the agricultural science major had the largest percentage of students who used labels associated with stigma.
Amarasuriya et al. [28]	Quantifying and predicting depression literacy of undergraduates: a cross sectional study in Sri Lanka	n = 4,671 Gender 68.9% female 31.0% male Age mean age 22.17 18–20 years 11.0% 21–23 years 71.8%  ≥ 24 years 17.0% Ethnicities 91.7% Sinhala 4.1% Tamil 3.1% Sri Lankan Moor 1.0% other	▪ Medicine ▪ Arts/education ▪ Law ▪ Management and finance ▪ Science ▪ Computing	Vignette depicting an undergraduate student with depression followed by questions assessing participants’ ability to recognize the disorder in the vignette and their beliefs regarding treatment	Medical students were more likely to recognize depression and had higher agreement with experts regarding treatment.
Furnham et al. [20]	Mental health literacy among university students	n = 426 Gender 74.2% female 25.8% male Age mean age 21.29 Ethnicities 60% White/Caucasian 31% Asian 6% Afro-Caribbean	▪ Psychology ▪ Economics ▪ Business ▪ Law	Questionnaire presenting 97 disorders from the DSM-IV-TR, where participants used yes/no responses to answer whether they had heard of the disorder, knew someone who had it, were able to define it, thought experts knew its cause, believed it had a cure, and believed it was common	Those who had previously studied psychology or psychiatry more frequently reported being able to recognize and define the disorders.
Kristina et al. [23]	Mental health literacy among university students in Yogyakarta	n = 650 Gender 67.7% female 32.3% male Age not reported Ethnicities not reported	▪ Health field ▪ Non health field	Mental health literacy questionnaire (MHLq) consisting of 33 items across three dimensions: knowledge/stereotypes, first aid skills and help-seeking, and self-help strategies	Students in health-related fields scored significantly higher than students from non-health related fields.
Lauber et al. [24]	Mental health literacy in an educational elite—an online survey among university students	n = 225 Gender 52.7% female 47.3% male Age mean age 26.41  ≤ 24 years 65.9% 25–29 years 25.6%  ≥ 30 years 8.5% Ethnicities not reported	▪ Law ▪ Economics ▪ Medicine ▪ Natural sciences ▪ Philosophy/arts ▪ Psychology	Questionnaire presenting 10 symptoms of depression (5 true and 5 false) and 10 symptoms of schizophrenia (5 true and 5 false), where participants rated each symptom as either a main symptom, an additional symptom, or not a symptom of the disorder	Medical and psychology students had the highest scores in recognizing true symptoms of the disorders assessed; male students majoring in natural sciences, economics, and philosophy performed particularly poorly.
Mahfouz et al. [52]	Mental health literacy among undergraduate students of a Saudi tertiary institution: a cross-sectional study	n = 531 Gender 52.0%female 48.0% male Age mean age 21.5 18–20 years 28.3% 20–22 years 45.2% 22–24 years 23.4% 24–28 years 3.1% Ethnicities not reported	▪ Medical ▪ Non-medical	Questionnaire consisting of 16 items related to mental health literacy including questions regarding etiology of mental illness and perception of and care for individuals with mental illness	No significant difference in overall mental health literacy was found between students from the medical and non-medical fields; some differences were found between medical and non-medical students’ attitudes towards individuals with mental illness.
Miles et al.   [25]	Mental health literacy in a diverse sample of undergraduate students: demographic, psychological, and academic correlates	n = 1,213 Gender 62.0% female 37.5% male 0.5% other Age mean age 22.0 18–22 years 68.9% 23–27 years 20.9% 28–32 years 5.4% 33–37 years 2.7%  ≥ 38 years 2.1% Ethnicities 27.3% Black/African American 26.7%White/Caucasian 19.0% Asian/Asian American 18.5% Hispanic/Latino 5.9% multi-racial 0.3% Native American 2.2% other	▪ Psychology ▪ Applied health sciences ▪ STEM ▪ Humanities/social sciences ▪Business   /economics/accounting ▪ Education ▪ Other	Questionnaire consisting of 38 multiple-choice items assessing knowledge and related topics of more than 20 disorders from the DSM-5, where participants chose one of five possible answer choices	High performers were more likely to major in psychology or applied health fields and low performers were more likely to major in business/economics/accounting or STEM fields.
