Mental Health Literacy in the United States: A Systematic Review of Population Based Studies

Background and Purpose: Mental health literacy is defined as individuals' knowledge and beliefs about mental disorders that influence their recognition, management, and prevention (Jorm et al., 1997). Over the past three decades, numerous population based studies in the U. S. have documented the public's beliefs and attitudes toward common mental disorders (e.g., major depression, schizophrenia) and their treatments. Findings from these studies provide an assessment of the level of mental health literacy in the U. S. The aims of this literature review are to (1) evaluate existing methods used to study public's perceptions and attitudes toward mental disorders and treatments; (2) summarize and discuss mental health literacy findings; and (3) draw conclusions for improving mental health literacy in the U. S.

Methods: Electronic bibliographic databases, websites, and manual searches were used to identify relevant articles. Published articles in peer review journals were chosen if they met the following criteria: (1) used probability samples of noninstitutionalized adults 18 years of age or older; (2) reported findings relevant to mental health literacy (e.g., recognition of mental disorders, stigma, attitudes toward mental health treatments). Two reviewers working independently systematically coded studies' aims, sampling techniques, measures, analytical strategy, results, limitations and implications. Reviewers then met to discuss and come to a consensus of their analyses.

Results: Twelve articles published between 1987 and 2007 were included in this review. The majority of studies used cross-sectional designs, vignette methodology and multivariate models to identify correlates of mental health literacy. Findings indicate that the majority of Americans recognize common mental disorders (e.g., schizophrenia, substance abuse) and endorse multifactorial explanations of mental illness that blends stressful life circumstances with biological mechanisms. Strong stereotypes of viewing individuals suffering from mental disorders as dangerous and a desire for social distance persist particularly for substance abuse disorders. The few studies that examined racial and ethnic differences in stigma found that Asians and Hispanics perceived individuals with mental illness as significantly more dangerous than Whites. Increased contact with individuals with mental illness was associated with lower levels of perceived dangerousness among Whites but not among African Americans. Studies indicate that Americans report preferring counseling over psychotropic medications. The public views these medications as effective in relieving symptoms, yet reported an unwillingness to use them citing that these medications are harmful to the body. Longitudinal studies that tracked public perceptions of mental illness suggest that Americans have broadened their views of mental disorders beyond the label of psychosis but are more likely now to include dangerousness in their description of mental disorders than in the past. Conclusions and Implications: The general public in U. S. has a basic understanding of common mental disorders yet continues to endorse stigmatizing attitudes toward mental illness and apprehensions toward taking psychotropic medications. Racial and ethnic differences in stigma suggest differences in mental health literacy between these populations. Future studies are needed to develop and test culturally appropriate interventions aimed at improving mental health literacy in order to reduce stigma, and promote appropriate help-seeking.