Abstract
This study aimed to examine mental health literacy, perception of health, and attitudes toward seeking professional psychological help among individuals from 4 ethnic groups (Assyrian, Turkish, Arabic, and Kurdish) living in the multicultural context of Mardin, Türkiye. This descriptive, cross-sectional, and correlational study included 398 participants recruited using convenience and snowball sampling. Data were collected using a demographic characteristics form, the Mental Health Literacy Scale, the Attitudes Toward Seeking Professional Psychological Help Scale–Short Form, and the Perception of Health Scale. Data were analyzed using descriptive statistics, independent-samples t tests, one-way analysis of variance, Pearson correlation analysis, and multiple linear regression. Significant differences were observed among ethnic groups in mental health literacy, perception of health, and attitudes toward seeking professional psychological help (P < .05). Mental health literacy was weakly and positively correlated with help-seeking attitudes (r = 0.138, P = .006). Perception of health was positively correlated with both help-seeking attitudes (r = 0.640, P < .001) and mental health literacy (r = 0.328, P < .001). The multiple linear regression model explained 41.5% of the variance in help-seeking attitudes (R2 = .415). Perception of health showed a strong positive association with help-seeking attitudes (β = 0.666, P < .001), whereas mental health literacy showed a small negative coefficient after perception of health was included in the model (β = −0.080, P = .049). Mental health literacy, perception of health, and attitudes toward seeking professional psychological help differed among the ethnic groups examined. Perception of health showed the strongest association with help-seeking attitudes. Given the cross-sectional design and the absence of direct measures of cultural beliefs, stigma, religiosity, and related constructs, the observed ethnic-group differences should not be interpreted as evidence of cultural or causal effects. These findings may inform context-sensitive approaches to mental health promotion and professional help-seeking in multicultural populations.
Keywords: ethnic groups, health perception, mental health literacy, multicultural populations, psychological help-seeking
1. Introduction
The impact of mental disorders on individual and societal well-being is increasing globally, making the understanding of mental health issues an important public health concern today.[1] According to World Health Organization data, approximately 8% of the world’s population, or about 586 million people, experience some form of mental disorder.[2] In this context, the concept of mental health literacy plays a critical role in the prevention, recognition, and management of mental health issues.
Mental health literacy refers to the level of knowledge, beliefs, and awareness individuals have regarding recognizing, managing, and preventing mental health issues.[3,4] According to Karaman et al, this concept encompasses not only individuals’ knowledge of mental disorders but also increasing the level of knowledge and skills regarding mental health in society.[5] Therefore, mental health literacy is considered a fundamental component that guides individuals’ behaviors in understanding mental disorders, determining appropriate intervention methods, and seeking professional help. However, mental health literacy is not limited to the process of acquiring information; it also encompasses combating stigma associated with mental illness and fostering positive attitudes toward psychological interventions. In this context, it is stated that educational programs aimed at increasing mental health literacy have the potential to increase acceptance of professional help by reducing stigmatizing attitudes among individuals.[6,7]
Although related, mental health literacy, health perception, and stigma represent distinct constructs.[4,7,8] Mental health literacy specifically refers to knowledge and beliefs related to recognizing, managing, and seeking help for mental health problems.[4] Health perception reflects individuals’ subjective evaluation of their own health status,[8] while stigma relates to negative attitudes or social judgments associated with mental health conditions and help-seeking.[7] Clarifying these distinctions is important for interpreting how these constructs may relate to one another in different social contexts.
Health perception is a multidimensional concept encompassing the thoughts, feelings, biases, and expectations individuals have regarding their own health status.[8] Health perception determines not only individual awareness but also an individual’s health behaviors and approach to health services. Kerkez and Şahin considered health literacy to be a shared function of cultural, social, and individual factors and emphasized that cultural factors are decisive in individuals’ health perceptions and behaviors in this context.[9]
Cultural beliefs and values may influence attitudes and behaviors toward mental health.[10] Cross-cultural studies have revealed that individuals living in Western societies (particularly in Europe and North America) have a higher level of mental health literacy compared with individuals in Asian and African cultures.[11] This difference is evident not only in terms of level of knowledge but also in terms of intentions to seek psychological help and patterns of health service utilization.