Paulus et al. [53]	Mental health literacy for anxiety disorders: how perceptions of symptom severity might relate to recognition of psychological distress	n = 270 Gender 76.7% female 19.6% male 3.7% undisclosed Age mean age 26.8 years Ethnicities 65.2% White 9.6% Asian/American 7.0% Latino/Hispanic 6.3% multi-racial 3.7% Black 0.04% Middle Eastern 0.04% Native American 0.04% Pacific Islander/ Native Hawaiian 7.0% undisclosed	▪ Psychology ▪ Non-psychology	Nine vignettes depicting either mild, moderate, or severe cases of social anxiety disorder, generalized anxiety disorder, and major depressive disorder, where participants rated the severity of the case	Unlike participants in other majors, psychology majors underrated mild cases and overrated severe cases.
Rafal et al.   [27]	Mental health literacy, stigma, and help-seeking behaviors among male college students	n = 1,242 Gender 100% male Age mean age 25.21 years Ethnicities 64.9% White 7.8% African American 1.3% American Native or American Indian 16.9% Asian 0.6% Native Hawaiian or Pacific Islander 8.5% other	▪ STEM ▪ Non-STEM	Questionnaire consisting of 71 items assessing knowledge and beliefs regarding mental health, knowledge of resources, attitudes toward mental health, self-stigma, subjective norms, and help-seeking intentions, where all categories used a Likert scale, except for knowledge of resources, which used yes/no responses	Undergraduate and graduate students from STEM fields showed lower knowledge about mental health in comparison to students from non-STEM fields.
Thai and Nguyen        [30]	Mental health literacy: knowledge of depression among undergraduate students in Hanoi, Vietnam	n = 350 Gender 76.6% female 23.4% male Age mean age 20.7 years 19–20 years 46.9% 21–22 years 47.1% 23–26 years 6.0% Ethnicities not reported	▪ public health ▪ sociology	Vignette depicting a student with depression followed by questions assessing recognition of the disorder, intentions to seek help, knowledge of methods of support, and knowledge of interventions	No significant difference was found between public health and sociology students regarding disorder recognition. No comparisons were made between the two majors for the other three areas of assessment.
Turgut et al. [54]	Mental health literacy and general health perceptions of faculty of health sciences students	n = 310 Gender 87.4% female 12.6% male Age mean age 21.4 years	▪Nutrition/dietetics ▪ Child development ▪ Health management ▪ Social work ▪ Orthotics-Prosthetics	Mental health literacy scale (MHLS) with 22 items across three dimensions: knowledge, beliefs, and resources, where the first two categories used a Likert scale and the last category used yes/no responses	Mental health literacy differed based on department, with social work students scoring higher on the belief-oriented section and orthotics-prosthetics students scoring higher on the resource-oriented section.

Author contributions

RM and LR conceived and designed the study; SB collected data and organized the dataset; AK analyzed the data and created the tables; RM, LR, and AK interpreted the results; RM drafted the manuscript; MLC assisted with manuscript writing; RM and MLC conceptualized and prepared the review table on mental health literacy and fields of study; LR provided guidance on manuscript preparation and data analysis; all authors read and approved the manuscript.

Funding

This work was supported by a grant awarded from the JCK Foundation [2016–2021] and The Professional Staff Congress and The City University of New York under Grant #63184–00 51.

Data availability

The data that support the findings of this study are available from the corresponding author, [RM], upon reasonable request.

Declarations

Ethics approval and consent to participate

This study and its consent procedures were approved by the Institutional Review Board (IRB) of Brooklyn College of the City University of New York (IRB reference number: 2016–1018). Informed consent was obtained from all individual participants included in the study. All study procedures were conducted in accordance with the ethical standards as established by the 1964 Declaration of Helsinki.

Competing interests

The authors declare no competing interests.