Development of mental health literacy scale for depression affecting the help-seeking process in health professional students

Abstract

Despite depression being a global mental health disorder, many people with depression do not seek psychiatric help. In particular, it has been reported that only 15.7% of medical students seek treatment. A longer duration of untreated illness (DUI) leads to clinically poor results. To shorten the DUI, the mental health literacy (MHL) with regard to depression needs to be improved, although it is unclear which MHL components will improve the help-seeking process. Additionally, the existing MHL scale for depression is poorly validated for structural validity. Therefore, the purpose of this study was to develop an MHL scale for depression with verified reliability and validity (particularly structural validity) and verify its relationship with the help-seeking process. For this purpose, we adapted the mixed research method. First, we conducted a systematic literature review on MHL scales for depression to prepare a draft scale with content validity. Second, we conducted semi-structured interviews on MHL with outpatients with depression. Consequently, 78 questions on MHL for depression were extracted. Third, to develop our scale, we verified the reliability and validity of these questions with 782 health professional students. The sample size was 780 and data collection was performed by collective survey method. It was conducted in 2018 in Japan. To verify the factor structure, exploratory and confirmatory factor analyses were conducted. We also examined the internal consistency, test-retest reliability, and criterion-related validity. The exploratory factor analysis revealed a three-factor structure (recognition of depression symptoms, help-seeking preferences, and depression onset possibility) with 10 items. According to the confirmatory factor analysis results, the goodness of fit indicators had a good fit. The internal consistency, test-retest reliability, and criterion-related validity had good values. Fourth, the relationship between the MHL of depression and other factors affecting the help-seeking process was examined using structural equation modelling. The same sample size (as above) was applied. All three components of the MHL of depression influenced ‘recognition of depres-sion’. In particular, depression onset possibility had the greatest impact on the help-seeking process. Whereas, the MHL of depression had little or no influence on ‘intention of consultation’ and ‘psychiatric consultation’ (second and third steps of help-seeking). The largest influence on psychiatric consultation was the recommen-dation of consultation from others. The multiple correlation coefficients were the recognition of depression, R2 = 0.33; intention of consultation, R2 = 0.43; and psychiatric consultation, R2 = 0.36; and the model was agoodfit. This study identified the specific components of the depression MHL that influence the help-seeking process. Subsequently, it is necessary to provide specific MHL education to health professional students, their families, university staff, and teachers.