In collectivist cultures, individuals tend to turn to informal support sources such as family, friends, or religious leaders rather than getting professional help when faced with mental health issues. This tendency is associated with cultural norms and the influence of social stigma.[3] In cultures where stigma is strong, seeking professional psychological help is often delayed or rejected altogether. In contrast, it has been found that stigma decreases among individuals with high levels of mental health literacy, and that help-seeking behaviors occur earlier and more effectively.[7]
Seeking professional psychological help is important in terms of individuals’ accessing appropriate professional support for their mental distress in a timely manner.[12] However, this process can be complicated by cultural, religious, social, or economic barriers.[13] In their comparative study of Chinese and German students, Zhou et al noted that Chinese students showed a higher psychological openness to seeking help, while in Pakistan, collectivist cultural influences and religious beliefs played a significant role in the stigmatization of mental illness.[14,15]
The present study aims to compare mental health literacy, perception of health, and attitudes toward seeking professional psychological help among different ethnic groups living in the multicultural context of Mardin. Examining differences across ethnic groups within a multicultural setting may contribute to the development of more context-sensitive strategies to reduce stigma associated with mental health services, improve mental health literacy, and encourage help-seeking attitudes. In this regard, the study seeks to answer the following questions:
Are there significant differences in mental health literacy among different ethnic groups?
Does perception of health differ significantly among ethnic groups, and is perception of health associated with attitudes toward seeking professional psychological help?
What is the relationship between mental health literacy and attitudes toward seeking professional psychological help?
2. Materials and methods
2.1. Type of research
This study employed a descriptive, cross-sectional, and correlational design.
2.2. Population and sample selection
The study population consisted of individuals from 4 ethnic groups (Assyrian, Turkish, Arabic, and Kurdish) living in the multicultural city of Mardin. The sample included individuals from 4 different ethnic groups (Assyrian, Turkish, Arabic, and Kurdish) living in Mardin, Turkey, who voluntarily agreed to participate in the study. Convenience and snowball sampling methods were used. Initial participants were approached in community settings within Mardin and invited to participate voluntarily. These participants were then asked to refer other eligible individuals from the target ethnic groups. Data collection was conducted face-to-face by the researchers. Individuals with sufficient communication skills and willingness to participate were included in the study.
2.2.1. Inclusion criteria
Being a member of the Assyrian, Turkish, Arabic, or Kurdish ethnic group living within the borders of Mardin province.
Being 18 years of age or older.
Having sufficient communication skills and being able to understand and answer research questions.
Agreeing to participate in the study voluntarily and providing informed consent.
2.2.2. Exclusion criteria
Having cognitive functions significantly impaired due to mental disorders or being unable to fill out the scales independently.
Refusing to participate in the study or not providing informed consent.
Having filled out the scales incompletely or incorrectly during the data collection process.
Not living in Mardin or not belonging to one of the 4 ethnic groups covered by the study.
2.3. Data collection tools
All questionnaires were administered in Turkish since validated Turkish versions of the instruments were used. When necessary, participants were provided with verbal clarification by the researchers to facilitate understanding of questionnaire items. However, no formally translated versions in other local languages were used.
2.3.1. Demographic characteristics form
The survey prepared by the researcher included questions such as age, gender, educational status, income status, ethnic origin, and whether or not the individual had received a psychiatric diagnosis.
2.3.2. Mental Health Literacy Scale
The scale, originally developed by Jung et al and validated in Turkish by Göktaş et al, consists of 22 items across 3 subscales: 10 Knowledge-Oriented items, 8 Belief-Oriented items, and 4 Resource-Oriented items. Total scores range from 0 to 22, with higher scores indicating higher levels of mental health literacy. The Knowledge-Oriented and Belief-Oriented subscales consist of 18 items with 6 response options: “strongly agree,” “agree,” “undecided,” “disagree,” “strongly disagree,” and “don’t know.” The 4 Resource-Oriented items have “yes” and “no” response options. For positively keyed items, responses of “strongly agree,” “agree,” or “yes” are scored as 1, whereas the remaining responses are scored as 0. All 8 items of the Belief-Oriented subscale (items 13, 15, 16, 17, 19, 20, 21, and 22 according to the original item numbering) are reverse-coded. The Knowledge-Oriented subscale assesses knowledge regarding mental disorders and their recognition and treatment, whereas the Belief-Oriented subscale assesses beliefs related to mental disorders. The Resource-Oriented subscale assesses knowledge of available mental health resources and how to access them.[16,17] Göktaş et al reported a Cronbach’s α coefficient of 0.71 for the Turkish version.[17] The Cronbach α value in the present study is 0.88.
2.3.3. Attitudes Toward Seeking Professional Psychological Help Scale–Short Form
The Attitudes Toward Seeking Professional Psychological Help Scale–Short Form, developed by Fischer and Farina, consists of 10 items and was designed as a shortened version of the original Attitudes Toward Seeking Psychological Help Scale.[18] The original study reported a single-factor structure and a Cronbach’s α coefficient of 0.84. The Turkish validity and reliability study was conducted by Topkaya.[19] In the present study, the 10-item form was administered using a 4-point Likert response format ranging from 1 to 4. Total scores therefore ranged from 10 to 40, with higher scores indicating more positive attitudes toward seeking professional psychological help. The Cronbach’s α coefficient in the present study was 0.66.
2.3.4. Perception of Health Scale
The Turkish validity and reliability study of the Perception of Health Scale (PHS) developed by Diamond et al was conducted by Kadioğlu and Yildiz in 2012.[20,21] The scale consists of 4 subscales: Control Centre, Self-Awareness, Certainty, and Importance of Health and has a total of 15 items. The sum of the scores obtained from the subscales yields the Perception of Health score. Positive statements are scored normally, while negative statements are reverse-scored. The minimum possible score on the scale is 15, and the maximum possible score is 75. The possible scores on the scale are Control Centre (min = 5, max = 25), Self-Awareness (min = 3, max = 15), Certainty (min = 4, max = 20), and Importance of Health (min = 3, max = 15). Items 1, 5, 9, 10, 11, and 14 are positive statements on the scale, while items 2, 3, 4, 6, 7, 8, 12, 13, and 15 are negative statements. Positive responses are scored as “Strongly Agree = 5,” “Agree = 4,” “Undecided = 3,” “Disagree = 2,” and “Strongly Disagree = 1.” Reverse scoring was applied to negative responses on the scale. The Cronbach’s α value for PHS is 0.77. The Cronbach’s α values for the PHS subscales are as follows: “Control centre 0.76,” “Self-awareness 0.63,” “Certainty 0.71,” and “Importance of health 0.60.” The Cronbach’s alpha value for this study is 0.77.
2.3.5. Evaluation of data
IBM SPSS Statistics, version 27.0 (IBM Corp.) was used for data analysis. Descriptive statistics (mean, standard deviation, frequency, and percentage) were calculated to summarize the data. Independent-samples t tests, one-way analysis of variance, and Pearson correlation analyses were performed, as appropriate, to examine differences and associations among the study variables. For variables showing statistically significant differences in one-way analysis of variance, the Tukey post hoc test was used to determine between which groups the differences occurred. Multiple linear regression analyses were conducted to examine the relationships among mental health literacy, perception of health, and attitudes toward seeking professional psychological help. Statistical significance was set at P < .05.
2.3.6. Ethical considerations
Before starting the study, ethical approval was obtained from the Non-Interventional Ethics Committee of Mardin Artuklu University (2025/2-33). Informed consent forms were obtained from all participants. The study was conducted in accordance with the principles of the Declaration of Helsinki.
2.3.7. Limitations of the study
This study has several limitations. First, the use of convenience and snowball sampling may have introduced selection bias, as participants who were more accessible or more willing to participate may differ systematically from the broader target population. Therefore, the findings should be interpreted as specific to the study context and may not be generalizable to other populations or settings. Second, although multiple linear regression analyses were conducted to further examine the relationships among the study variables, fully adjusted multivariable models controlling for potential confounding factors such as age, education, income, and psychiatric history were not performed. Therefore, the observed associations should be interpreted cautiously. In addition, Mardin’s multilingual structure may have created difficulties in participants’ understanding of some scale items, potentially affecting measurement accuracy. A further limitation is that culture, religiosity, stigma, and fatalistic beliefs were not directly measured. Therefore, interpretations related to cultural influences should be approached cautiously, and ethnicity should not be considered a direct proxy for culture. Finally, since the exclusion of mental disorders affecting cognitive function was based on participant self-report and observation, this factor may not have been fully controlled.
2.3.8. Background information about the research area (Mardin)
Mardin is a large city located in southeastern Turkey with a population of approximately 840,000. Compared with other regions of the country, this city has a distinctly heterogeneous cultural and ethnic structure. Mardin’s population consists of various ethnic groups such as Kurds, Arabs, Turks, and Assyrians. In this city, where the official language is Turkish, different ethnic and religious communities live together in peace. Among the ethnic groups, Kurds, Arabs, and Turks predominantly adhere to the Islamic faith, while Assyrians generally adopt Christianity.
3. Results
Of the 398 individuals who participated in the study, 54% were men (n = 215). The mean age of the participants was 29.90 ± 10.06 years (min: 18–max: 79). When the level of education was examined, it was found that 56.8% of the participants had a bachelor’s degree or higher. It was found that 60.8% of participants evaluated their income as “good.” Of the participants, 25.6% were Kurdish. It was found that 91.5% of participants did not have any psychiatric diagnosis (Table 1).
Table 1.
Sociodemographic characteristics.
| Variables | n (398) | % |
|---|---|---|
| Gender | ||
| Female | 183 | 46.0 |
| Male | 215 | 54.0 |
| Educational status | ||
| University and below | 172 | 43.2 |
| University and above | 226 | 56.8 |
| Income status | ||
| Very good | 48 | 12.1 |
| Good | 242 | 60.8 |
| Bad | 77 | 19.3 |
| Very bad | 31 | 7.8 |
| Ethnic origin | ||
| Turkish | 99 | 24.9 |
| Kurdish | 102 | 25.6 |
| Arabic | 99 | 24.9 |
| Assyrian | 98 | 24.6 |
| Psychiatric illness | ||
| Yes | 34 | 8.5 |
| No | 364 | 91.5 |
| Mean age | ||
| Min: 18 | Mean: 29.90 ± 10.06 | |
| Max: 79 | ||
The mean score for participants’ attitudes toward seeking psychological help was 26.06 ± 4.30, and the mean PHS score was 51.10 ± 7.87. The mean Mental Health Literacy Scale subscale scores were 3.43 ± 2.41 for the Belief-Oriented subscale, 2.90 ± 1.20 for the Resource-Oriented subscale, and 6.13 ± 3.47 for the Knowledge-Oriented subscale. The mean total Mental Health Literacy Scale score was 12.46 ± 5.70. The mean PHS subscale scores were 15.73 ± 3.47 for Center of Control, 13.43 ± 2.95 for Certainty, 10.87 ± 2.26 for Self-Awareness, and 11.03 ± 2.22 for Importance of Health (Table 2).
Table 2.
Scale total mean scores and subscale total mean scores.
| Scale and subscales | Minimum | Maximum | Mean ± SD |
|---|---|---|---|
| ATSPPH-SF | 10 | 39 | 26.06 ± 4.30 |
| Center of Control | 7 | 25 | 15.73 ± 3.47 |
| Certainty | 5 | 20 | 13.43 ± 2.95 |
| Self-Awareness | 5 | 15 | 10.87 ± 2.26 |
| Importance of Health | 5 | 15 | 11.03 ± 2.22 |
| Perception of Health total | 33 | 72 | 51.10 ± 7.87 |
| MHLS Beliefs-Oriented | 0 | 8 | 3.43 ± 2.41 |
| MHLS Resource-Oriented | 0 | 4 | 2.90 ± 1.20 |
| MHLS Knowledge-Oriented | 0 | 10 | 6.13 ± 3.47 |
| MHLS total | 1 | 22 | 12.46 ± 5.70 |
ATSPPH-SF = Attitudes Toward Seeking Professional Psychological Help Scale–Short Form, MHLS = Mental Health Literacy Scale, SD = standard deviation.
Pearson correlation analysis showed a weak positive correlation between mental health literacy and attitudes toward seeking professional psychological help (r = 0.138, P = .006). Perception of health was strongly and positively correlated with attitudes toward seeking professional psychological help (r = 0.640, P < .001) and was also positively correlated with mental health literacy (r = 0.328, P < .001; Table 3).
Table 3.
Correlations between scales and subscales.
| ATSPPH-SF total | Mental Health Literacy Scale total | Perception of Health total | ||
|---|---|---|---|---|
| ATSPPH-SF total | r | 1 | ||
| P | ||||
| Mental Health Literacy Scale total | r | 0.138 | 1 | |
| P | .006 * | |||
| Perception of Health total | r | 0.640 | 0.328 | 1 |
| P | .000 ** | .000 ** |
r: Pearson correlation.
Bold P values indicate statistical significance (P < .05).
ATSPPH-SF = Attitudes Toward Seeking Professional Psychological Help Scale–Short Form.
P < .05.
P < .001.
When scale scores were examined according to gender, no statistically significant differences were found between female and male participants in attitudes toward seeking psychological help, perception of health, or mental health literacy (P > .05). Significant differences according to educational level were observed in attitudes toward seeking psychological help (P = .022) and perception of health (P < .001), whereas no significant difference was found in mental health literacy. Significant differences according to income status were observed in attitudes toward seeking psychological help, perception of health, and mental health literacy. Significant differences were also observed across ethnic groups in attitudes toward seeking psychological help, perception of health, and mental health literacy (P < .05). Participants with a history of psychiatric illness had significantly higher scores for attitudes toward seeking psychological help (t = 3.975, P = .001) and perception of health (t = 3.384, P = .001), whereas no significant difference was observed in mental health literacy (Table 4).
Table 4.
Comparison of sociodemographic characteristics with scale total scores.
| Variables | ATSPPH-SF | Perception of Health Scale | Mental Health Literacy Scale |
|---|---|---|---|
| Gender | |||
| Female | 26.15 ± 4.55 | 51.08 ± 7.94 | 13.97 ± 3.93 |
| Male | 25.99 ± 4.09 | 51.11 ± 7.82 | 13.95 ± 3.65 |
| Test value | t = 0.364 | t = −0.031 | t = 0.053 |
| Significance | P = .716 | P = .975 | P = .958 |
| Educational status | |||
| University and below | 26.63 ± 4.47 | 52.66 ± 8.29 | 12.20 ± 5.94 |
| University and above | 25.63 ± 4.12 | 49.90 ± 7.32 | 15.03 ± 3.06 |
| Test value | t = 2.324 | t = 3.517 | t = −0.796 |
| Significance | P = .022 | P = .000 | P = .426 |
| Income status | |||
| Very good (1) | 27.08 ± 5.35 | 54.70 ± 9.42 | 14.16 ± 3.74 |
| Good (2) | 25.49 ± 3.68 | 50.03 ± 6.97 | 14.40 ± 3.51 |
| Bad (3) | 25.97 ± 4.37 | 49.96 ± 8.58 | 12.92 ± 4.39 |
| Very bad (4) | 29.19 ± 5.28 | 56.64 ± 6.10 | 12.83 ± 3.61 |
| Test value | F = 8.197 | F = 11.321 | F = 4.103 |
| Significance | P = .001 | P = .001 | P = .007 |
| Post hoc | 2, 3 < 4 | 1 > 2, 3 | 1, 2 > 3 |
| Ethnic origin | |||
| Turkish (1) | 26.58 ± 4.76 | 51.16 ± 9.12 | 14.06 ± 3.99 |
| Kurdish (2) | 26.47 ± 5.46 | 50.55 ± 9.71 | 13.71 ± 4.13 |
| Arabic (3) | 24.52 ± 3.30 | 48.10 ± 5.64 | 13.24 ± 4.30 |
| Assyrian (4) | 26.68 ± 2.75 | 54.63 ± 4.08 | 14.86 ± 2.09 |
| Test value | F = 5.891 | F = 12.543 | F = 3.292 |
| Significance | P = .001 | P = .001 | P = .021 |
| Post hoc | 3 < 1, 2, 4 | 4 > 1, 2, 3; 1 > 3 | 4 > 1, 2, 3 |
| Psychiatric illness | |||
| Yes | 28.82 ± 4.66 | 55.41 ± 8.71 | 13.00 ± 4.02 |
| No | 25.81 ± 4.18 | 50.69 ± 7.67 | 14.05 ± 3.74 |
| Test value | t = 3.975 | t = 3.384 | t = −1.563 |
| Significance | P = .001 | P = .001 | P = .119 |
Post hoc: Tukey.
Bold P values indicate statistical significance (P < .05).
ATSPPH-SF = Attitudes Toward Seeking Professional Psychological Help Scale–Short Form.
Multiple linear regression analysis was conducted to examine the associations of perception of health and mental health literacy with attitudes toward seeking professional psychological help. The overall model was statistically significant, F(2, 395) = 140.147, P < .001, explaining 41.5% of the variance in help-seeking attitudes (R2 = 0.415; adjusted R2 = 0.412). Perception of health was positively associated with attitudes toward seeking professional psychological help (B = 0.364, β = 0.666, 95% confidence interval [0.321–0.408], P < .001). Mental health literacy showed a small negative coefficient after perception of health was included in the model (B = −0.061, β = −0.080, 95% confidence interval [−0.121 to −0.0001], P = .049; Table 5).
Table 5.
Results of multiple linear regression analysis on the prediction of attitudes toward seeking psychological help.
| Variable | B | SE | β | t | P | 95% CI |
|---|---|---|---|---|---|---|
| Constant | 8.204 | 1.088 | – | 7.538 | <.001 | 6.065–10.344 |
| Perceived health | 0.364 | 0.022 | 0.666 | 16.353 | <.001 | 0.321–0.408 |
| Mental health literacy | −0.061 | 0.031 | −0.080 | −1.971 | .049 | −0.121 to −0.0001 |
Model statistics: R = 0.644, R2 = 0.415, adjusted R2 = 0.412, F(2, 395) = 140.147, P < .001, Durbin–Watson = 1.633.
β = standardized beta coefficient, CI = confidence interval, SE = standard error.
4. Discussion
The present study identified significant differences in mental health literacy, perception of health, and attitudes toward seeking professional psychological help among the 4 ethnic groups included in the study. Significant associations were also observed among the 3 study variables. Mental health literacy was positively correlated with attitudes toward seeking professional psychological help, while perception of health was positively correlated with both mental health literacy and help-seeking attitudes. These findings should be interpreted within the specific social and demographic context of the study population.
No significant gender differences were observed in attitudes toward seeking professional psychological help, perception of health, or mental health literacy. This finding is consistent with previous studies suggesting that gender is not consistently associated with mental health literacy or professional help-seeking attitudes.[22] Differences across studies may reflect variations in sample characteristics, study settings, and measurement approaches.
Educational level was significantly associated with attitudes toward seeking professional psychological help and perception of health, whereas no significant difference was observed in overall mental health literacy. Participants with university-level education or below had higher mean scores for help-seeking attitudes and perception of health than those with education above the university level. These findings differ from some previous studies reporting that higher educational attainment is associated with greater mental health literacy and more favorable help-seeking attitudes.[22–24] Differences in sample characteristics and study settings may partly account for these contrasting findings.
Significant differences were observed among ethnic groups in attitudes toward seeking professional psychological help, perception of health, and mental health literacy. Assyrian participants had higher mean scores for perception of health and mental health literacy, whereas Arabic participants had lower mean scores for help-seeking attitudes than the other groups. Previous research has shown that mental health-related beliefs and help-seeking patterns may vary across sociocultural contexts and population groups.[25] However, the differences observed in the present study should not be attributed directly to cultural factors. Ethnicity was included as a sociodemographic grouping variable, and cultural values, religiosity, stigma, fatalistic beliefs, and related constructs were not directly assessed. Therefore, the mechanisms underlying these group differences cannot be determined from the current data. Further studies incorporating direct measures of relevant sociocultural factors are needed to clarify these differences.
Participants with a history of psychiatric illness had significantly more positive attitudes toward seeking professional psychological help and higher perception of health scores than those without such a history, whereas no significant difference was observed in mental health literacy. Previous experience with mental health problems or services may be associated with greater familiarity with professional support and more favorable help-seeking attitudes; however, information on the type, duration, and extent of previous mental health service use was not collected in this study. Therefore, this explanation remains tentative. Previous research has demonstrated associations between mental health-related experiences and professional help-seeking attitudes.[26–28] In addition, studies have shown a positive association between mental health literacy and attitudes toward seeking psychological help.[23,24,28]
The correlation analysis showed that mental health literacy was positively associated with attitudes toward seeking professional psychological help, although the strength of this association was relatively weak. Perception of health was also positively associated with both mental health literacy and help-seeking attitudes, with the strongest association observed between perception of health and attitudes toward seeking professional psychological help. These findings are broadly consistent with previous studies reporting positive associations between mental health literacy and attitudes toward professional help-seeking.[23,24,28] Greater mental health literacy may facilitate the recognition of mental health concerns and awareness of available professional support, which may contribute to more favorable help-seeking attitudes.[23,24] However, given the cross-sectional design of the present study, these associations should not be interpreted as indicating causal relationships.
In conclusion, this study identified differences in mental health literacy, perception of health, and attitudes toward seeking professional psychological help among the ethnic groups examined in the multicultural context of Mardin. Educational level, income, and history of psychiatric illness were also associated with some of these outcomes. Mental health literacy was positively but weakly correlated with help-seeking attitudes, whereas perception of health showed a stronger positive association with help-seeking attitudes and remained the stronger correlate in the multiple regression model. These findings should be interpreted within the cross-sectional design of the study and should not be used to infer causal relationships. Furthermore, because cultural beliefs, stigma, religiosity, fatalism, and related sociocultural constructs were not directly assessed, the observed differences between ethnic groups should not be interpreted as evidence of cultural effects. Future research incorporating direct measures of these factors may help clarify the mechanisms underlying group differences and inform context-sensitive mental health promotion and help-seeking strategies in multicultural populations.
5. Conclusion and recommendations
The present study identified differences in mental health literacy, perception of health, and attitudes toward seeking professional psychological help among ethnic groups living in the multicultural context of Mardin. Educational level, income status, psychiatric history, and other contextual factors were also associated with some of the study outcomes. Mental health literacy was positively correlated with help-seeking attitudes, while perception of health showed a stronger positive association with help-seeking attitudes. These findings highlight the importance of considering social and contextual characteristics when planning mental health promotion and support strategies. From a nursing perspective, strengthening mental health literacy and facilitating access to professional psychological support may contribute to more responsive community-based mental health services. Further studies with larger and more representative samples, including direct measures of cultural beliefs, stigma, religiosity, and other relevant contextual factors, are needed to better understand the observed group differences.
Author contributions
Conceptualization: Behiye Dilmen Bayar, Ömer Tanriverdi.
Data curation: Behiye Dilmen Bayar, Ömer Tanriverdi.
Formal analysis: Behiye Dilmen Bayar, Ömer Tanriverdi.
Funding acquisition: Behiye Dilmen Bayar.
Investigation: Behiye Dilmen Bayar.
Methodology: Behiye Dilmen Bayar, Ömer Tanriverdi.
Project administration: Behiye Dilmen Bayar.
Resources: Behiye Dilmen Bayar.
Software: Behiye Dilmen Bayar.
Supervision: Behiye Dilmen Bayar.
Validation: Behiye Dilmen Bayar.
Visualization: Behiye Dilmen Bayar.
Writing – original draft: Behiye Dilmen Bayar, Ömer Tanriverdi.
Writing – review & editing: Behiye Dilmen Bayar, Ömer Tanriverdi.
Abbreviation:
- PHS
- Perception of Health Scale
The authors have no funding and conflicts of interest to declare.
The datasets generated and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.
How to cite this article: Dilmen Bayar B, Tanriverdi Ö. Mental health literacy, perception of health, and attitudes toward seeking professional psychological help across ethnic groups: A cross-sectional study. Medicine 2026;105:39(e50546).
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